RE: Re: Testosterone Where Did It Go!

[Guest guest]

On Jan 21, 2012, at 7:22 PM, wrote: OXY 5MG/ACETAM 325MG bid, METHADONE 10MG bid and I was on them for a year after I started SPIRO. I'll have to look up other meds when I get time, I know there were 7 meds and they weren't stopped for 6 - 8 months. Your higher effect theory may be very valid since everything was controlled and I grew boobs on 25MG bid! I do not know what my testosterone level was or is now. In fact, I didn't even know what androgen was or that it and testosterone were related! That's why I am advocating a standard to test to prior and periodically during implementation, that of course after determining the low threshold unless we can find another med. that will do the trick with out affecting Androgen! At the minimum, IMHO we should recognize and advertise items to consider when determining what to RX, ie: age, opioids, MDD maybe, etc. Then we should make sure to tell what to look for to determine adverse reaction and start with removing the word "painful" from the word gyneocomastia! I would say not including the word painful is not full disclosure. We might play off other SX of gender change like body hair loss. My mind is not working well tonight, "brain fog" from working on performance (or lack thereof) appraisal of a Chief of Endocronology! - 65 yo super ob., fastidious male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with DASH. Stats w/o meds = BP 175/90 HR 59 BS 125. D/C Spironolactone 12/20/2011 due to adverse SX. Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS. > > > Dr. Grim, do you think being on Oxycodone and Methodone for 5+ years > > could have any effect on my adverse reaction to Spironolactone? What > > about street drugs which I don't use? Maybe at the minimum there > > should be a drug test so you know what may be ahead! Maybe Inspra > > would be a better choice! > > > > Health Information, Tips, Community and More at HealthCentral.com > > http://www.healthcentral.com/chronic-pain/c/23153/113990/testosterone/pf/ > > ChronicPainConnection.com > > > > See all of our health sites at www.HealthCentral.com > > > > Chronic Pain Home > > > General > > > Treatment > > > Alternative Treatment > > > Chronic Pain Medication Lead to Sexual Dysfunction, Other Problems > > for Men > > Testosterone Replacement Therapy for Men in Pain > > by Lasich, MD > > Monday, June 14, 2010 > > How many men would take pain pills if they knew that the pills might > > shrink their testicles? Besides testicular size, pain pills can > > wreck havoc on a man's ability to have sex, make babies, build > > muscles, and enjoy life. All of these side effects to opioid > > medications are caused by the fact that chronic opioid use lowers > > testosterone levels. This fact is not widely known, yet widely > > experienced. "Opioid-induced androgen deficiency" affects thousands > > of men. In a complex process that involves some very important > > hormones, both men and women can experience symptoms of low > > testosterone. > > The most common symptoms from abnormally low testosterone levels - > > hypogonadism - are: > > Fatigue > > Depression > > Low libido > > Erectile dysfunction > > Sexual dysfunction > > Osteoporosis > > Low muscle mass > > Infertility > > Hot flashes > > Night sweats > > Testicular atrophy > > If any of this sounds familiar, a doctor can order a simple blood > > test (the Total Testosterone Level) to check your testosterone > > level. This test is best done early in the morning to get the most > > accurate reading. Checking baseline hormonal levels, including the > > testosterone level, before and after initiating opioid treatment is > > recommended by some experts. Additionally, when consenting for > > opioid treatment, the patient should also be informed about the > > potential for opioids to drastically lower testosterone levels. > > If this discussion took place, many men might elect to avoid > > opioids. If men knew that upwards of 80% of those who begin taking > > opioids will experience erectile dysfunction from low testosterone > > levels, they might want to seek alternative pain relieving options. > > Those who do agree to opioid pain management despite the risks > > should know about testosterone-replacement therapy. > > Testosterone-replacement therapy is utilized to treat opioid-induced > > testosterone insufficiency. Prior to initiating testosterone > > treatment men need to have the prostate specific antigen level (PSA) > > test because testosterone can worsen prostate conditions like cancer > > and hypertrophy. Additionally, other conditions could also worsen > > like heart failure and sleep apnea. So, not every man is a candidate > > for testosterone replacement. Those who are candidates have a few > > different modes of replacement like injections, patches, gels and > > bio-identicals hormones. One study showed that the testosterone > > patch delivering 7.5 mg per day was effective at normalizing > > testosterone levels and relieving symptoms of hypogonadism. In fact, > > that same study showed that pain intensity actually improved as the > > testosterone levels normalized. Testosterone-replacement therapy is > > probably the most underutilized, yet most often needed adjunct > > therapy for someone who is a long-term opioid user. > > Everyone, both men and women need to be more aware of the long-term > > effects that opioids have on the human body. Testosterone and all > > the hormones related to the hypothalamic-pituitary axis (thyroid, > > adrenaline, and sex hormones) have the potential for becoming > > abnormally low. At some point, these hormonal imbalances have the > > potential to affect quality of life more than the pain itself. At > > that point, the risks of long-term opioid use needs to be re- > > evaluated because the risks might outweigh the benefits. At some > > point, opioid pain management might not be worth the price. > > > > We comply with the HONcode standard for > > trustworthy health information: verify here. > > About Us | > > Contact Us | > > Privacy Policy | > > Terms of Use | > > Security Policy > > By using this service, you accept our Terms of Use. Please read > > them. The consumer health information on is for informational > > purposes only and is not a substitute for medical advice or > > treatment for any medical conditions. You should promptly seek > > professional medical care if you have any concern about your health, > > and you should always consult your physician before starting a > > fitness regimen. Copyright © 2012 Remedy Health Media, LLC. All > > Rights Reserved. > > > > Current Opinion in Endocrinology & Diabetes: > > June 2006 - Volume 13 - Issue 3 - p 262-266 > > doi: 10.1097/01.med.0000224806.08824.dc > > Androgens > > Opioid-induced androgen deficiency > > l, Harry W > > & #65532; > > Abstract > > Purpose of review: Opioid-induced androgen deficiency has become one > > of the most common causes of testosterone deficiency among men in > > many communities. Its increase parallels the large increase in > > opioid use. This form of hypogonadotrophic hypogonadism is present > > in most men chronically consuming sustained-action opioids, > > including those receiving methadone for heroin addiction and those > > consuming opioids for control of either malignant or non-malignant > > chronic pain. A similar, but less well defined illness occurs in > > women. Opioid-induced androgen deficiency is not widely recognized. > > This review examines its pathophysiology, some of its signs and > > symptoms, and indicates some areas where current observations > > suggest additional investigations would be fruitful. > > Recent findings: Recognition of opioid-induced androgen deficiency > > in men not receiving methadone for heroin addiction is a new > > observation, and in these men contributes to fatigue, depression, > > vasomotor phenomena, anemia, diminished libido, erectile dysfunction > > and osteoporosis. These signs and symptoms improved during > > testosterone replacement therapy in several small non-placebo- > > controlled trials. > > Summary: A large majority of men consuming sustained-action opioids > > have symptomatic androgen deficiency which apparently responds to > > replacement therapy. Opioid-induced androgen deficiency is > > frequently overlooked, with its symptoms attributed to underlying > > disease states including malignant disease, chronic back disorders, > > HIV disease, and psychosocial illnesses contributing to opioid > > habituation. > > © 2006 Lippincott & Wilkins, Inc. > > > > - 65 yo super ob., fastidious male - 12mm X 13mm rt. a.adnoma > > with previous rt. flank pain. Treating with DASH. Stats w/o meds = > > BP 175/90 HR 59 BS 125. D/C Spironolactone 12/20/2011 due to adverse > > SX. > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, > > Gynecomastia, MDD and PTSD. > > Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin > > and Metformin 2000MG. Started washing Spironolactone 12/20/11 to > > prepare for AVS. > > > > >

