Who experiences Apnea/Polycythemia w/TRT and what are you doing about it?

[pcgizzmo]

I have sleep apnea and TRT makes it worse. I also have borderline Polycythemia my Hemoglobin is currently 16.8. (Polycythemia is probably caused by Apnea) I am on a CPAP for the apnea and my blood count is getting better. I need to start TRT but I am afraid it will make my apnea worse. I just wondered who here is on a CPAP for apnea as well as might have possible polycythemia due to apnea and or TRT and how are you coping and what are you doing for your symptoms? Thanks...

[pmgamer18]

Originally Posted by pcgizzmo

I have sleep apnea and TRT makes it worse. I also have borderline Polycythemia my Hemoglobin is currently 16.8. (Polycythemia is probably caused by Apnea) I am on a CPAP for the apnea and my blood count is getting better. I need to start TRT but I am afraid it will make my apnea worse. I just wondered who here is on a CPAP for apnea as well as might have possible polycythemia due to apnea and or TRT and how are you coping and what are you doing for your symptoms? Thanks...

Most men find out after they are on TRT that they have apnea and do good on TRT with the CPAP. If blood count is not good just give blood.

[021mk]

Originally Posted by pcgizzmo

I have sleep apnea and TRT makes it worse. I also have borderline Polycythemia my Hemoglobin is currently 16.8. (Polycythemia is probably caused by Apnea) I am on a CPAP for the apnea and my blood count is getting better. I need to start TRT but I am afraid it will make my apnea worse. I just wondered who here is on a CPAP for apnea as well as might have possible polycythemia due to apnea and or TRT and how are you coping and what are you doing for your symptoms? Thanks...

I have apnea and it was getting worse when I was on TRT. I went off the patches due to feeling depressed. It took me about 3 weeks to start feeling my old apnea symptoms come back. I re-started the patches tonight, but I know this is something I'll have to address

[ASaxon]

I have moderate to severe sleep apnea (runs in my family) and use a CPAP machine. I was diagnosed with apnea before hypogonadism as I was running every test in the book to try to figure out why I was feeling the way I was feeling. After being on CPAP for four + months I realized some improvement to energy and fatigue but I still had other nagging symptoms that drove me to get more testing that eventually lead to hypogonadism.

Since being on TRT I’ve notice a night and day different in the rest of my symptoms but I still had one symptom that was severely impacting my quality of life. I was having anxiety and panic attacks. After a few more trips to the ER with them not being able to find anything wrong with me I got referred to a neurologist who ran some test to rule out neurological conditions and then prescribed me a low dose of Zoloft. Within two weeks I stopped having any panic attacks and within a month I was feeling near normal again.

The symptoms you describe seem like you could have some level of an anxiety disorder. The disorder can be caused by hypogonadism to some degree but if you are having episodes of depression and anxiety you may want to try a low dose of a SSRI just to see if it helps. For me the TRT / SSRI combination has brought me nearly back to normal. I’ve had a difficult last three years which has likely exacerbated my anxiety so I’m hoping that as I reduce my life stress I’ll be able to come off of Zoloft but for now both Zoloft and TRT has changed my life as living with daily panic attacks is no fun. And just like TRT you cannot come on and off of Zoloft when you feel like it. Zoloft has to be tapered up in dosage and then tapered down.

Just something to look into if you haven’t already.

Also, remember that you can’t just start and stop TRT, it doesn’t work that way. You need to stay on your treatment for a month or two before you can make adjustments. If you have symptoms that develop that you are concerned with talk to your doctor and see what he recommends but don’t stop TRT unless your doctor tells you to. It took me a few months to feel significantly better with the TRT / Zoloft combo.

About your CPAP: Just make sure you continue to use your CPAP every night. The danger with apnea and TRT is in people that don’t know they have apnea or refuse to use CPAP. People that are on CPAP don’t have anything to worry about as any increases in apnea will likely be treated with CPAP usage and if there is any change in apneas on CPAP it will likely be minor. So I wouldn’t worry about it so long as you are using your CPAP nightly.

