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Effort to improve treatment of OSA and IH
#51
RE: Effort to improve treatment of OSA and IH
Pretty much that. If you choose to withdraw from injected or absorbed testosterone, normal production will take several months, up to a year to return to per-treatment levels. This can be a prolonged period of symptoms more profound than what was being treated before replacement therapy, and there is no promise of return to baseline. Generally to receive TRT, your total T levels will be under 300 ng/dL, compared to normal levels of 400 to 600 ng/dL, however low-normal may be as low as 270 ng/dL. I would suggest that it may not be worthwhile if you are marginally low, and in my case results were between 181 and 209 thanks (i think) to a severe Lyme meningitis infection the previous year. It's fine to get tested to see where you stand, then carefully consider the pros and cons to the therapy and how much you are likely to benefit. Improvement of chronic sleepiness, fatigue, motivation, sexual dysfunction, mental fog, increased physical condition, improved mood etc. can be possible benefits. The cons can be high polycythemia, possible cardiovascular complications, hair loss, sterility, dependence etc.
https://www.auanet.org/guidelines/testos...-guideline
https://www.urologytimes.com/view/testos...-real-risk
Sleeprider
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#52
RE: Effort to improve treatment of OSA and IH
(09-08-2020, 06:01 PM)Sleeprider Wrote: The number of males on this site that use TRT, including myself, is very high. If your tests show a need for that, then consider the pros and cons and decide if it's worth it to try. It is a one-way trip as you will become 100% exogenous.
Well, since you brought up the topic, maybe we can discuss. I'm in my early 20's now, but I've been on TRT (Testosterone cyp + HCG) since my mid to late teens due to low levels. Since my teen years, I've been constantly feeling exhausted, both physically and mentally. The testosterone levels were the first things I noticed (had it tested on a whim, then repeated several times) as they were low, which is very strange for an apparently healthy teenager. After significant initial pushback from my parents and some non-specialists, I found a Harvard-affiliated clinic in Boston run by experts in the field of androgens who put me on Testosterone and HCG. The doctors were never quite sure what the cause of the issue was - didn't seem to be Klinefelter's or anything like that. I never used steroids for bodybuilding or anything like that either.

Anyways, it made a difference in terms of puberty and physical traits, but I didn't feel too much better and I always wondered at the back of my mind whether there was more going on but my parents were extremely stubborn about letting me see any more doctors. I thought it was important to prioritize getting the hormones roughly on track while I was still a teenager in my puberty years, but I resolved to revisit other potential issues after college. I'm also on Levoxyl due to mildly deficient thyroid levels (I was super suspicious considering how rare it is for a teenager to have testosterone deficiency so I sought out another doctor for this matter at the same time), but I honestly doubt whether I need it - if I get to a spot where I'm feeling overall well, I'll talk to a doctor about getting off Levoxyl.

Regarding testosterone deficiency and sleep issues, it seems that there's something of a link. I kind of wonder if I had tackled the sleep issues first, whether the testosterone situation would have resolved itself.

Also, I gained a ton of weight throughout college, and testosterone therapy seems less effective on patients with a lot of fatty tissue due to estrogen conversion in fat cells, so that's a big part of why I need to lose weight myself.


(09-08-2020, 07:52 PM)sheepless Wrote: "It is a one-way trip as you will become 100% exogenous."

what does this mean? are you saying we become irreversibly dependent on an external source & stop producing t naturally?

Essentially yes. The higher testosterone levels convert to estradiol (estrogen) which shuts down the production of LH and FSH released by the pituitary/hypothalamus. LH/FSH are roughly responsible for signaling your testes to produce testosterone, sperm, etc... If the testes do not receive these, they will stop producing these things and as a side effect, shrivel up a bit. This can largely be counteracted by introducing HCG, a chemical analogue for LH. That being said it should be possible to get back to baseline by quitting TRT, but maybe it doesn't always work that great in practice. That's basically the mechanism of how irresponsible bodybuilders sometimes screw themselves over when they use Testosterone without thinking (ever heard of the stereotype of bodybuilders with small testes?). There are some drugs that can restimulate your own production and get you back to your baseline though.
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#53
RE: Effort to improve treatment of OSA and IH
Quietsign, very good summary. It's unusual to see young men in their teens and 20s with TRT, however since your therapy is also using HCG, some of the adverse affects with reduced or eliminated spermatogenisis may be mitigated or eliminated. It sounds like your medical team considered the risks and benefits and have a balanced program in place. The use of Levoxyl is intended for thyroid deficiencies and your review of that use looks like a good idea since it is contraindicated for fertility therapy where the thyroid is not responsible for low hormone levels. Just out of curiosity, do you inject SC or IM? I moved to SC weekly with lower 40 mg doses to reduce estradiol.