[Guest guest]

We u also taking fenesteride or similar Rx ?May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 22, 2012, at 6:41, <jclark24p@...> wrote:

We include the word "painful" as a determinant for switching treatment. In 16 months it never caused me pain yet symptoms of femininity progressed for 16 months. Change was not considered because the breasts were not painful, in fact, it took 3 requests even after 16 months and with other signs of what was happening. (Loss of body hair, libido, and significant reduction in penis and testicle size!) If you want full disclosure maybe you need to add those symptoms!

> > >

> > > > Dr. Grim, do you think being on Oxycodone and Methodone for 5+

> > years

> > > > could have any effect on my adverse reaction to Spironolactone?

> > What

> > > > about street drugs which I don't use? Maybe at the minimum there

> > > > should be a drug test so you know what may be ahead! Maybe Inspra

> > > > would be a better choice!

> > > >

> > > > Health Information, Tips, Community and More at HealthCentral.com

> > > > http://www.healthcentral.com/chronic-pain/c/23153/113990/testosterone/pf/

> > > > ChronicPainConnection.com

> > > >

> > > > See all of our health sites at www.HealthCentral.com

> > > >

> > > > Chronic Pain Home >

> > > > General >

> > > > Treatment >

> > > > Alternative Treatment >

> > > > Chronic Pain Medication Lead to Sexual Dysfunction, Other Problems

> > > > for Men

> > > > Testosterone Replacement Therapy for Men in Pain

> > > > by Lasich, MD

> > > > Monday, June 14, 2010

> > > > How many men would take pain pills if they knew that the pills

> > might

> > > > shrink their testicles? Besides testicular size, pain pills can

> > > > wreck havoc on a man's ability to have sex, make babies, build

> > > > muscles, and enjoy life. All of these side effects to opioid

> > > > medications are caused by the fact that chronic opioid use lowers

> > > > testosterone levels. This fact is not widely known, yet widely

> > > > experienced. "Opioid-induced androgen deficiency" affects

> > thousands

> > > > of men. In a complex process that involves some very important

> > > > hormones, both men and women can experience symptoms of low

> > > > testosterone.

> > > > The most common symptoms from abnormally low testosterone levels -

> > > > hypogonadism - are:

> > > > Fatigue

> > > > Depression

> > > > Low libido

> > > > Erectile dysfunction

> > > > Sexual dysfunction

> > > > Osteoporosis

> > > > Low muscle mass

> > > > Infertility

> > > > Hot flashes

> > > > Night sweats

> > > > Testicular atrophy

> > > > If any of this sounds familiar, a doctor can order a simple blood

> > > > test (the Total Testosterone Level) to check your testosterone

> > > > level. This test is best done early in the morning to get the most

> > > > accurate reading. Checking baseline hormonal levels, including the

> > > > testosterone level, before and after initiating opioid treatment

> > is

> > > > recommended by some experts. Additionally, when consenting for

> > > > opioid treatment, the patient should also be informed about the

> > > > potential for opioids to drastically lower testosterone levels.

> > > > If this discussion took place, many men might elect to avoid

> > > > opioids. If men knew that upwards of 80% of those who begin taking

> > > > opioids will experience erectile dysfunction from low testosterone

> > > > levels, they might want to seek alternative pain relieving

> > options.

> > > > Those who do agree to opioid pain management despite the risks

> > > > should know about testosterone-replacement therapy.

> > > > Testosterone-replacement therapy is utilized to treat opioid-

> > induced

> > > > testosterone insufficiency. Prior to initiating testosterone

> > > > treatment men need to have the prostate specific antigen level

> > (PSA)

> > > > test because testosterone can worsen prostate conditions like

> > cancer

> > > > and hypertrophy. Additionally, other conditions could also worsen

> > > > like heart failure and sleep apnea. So, not every man is a

> > candidate

> > > > for testosterone replacement. Those who are candidates have a few

> > > > different modes of replacement like injections, patches, gels and

> > > > bio-identicals hormones. One study showed that the testosterone

> > > > patch delivering 7.5 mg per day was effective at normalizing

> > > > testosterone levels and relieving symptoms of hypogonadism. In

> > fact,

> > > > that same study showed that pain intensity actually improved as

> > the

> > > > testosterone levels normalized. Testosterone-replacement therapy

> > is

> > > > probably the most underutilized, yet most often needed adjunct

> > > > therapy for someone who is a long-term opioid user.

> > > > Everyone, both men and women need to be more aware of the long-

> > term

> > > > effects that opioids have on the human body. Testosterone and all

> > > > the hormones related to the hypothalamic-pituitary axis (thyroid,

> > > > adrenaline, and sex hormones) have the potential for becoming

> > > > abnormally low. At some point, these hormonal imbalances have the

> > > > potential to affect quality of life more than the pain itself. At

> > > > that point, the risks of long-term opioid use needs to be re-

> > > > evaluated because the risks might outweigh the benefits. At some

> > > > point, opioid pain management might not be worth the price.

> > > >

> > > > We comply with the HONcode standard for

> > > > trustworthy health information: verify here.

> > > > About Us |

> > > > Contact Us |

> > > > Privacy Policy |

> > > > Terms of Use |

> > > > Security Policy

> > > > By using this service, you accept our Terms of Use. Please read

> > > > them. The consumer health information on is for informational

> > > > purposes only and is not a substitute for medical advice or

> > > > treatment for any medical conditions. You should promptly seek

> > > > professional medical care if you have any concern about your

> > health,

> > > > and you should always consult your physician before starting a

> > > > fitness regimen. Copyright © 2012 Remedy Health Media, LLC. All

> > > > Rights Reserved.

