Need help for my guy!

My DH was recently told his 'free testosterone level' had checked as low. (No, we don't have the actual numbers yet.) After some internet research, it appears that obesity is a factor in causing this---but we can't find an answer to the question "Does losing weight make it go back up?" We'd love to hear from anyone, pre- or post-op who's had some experience with this. He's about 60 pounds overweight, and considering taking supplemental testosterone, with the idea that it *might* help him lose weight as well. Any input would be more than welcomed! Thanks, guys!

Hey Ms. Batt!  Here’s a lot of info  Gathered from several sources and sitting on my hard drive. Just passing it on-  No real “news” but some interesting info. Testosterone, as it relates to the Morbidly Obese and Bariatric Patient  Is a Vast Dump of info. Testosterone level changes in-  The Obese, Diabetics, It’s role in Muscle mass increase through exercise,  And it’s role in weight loss. The info here, Is predominantly related to the “moodiness” that can result Post-op, and how to go about testing for LOW Testosterone Levels. But it’s “what I had.”  

 

---------------------------------------------------------------------------- We often hear of the increase of free testosterone levels  Associated with the rapid weight loss following WLS.  Stored Testosterone in the Adipose Fatty Tissues  Is released into the body.   And significant increases of Free Testosterone can result.  But, for many,  The radical change in diet actually produces  The opposite effect.  Studies linking reduced fat intake with lowered testosterone levels in humans were published as early as 1980.   Subjects cutting their fat intake in half experienced a 13% drop in free testosterone.  When they resumed their normal diet, testosterone levels returned to normal. The most recent trial can be found published  In the Journal of Clinical Endocrinology and Metabolism. At- 

 

http://jcem.endojournals.org/cgi/content/abstract/jc.2004-15 30v1 A group of 39 middle-aged men (50 to 60 years of age)  Were studied while they were consuming a  High-fat (33% of total calories) Low fiber diet  And after eight weeks on a  Low-fat (14% of total calories), high fiber diet. Both total and free testosterone levels fell by 10-12% after the low-fat diet.  

 

The clearance rates of testosterone were not changed,  Suggesting that the drop in testosterone  Was because of a decrease in production. This is just one reason why it's so important  To get the right balance of fats in your diet.  Lowered Testosterone Levels  Create what is often referred to as “Male Menopause.”  One of the major symptoms, aside from sexual problems  Is depression.  Sort of a double-edged sword in that  Reduced Testosterone can cause depression  But also RESULT from depression.  From "Does Male Menopause Exist?"  by Neil Sherman. healthAtoZ  at- http://www.healthatoz.com/healthatoz/Atoz/hc/men/life/alert1 2132001.jsp  "There are a lot of things that can lower testosterone levels aside from aging,"  Dr. Sternbach explains. "You can lower it from drug and alcohol abuse  Or from stress or medications. Depression lowers testosterone, as does obesity.”  So, what should men do?

"Well first of all, make sure you're not suffering from depression,"

Sternbach advises. "Many of the issues in testosterone levels

Could be confused with the effects of depression.

You need to sort that out. If you've got symptoms

That may be suspicious,

The first thing is to have a thorough physical and laboratory work

And make sure you rule out other medical conditions such as diabetes,

Which also affect testosterone levels.

Treat those first, before you consider looking at testosterone.

And you should also have a thorough

Psychological Evaluation and deal with those issues."

Addressing physicians, Sternbach says,  "You can't just get a lab test, and treat a number, you have to treat the whole person."  But for the “numbers”—  Low testosterone levels:  Different labs measure free testosterone differently.  But ranges they consider "normal" generally fall between  260 nanograms/deciliter to 1,000 ng/dL  (or 2.6 nanograms/milliliter to 10 ng/mL).  Since physicians and laboratories have only recently  Begun to recognize the importance of testing free testosterone,  You may have to lobby to get the test.  If you are unable to get that reading  And are forced to stick with total testosterone,  Normal ranges for men usually are between  250 ng/dL to 1,200 ng/dL of blood

(2.5 ng/mL to 12 ng/mL). “Sports Medicine” sources give the figures for  The normal level of testosterone in the bloodstream  Is between 350 and 1230 nanograms per deciliter.  And there is a good a little bit of play in the “range numbers”  From source to source, depending on the test group of men  That the study is founded on.  The result of the “Norm” being calculated from different studies-  College men, Patients seeking Testosterone Replacement Therapy, etc… 

 

Like everything on the OH Boards- “Ask YOUR Dr.!!”  

