Thursday, September 23, 2010

8.24 Male "Menopause" - Hormone Replacement?

Physician's Notebooks 8 - - See Homepage

24. Hormones and Older Men - Update 20 Nov. 2018 (Note: this very popular chapter should be preceded by reading the just previous chapter)
Men see a more gradual decline than women in sex hormone with aging. The blood Follicular Stimulating Hormone and Luteinizing Hormone (respectively, FSH and LH, the latter aka Interstitial Cell Stimulating Hormone, or ICSH) are hormones of the anterior pituitary gland that stimulate the testes in men or the ovaries in women to make their sex hormones, respectively, Estradiole (E2) and TEstosterone (TE) as well as being involved in sperm and egg production and release. 
   My sex hormone blood tests from ages 47 to 83 follow here. (The 3 numbers after my age are TE in nanogram/dL (often reported per mL, which is 0.01 dL), and, respectively, FSH & LH in milli-IU/ml)  Note: My blood tests were done 9 AM in overnight fasting, rested, healthy state from venous arm blood sample. Note in the below listing, the ± when it comes after the TE number is standard deviation, meaning that 95% of the test numbers in that year are within 2 times  + or -  (plus or minus) the average of 3 or more sample tests.

Age 47 – 1062, 5.4 & 7.3; age 48 – 846, 5.0 & 6.0; age 49 – 535, 6.0 & 7.2; age 50 – 630, 4.8 & 12.0; age 52 – 970, 6 & 25.0; age 53 – 615±5, 3.8± 0.5 & 8.35± 0.05; age 54 – 1100, 5.1 & 11.7; age 55 - 731±23, 6.6 & LH not done; age 58 – 672, 2.9 & 2.4; age 59 – 564, 3.0 & 3.3; age 61 – 570, 3.0 & 3.0; age 65 – 356, 2.7 & 3.0; age 66 – 387, 2.6 & 2.0; age 67 – 612, 2.4 & 2.5; age 68 – 375, 2.61 & 2.0; age 69 – 378, 2.14 & 2.10; age 70 – 758, 3.6 (FSH only from here); age 71 – 491, 3.2; age 72 – 479, 3.5; age 73 – 448 (No FSH); age 74 – 527, 2.67; age 75 and 4 mos, 400 and 1.4; age 75 and 9 mos 138 (vitamin B12 and folic acid deficiency) and 2.25; age 77 (B12 and folic acid mega supplements from here) - 550±71 (TE only from here); age 78 - 566±102; age 79 - 521±106; age 80 - 560±63; age 81 in year 2014 - two tests only gave 564 and 615. In year 2015 (767 and 640)
Averages of TE±Standard Deviation pg/ml by age decade: age 40s decade, 814±264(3 tests); age 50s decade, 755±202; age 60s decade, 446±113; age 70s decade, 527±101; age 80 to 82, 703 ave. (Note the improvement from the age 60s low due to taking megadoses vitamin B12 and folic acid from age 75 on.    

I last got a woman pregnant in 1984 at age 51. In 1985 my sperm count was recorded very low; in 2011 at age 78, it was zero.

In the 38 yrs, from age 47 to now age 85, my average TE has dropped from a high of 1100 nano/dL (single test, age 54) to low average 446 during age 60s, while FSH and LH has not risen, even with a TE as low as 138 at age 75 when I had vitamin B12 and folic acid deficiencies proven by blood tests and anemia. The data suggest a man can drop TE to 1/8th of his highest test without ticking off the brain and pituitary glands' negative feedback.(My latest FSH, age 85, after months in hospital was 0.1) I have been waiting to see the elevation of FSH & LH that will tell me my body sensing system detects the drop in TE of my aging system (I was still waiting at start of age 85) At that point, I had planned to consider starting TEstosterone replacement. (See later for my most recent TE injection experiment now in progress)
  Now, focus on the remarkable drop in serum testosterone (TE) to an apparent low – 138 ng/dL - in my blood sample in 2008, 23 Oct. at age 75. It coincided with the development of an anemia (hematocrit 33% verging on large size RBC, or macrocytic anemia with MCV 98). I wondered if it was the start of my male menopause. But my anemia turned out to be due to a combined deficiency of folic acid and vitamin B12 proven by blood tests and, once I treated it and restored normal B12 and folic levels, my TE rose to 450 (and still remained in the 400 to 700 range in blood tests to age 85) and I began to get better erections (but still weak). So you older men, rather than starting TE injections, first check your blood test B12 and folic acid if your erections fail. (By June 2012 still on megadoses of folic acid and vitamin B12 my TE increased to 753, a high level not seen since my late age decade 50s)
TEstosterone injections have risk, relating to overdose: Most importantly stimulating prostate cancer and worsening its development and spread; also hyper sexual stimulation, and high cholesterol and increased blood coagulation index which may be dangerous in the circulatory system. 

