Sleep Apnea and Low T for Men

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
old64mb
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Re: Sleep Apnea and Low T for Men

Post by old64mb » Wed Nov 19, 2014 3:12 pm

Was checking in after a long time away and saw this. Think I've posted much of this before, but I'll provide a fairly simple explanation that should answer a few questions. Won't provide links, just know some of the papers off hand, but you should be able to find them if you search.

Biggest covariate with testosterone is obesity. Hypogonadotropic hypogonadism (HH) means something gets in the way of the signaling the pituitary gland to produce luteinizing hormone (LH) which in turn gets in the way of telling the gonads to produce T. Nobody's entirely sure of the mechanism of how this works. It's thought aromatase production rises, and then estradiol gets produced more and some testosterone production is instead diverted to estradiol, the hypthalmo-pituitary-gonadal axis gets screwy, and then the whole kit and kaboodle interferes with LH production, which then interferes with T.

Sound complex? It is. I've seen the charts and chapters on this in books. You probably don't want to unless you like spaghetti. It's a mess, but it's a pretty good rule of thumb that the first thing any endocrine will tell you if you're >30 BMI is to lose weight.

However, where it gets more interesting is how sleep correlates.

In the process of getting Xyrem approved, one of the more interesting studies (think it was by Van Cauter at Chicago) that came out was the effect on T - it rose pretty dramatically. It is pretty well known that most of the big hormones get secreted during Stage III/IV sleep and not at other times, and Xyrem increases that substantially. Nobody's done much work since, but it's pretty reasonable to argue that the quantity of Stage IV sleep matters.

Endocrines simply aren't familiar with this work, so will look at you crosseyed if you even bring it up. Sleep doctors aren't generally that familiar with endocrinology save for what exogenous T consumption (eg androgel et al) can worsen sleep apnea substantially. (It's thought there's a protective effect with estrogen, and taking exogenous T not only turns T production off but estrogen as well.) Guillemenault published on this years and years ago, so it's well known, but again, almost unheard of outside the sleep community.

So, to answer your question, how does apnea affect T production? If you have untreated or barely treated apnea, it disrupts your sleep cycles as you wake up before or during deep sleep, and getting back to that stage becomes harder and harder as the night progresses as the vast majority of deep sleep takes place early in the evening. No Stage IV sleep = problems with T being secreted.

Hope that helps.

bv1800
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Re: Sleep Apnea and Low T for Men

Post by bv1800 » Thu Nov 20, 2014 9:11 am

So you are saying that I got lucky to move to a new PCP and he not only related my lethargy and malaise to weight (i.e., excess fat, of which I was carrying 80+ lbs), but also connected it to low T and sleep.

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Malibu
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Sleep Apnea and Low T for Men

Post by Malibu » Thu Nov 20, 2014 12:09 pm

Yes. I would say lucky.

Most PCP 's are not well versed in low T things.

Usually if you are on the low end of the range depending on age they say you are fine. Which in some cases is true. If you are not presenting symptoms and you are a happy camper no need to give medications that are not going to help. Some people on the low end present major symptoms. Most like me who are low (232) very definitely are going to present symptoms.

Keep in mind there are hundreds of other problems that can make you fatigued, brain fogged, etc

My doctor said to try this for a month and if it helped problem solved. If it did nothing we stop.

Problem like any other hormone thing is your body sees it coming from another source and will scale back what it does which if you want to quit you have to preferably slow decrease it so your body starts making it again

Make sure your doctor does testing after you start and at regular intervals

tlewis303
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Re: Sleep Apnea and Low T for Men

Post by tlewis303 » Thu Nov 20, 2014 1:13 pm

Today marks 1 week on TRT Androgel and I don't feel any better. I guess I need to be patient.
As far as mention before about TRT affecting sleep and OSA, well I already have fragmented sleep so don't know how that could get worse even with CPAP therapy.
I'm hoping low T is the problem I have had multiple labs on everything even Lyme twice.

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tlewis303
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Re: Sleep Apnea and Low T for Men

Post by tlewis303 » Thu Nov 20, 2014 1:15 pm

Malibu,
What TFT do you or did you use? It worked pretty quick on you as I remember you saying.

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Malibu
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Re: Sleep Apnea and Low T for Men

Post by Malibu » Thu Nov 20, 2014 1:39 pm

Testosterone Micronized 10 percent cream

Only been on this for a shade over 2 months...blood tests coming up to see what the official numbers are.

The tricky part of all this therapy is what works for me may not work for you and vice versa.

The cream made by a compounding pharmacy nearby was the most cost effective deal (65 dollars a month) and it's what my doctor has had the most success with. Of course my insurance didn't cover compounding stuff but 65 dollars was a slight better than the 300 dollar a month insurance covered main stream brands!

