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- Fri Sep 19, 2008 11:51 am
My husband had testicular cancer and lost one testicle 14 yrs ago. He's doing well and all test are fine. About 5 years ago he asked the Dr to test for low testostrone and he came back borderline low. The Dr put him on Androgel and he's been on it ever since. I have serious concerns about this since the Dr has never retested to be sure the levels are right and I worry about Prostate cancer. He has had and continues to have problems with urinary flow and leakage (which he doesn't tell his Dr), he no doubt has sleep apnea (I listen to him at night ... not breathing, snoring, snorting to get a breath and not feeling rested in the morning), again, he doesnt' tell his Dr this and also, he's become much more easily aggitated about things, angry and obsessive at times. We've been married 24 yrs and I've notice a big difference in his personality this past 5 years. I'd like to send his Dr a letter telling him all the things that my husband won't bring up (he's afraid the Dr will test him and take away the androgel), he also has told me that he doesn't use the androgel each year when he has blood work done just in case they test his testostrone level so I presume he knows it may be high. The Dr only checks PSA, Testicular Cancer markers, and CBC. I feel like he's addicted to the drug and the "high" it gives him and isn't able to consider (and doesnt' want to think about) the long term problems which obviously would affect us both. What type of follow up should be being done? Is his Dr liable to share info that I send to him about problems that he's having that he's not sharing? Obviously, he'd be angry at me if he knew I'd shared info with the Dr about problems he's having. I don't want to see him end up with prostate cancer when it could possibly be minimalized by customizing his testostrone doseage and better follow up care. Can you help me so I can do what's right for him?
| Dr. Safaa Mahmoud
- Mon Oct 13, 2008 4:47 pm
Androgel is a gel containing 1% testosterone. Indications of its use include men who have testicular failure diagnosed by low serum testosterone levels and above normal gonadotropins (FSH, LH) levels. Serum testosterone levels are measured 14 days after therapy initiation to ensure proper dosing and serum level.
It is true that testosterone esters can potentiate sleep apnea, especially in obese individuals or patients with chronic lung diseases. Depression, nervousness and emotional lability are known side effects that resulted in discontinuation of therapy in some studies.
Patients on testosterone replacement therapy should undergo screening for prostate cancer with PSA and DRE every 6-12 month. PSA is the most useful test for prostate cancer screening and it is reassuring that his doctor regularly examine him clinically and order a blood evaluation for PSA. Any warning or new symptoms should be reported to initiate proper investigations that include non invasive techniques like transrectal US.
I understand your worry about his symptoms and his reaction if you inform his doctor without his agreement. However, it is essential to inform his doctor with his current symptoms for proper management. You have to try to convince him get checked and to make sure he is going to inform his doctor with all his complaints. His doctor should also know hat your husband is not following the recommended dose so that testosterone level evaluation is essential.
Please keep us updated.