[pcgizzmo]

Thanks for the replies.


ASaxon,

I have had Dr's try and put me on SSRI's in the past and I have resisted. My main reason is that I am 36 and in my mind want to be a normal person and not have to take meds. There reasons have been numerous. When I first started having apnea I was waking up gasping for air and they told me it sounded like panic attacks. This also all started when my dad passed away. So, I don't doubt that I was suffering from some form of depression then but that was two years ago. I have partially resisited the TRT thing until it is now begining to affect my marriage. I have been lucky in the fact that my muscle mass has not really been affected that much but, my libido has and that is starting to cause trouble on the home front. I will talk w/my Dr. and see if maybe there is a low dose I could take. I don't really feel depressed. I have had anxiety attacks in the past but, not really on a weekly or monthly basis. I know exercise is supposed to be a good anti-depressant and I do work out 3-4 times a week. Thanks again for the info.

Paul

[ASaxon]

Zoloft is given to relieve anxiety as well as depression. Both conditions are treated with Zoloft. I don’t know if it’s different with other SSRI’s but Zoloft specifically deals with anxiety issues as well.

[earthdog]

I have sleep apnea and was on CPAP for a couple of years before I started TRT. I don't think the apnea has changed for the better or worse since starting TRT. I'm still on CPAP.

[1cc]

Found this:

"Polycythemia has been associated with testosterone replacement therapy and is correlated with elevated bioavailable testosterone and estradiol levels. Physiologic replacement with transdermal testosterone, however, resulted in fewer cases of polycythemia than replacement with testosterone enanthate injections. Although the mechanism is unclear, testosterone replacement therapy may also cause or worsen obstructive sleep apnea."

http://www.duj.com/Article/Hellstrom2/Hellstrom2.html

[1cc]

The Short-Term Effects of High-Dose Testosterone on Sleep, Breathing, and Function in Older Men

therapy may precipitate obstructive sleep apnea in men. Despite increasing androgen use in older men, few studies have examined sleep and breathing. Randomized, double-blind, placebo-controlled studies examining effects of testosterone simultaneously on sleep, breathing, and function in older men are not available. Seventeen community-dwelling healthy men over the age of 60 yr were randomized to receive three injections of im testosterone esters at weekly intervals (500 mg, 250 mg, and 250 mg) or matching oil-based placebo and then crossed over to the other treatment after 8 wk of washout. Polysomnography, anthropometry, and physical, mental, and metabolic function were assessed at baseline and after each treatment period. Testosterone treatment reduced total time slept (1 h), increased the duration of hypoxemia (5 min/night), and disrupted breathing during sleep (total and non-rapid eye movement respiratory disturbance indices both increased by approximately seven events per hour) (all P < 0.05). Despite expected effects on body composition (increase in total and lean mass, reduction in fat mass, P < 0.05, bioimpedance method), upper airway dimensions did not change (acoustic reflectometry). Driving ability (computer simulation), physical activity (accelerometry, Physical Activity Scale in the Elderly), quality of life (SF36, Functional Outcomes of Sleep Questionnaire), mood (Profile of Mood States Questionnaire), sleepiness (Epworth, Stanford scales), and insulin resistance (homeostasis model) also were not changed by treatment. Short-term administration of high-dose testosterone shortens sleep and worsens sleep apnea in older men but did not alter physical, mental, or metabolic function. These changes did not appear to be due to upper airway narrowing. Further study of longer-term lower-dose androgen therapy on sleep and breathing is needed to evaluate its safety in older men.

http://jcem.endojournals.org/cgi/content/full/88/8/3605

[stat1951]

I had sleep apnea problems for probably 10 - 12 years befroe finally getting it diagnosed with a sleep test. That was in the mid 90s. I have been on a CPAP Machine since then. I started TRT in July of 2004. As far as I can determine, the TRT has made the apneas neither better nor worse.