The nice thing about the cream is he can custom tune the amount of testosterone with the same amount of cream. Unlike the others where you might have to do several pumps/applications.

If you look on the web (and my doctor had info on this he gave me) you will see that the amount is critical to most as in 30mg has no effect...then 60 has no effect....but 90 all of a sudden raises the numbers to an acceptable range. 120 puts them over the acceptable range.... just an example of course but a documented effect.

So your 2 pumps may not be enough to make a difference but 3 would make you feel great. Tricky stuff here and having a good doctor can make or break how you feel in the end.

I will try to find those web links for you...Mayo Clinic I believe is the one I was looking at.

It could be also that it will just take time to adjust. The pharmacist said it could take weeks to start feeling the effect but some feel better right away

tlewis303
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Re: Sleep Apnea and Low T for Men

Post by tlewis303 » Thu Nov 20, 2014 1:57 pm

Well I guess I will have to wait until I get labs done in about 3 weeks to see if I need more mg/day. So if I still don't feel well and the labs come back with an in range level of T then I'm barking up the wrong tree. On the other hand if I don't feel well and levels are still down then I will have to increase amount. Its not rocket science but so frustrating as I just want to feel consistently well. Save the bads days for when I'm 80. lol

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Sleeprider
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Re: Sleep Apnea and Low T for Men

Post by Sleeprider » Thu Nov 20, 2014 9:50 pm

I did not absorb transdermal T in the form of Androgel 1.62. Not only that it was expensive. Moving to injection was cheap and effective. No guessing what is in your system. Some guys can't use gels or cream, and frankly it poses less risk of exposure to women and children that may be in your household, and is less restrictive if you swim or work-out mid-day or earlier.

If you have to pay for this treatment through high deductibles or copays, by all means talk to your doctor about injection forms that are taken once a week or biweekly.

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Malibu
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Sleep Apnea and Low T for Men

Post by Malibu » Thu Nov 20, 2014 10:07 pm

Sleeprider...

Have you had any problems with elevated red blood cell count??

Injections are said to be more prone to that compared to creams and gels in the morning which mimic the starting out high in the morning and dropping throughout the day

It's good you found something that works!

tlewis303
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Re: Sleep Apnea and Low T for Men

Post by tlewis303 » Fri Nov 21, 2014 8:50 am

Androgel provided a discount card, so I pay $10 per month versus $60 if I didn't have it.
I had heard that injections leave you with a roller coaster affect on the T levels, any truth to that?
I know the FDA just approved an injection that is 4x a year, waiting to see more info about it.

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BigTex
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Re: Sleep Apnea and Low T for Men

Post by BigTex » Fri Nov 21, 2014 3:54 pm

tlewis303 wrote:Androgel provided a discount card, so I pay $10 per month versus $60 if I didn't have it.
I had heard that injections leave you with a roller coaster affect on the T levels, any truth to that?
I know the FDA just approved an injection that is 4x a year, waiting to see more info about it.

If you do your injections every week you will not notice any roller coaster affect.
However, some "clueless" docs will prescribe you too little and only do the injections every two weeks some people will notice.

Find a doc thats not treating your numbers but treating you.

10ml of Watson Test Cyp from Walgreens costs me $105 I think it is.
I use a little less then 1ml per week so its pretty cheap,

tlewis303
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Re: Sleep Apnea and Low T for Men

Post by tlewis303 » Mon Nov 24, 2014 11:08 am

I've been on the Gel for about 11 days now and haven't noticed any improvement for the way I feel.
Suppose to do labs again in 2 weeks to see if levels have come up. I guess that will be the telling point so to speak whether its absorbing well enough.

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bjl
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Re: Sleep Apnea and Low T for Men

Post by bjl » Tue Nov 25, 2014 10:57 am

And here's my story (kinda long, skip to the end where it says "Summary Points" if you want)...

I was diagnosed with severe OSA (AHI = 60) about 7 years ago. I didn't even know I had sleep apnea. I had a sleep study done because my wife complained about my snoring. As far as I knew, I slept through the night just fine (although my wife didn't). I was a bit overweight back then, but not excessively so (I thought). I started CPAP, but I never thought it was effective. It definitely helped my snoring, but I didn't feel any more alert or have one of those "Oh so *that's* what sleep is supposed to be like" moments. So I stopped using CPAP and just tried to sleep on my side a lot which helped with the snoring a bit.