> > > >

> > > > Current Opinion in Endocrinology & Diabetes:

> > > > June 2006 - Volume 13 - Issue 3 - p 262-266

> > > > doi: 10.1097/01.med.0000224806.08824.dc

> > > > Androgens

> > > > Opioid-induced androgen deficiency

> > > > l, Harry W

> > > > & #65532;

> > > > Abstract

> > > > Purpose of review: Opioid-induced androgen deficiency has become

> > one

> > > > of the most common causes of testosterone deficiency among men in

> > > > many communities. Its increase parallels the large increase in

> > > > opioid use. This form of hypogonadotrophic hypogonadism is present

> > > > in most men chronically consuming sustained-action opioids,

> > > > including those receiving methadone for heroin addiction and those

> > > > consuming opioids for control of either malignant or non-malignant

> > > > chronic pain. A similar, but less well defined illness occurs in

> > > > women. Opioid-induced androgen deficiency is not widely

> > recognized.

> > > > This review examines its pathophysiology, some of its signs and

> > > > symptoms, and indicates some areas where current observations

> > > > suggest additional investigations would be fruitful.

> > > > Recent findings: Recognition of opioid-induced androgen deficiency

> > > > in men not receiving methadone for heroin addiction is a new

> > > > observation, and in these men contributes to fatigue, depression,

> > > > vasomotor phenomena, anemia, diminished libido, erectile

> > dysfunction

> > > > and osteoporosis. These signs and symptoms improved during

> > > > testosterone replacement therapy in several small non-placebo-

> > > > controlled trials.

> > > > Summary: A large majority of men consuming sustained-action

> > opioids

> > > > have symptomatic androgen deficiency which apparently responds to

> > > > replacement therapy. Opioid-induced androgen deficiency is

> > > > frequently overlooked, with its symptoms attributed to underlying

> > > > disease states including malignant disease, chronic back

> > disorders,

> > > > HIV disease, and psychosocial illnesses contributing to opioid

> > > > habituation.

> > > > © 2006 Lippincott & Wilkins, Inc.

> > > >

> > > > - 65 yo super ob., fastidious male - 12mm X 13mm rt. a.adnoma

> > > > with previous rt. flank pain. Treating with DASH. Stats w/o meds =

> > > > BP 175/90 HR 59 BS 125. D/C Spironolactone 12/20/2011 due to

> > adverse

> > > > SX.

> > > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2,

> > > > Gynecomastia, MDD and PTSD.

> > > > Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg

> > aspirin

> > > > and Metformin 2000MG. Started washing Spironolactone 12/20/11 to

> > > > prepare for AVS.

> > > >

> > > >

> > >

> >

> >

>

[Guest guest]