 

T-levels begin dropping as early as mid-20’s, but-  Once you reach middle age,  (and that’s a 15 year span, from Approx. 35 to 50, depending on your genetics)  Testosterone levels begin to drop at a rate of about 1% to 2 % each year.  In the short-term, this might not sound like much.  By the time you reach your 70's,  This constant decline increases the risk of increased fat storage,  Brittle bones, muscle loss and impotence.  Very low testosterone levels can also increase your risk of dying from a heart attack.  

 

Testosterone travels around your bloodstream in two forms —  Free testosterone or  Bound testosterone.  Roughly two percent of total testosterone  Is made up of free testosterone, which is the most "active" form.  The rest is attached to sex hormone-binding globulin  (Known as SHBG) and other proteins.  In aging men, it's possible for total testosterone to appear normal,  While free testosterone is actually low.  If you do get your testosterone levels measured,  Make sure to ask for a reading of both total and free testosterone.  While a blood or saliva test is a more accurate way  Of establishing your levels of testosterone,  You can also use ---  The Saint Louis University  Androgen Deficiency in Aging Men (ADAM) Questionnaire.  Dr. John Morley, a researcher with the Saint Louis University School of Medicine,  Developed the self-screening tool  To help identify symptoms of low testosterone in men.  Choose the responses below that best describe how you have been feeling.  ----------------------------------------------------------------------------- 1. Do you have a decrease in libido (sex drive)? 2. Do you have a lack of energy? 3. Do you have a decrease in strength and/or endurance? 4. Have you lost height? 5. Have you noticed a decreased "enjoyment of life"? 6. Are you sad and/or grumpy? 7. Are your erections less strong? 8. Have you noticed a deterioration in your ability to play sports? 9. Are you falling asleep after dinner? 10. Has there been a recent deterioration in your work performance? ------------------------------------------------------------------------------ If you answer yes to question one or seven,  Or at least three of the other questions you may have low testosterone levels.  Another common sign of low testosterone is a change in mood and behavior.  You find it very easy to get angry at trivial incidents.  Things you used to enjoy now seem like chores.  Life no longer seems to be an endless stream of possibilities.  When men who cannot produce testosterone  Come off hormone replacement therapy,  They become irritable and depressed.  Their mood improves when they resume treatment.  In fact, some researchers think that low testosterone levels  Are one reason why some men become grumpy and irritable as they age.  Stress can also cause men of any age to experience a drop in testosterone levels.  The reason is that certain regions of your brain  Are "loaded" with receptors for testosterone.  In fact, men with depression have free testosterone levels  Almost 20% lower than normal.  In contrast, high levels of testosterone lift your mood,  Giving you a feeling of well-being.  If you do have a blood test,  Remember that testosterone levels are generally –  Higher in the morning and lower in the evening.  According to a 2003 study in - The Journal of clinical endocrinology and metabolism.  There are also peaks and troughs during the year. Testosterone levels reach a high during June and July, And drop during winter and early spring .  Before you go and get your testosterone levels tested,  Be sure you know the facts:  Laboratories vary in how they perform testosterone tests.  To be sure of the result,  Have your testosterone tests done at the same location  At roughly the same time of day.  (Hormones fluctuate throughout the day, so testing at about the same time is best.) 