In mid 2002 I developed mild anxiety problems that would occasionally flare to moderate levels. I coped with it via talk therapy and occasional sleep aids for the insomnia that came along with the anxiety. In June of 2004 the anxiety levels went to very severe levels. It was accompanied by severe insomnia. It was also accompanied by a sudden onset erectile dysfunctioning and loss of libido (hypogonaidsm) - and also the suddden onset of several physical symptoms. I was also found to have significantly high levels of cortisol (several times above normal maximum levels).

SSRIs (like Zoloft or Lexapro) did nothing to help my anxiety - plus had side effects of severe nausea that would not abate and strong sexual dysfunction. Obviously having TRT start helping my ED problems and loss of libido and then having SSRI produce that type of side effect was very counter porductive! SSNRIS meds (like Effexor or Cymbalta) not only didn't help, they made my anxiety much, much worse. Benzos have been the only thing - along with strong levels of TRT - that have helped control my anxiety. My prescribed version is Xanax XR, taking 1 mg twice a day. Interstingly, a recent visit to NIH Hospital (for 2 weeks where they were examining my hypercortisolism problem) led to some strong suggestions that I was actually - in their professional opinions - highly undermedicated for treating my anxiety. In other words that I should be taking a much stronger dose of the Xanax XR daily (and they agreed with Xanax XR or Klonopin as being a preferred regimen of treatment for more pure cases of anxiety than any SSRI or SNRI - and these were two psychaitrists who were part of my overall team of several doctors and technicians). The figure of 4 - 6 mg Xanax XR daily (and even higher) was tossed around, with the thory - as I understood it - being that a stronger dose was needed to actually have any chance of effecting "a cure" rather than just "plodding along", with a dosage just good enough to get by but not strong enough to get better. An interesting thought.

As to:

My main reason is that I am 36 and in my mind want to be a normal person and not have to take meds.

I at one time felt very similar to this until I realized that the proper meds in the proper doses - when needed for specific problems - aren't something to be feared but specifically can be exactly what is needed so that one can resume being a "normal person" and go back to being productive and having fun, etc., etc.

I don't believe that any of us would look at a daibetic or a hypothyroid (etc.) and consider them in any way "less than normal" simply because they have to take a medication every day. Yet by doing that those people are able to live very normal lives, have fun, be productive, etc.

TRT is the same way. If one is truly hypogonadal, chances are - with the slim exception - that one will be one a TRT protocol for the rest of their life, and will not be something that they do on an on-again-off-again basis, or that they "cycle" like doing steroids.

With psychological disorders, many people end up getting cured when the right combination of talk therapy, pharmaceutical intervention, and hormone adjustments are made. Other people simply have - like diabetics - chemical imbalances that their body (or often their brain) cannot permanently adjust back to a "normal" so will be destined to take a pharmaceutical medicine forever also... just as that diabetic has to take insulin forever.

Taking the medication (or hormone or whatever), when required, allows one to live that "normal life" while a person who fights the "stigma" or fear of the medication or fear of "not being natural", etc., is destined to live a miserable, stressful, less healthy (and probably much shorter) life.

As to the H&H levels (have you had Hematocrit levels also checked?), I simply donate blood on a fairly regular basis as it is not only good for controlling those items, but is also (IMHO) a healthy protocol for any non anemic male to perform (plus provides a highly important health service to the community at large).

Larry

[1cc]

Here's something by swale about phlebotomy.

http://www.sculptedbyiron.com/forum/...ght=phlebotomy

[Numb&Dumber]

pcgizzmo,


If you already have sleep apnea I'd say that TRT will most definately make it worse. I believe that sleep apnea is made worse from edema developing in the lungs and other soft tissues in the throat and nasal passages. Edema is a swelling from excessive collection of fluid in the tissue. An increase in Estrogen can increase intracellular sodium and water uptake, resulting in high blood pressure and Edema. So you might want to have your E checked. Also, TRT will suppress LH. I read somewhere on this site where SWALE or Marianco (one of them) said that they had noticed that in men with long term suppression of their natural LH had reduced levels of Pregnenolone. Pregnenolone is the precursor to Progesterone. Progesterone is a natural diuretic and prevents the cell's uptake of sodium and water, thus preventing high blood pressure and edema. If you do start on TRT and it does make your sleep apnea worse, then make sure you exercise daily and reduce sodium in your diet.