Sorry late night spelling. Fines works by decreasing gonadotropins from the pituitary-thus shrinking prostate and other testosterone dependent items such as testicles. As it is thought that spiro occupies estrogen and testosterone receptors and with finestr lowering circulating testost this might lead to an increased estrogen effect AKA gynecomastia. See what you can find on this. CE Grim MD On Jan 22, 2012, at 12:49 PM, wrote: I did not find fEn... but did find fInesteride and looking at that in MedLineplus I presume that is what you meant. If so the answer is "no" and no reason for it since last PSA in Nov 2011 = .27 (0 - 4.0). PCP even made it optional since "Previous test was so low". Then when I looked it up and found this, "It is important to note that a man who is receiving hormone therapy for prostate cancer may have a low PSA level during, or immediately after, treatment. The low level may not be a true measure of the man's PSA level. Men receiving hormone therapy should talk with their doctor, who may advise them to wait a few months after hormone treatment before having a PSA test." Am I having hormone treatment (Spironolactone), it's just not for prostate cancer? Maybe another caution we should publish? O a reason to choose a medicine that does NOT AFFECT ANDROGEN if we can find one! - 65 yo super ob., fastidious male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with DASH. Stats w/o meds = BP 175/90 HR 59 BS 125. D/C Spironolactone 12/20/2011 due to adverse SX. Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS. Added Added Amlodipine Besylate 5MG bid 1/12/12. > > > > > > > > > > > Dr. Grim, do you think being on Oxycodone and Methodone for 5+ > > > > years > > > > > > could have any effect on my adverse reaction to Spironolactone? > > > > What > > > > > > about street drugs which I don't use? Maybe at the minimum there > > > > > > should be a drug test so you know what may be ahead! Maybe Inspra > > > > > > would be a better choice! > > > > > > > > > > > > Health Information, Tips, Community and More at HealthCentral.com > > > > > > http://www.healthcentral.com/chronic-pain/c/23153/113990/testosterone/pf/ > > > > > > ChronicPainConnection.com > > > > > > > > > > > > See all of our health sites at www.HealthCentral.com > > > > > > > > > > > > Chronic Pain Home > > > > > > > General > > > > > > > Treatment > > > > > > > Alternative Treatment > > > > > > > Chronic Pain Medication Lead to Sexual Dysfunction, Other Problems > > > > > > for Men > > > > > > Testosterone Replacement Therapy for Men in Pain > > > > > > by Lasich, MD > > > > > > Monday, June 14, 2010 > > > > > > How many men would take pain pills if they knew that the pills > > > > might > > > > > > shrink their testicles? Besides testicular size, pain pills can > > > > > > wreck havoc on a man's ability to have sex, make babies, build > > > > > > muscles, and enjoy life. All of these side effects to opioid > > > > > > medications are caused by the fact that chronic opioid use lowers > > > > > > testosterone levels. This fact is not widely known, yet widely > > > > > > experienced. "Opioid-induced androgen deficiency" affects > > > > thousands > > > > > > of men. In a complex process that involves some very important > > > > > > hormones, both men and women can experience symptoms of low > > > > > > testosterone. > > > > > > The most common symptoms from abnormally low testosterone levels - > > > > > > hypogonadism - are: > > > > > > Fatigue > > > > > > Depression > > > > > > Low libido > > > > > > Erectile dysfunction > > > > > > Sexual dysfunction > > > > > > Osteoporosis > > > > > > Low muscle mass > > > > > > Infertility > > > > > > Hot flashes > > > > > > Night sweats > > > > > > Testicular atrophy > > > > > > If any of this sounds familiar, a doctor can order a simple blood > > > > > > test (the Total Testosterone Level) to check your testosterone > > > > > > level. This test is best done early in the morning to get the most > > > > > > accurate reading. Checking baseline hormonal levels, including the > > > > > > testosterone level, before and after initiating opioid treatment > > > > is > > > > > > recommended by some experts. Additionally, when consenting for > > > > > > opioid treatment, the patient should also be informed about the > > > > > > potential for opioids to drastically lower testosterone levels. > > > > > > If this discussion took place, many men might elect to avoid > > > > > > opioids. If men knew that upwards of 80% of those who begin taking > > > > > > opioids will experience erectile dysfunction from low testosterone > > > > > > levels, they might want to seek alternative pain relieving > > > > options. > > > > > > Those who do agree to opioid pain management despite the risks > > > > > > should know about testosterone-replacement therapy. > > > > > > Testosterone-replacement therapy is utilized to treat opioid- > > > > induced > > > > > > testosterone insufficiency. Prior to initiating testosterone > > > > > > treatment men need to have the prostate specific antigen level > > > > (PSA) > > > > > > test because testosterone can worsen prostate conditions like > > > > cancer > > > > > > and hypertrophy. Additionally, other conditions could also worsen > > > > > > like heart failure and sleep apnea. So, not every man is a > > > > candidate > > > > > > for testosterone replacement. Those who are candidates have a few > > > > > > different modes of replacement like injections, patches, gels and > > > > > > bio-identicals hormones. One study showed that the testosterone > > > > > > patch delivering 7.5 mg per day was effective at normalizing > > > > > > testosterone levels and relieving symptoms of hypogonadism. In > > > > fact, > > > > > > that same study showed that pain intensity actually improved as > > > > the > > > > > > testosterone levels normalized. Testosterone-replacement therapy > > > > is > > > > > > probably the most underutilized, yet most often needed adjunct > > > > > > therapy for someone who is a long-term opioid user. > > > > > > Everyone, both men and women need to be more aware of the long- > > > > term > > > > > > effects that opioids have on the human body. Testosterone and all > > > > > > the hormones related to the hypothalamic-pituitary axis (thyroid, > > > > > > adrenaline, and sex hormones) have the potential for becoming > > > > > > abnormally low. At some point, these hormonal imbalances have the > > > > > > potential to affect quality of life more than the pain itself. At > > > > > > that point, the risks of long-term opioid use needs to be re- > > > > > > evaluated because the risks might outweigh the benefits. At some > > > > > > point, opioid pain management might not be worth the price. > > > > > > > > > > > > We comply with the HONcode standard for > > > > > > trustworthy health information: verify here. > > > > > > About Us | > > > > > > Contact Us | > > > > > > Privacy Policy | > > > > > > Terms of Use | > > > > > > Security Policy > > > > > > By using this service, you accept our Terms of Use. Please read > > > > > > them. The consumer health information on is for informational > > > > > > purposes only and is not a substitute for medical advice or > > > > > > treatment for any medical conditions. You should promptly seek > > > > > > professional medical care if you have any concern about your > > > > health, > > > > > > and you should always consult your physician before starting a > > > > > > fitness regimen. Copyright © 2012 Remedy Health Media, LLC. All > > > > > > Rights Reserved. > > > > > > > > > > > > Current Opinion in Endocrinology & Diabetes: > > > > > > June 2006 - Volume 13 - Issue 3 - p 262-266 > > > > > > doi: 10.1097/01.med.0000224806.08824.dc > > > > > > Androgens > > > > > > Opioid-induced androgen deficiency > > > > > > l, Harry W > > > > > > & #65532; > > > > > > Abstract > > > > > > Purpose of review: Opioid-induced androgen deficiency has become > > > > one > > > > > > of the most common causes of testosterone deficiency among men in > > > > > > many communities. Its increase parallels the large increase in > > > > > > opioid use. This form of hypogonadotrophic hypogonadism is present > > > > > > in most men chronically consuming sustained-action opioids, > > > > > > including those receiving methadone for heroin addiction and those > > > > > > consuming opioids for control of either malignant or non-malignant > > > > > > chronic pain. A similar, but less well defined illness occurs in > > > > > > women. Opioid-induced androgen deficiency is not widely > > > > recognized. > > > > > > This review examines its pathophysiology, some of its signs and > > > > > > symptoms, and indicates some areas where current observations > > > > > > suggest additional investigations would be fruitful. > > > > > > Recent findings: Recognition of opioid-induced androgen deficiency > > > > > > in men not receiving methadone for heroin addiction is a new > > > > > > observation, and in these men contributes to fatigue, depression, > > > > > > vasomotor phenomena, anemia, diminished libido, erectile > > > > dysfunction > > > > > > and osteoporosis. These signs and symptoms improved during > > > > > > testosterone replacement therapy in several small non-placebo- > > > > > > controlled trials. > > > > > > Summary: A large majority of men consuming sustained-action > > > > opioids > > > > > > have symptomatic androgen deficiency which apparently responds to > > > > > > replacement therapy. Opioid-induced androgen deficiency is > > > > > > frequently overlooked, with its symptoms attributed to underlying > > > > > > disease states including malignant disease, chronic back > > > > disorders, > > > > > > HIV disease, and psychosocial illnesses contributing to opioid > > > > > > habituation. > > > > > > © 2006 Lippincott & Wilkins, Inc. > > > > > > > > > > > > - 65 yo super ob., fastidious male - 12mm X 13mm rt. a.adnoma > > > > > > with previous rt. flank pain. Treating with DASH. Stats w/o meds = > > > > > > BP 175/90 HR 59 BS 125. D/C Spironolactone 12/20/2011 due to > > > > adverse > > > > > > SX. > > > > > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, > > > > > > Gynecomastia, MDD and PTSD. > > > > > > Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg > > > > aspirin > > > > > > and Metformin 2000MG. Started washing Spironolactone 12/20/11 to > > > > > > prepare for AVS. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

[Guest guest]

