I have a problem taking testosterone now. I am 70 years old. The standard testosterone level is 380 to 400 ng/dL. Mine is 90. PSA is normal. What should I do?
Background: I was diagnosed with HIV in 1986. In 2001 I had non-Hodgkins lymphoma, with six months of chemotherapy. After that my T-cells were ~20. I was diagnosed with hypogonadism and had adrenal insufficiency. Since then I have been taking testosterone supplements. In 2006 I received a new combination therapy and my viral load became undetectable and T-cell began to rise. In 2024 I was on 50 mg (0.5 mL) per week of subcutaneous testosterone. When I developed severe urinary flow problems, I had a Aquablation procedure for BPH, and since then I am not able to take testosterone. I tried with a low level gel but as soon as I take it I develop urinary retention. So I have stopped all testosterone. My level of testosterone now is 90.
True vet here as you have been a member of the forum from the start!
Blessed that you found one of the few forums that changed the game as we run in a different lane over here.
No mumbo jumbo or fluff here we keep it real!
You definitely need to address this as your TT 90 ng/dL is horribly low which means the most critical fraction FT would be absurdly low and you are at a huge disadvantage here when it comes to your overall health (mental/physical) especially cardiovascular and bone health.
More importantly, its metabolites estradiol and DHT are needed in healthy amounts to experience the full spectrum of testosterone-beneficial effects on (cardiovascular health, brain health, libido, erectile function, bone health, tendon health, immune system, lipids, and body composition).
*Natural testosterone is viewed as the best androgen for substitution in hypogonadal men. The reason behind the selection is that testosterone can be converted to DHT and E2, thus developing the full spectrum of testosterone activities in long-term substitution
*Preparations of native testosterone or its esters (aromatizable T) should be used for TTh
You need to seek out a
urologist who also specializes in testosterone therapy and can address your situation.
50 mg T is a low weekly dose and chances are your FT especially trough may have been too low.
Standard starting dose across the board by those in the know is 100 mg T/week or 50 mg T injected twice-weekly.
Yes there are many ends and some uros who will start older men on 60-80 mg T/week.
Rare any would go below 60 mg T/week.
Blood work should have been done at the true trough (lowest point) before your next injection so you can make sure you are still hitting a healthy FT level otherwise you can experiences symptoms of low-T towards the end of the week.
Although blood levels will be more stable throughout the week when injecting strictly sub-q there is still going to be a difference between the peak--->trough when injecting once weekly.
Do you have any of your previous. labs to post (TT, FT, estradiol and SHBG) and if so how many days post-injection were they done?
The standard starting dose for Xyosted is 75 mg T/week.
Have you had. any follow-up testing since the mist (aquablation) procedure?
What were your symptoms before the procedure and what improvements did you notice after?
Being in a hypogonadal state would be worse in the long-run for LUTS/BPH let alone your overall health.
In cases of men with severe LUTS use of testosterone needs to be approached cautiously and the condition needs to be addressed/treated.
* Meta-analyses have not found significant changes in LUTS between patients treated with testosterone or placebo [143-149]. According to the literature, there are no grounds to discourage testosterone therapy in hypogonadal patients with BPH/LUTS and there is evidence of limited benefit from androgen administration. The only concern is related to patients with severe LUTS (IPSS > 19), as they are usually excluded from RCTs; therefore, limiting the long-term safety data of testosterone therapy in this specific setting [68].
The EAU Sexual and Reproductive Health Guidelines aim to provide a overview of the aspects relating to sexual and reproductive health in adult males.
uroweb.org
3.5.3 Lower urinary tract symptoms/benign prostatic hyperplasia
A trial of 60 patients undergoing testosterone therapy for six months showed no significant differences on post-void residual urine and prostate volume, while storage symptoms as measured by IPSS significantly improved, despite an increase in prostate-specific antigen (PSA) level [138]. A larger pre-treatment prostate volume was a predictive factor of improvement in LUTS. Similarly, a placebo controlled RCT including 120 men with hypogonadism (total testosterone < 12nmol/L) with MetS and listed for benign prostatic hyperplasia (BPH) surgery, showed that testosterone therapy did not result in a difference in LUTS severity compared to placebo. Conversely, an improvement in ultrasound (US) markers of inflammation in the expression of several pro-inflammatory genes was found in the treatment active arm [139]. A long-term study of 428 men undergoing testosterone therapy for eight years demonstrated significant improvements in IPSS, no changes in maximum flow rate (Qmax) and residual urine volume, but also a significant increase in prostate volume [140]. Similar data from the Registry of Hypogonadism in Men (RHYME), including 999 patients with a follow-up of three years, did not demonstrate any significant difference in PSA levels or total IPSS in men undergoing testosterone therapy, compared to untreated patients [141]. Similar results were reported in an Italian registry (SIAMO- NOI), collecting data from 432 men with hypogonadism from 15 centres [142]. Meta-analyses have not found significant changes in LUTS between patients treated with testosterone or placebo [143-149]. According to the literature, there are no grounds to discourage testosterone therapy in hypogonadal patients with BPH/LUTS and there is evidence of limited benefit from androgen administration. The only concern is related to patients with severe LUTS (IPSS > 19), as they are usually excluded from RCTs; therefore, limiting the long-term safety data of testosterone therapy in this specific setting [68].
ABSTRACT
Lower urinary tract symptoms (LUTS) are a cluster of voiding symptoms, such as a weak stream, hesitancy, intermittency, urinary frequency, urgency, and nocturia. LUTS are frequent in elderly men and is considered the ultimate clinical symptoms of benign prostatic hyperplasia. With aging, male hypogonadism is increased which is defined as the decreased ability of the testes to produce sperm and sex steroids because of a pituitary/hypothalamic, or testicular deficiency. In academic andrology associations, the term “male hypogonadism” is commonly used to categorize...
Updates on androgen replacement therapy and lower urinary tract symptoms: a narrative review (2022)
Raed M. Al-Zoubi, Mustafa Alwani, Omar M. Aboumarzouk, Mai Elaarag, Ahmad R. Al-Qudimat, Laxmi Ojha & Aksam Yassin
ABSTRACT
Lower urinary tract symptoms (LUTS) are caused by higher tension at the bladder neck level (due to fibrosis or stiffness) or benign prostatic hyperplasia, which causes static obstruction of the bladder outlet. Both forms cause a group of symptoms such as hesitancy, intermittency, weak stream, nocturia, urine frequency, and urgency. Additionally...
In the final edition of EAUTV at EAU24 our expert panel discusses Male LUTS. Moderator Prof. Jean-Nicolas Cornu and discussants Prof. Marcus Drake and Prof. Thomas Herrmann cover the distinctions between prostate symptoms and LUTS, storing and voiding issues, and more.
