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Dr. Phil, MD
Dr. Phil, MD, Medical Doctor
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Experience:  Medical Doctor Trained at a Top Academic Institution
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Is 214 testosterone low in a 48 year old male?

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What is considered "Low" testosterone levels in a 48 year old male? Supposedly mine is 214 and a doctor that I have been seeing wants to put me on Androgel. But here's the kicker. The side effects of Testosterone replacement therapy are numerous, such as colon cancer, mood swings, etc. But the big one that concerned me is sleep apnea. The doctor put me on this, and then wanted to have me tested for sleep apnea? That makes me raise an eyebrow a little. So why would a doctor prescribe something that could potentially make you fail a sleep study test? Needless to say I didn't take the Androgel, and I have not gone to the sleep study nor will I.

Are you obese or take any meds?

Customer: replied 4 years ago.

I am 6'4" and 271. Overweight, yes. Obese? By medical standards, I guess. I am on blood pressure and cholesterol medications. I also voluntarily take a baby aspirin, a fish oil, and a vitamin C daily. Ok. So is there not a level that is considered to be "LOW" like those having numbers under 200? I realize 250 - 1100 is the range, however, is 214 "LOW" or is it low once you are under 200? Also would it be a good idea to put a patient on testosterone therapy which can cause sleep apnea...then test that patient for sleep apnea? Seems to not be a real good ethical decision to me. Why would I be put on something, and then tested for something that the hormone replacement therapy could be causing?

You are obviously educated on this matter. It seems you have done your homework. It may surprise you to learn that I agree with your doctor actually. Your testosterone is VERY low for a 48 year old guy. You need the medicine.

Plus, the testosterone will give you energy, help with weight loss which will hopefully fix the sleep apnea.

Customer: replied 4 years ago.

Ok, then answer this as objectively as you can. I do understand you are diagnosing (not really) through a computer screen.

About two years ago, I did have a sleep study done at the referral of a neurologist because my wife seemed to think I was having memory issues. The neurologist asked several "Memory" questions during the interview and came to the conclusion that the common denominator seemed to be my wife. No one else seemed to see that I was having a memory loss. So if the common denominator was my wife, possibly the problem was with my wife, and not me. Maybe she only thought she had told me something, and in fact had not. The sleep study consisted of an all night stay/sleep, followed by an all day stay with 5 naps to be recorded. After the attempt to take the 3rd nap during the day and could "NOT" go to sleep with the 3rd attempt being after lunch after a meal was eaten and still could not go to sleep, the sleep study technician released me early stating "You don't have what we're looking for". However, by the time I got back to an appointment with the neurologist, she said I had very very mild sleep apnea. The way I understand sleep apnea is you are in a constant state of fatigue because you never really go into REM sleep due to breathing cessation. So then the problem I have with this is....I dream and remember those dreams vividly, just about every night. Dreaming is REM sleep. Secondly, I wake fully refreshed daily, rearing to go. I may doze off during the day, after lunch, or after work from being exhausted just as much as from being bored. But to sit at a traffic light with the sun beating in my face, exhausted from a hard day at work, and drift off while waiting for the light to change...or fall asleep on any given moments notice...that does not apply. So if I do have some symptoms of sleep apnea, I would have to say, and I am not a doctor...just using a little common sense, they would have to be awfully mild.

Thanks for that extra info.

Clearly you don't have classic or severe sleep apnea.

There are stages however that can progress over time. Most folks don't fall asleep at a stoplight regardless of how hard their day was.

I suggest a sleep study and testosterone.

Customer: replied 4 years ago.

One final question. Have you looked at your PDR on Androgel 1.62% and the side effects thereof? Why would you put a patient on a product that will cause or aggravate a current condition and not bother to tell them that not only can hormone replacement therapy cause things such as colon cancer and you should be monitored very closely during the time and following after you've been on the replacement therapy, but it can cause and or aggravate sleep apnea. The failure to mention this brings up ethics to me. Why would you put a patient on a hormone replacement therapy, and then several weeks later test them for a condition that the Androgel could be causing or at least amplifying?

That is a potential side effect that I have never seen.

Also, the majority of the people who have low testosterone have sleep apnea.

So, one wonders whether or not these people in the drug trials have this problem anyways and it got listed as a side effect.

I can say this for sure, if you lose weight sleep apnea resolves in majority of cases. Testosterone will help that.

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