Also, NEVER take antidepressants, unless you're suicidal or something. Antidepressants can cause permanant sexual dysfunction. If you think that your serotonin is low then try boosting it naturally by exercising daily and getting at least an hour of sunlight a day. Sunlight will increase serotonin and dopamine and has been shown in studies to increase LH by 72%. LH is the main hormone that signals the testicles to produce testosterone.

Now, all that said, I have this feeling you may not even need TRT. I don't know anything about your lifestyle or any of your hormone levels, but you just sound like you might be a little depressed, probably socially and physically inactive and stressed out. But TRT really should be a last resort. You need to find out why your T is low, and try to treat that. Be careful with doctors. They'll just treat the symptoms, and usually all that does is create a new set of problems.

[Numb&Dumber]

One other thing. Even if you're not depressed your anxiety attacks could be a sign of low serotonin. Again, DO NOT take medication for this. If your serotonin is a little low then exercise and sunlight should be enough to correct the imbalance.

[SWALE]

1cc-I am forbidden from accessing what I wrote at SBI. LOL.

It is only innappropriate TRT (greater than one week injection intervals) that makes IM worse than patches.

[1cc]

Originally Posted by SWALE

1cc-I am forbidden from accessing what I wrote at SBI. LOL.

It is only innappropriate TRT (greater than one week injection intervals) that makes IM worse than patches.

This will take care of that!

Originally Posted by SWALE

I have never seen hard and fast incidences from a study, but know that the (unncecessarily high) acceleration from bi-weekly dosing is more likely to raise H&H (Hemoglobin and Hematocrit) to dangerous levels.

The ceiling for me is a Hemoglobin of 18.0 and a Hematocrit of 55.0. Then they are on their way down to the Red Cross to donate a wonderfully healthy (as my patients are all going to the gym, eating right, and taking their supplements--well, they TELL me they are at least!) pint of the good stuff.

For those who would be deferred due to a prexisting condition or, perhaps, use of finasteride (another reason I am not fond of it) then a therapeutic phlebotomy can be arranged at the local hospital.

I must admit the TheKing's strategy WOULD work. I also notice that he has a particular talent for figuring out how to get around the rules (LOL). However, as a physician, and Board Member at my local Red Cross, I must say that doing as he advises is an unethical--and potentially dangerous--waste of scant Red Cross resources.

There is no given time duration for witholding TRT from a polycythemic patient. Every case is different.

I am happy to note that usually when the H&H is too high, it is becasue the patient forgot to drink water while they were fasting for their labwork. That is why I always grab a Comprehensive Metabolic Panel along with their CBC (Complete Blood Count). If the BUN/creatinine ratio is greater than 20.0, I know that they are dehydrated. This concentrates the blood, and falsely elevates the H&H.

[howard-sd]

Originally Posted by Numb&Dumber

pcgizzmo,
If you already have sleep apnea I'd say that TRT will most definately make it worse. I believe that sleep apnea is made worse from edema developing in the lungs and other soft tissues in the throat and nasal passages.

Sorry to differ on two of the above points:

1 - I have sleep apnea, have been on CPAP since 1997, on TRT since 2001. I monitor my apnea level through the measuring algorithms built into my machine, and have seen no increase in apneic events after I started TRT. (Yes, from time to time, I do a measurement of my AHI [apnea & hypopnea index] without CPAP.)

2 - Apnea can be induced from physical restrictions in a number of places, including a loose soft palate or position of the jaw at rest occluding the throat, or any combination.

Treating low testosterone with TRT will increase a person's energy level, making it easier to control or lose weight, one of the proven methods to reduce AHI.

To say that TRT will definately make sleep apnea worse is pure conjecture, and probably not supportable by controlled studies.

