Lifeisabeach wrote: ↑Thu Jun 25, 2020 4:29 am
So with that background in mind, while I don't know what a "normal" anything is, I haven't ever had the issues your husband is having, nor does my wife have any complaints.[.,..] but I would wager his problems are more rooted in his lifestyle for the reasons RRR laid out. I wish I could offer you more hope, but there's not going to be a quick solution here. The others gave great advice and there's little to add, but the bottom line is your husband has to WANT to improve and WANT to do something about it before anything will change, and he will need all the support he can get.
Just a word of warning about testosterone injections. In my case, it caused me to gain a lot of weight very quickly in a short period. I could actually see my leg swell up after taking an injection. It apparently was causing me to retain fluid. But worse than this? At the time, my sleep apnea was not being treated, and the t-injections made it worse. Oh man, so, sooooo much worse.
If you are not having a libido problem, then your level may be fine for you and your body regardless of the blood T number or the usual range for men. But her H is having a libido problem. He was diagnosed with "low T" by his doctor which probably means less than 400 ng/dL. This is low enough for many men (not all) to lose their libido or not have a very strong one (e.g. only interested in sex maybe every 2 weeks instead of every 3 days which is more normal in a marriage). When he had low T, my husband could still do everything and wanted to occasionally, but it was often 'take it or leave it', he could forget for several weeks and be fine with that, even if it was his birthday or our anniversary, it wasn't a priority and didn't often enter his mind.
If he was diagnosed by his doctor with low T, that is not a 'lifestyle problem'. But sleep apnea can lower testosterone. Having sleep apnea is not a 'lifestyle problem' unless losing weight alone fixes the apnea (but waiting for weight loss success is too slow, he needs to use CPAP every night and not just for 5 hours).
Quotes from a few web articles:
"Researchers have found evidence that men who have obstructive sleep apnea are more likely to have ED, and vice versa. A 2009 Trusted SourceJournal of Sexual MedicineTrusted Source studyTrusted Source found that 69 percent of male participants diagnosed with OSA also had ED." "Sleep deprivation caused by sleep apnea may cause a man’s testosterone levels to dip." "According to the International Society for Sexual Medicine, many men with OSA who use continuous positive airway pressure (CPAP) for treatment experience improved erections. "
"In the JAMA study, 10 men volunteered to have their testosterone levels checked during eight nights of sleep restriction. They were only allowed five hours of sleep per night. The study found that their daytime testosterone levels decreased by 10 to 15 percent. The lowest testosterone levels were in the afternoon and evening. The study also found a progressive loss of energy over the week of sleep deprivation."
"In one study, researchers from Fujian Medical University separated subjects into four groups based on the severity of their sleep apnea and measured their testosterone levels. Results showed that men suffering from severe OSA had much lower testosterone levels and a higher rate of erectile dysfunction compared to the groups suffering from simple snoring or mild OSA."
You are right that sometimes T therapy can make apnea worse: "Some studies have suggested that Testosterone Replacement Therapy (TRT) may exacerbate the severity of pre-existing Sleep Apnea. Talk to your healthcare professional to determine if you consider a sleep study prior to initiating TRT."
There is a strong connection between low T and apnea, but we really don't know which is mostly the chicken or the egg. "Studies have shown that low testosterone levels frequently occur in men with obstructive sleep apnea." In one study, "16.5% of men who used testosterone developed obstructive sleep apnea, compared to only 12.7% in the control group.". So if you didn't already have sleep apnea, then starting T therapy might make you start having it (still this was only 4% difference in that study, that doesn't rule out trying the therapy). But this poster's husband already has apnea and is already on CPAP, so if her husband tries T therapy and his apnea numbers get worse, he might be able to address that by increasing his CPAP pressure.
Treating the apnea might raise his testosterone. The wearing a mask for only "5 hours a night" is a red flag to me. The first step for her husband should be to use his mask for the entire night, and monitor his AHI with Oscar, adjust pressure to get the AHI below 5.
By the way, if you research any studies on T therapy benefits and risks, I suggest looking closely to see if the study was properly designed and run. A well-designed study would include these things: 1) All the men in the study initially (at start of study) had confirmed low T blood levels (which is < 400 ng/dL, it is a bad idea to take T therapy if you don't have proven low T), and 2) the men's blood levels of Total T, Free T, estrogen, and hemoglobin were tested often during the study (else the people who planned the study weren't very knowledgeable), 3) the men's dosage was adjusted individually to get their levels up to about 600 ng/dL (if they give every man the same dosage, that is really dumb, it is not 'one size fits all'), and 4) preferably the study went on for at least 6 months to give the men's bodies time to adjust. Also 5) the T level should be as constant as possible which means shots at least twice a week, patches, pellets, cream, or gel, in other words NOT a weekly or biweekly or monthly shot which leads to rollercoaster. Ideally, 6) they should be giving estrogen-lowering drugs to the small subset of men who convert the T into too much estrogen. If a study has not done the necessary checking and adjusting dosages for each man, then it is no surprise that some men have bad results. That would be like a CPAP study where every person was assigned the same pressure range, and the doctors did not regularly check their machine data and keep adjusting the ranges to optimize their AHI. Many people would obviously have bad results in that situation. Disturbingly, many of the testosterone therapy studies in peer-reviewed journals did not even involve any follow-up blood tests to see if the men's levels were too high or too low during the course of the study.
You say "there is no quick solution here". That might often be true, but sometimes there is. In my husband's case, the T therapy fixed it within a few days (but in his case he didn't have complications of obesity or apnea). It was sort of like a light switch, problem was solved. A lot better than paying hundreds or thousands of dollars in marriage counseling bills, and having all those uncomfortable conversations about me not being happy and him feeling like a failure or resenting my wanting him to change - we avoided all that. I wish we had tested for low T many years earlier. Now my own libido is reduced and I'm on T therapy myself (but much lower dosage since I'm a woman, they don't do shots for women since low dose, I take a sublingual compounded lozenge.) Since I've been on both sides of the fence, I understand how important it is to not ignore and dismiss the lack of libido problem. If your spouse isn't happy, you need to take action, don't give up, keep trying various things to improve it for the sake of your marriage. Sometimes you need to see a different doctor if your doctor doesn't seem to be helpful or experienced in this area.
Yes, some men have bad side effects, that is true of any medicine or hormone. I wonder if you started at too high a dosage? Initially my H's doc prescribed way too high of a dose. (It was weird during that period when his T levels got overly high, he started 'sleep groping' me and initiating sex when he was asleep which he never did before, but he stopped doing when they lowered the dosage.) My H doesn't weigh very much, and I think the doctor probably gave the same amount to his 200lb patients which was not appropriate for my H. I wonder if they were monitoring your T levels and estrogen levels closely. I've heard of doctors prescribing T shots and then not checking the blood T levels a couple weeks later which is so important. The estrogen level needs to be monitored for a few months to check to see if it is creeping up too much. Also, I wonder if you injected twice a week and did you give your body a few weeks to adjust? If less frequently than twice a week, you could be on the infamous "hormone rollercoaster" of ups and downs in T, and maybe it was the rollercoaster that was making the apnea worse. The leg swelling up thing sounds interesting and probably not very common. That has never happened to my H, did you doctor have any theories on why? Did you try injecting in other places such as your stomach? The weight gain sounds like too much estrogen (your body converts some portion of the T to estrogen), so maybe you needed to be on an estrogen lowering drug along with the T therapy, that is true of many men. Usually T therapy helps promote weight loss unless you have too much estrogen, but of course this varies with every person.