 

The most useful number to know is the "free testosterone" (or bioavailable testosterone).  The "total testosterone" reflects free and bound testosterone.  Bound testosterone is not available to boost libido or effect mood  Because it is linked to proteins, such as albumin.  Testosterone does not affect sexual function,  Only sexual drive. (And it is certainly not the only component of sexual drive.)  So look for other explanations and solutions if erection difficulties  Or problems with the timing of ****** occur.  If you do find a low level of free testosterone  You’ll need to get other lab tests to determine  If you're a good candidate for testosterone supplements:  THE TESTS-  ------------------------------------------------------------ Testosterone (T) Recommended with deficiency or excess symptoms;  Indicator of low sex drive, hair loss, muscle mass and bone status.  It is recommended that Testosterone and SHBG  Be tested together to determine imbalances of testosterone and estrogen;  An important indicator of Andropause onset and/or premature aging in men. ------------------------------------------------------------ Sex Hormone Binding Globulin (SHBG) SHBG (sex hormone binding globulin) measurement is used  As a relative index of overall exposure to all forms of estrogens,  As an indirect index of estrogen interaction with the liver  And as an indicator of bioavailable testosterone.  High levels indicate excess exposure to estrogens  And lower bio-availability of testosterone to tissues,  It is recommended that SHBG be tested along with testosterone  In order to determine an imbalance between testosterone and estrogen.  Such an imbalance is an important indicator of  Andropause onset and/or premature aging in men. ------------------------------------------------------------ Male Profile I (T, SHBG, PSA) -a popular “combo” test. Overall assessment of male vitality,  Performance and prostate health;  Indicator of prostate enlargement or cancer risk. ------------------------------------------------------------

Prostate Specific Antigen (PSA) PSA a protein produced by the prostate gland  Is an important indicator of prostatic enlargement  Or increased risk of prostate cancer.  High PSA levels are a warning sign of prostate health risks.  A normal PSA reading is prerequisite to initiating testosterone therapy. ------------------------------------------------------------ Male Profile II (IGF-1, T, SHBG, PSA) –the “gold standard” of “combo” tests for men. Best comprehensive assessment of overall male health,  Vitality, and prostate health; indicator of Adult Growth Hormone deficiency,  Rapid aging and increased prostate cancer risk. ------------------------------------------------------------ Somatomedin C (IGF-1) IGF-1 is important because it is a reliable indicator of  Human growth hormone. IGF-1 needs to be  Within the expected range for this reason:  Low IGF-1 levels indicate Adult Growth Hormone Deficiency  Associated with rapid aging, decreased muscle and bone mass,  Slowing cognition, low libido and poor quality of life. ------------------------------------------------------------  Currently, testosterone can be administered by injection, pill, or skin patch.  Most physicians favor either the injection or patch  Because the pill has more potential for negative medical consequences.  The two negatives of the shots: the annoyance of getting a shot  Every two weeks to three weeks, and the "spike effect,"  Which gives a man a sudden boost of testosterone that usually wears off  By the time of the next injection.  The skin patch has the added advantage of  Eliminating the spike effect because the same amount of testosterone  Is absorbed through the skin each day as a new patch is applied.  The patch approach is slightly more expensive than injections,  But involves no needles.  The preferred way to go nowadays is the Cream or Gel transdermal delivery systems.  They are easy to apply, well absorbed,  And rapidly establish stable serum androgen levels  (Usually by the end of the second day). 

 

Much is made of the risk posed by accidental transferal of testosterone to others,  Such as children or sexual partners.  Simply covering with a T-shirt has been shown to block transfer of the hormone.  The testosterone sinks into the skin within an hour,  Which acts as the actual reservoir for the hormone’s delivery.  One may then shower, or even swim, without worry.  So, That’s what I had. Add ons guys? Thoughts?  Moodiness can occur for a number of reasons  In Post-Op Bariatric Patients.  Mourning the loss of food, adjusting to new life style,  Pressure to succeed, Loss of comforting and coping mechanisms, etc…  And for us Guys- Add in The Testosterone Roller Coaster than can result.  

 

Don’t assume anything about a “bad mood.”  Very likely, could be the result of  Chemical / Hormonal Imbalances beyond your control.  Who says we don’t get “hormonal” at times?  

 

Best Wishes-  Dx

 

 

Thanks! I'll copy and paste this to e-mail, and send it to him. His levels have been tested twice, but as I said, we don't know the exact numbers, just that the doc said "low". We're looking into the patch, pros and cons, etc., and we'd REALLY like to hear from anyone who'se used this or any OTHER form of testosterone replacement therapy. Anyone out there???