A few years later I started having problems with ED. I weighed even more at that point. Because of my complaint about the ED, my PCP did T tests which came back low. He suggested TRT. I resisted because I don't like to take any drugs if I don't have to. He never suggested losing weight or making any other lifestyle changes. He never inquired about how the CPAP was going or how my sleep was. Finally, I decided to try TRT. I started on 100mg T cypionate every other week and eventually went up to 200mg every other week. The results were pretty immediate. ED was gone, I had much more energy and I was much more alert. The added energy helped me to exercise more which helped me to lose weight. My PSA ticked up a tiny bit, but remained stable so no cause for concern. Then I started reading a bit about TRT. As has been mentioned throughout this thread, there's lots of conflicting information and my PCP didn't appear to be aware of any of it. All he knew was that low T == TRT and that he had to monitor my PSA. In addition I noticed (sorry if this is too much information) that my testicles were shrinking. This turns out to be pretty common. Since your testes no longer need to produce T, they atrophy. Now I wasn't planning to have any more children, but any guy reading this will understand that having shrinking testicles is pretty disconcerting. However my PCP had never heard of this. So I decided to stop TRT. My T plummeted and I definitely felt bad for a few weeks. On the other hand, my testicles came back to their normal size. Unfortunately, around that same time I started having some other (probably unrelated) health problems which are too complicated to go into here.

During this time I had adopted a healthier lifestyle. I was eating better and exercising a lot more. While I was doing TRT, I looked really good. I slimmed down a lot, lost the innertube around my belly and started building muscle. I continued with the lifestyle changes after I stopped TRT. As expected, I lost some of my muscle weight and the inntertube came back although not as bad as it had been. When I started having some other health issues, I realized that I really hadn't been feeling that well for a while. Less energy, brain fog, some anxiety and depression. I had completely forgotten how good I felt while I was doing TRT.

Fast-forward to now. I'm having lots of sleep issues and some continued health issues for which I haven't yet found the root cause. I was re-diagnosed with mild OSA (AHI = 15) and so I restarted CPAP which seems to be having a more positive effect this time. I'm seeing a functional medicine doctor to help figure this out. One of the first things he noticed was the low T. Functional medicine doctors try to see the big picture so we're waiting on some additional tests before figuring out a treatment plan.

Summary points:

- I felt no difference in my sleep/sleep apnea when I was doing TRT.
- If you're having issues that you feel might be related to low T, get tested. You need to get at least your Total and free T, SHBG, and estradiol tested. If your doc doesn't do these tests, find a new doc.
- If you're able to bring back your T levels, but your estradiol is still high, this may need to be treated as well.
- Most GPs are clueless about TRT. Find an endocrinologist or urologist the specializes in this.
- Before starting on TRT, see if lifestyle changes would help. Especially true if you're overweight and/or don't exercise much. I think this is good advice before starting many drugs that docs like to prescribe nowadays.
- I don't think anyone really knows what the long-term effects of TRT are. However, I believe the theory that TRT can cause prostate cancer has been sufficiently refuted at this point. So talk to a knowledgeable doc and decide for yourself whether the risks are worth the potential benefits. For me, I think I felt much better when on TRT and so I may start this up again.
- When I was doing TRT, I took T cypionate by self-administered injection from which I felt an almost immediate effect. But everyone is different and you should work with a knowledgeable and flexible doc to figure out what works for you. If I do this again, I would probably do 100 mg every week rather than 200mg every other week to avoid the rollercoaster effect. Creams/gels although less convenient, tend to have less of a roller-coaster effect because you use them every day. However, it probably takes longer for you to see any positive effect as the T builds up in your system.

Hope the above helps. I'd be happy to answer any additional questions if I can help further.

-b

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tlewis303
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Re: Sleep Apnea and Low T for Men

Post by tlewis303 » Tue Nov 25, 2014 2:19 pm

Sure. Good story. I also read where the levels of T can come up to within normal range but it takes the body a while to re-balance out everything.
I guess that makes sense. Well Thursday will be 2 weeks and I don't feel any different. I'm going to start taking melatonin around dinner time per doc to see if that can help with staying asleep and not tossing and turning so much. Its just so crazy how OSA and low T and lack of sleep and weight gain are all inter-linked here. I haven't even seen a reduction is the fog either. Maybe labs will show I need more mg/day. I smoked for over 30yrs and stopped last spring and although I've had brain fog for over 4yrs I really started to feel bad the last few months. During the smoking years I was hardly ever sick and felt good 99% of the time. Go figure...

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Re: Sleep Apnea and Low T for Men

Post by tlewis303 » Mon Dec 15, 2014 12:14 pm

So the single application only raised my T level 50 point still in low range. Now will use 2 pumps per shoulder. Anyone ever had to do this to increase and obtain normal T numbers?

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