pubmed spiro and finest yielded 75 articles mostly addressing hirsuitism and baldness in women.On Jan 22, 2012, at 3:18 PM, wrote: Medline explains it well enough so even I understood what you were thinking. It apparently can cause gyneo on its own and I'M sure coadministering with spiro wouldn't help matters at all! > > > > > > > > > > > > > > > Dr. Grim, do you think being on Oxycodone and Methodone > > for 5+ > > > > > > years > > > > > > > > could have any effect on my adverse reaction to > > Spironolactone? > > > > > > What > > > > > > > > about street drugs which I don't use? Maybe at the > > minimum there > > > > > > > > should be a drug test so you know what may be ahead! > > Maybe Inspra > > > > > > > > would be a better choice! > > > > > > > > > > > > > > > > Health Information, Tips, Community and More at > > HealthCentral.com > > > > > > > > http://www.healthcentral.com/chronic-pain/c/23153/113990/testosterone/pf/ > > > > > > > > ChronicPainConnection.com > > > > > > > > > > > > > > > > See all of our health sites at www.HealthCentral.com > > > > > > > > > > > > > > > > Chronic Pain Home > > > > > > > > > General > > > > > > > > > Treatment > > > > > > > > > Alternative Treatment > > > > > > > > > Chronic Pain Medication Lead to Sexual Dysfunction, > > Other Problems > > > > > > > > for Men > > > > > > > > Testosterone Replacement Therapy for Men in Pain > > > > > > > > by Lasich, MD > > > > > > > > Monday, June 14, 2010 > > > > > > > > How many men would take pain pills if they knew that the > > pills > > > > > > might > > > > > > > > shrink their testicles? Besides testicular size, pain > > pills can > > > > > > > > wreck havoc on a man's ability to have sex, make babies, > > build > > > > > > > > muscles, and enjoy life. All of these side effects to > > opioid > > > > > > > > medications are caused by the fact that chronic opioid > > use lowers > > > > > > > > testosterone levels. This fact is not widely known, yet > > widely > > > > > > > > experienced. "Opioid-induced androgen deficiency" affects > > > > > > thousands > > > > > > > > of men. In a complex process that involves some very > > important > > > > > > > > hormones, both men and women can experience symptoms of > > low > > > > > > > > testosterone. > > > > > > > > The most common symptoms from abnormally low > > testosterone levels - > > > > > > > > hypogonadism - are: > > > > > > > > Fatigue > > > > > > > > Depression > > > > > > > > Low libido > > > > > > > > Erectile dysfunction > > > > > > > > Sexual dysfunction > > > > > > > > Osteoporosis > > > > > > > > Low muscle mass > > > > > > > > Infertility > > > > > > > > Hot flashes > > > > > > > > Night sweats > > > > > > > > Testicular atrophy > > > > > > > > If any of this sounds familiar, a doctor can order a > > simple blood > > > > > > > > test (the Total Testosterone Level) to check your > > testosterone > > > > > > > > level. This test is best done early in the morning to > > get the most > > > > > > > > accurate reading. Checking baseline hormonal levels, > > including the > > > > > > > > testosterone level, before and after initiating opioid > > treatment > > > > > > is > > > > > > > > recommended by some experts. Additionally, when > > consenting for > > > > > > > > opioid treatment, the patient should also be informed > > about the > > > > > > > > potential for opioids to drastically lower testosterone > > levels. > > > > > > > > If this discussion took place, many men might elect to > > avoid > > > > > > > > opioids. If men knew that upwards of 80% of those who > > begin taking > > > > > > > > opioids will experience erectile dysfunction from low > > testosterone > > > > > > > > levels, they might want to seek alternative pain relieving > > > > > > options. > > > > > > > > Those who do agree to opioid pain management despite the > > risks > > > > > > > > should know about testosterone-replacement therapy. > > > > > > > > Testosterone-replacement therapy is utilized to treat > > opioid- > > > > > > induced > > > > > > > > testosterone insufficiency. Prior to initiating > > testosterone > > > > > > > > treatment men need to have the prostate specific antigen > > level > > > > > > (PSA) > > > > > > > > test because testosterone can worsen prostate conditions > > like > > > > > > cancer > > > > > > > > and hypertrophy. Additionally, other conditions could > > also worsen > > > > > > > > like heart failure and sleep apnea. So, not every man is a > > > > > > candidate > > > > > > > > for testosterone replacement. Those who are candidates > > have a few > > > > > > > > different modes of replacement like injections, patches, > > gels and > > > > > > > > bio-identicals hormones. One study showed that the > > testosterone > > > > > > > > patch delivering 7.5 mg per day was effective at > > normalizing > > > > > > > > testosterone levels and relieving symptoms of > > hypogonadism. In > > > > > > fact, > > > > > > > > that same study showed that pain intensity actually > > improved as > > > > > > the > > > > > > > > testosterone levels normalized. Testosterone-replacement > > therapy > > > > > > is > > > > > > > > probably the most underutilized, yet most often needed > > adjunct > > > > > > > > therapy for someone who is a long-term opioid user. > > > > > > > > Everyone, both men and women need to be more aware of > > the long- > > > > > > term > > > > > > > > effects that opioids have on the human body. > > Testosterone and all > > > > > > > > the hormones related to the hypothalamic-pituitary axis > > (thyroid, > > > > > > > > adrenaline, and sex hormones) have the potential for > > becoming > > > > > > > > abnormally low. At some point, these hormonal imbalances > > have the > > > > > > > > potential to affect quality of life more than the pain > > itself. At > > > > > > > > that point, the risks of long-term opioid use needs to > > be re- > > > > > > > > evaluated because the risks might outweigh the benefits. > > At some > > > > > > > > point, opioid pain management might not be worth the > > price. > > > > > > > > > > > > > > > > We comply with the HONcode standard for > > > > > > > > trustworthy health information: verify here. > > > > > > > > About Us | > > > > > > > > Contact Us | > > > > > > > > Privacy Policy | > > > > > > > > Terms of Use | > > > > > > > > Security Policy > > > > > > > > By using this service, you accept our Terms of Use. > > Please read > > > > > > > > them. The consumer health information on is for > > informational > > > > > > > > purposes only and is not a substitute for medical advice > > or > > > > > > > > treatment for any medical conditions. You should > > promptly seek > > > > > > > > professional medical care if you have any concern about > > your > > > > > > health, > > > > > > > > and you should always consult your physician before > > starting a > > > > > > > > fitness regimen. Copyright © 2012 Remedy Health Media, > > LLC. All > > > > > > > > Rights Reserved. > > > > > > > > > > > > > > > > Current Opinion in Endocrinology & Diabetes: > > > > > > > > June 2006 - Volume 13 - Issue 3 - p 262-266 > > > > > > > > doi: 10.1097/01.med.0000224806.08824.dc > > > > > > > > Androgens > > > > > > > > Opioid-induced androgen deficiency > > > > > > > > l, Harry W > > > > > > > > & #65532; > > > > > > > > Abstract > > > > > > > > Purpose of review: Opioid-induced androgen deficiency > > has become > > > > > > one > > > > > > > > of the most common causes of testosterone deficiency > > among men in > > > > > > > > many communities. Its increase parallels the large > > increase in > > > > > > > > opioid use. This form of hypogonadotrophic hypogonadism > > is present > > > > > > > > in most men chronically consuming sustained-action > > opioids, > > > > > > > > including those receiving methadone for heroin addiction > > and those > > > > > > > > consuming opioids for control of either malignant or non- > > malignant > > > > > > > > chronic pain. A similar, but less well defined illness > > occurs in > > > > > > > > women. Opioid-induced androgen deficiency is not widely > > > > > > recognized. > > > > > > > > This review examines its pathophysiology, some of its > > signs and > > > > > > > > symptoms, and indicates some areas where current > > observations > > > > > > > > suggest additional investigations would be fruitful. > > > > > > > > Recent findings: Recognition of opioid-induced androgen > > deficiency > > > > > > > > in men not receiving methadone for heroin addiction is a > > new > > > > > > > > observation, and in these men contributes to fatigue, > > depression, > > > > > > > > vasomotor phenomena, anemia, diminished libido, erectile > > > > > > dysfunction > > > > > > > > and osteoporosis. These signs and symptoms improved during > > > > > > > > testosterone replacement therapy in several small non- > > placebo- > > > > > > > > controlled trials. > > > > > > > > Summary: A large majority of men consuming sustained- > > action > > > > > > opioids > > > > > > > > have symptomatic androgen deficiency which apparently > > responds to > > > > > > > > replacement therapy. Opioid-induced androgen deficiency is > > > > > > > > frequently overlooked, with its symptoms attributed to > > underlying > > > > > > > > disease states including malignant disease, chronic back > > > > > > disorders, > > > > > > > > HIV disease, and psychosocial illnesses contributing to > > opioid > > > > > > > > habituation. > > > > > > > > © 2006 Lippincott & Wilkins, Inc. > > > > > > > > > > > > > > > > - 65 yo super ob., fastidious male - 12mm X 13mm > > rt. a.adnoma > > > > > > > > with previous rt. flank pain. Treating with DASH. Stats > > w/o meds = > > > > > > > > BP 175/90 HR 59 BS 125. D/C Spironolactone 12/20/2011 > > due to > > > > > > adverse > > > > > > > > SX. > > > > > > > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, > > DM2, > > > > > > > > Gynecomastia, MDD and PTSD. > > > > > > > > Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, > > 81mg > > > > > > aspirin > > > > > > > > and Metformin 2000MG. Started washing Spironolactone > > 12/20/11 to > > > > > > > > prepare for AVS. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