[pmgamer18]

Originally Posted by howard-sd

Sorry to differ on two of the above points:

1 - I have sleep apnea, have been on CPAP since 1997, on TRT since 2001. I monitor my apnea level through the measuring algorithms built into my machine, and have seen no increase in apneic events after I started TRT. (Yes, from time to time, I do a measurement of my AHI [apnea & hypopnea index] without CPAP.)

2 - Apnea can be induced from physical restrictions in a number of places, including a loose soft palate or position of the jaw at rest occluding the throat, or any combination.

Treating low testosterone with TRT will increase a person's energy level, making it easier to control or lose weight, one of the proven methods to reduce AHI.

To say that TRT will definately make sleep apnea worse is pure conjecture, and probably not supportable by controlled studies.

I agree with you my wife got tested and had apnea but could not use the machine it drove you nuts she would put on the mask then her mouth would open so they gave her a strap to keep her mouth shut man she looked like she just landed from mars. She checked on this.
http://www.restoremedical.com/pillar.asp
And the Dr. told her before she does this to try to lose weight she lost 40 lbs and the apnea is now gone.

[stat1951]

Originally Posted by howard-sd

Sorry to differ on two of the above points:

1 - I have sleep apnea, have been on CPAP since 1997, on TRT since 2001. I monitor my apnea level through the measuring algorithms built into my machine, and have seen no increase in apneic events after I started TRT. (Yes, from time to time, I do a measurement of my AHI [apnea & hypopnea index] without CPAP.)

2 - Apnea can be induced from physical restrictions in a number of places, including a loose soft palate or position of the jaw at rest occluding the throat, or any combination.

Treating low testosterone with TRT will increase a person's energy level, making it easier to control or lose weight, one of the proven methods to reduce AHI.

To say that TRT will definately make sleep apnea worse is pure conjecture, and probably not supportable by controlled studies.

I personally - as relates to my apnea - would agree with this post. My grandfather had sleep apnea very bad (but of course they had no definitive treatments back then - I don't even know if he ever saw a local doctor who even knew what it was)... and I am sure that it led to his early death from cardio problems (his family was otherwise very long lived - most going well into heir 90s while he died in early 70s). He did not smoke nor drink nor was he overweight. He was somewhat short and thinner and but very wiry and muscular. He had severe snoring and sleep apnea as early as his late 20s.

I developed severe snoring and my late 20s and started getting actual apnea events in my early to mid 30s. The condition seemed to worsen almost monthly. At that time I had bulked up quite a bit (from my early 20s to my early 30s) from having been bitten by the weight training bug - power oriented training for primarily strength and secondarily size. The severer snoring and sleep apneas started when I was probably around 200 - 210 and I maxed out (back then) in the 240 - 250 range but mainly muscular.

After putting up with it for 10 - 12 years my wife contacted a specialist and had a sleep test arranged.

Possibly a genetic connection?

According to the doctor, I indeed had the combination of Apnea as "induced from physical restrictions in a number of places, including a loose soft palate or position of the jaw at rest occluding the throat", etc. Surgery was discussed, but he felt that my condition was so severe that I would probably have to stay on a CPAP anyway, just at a lower air pressure setting. Since I had no problems with using the CPA machine I opted to forego the surgery at that time (though I do check on new options periodically in case a procedure is developed that will insure a 100% cure - for my particulars). If an advanced surgical procedure comes along that will do the trick and allow me to discontinue use of CPAP then I would jump on it. Not that I have a problem with wearing / using the CPA, it's just a pain when travelling, etc.

I have also discussed this with my wife and she has said that on the occasion where I drift off watching TV or reading that she has noticed that my snoring is not quite as severe and my apnea events are much less frequent that prior to being on TRT.

Personally I believe that TRT-induced sleep apnea is like most other side effects of any medication, hormone, etc. It is a very minor risk for a small segment (very small IMHO) of TRT patients, either to cause sleep apnea to develop or worsen existing sleep apnea.

Larry