I did not use any TRT until I was over 60, so our concerns, objectives and risks are very different.
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#54
RE: Effort to improve treatment of OSA and IH
(09-09-2020, 08:26 AM)Sleeprider Wrote: Quietsign, very good summary. It's unusual to see young men in their teens and 20s with TRT, however since your therapy is also using HCG, some of the adverse affects with reduced or eliminated spermatogenisis may be mitigated or eliminated.  It sounds like your medical team considered the risks and benefits and have a balanced program in place.  The use of Levoxyl is intended for thyroid deficiencies and your review of that use looks like a good idea since it is contraindicated for fertility therapy where the thyroid is not responsible for low hormone levels.   Just out of curiosity, do you inject SC or IM?  I moved to SC weekly with lower 40 mg doses to reduce estradiol.

I did not use any TRT until I was over 60, so our concerns, objectives and risks are very different.

I didn't know that about Levoxyl - thanks for mentioning. I've been dragging my feet since the pandemic has made it hard to establish contact with new doctors (I moved to a new area for my job). But I realize this is important, and will address this after feeling more stable about my sleep situation. One change at a time, you know?

I inject subcutaneous and always have, for both Testosterone and HCG. It seemed that there are essentially no drawbacks to SC over IM, only benefits. My understanding is that Testosterone used to be injected IM mostly for historical reasons and bias. Regarding HCG, I don't know whether or not it's sufficient on it's own to maintain spermatogenisis, but the doctors have told me it's a pretty steady process, and if I should ever choose to try to have kids, using a higher dose of HCG for several months should do it. However that's mostly out of academic curiousity - the process of having kids is not remotely on my radar.

My current TRT regiment is about 50 mg Test cyp 3x per week, and about 300 IU of HCG 3x per week. I'm hoping to reduce the dosage of Testosterone as I lose weight. I opted to do smaller more frequent injections out of concern for Estradiol and acne.

Regarding sleep, I don't have another night's data because the resmed is sometimes finicky about not recording data when you sleep past the day cutoff mark (or maybe it's when you change pressures). I've been sleeping for 10-12 hours per night and have been feeling really good when I wake up for at least several hours. Is this normal to be craving lots of sleep when one finally gets on a good cpap program? I'm practically waking up with a smile on my face. I feel like I'm catching up on a decade of sleep right now...
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#55
RE: Effort to improve treatment of OSA and IH
Wow 150 mg T-cyp per week. What kind of blood level are you achieving with that. It's a very high dose. If I was doing that I'd be at over 1200 ng/dL.
Sleeprider
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____________________________________________
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#56
RE: Effort to improve treatment of OSA and IH
(09-09-2020, 09:06 PM)Sleeprider Wrote: Wow 150 mg T-cyp per week. What kind of blood level are you achieving with that.  It's a very high dose. If I was doing that I'd be at over 1200 ng/dL.

Hmm, is that so high? I was under the impression that a starting dose is 100 mg/week. My blood levels were roughly 600 ng/dl last I checked, but it's been a while. Fairly mid range. I weigh roughly 215 lbs though.
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#57
RE: Effort to improve treatment of OSA and IH
We all respond differently and convert the cypionate at different rates. I maintain 600 with 50 mg/week. You seem to be where you should be.
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#58
RE: Effort to improve treatment of OSA and IH
(09-08-2020, 08:31 AM)Sleeprider Wrote: Your therapy is good or excellent and you are sleep normal to long continuous hours at night.  Continued hypersomnia, without a known cause, during the day is a condition that affects a number of people, and as the name, idiopathic implies, there is not a known cause or a clear therapy once sleep disordered breathing is resolved.  I assume  you have had a complete blood workup and have not identified anything out of the ordinary, although you mention other health issues.  Weight loss may be helpful, keeping active and whatever techniques you use to avoid the conditions that bring on sleepiness. Narcolepsy and chronic fatigue are variations.  If your doctor is unhelpful, I am not any better as it is not something I know much about.  Congrats on the weight loss, something I need to do.

Here is another night's data. It was strange: I took a nap fairly late, and this meant I was laying in bed unable to sleep for a while. I had to take 5mg melatonin to fall asleep. Any idea what's going on with the clear airway apneas? Should I lower the pressure further?

   
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#59
RE: Effort to improve treatment of OSA and IH
Another night's data, this time with a simpler chin strap (instead of the Knightsbridge, used a loopy style elastic band) and a much smaller piece of mouth tape (using a larger piece to create a seal works better but makes my lips chapped). Is this an acceptable leak rate?

   
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#60
RE: Effort to improve treatment of OSA and IH
I’m not on my computer so I cannot give you step by step. But right click on the left side of leaks graf. Choose dotted line. One is for the permissible leak for the mask you have entered on the machine. Anything above the dotted line your machine cannot adjust for it and you are not getting therapy.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
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