[Guest guest]

Usually will try test patches or monthly injections at home and see if things get better. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 22, 2012, at 18:47, Francis Bill SUSPECTED PA <georgewbill@...> wrote:

Not sure what the VA would do if they found your testosterone or androgen a bit low.

I just got a update of my records seems in my case they over look a few abnormal tests. Also there interpretation of what I say can be much different from what I am saying. They also put answers to questions that I am never asked.

> >

> > > Dr. Grim, do you think being on Oxycodone and Methodone for 5+ years

> > > could have any effect on my adverse reaction to Spironolactone? What

> > > about street drugs which I don't use? Maybe at the minimum there

> > > should be a drug test so you know what may be ahead! Maybe Inspra

> > > would be a better choice!

> > >

> > > Health Information, Tips, Community and More at HealthCentral.com

> > > http://www.healthcentral.com/chronic-pain/c/23153/113990/testosterone/pf/

> > > ChronicPainConnection.com

> > >

> > > See all of our health sites at www.HealthCentral.com

> > >

> > > Chronic Pain Home >

> > > General >

> > > Treatment >

> > > Alternative Treatment >

> > > Chronic Pain Medication Lead to Sexual Dysfunction, Other Problems

> > > for Men

> > > Testosterone Replacement Therapy for Men in Pain

> > > by Lasich, MD

> > > Monday, June 14, 2010

> > > How many men would take pain pills if they knew that the pills might

> > > shrink their testicles? Besides testicular size, pain pills can

> > > wreck havoc on a man's ability to have sex, make babies, build

> > > muscles, and enjoy life. All of these side effects to opioid

> > > medications are caused by the fact that chronic opioid use lowers

> > > testosterone levels. This fact is not widely known, yet widely

> > > experienced. "Opioid-induced androgen deficiency" affects thousands

> > > of men. In a complex process that involves some very important

> > > hormones, both men and women can experience symptoms of low

> > > testosterone.

> > > The most common symptoms from abnormally low testosterone levels -

> > > hypogonadism - are:

> > > Fatigue

> > > Depression

> > > Low libido

> > > Erectile dysfunction

> > > Sexual dysfunction

> > > Osteoporosis

> > > Low muscle mass

> > > Infertility

> > > Hot flashes

> > > Night sweats

> > > Testicular atrophy

> > > If any of this sounds familiar, a doctor can order a simple blood

> > > test (the Total Testosterone Level) to check your testosterone

> > > level. This test is best done early in the morning to get the most

> > > accurate reading. Checking baseline hormonal levels, including the

> > > testosterone level, before and after initiating opioid treatment is

> > > recommended by some experts. Additionally, when consenting for

> > > opioid treatment, the patient should also be informed about the

> > > potential for opioids to drastically lower testosterone levels.

> > > If this discussion took place, many men might elect to avoid

> > > opioids. If men knew that upwards of 80% of those who begin taking

> > > opioids will experience erectile dysfunction from low testosterone

> > > levels, they might want to seek alternative pain relieving options.

> > > Those who do agree to opioid pain management despite the risks

> > > should know about testosterone-replacement therapy.

> > > Testosterone-replacement therapy is utilized to treat opioid-induced

> > > testosterone insufficiency. Prior to initiating testosterone

> > > treatment men need to have the prostate specific antigen level (PSA)

> > > test because testosterone can worsen prostate conditions like cancer

> > > and hypertrophy. Additionally, other conditions could also worsen

> > > like heart failure and sleep apnea. So, not every man is a candidate

> > > for testosterone replacement. Those who are candidates have a few

> > > different modes of replacement like injections, patches, gels and

> > > bio-identicals hormones. One study showed that the testosterone

> > > patch delivering 7.5 mg per day was effective at normalizing

> > > testosterone levels and relieving symptoms of hypogonadism. In fact,

> > > that same study showed that pain intensity actually improved as the

> > > testosterone levels normalized. Testosterone-replacement therapy is

> > > probably the most underutilized, yet most often needed adjunct

> > > therapy for someone who is a long-term opioid user.

> > > Everyone, both men and women need to be more aware of the long-term

> > > effects that opioids have on the human body. Testosterone and all

> > > the hormones related to the hypothalamic-pituitary axis (thyroid,

> > > adrenaline, and sex hormones) have the potential for becoming

> > > abnormally low. At some point, these hormonal imbalances have the

> > > potential to affect quality of life more than the pain itself. At

> > > that point, the risks of long-term opioid use needs to be re-

> > > evaluated because the risks might outweigh the benefits. At some

> > > point, opioid pain management might not be worth the price.

> > >

> > > We comply with the HONcode standard for

> > > trustworthy health information: verify here.

> > > About Us |

> > > Contact Us |

> > > Privacy Policy |

> > > Terms of Use |

> > > Security Policy

> > > By using this service, you accept our Terms of Use. Please read

> > > them. The consumer health information on is for informational

> > > purposes only and is not a substitute for medical advice or

> > > treatment for any medical conditions. You should promptly seek

> > > professional medical care if you have any concern about your health,

> > > and you should always consult your physician before starting a

> > > fitness regimen. Copyright © 2012 Remedy Health Media, LLC. All

> > > Rights Reserved.

> > >

> > > Current Opinion in Endocrinology & Diabetes:

> > > June 2006 - Volume 13 - Issue 3 - p 262-266

> > > doi: 10.1097/01.med.0000224806.08824.dc

> > > Androgens

> > > Opioid-induced androgen deficiency

> > > l, Harry W

> > > & #65532;

> > > Abstract

> > > Purpose of review: Opioid-induced androgen deficiency has become one

> > > of the most common causes of testosterone deficiency among men in

> > > many communities. Its increase parallels the large increase in

> > > opioid use. This form of hypogonadotrophic hypogonadism is present

> > > in most men chronically consuming sustained-action opioids,

> > > including those receiving methadone for heroin addiction and those

> > > consuming opioids for control of either malignant or non-malignant

> > > chronic pain. A similar, but less well defined illness occurs in

> > > women. Opioid-induced androgen deficiency is not widely recognized.