The depo-TEstosterone experiment.  After being in hospital from late March to late June 2018 because of fractured pelvis from accident and hip-joint replacement surgery, I was finally discharged 24 June 2018 and decided to start Depo-TE shots on an experimental basis. At that time I could walk (Result of successful hip-joint replacement; just previously I could not walk) but with very little stamina, having to rest at frequent intervals. And I had an anemia (Hct 33%) from previous blood loss and poor eating in hospital.  Just before the Depo-TE injection, I got a blood test which showed my blood TE, 700 ng/dL and my Hct 33%.  I also had bilateral thigh muscles weakness and feet paresthesia not involving pain and heat to above ankles and probably from collapsed L-S vertebrae lumbar stenosis syndrome not related to the accident or the surgery but just the result of old age wear and tear and osteoporosis.  
I got my first 250 mg Depo-Te (testosterone enanthate) intramuscular (IM) in shoulder, 19 July 2018 and 1 hour later my blood test showed blood TE 1000 ng/dL (10 ng/mL).  During the following 2 weeks I noted gradual improvement in my stamina, I no longer needed to rest during long walks. And the feeling of chest compression from the anemia left me.  Then on 02 August, I doubled my TE dose (Not advised in instruction sheet which gives max dose 250 mg in 1 ml inj, up to Q 4 weeks) getting 500 mg Depo-TE in shoulder and 1 hour later, my blood TE showed 1870 nano/dL, and 2 weeks later on 16 Aug., I got a 2nd 500 mg Depo-TE. A blood test taken on 16 Aug., 2 weeks after the 02 Aug. inj. 500 mg Depo-TE and just before, on same day (8/16) 2nd Depo-TE injection showed 1749 nano/dL. (Note that Depo-500 mg TE injections seem to peak and plateau as late as 1 to 2 weeks after the injection. It was giving me blood levels of TE between 1- to 2-thousand ng/dL, higher than I had experienced from age 40s on. 
 I got the 250 mg on 19 July, and two 500 mg single inj. each on 2 Aug. and 16 Aug., and, by then, I was feeling quite good with best physical stamina and hematocrit, 02 Aug., 41.3%, a marked increase from the previous low of 33%.  
 I notice mild increase in libido with more frequent though still weak erections.  Also very good appetite with gain of 2 kg.  My LDL cholesterol rose from 60 to 88 and I restarted pravastatin to keep LDL and blood test on 13 September, just before my TE injection, showed LDL cholesterol 44 and TG 46.
It is possible that the good effects are just normal recovery from my hospitalization period due to good nutrition and vitamins.  But the Depo-TE has certainly not got in the way of the good results.
Further, on 13 Sept., I meant to get my next Q 2-week, 500 mg injection but I was informed that Japanese medical regulations limited the Q 2-week dose to 250 mg and I had been breaking that rule but now I must follow Q 2-week 250 mg IM. So that was my 13 Sept. injection and just before it (2 weeks since last 500 mg) I had my blood drawn for sampling TE, and CBC and they showed TE 1160 ng/dL (2 weeks after 2nd 500 mg Depo-TE injection, showing that at 500 mg TE Q 2-week dose, the blood TE maintains between 1000 and 2000 ng/dL.

The sex hormone blood levels from samples I obtained from a 104-year-old man showed undetectably low TE and E2 from very old age complete testes failure. His FSH & LH blood tests, 136 & 202 units were more than 20 times higher than normal levels in young men, and even into early old age. (See my FSH & LH tests above; in July 2018, my FSH 0.08 units, very, very low) The results with the centenarian suggest the brain does respond to low enough TE and E2 even into very advanced old age.

  The hormonal treatment of older men with aging testicular failure is experimental and in a healthy old man should not be needed before age 80. I was 82 in 2015 and my tests still showed good TE that give me weak erections without Viagra (But with enthusiastic young partner the erections were good enough for satisfactory coitus)  and very good orgasms by masturbation so I did not need testosterone injections or Viagra. But this recent experiment with Depo-TE suggests TE injections may be a good part of the male Healthy Longevity program.
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