> > > This review examines its pathophysiology, some of its signs and

> > > symptoms, and indicates some areas where current observations

> > > suggest additional investigations would be fruitful.

> > > Recent findings: Recognition of opioid-induced androgen deficiency

> > > in men not receiving methadone for heroin addiction is a new

> > > observation, and in these men contributes to fatigue, depression,

> > > vasomotor phenomena, anemia, diminished libido, erectile dysfunction

> > > and osteoporosis. These signs and symptoms improved during

> > > testosterone replacement therapy in several small non-placebo-

> > > controlled trials.

> > > Summary: A large majority of men consuming sustained-action opioids

> > > have symptomatic androgen deficiency which apparently responds to

> > > replacement therapy. Opioid-induced androgen deficiency is

> > > frequently overlooked, with its symptoms attributed to underlying

> > > disease states including malignant disease, chronic back disorders,

> > > HIV disease, and psychosocial illnesses contributing to opioid

> > > habituation.

> > > © 2006 Lippincott & Wilkins, Inc.

> > >

> > > - 65 yo super ob., fastidious male - 12mm X 13mm rt. a.adnoma

> > > with previous rt. flank pain. Treating with DASH. Stats w/o meds =

> > > BP 175/90 HR 59 BS 125. D/C Spironolactone 12/20/2011 due to adverse

> > > SX.

> > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2,

> > > Gynecomastia, MDD and PTSD.

> > > Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin

> > > and Metformin 2000MG. Started washing Spironolactone 12/20/11 to

> > > prepare for AVS.

> > >

> > >

> >

>

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Please delete all redundant extra repeated text from your posts...the following text is to be deleted: > >> > > > > > > >> > > > > > > Dr. Grim, do you think being on Oxycodone and Methodone for> > > > > > > 5+> > > > > years> > > > > > > could have any effect on my adverse reaction to Spironolactone?> > > > > What> > > > > > > about street drugs which I don't use? Maybe at the minimum> > > > > > > there should be a drug test so you know what may be ahead!> > > > > > > Maybe Inspra would be a better choice!> > > > > > >> > > > > > > Health Information, Tips, Community and More at> > > > > > > HealthCentral.com> > > > > > > http://www.healthcentral.com/chronic-pain/c/23153/113990/tes> > > > > > > tosterone/pf/> > > > > > > ChronicPainConnection.com> > > > > > >> > > > > > > See all of our health sites at www.HealthCentral.com> > > > > > >> > > > > > > Chronic Pain Home >> > > > > > > General >> > > > > > > Treatment >> > > > > > > Alternative Treatment >> > > > > > > Chronic Pain Medication Lead to Sexual Dysfunction, Other> > > > > > > Problems for Men Testosterone Replacement Therapy for Men in> > > > > > > Pain by Lasich, MD Monday, June 14, 2010 How many> > > > > > > men would take pain pills if they knew that the pills> > > > > might> > > > > > > shrink their testicles? Besides testicular size, pain pills> > > > > > > can wreck havoc on a man's ability to have sex, make babies,> > > > > > > build muscles, and enjoy life. All of these side effects to> > > > > > > opioid medications are caused by the fact that chronic> > > > > > > opioid use lowers testosterone levels. This fact is not> > > > > > > widely known, yet widely experienced. " Opioid-induced> > > > > > > androgen deficiency " affects> > > > > thousands> > > > > > > of men. In a complex process that involves some very> > > > > > > important hormones, both men and women can experience> > > > > > > symptoms of low testosterone.> > > > > > > The most common symptoms from abnormally low testosterone> > > > > > > levels - hypogonadism - are:> > > > > > > Fatigue> > > > > > > Depression> > > > > > > Low libido> > > > > > > Erectile dysfunction> > > > > > > Sexual dysfunction> > > > > > > Osteoporosis> > > > > > > Low muscle mass> > > > > > > Infertility> > > > > > > Hot flashes> > > > > > > Night sweats> > > > > > > Testicular atrophy> > > > > > > If any of this sounds familiar, a doctor can order a simple> > > > > > > blood test (the Total Testosterone Level) to check your> > > > > > > testosterone level. This test is best done early in the> > > > > > > morning to get the most accurate reading. Checking baseline> > > > > > > hormonal levels, including the testosterone level, before> > > > > > > and after initiating opioid treatment> > > > > is> > > > > > > recommended by some experts. Additionally, when consenting> > > > > > > for opioid treatment, the patient should also be informed> > > > > > > about the potential for opioids to drastically lower testosterone> levels.> > > > > > > If this discussion took place, many men might elect to avoid> > > > > > > opioids. If men knew that upwards of 80% of those who begin> > > > > > > taking opioids will experience erectile dysfunction from low> > > > > > > testosterone levels, they might want to seek alternative> > > > > > > pain relieving> > > > > options.> > > > > > > Those who do agree to opioid pain management despite the> > > > > > > risks should know about testosterone-replacement therapy.> > > > > > > Testosterone-replacement therapy is utilized to treat> > > > > > > opioid-> > > > > induced> > > > > > > testosterone insufficiency. Prior to initiating testosterone> > > > > > > treatment men need to have the prostate specific antigen> > > > > > > level> > > > > (PSA)> > > > > > > test because testosterone can worsen prostate conditions> > > > > > > like> > > > > cancer> > > > > > > and hypertrophy. Additionally, other conditions could also> > > > > > > worsen like heart failure and sleep apnea. So, not every man> > > > > > > is a> > > > > candidate> > > > > > > for testosterone replacement. Those who are candidates have> > > > > > > a few different modes of replacement like injections,> > > > > > > patches, gels and bio-identicals hormones. One study showed> > > > > > > that the testosterone patch delivering 7.5 mg per day was> > > > > > > effective at normalizing testosterone levels and relieving> > > > > > > symptoms of hypogonadism. In> > > > > fact,> > > > > > > that same study showed that pain intensity actually improved> > > > > > > as> > > > > the> > > > > > > testosterone levels normalized. Testosterone-replacement> > > > > > > therapy> > > > > is> > > > > > > probably the most underutilized, yet most often needed> > > > > > > adjunct therapy for someone who is a long-term opioid user.> > > > > > > Everyone, both men and women need to be more aware of the> > > > > > > long-> > > > > term> > > > > > > effects that opioids have on the human body. Testosterone> > > > > > > and all the hormones related to the hypothalamic-pituitary> > > > > > > axis (thyroid, adrenaline, and sex hormones) have the> > > > > > > potential for becoming abnormally low. At some point, these> > > > > > > hormonal imbalances have the potential to affect quality of> > > > > > > life more than the pain itself. At that point, the risks of> > > > > > > long-term opioid use needs to be re- evaluated because the> > > > > > > risks might outweigh the benefits. At some point, opioid pain> management might not be worth the price.> > > > > > >> > > > > > > We comply with the HONcode standard for trustworthy health> > > > > > > information: verify here.> > > > > > > About Us |> > > > > > > Contact Us |> > > > > > > Privacy Policy |> > > > > > > Terms of Use |> > > > > > > Security Policy> > > > > > > By using this service, you accept our Terms of Use. Please> > > > > > > read them. The consumer health information on is for> > > > > > > informational purposes only and is not a substitute for> > > > > > > medical advice or treatment for any medical conditions. You> > > > > > > should promptly seek professional medical care if you have> > > > > > > any concern about your> > > > > health,> > > > > > > and you should always consult your physician before starting> > > > > > > a fitness regimen. Copyright © 2012 Remedy Health Media,> > > > > > > LLC. .> > > > > > >> > > > > > > Current Opinion in Endocrinology & Diabetes:> > > > > > > June 2006 - Volume 13 - Issue 3 - p 262-266> > > > > > > doi: 10.1097/01.med.0000224806.08824.dc> > > > > > > Androgens> > > > > > > Opioid-induced androgen deficiency l, Harry W & #65532;> > > > > > > Abstract Purpose of review: Opioid-induced androgen> > > > > > > deficiency has become> > > > > one> > > > > > > of the most common causes of testosterone deficiency among> > > > > > > men in many communities. Its increase parallels the large> > > > > > > increase in opioid use. This form of hypogonadotrophic> > > > > > > hypogonadism is present in most men chronically consuming> > > > > > > sustained-action opioids, including those receiving> > > > > > > methadone for heroin addiction and those consuming opioids> > > > > > > for control of either malignant or non-malignant chronic> > > > > > > pain. A similar, but less well defined illness occurs in> > > > > > > women. Opioid-induced androgen deficiency is not widely> > > > > recognized.> > > > > > > This review examines its pathophysiology, some of its signs> > > > > > > and symptoms, and indicates some areas where current> > > > > > > observations suggest additional investigations would be fruitful.> > > > > > > Recent findings: Recognition of opioid-induced androgen> > > > > > > deficiency in men not receiving methadone for heroin> > > > > > > addiction is a new observation, and in these men contributes> > > > > > > to fatigue, depression, vasomotor phenomena, anemia,> > > > > > > diminished libido, erectile> > > > > dysfunction> > > > > > > and osteoporosis. These signs and symptoms improved during> > > > > > > testosterone replacement therapy in several small> > > > > > > non-placebo- controlled trials.> > > > > > > Summary: A large majority of men consuming sustained-action> > > > > opioids> > > > > > > have symptomatic androgen deficiency which apparently> > > > > > > responds to replacement therapy. Opioid-induced androgen> > > > > > > deficiency is frequently overlooked, with its symptoms> > > > > > > attributed to underlying disease states including malignant> > > > > > > disease, chronic back> > > > > disorders,> > > > > > > HIV disease, and psychosocial illnesses contributing to> > > > > > > opioid habituation.> > > > > > > © 2006 Lippincott & Wilkins, Inc.> > > > > > >> > > > > > > - 65 yo super ob., fastidious male - 12mm X 13mm rt.> > > > > > > a.adnoma with previous rt. flank pain. Treating with DASH.> > > > > > > Stats w/o meds = BP 175/90 HR 59 BS 125. D/C Spironolactone> > > > > > > 12/20/2011 due to> > > > > adverse> > > > > > > SX.> > > > > > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19,> > > > > > > DM2, Gynecomastia, MDD and PTSD.> > > > > > > Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg> > > > > aspirin> > > > > > > and Metformin 2000MG. Started washing Spironolactone> > > > > > > 12/20/11 to prepare for AVS.> > > > > > >> > > > > > >> > > > > >> > > > >> > > > >> > > >> > >> >> > > > > ------------------------------------> >

[Guest guest]

Following lines of text are redundant in posts:

> > May your pressure be low!

> >

> > CE Grim MS, MD

> > Specializing in Difficult

> > Hypertension

> >

> > On Jan 22, 2012, at 18:47, Francis Bill SUSPECTED PA <georgewbill@...>

> wrote:

> >

> > > Not sure what the VA would do if they found your testosterone or

> androgen a bit low.

> > >

> > > I just got a update of my records seems in my case they over look a

few

> abnormal tests. Also there interpretation of what I say can be much

different

> from what I am saying. They also put answers to questions that I am never

> asked.

> > >

> > >

> > > > >

> > > > > > Dr. Grim, do you think being on Oxycodone and Methodone for 5+

> > > > > > years could have any effect on my adverse reaction to

> > > > > > Spironolactone? What about street drugs which I don't use?

> > > > > > Maybe at the minimum there should be a drug test so you know

> > > > > > what may be ahead! Maybe Inspra would be a better choice!

> > > > > >

> > > > > > Health Information, Tips, Community and More at

> > > > > > HealthCentral.com

> > > > > > http://www.healthcentral.com/chronic-pain/c/23153/113990/testo

> > > > > > sterone/pf/

> > > > > > ChronicPainConnection.com

> > > > > >

> > > > > > See all of our health sites at www.HealthCentral.com

> > > > > >

> > > > > > Chronic Pain Home >

> > > > > > General >

> > > > > > Treatment >

> > > > > > Alternative Treatment >

> > > > > > Chronic Pain Medication Lead to Sexual Dysfunction, Other

> > > > > > Problems for Men Testosterone Replacement Therapy for Men in

> > > > > > Pain by Lasich, MD Monday, June 14, 2010 How many

> > > > > > men would take pain pills if they knew that the pills might

> > > > > > shrink their testicles? Besides testicular size, pain pills

> > > > > > can wreck havoc on a man's ability to have sex, make babies,

> > > > > > build muscles, and enjoy life. All of these side effects to

> > > > > > opioid medications are caused by the fact that chronic opioid

> > > > > > use lowers testosterone levels. This fact is not widely known,

> > > > > > yet widely experienced. " Opioid-induced androgen deficiency "

> > > > > > affects thousands of men. In a complex process that involves

> > > > > > some very important hormones, both men and women can

> > > > > > experience symptoms of low testosterone.

> > > > > > The most common symptoms from abnormally low testosterone

> > > > > > levels - hypogonadism - are:

> > > > > > Fatigue

> > > > > > Depression

> > > > > > Low libido

> > > > > > Erectile dysfunction

> > > > > > Sexual dysfunction

> > > > > > Osteoporosis

> > > > > > Low muscle mass

> > > > > > Infertility

> > > > > > Hot flashes

> > > > > > Night sweats

> > > > > > Testicular atrophy

> > > > > > If any of this sounds familiar, a doctor can order a simple

> > > > > > blood test (the Total Testosterone Level) to check your

> > > > > > testosterone level. This test is best done early in the

> > > > > > morning to get the most accurate reading. Checking baseline

> > > > > > hormonal levels, including the testosterone level, before and

> > > > > > after initiating opioid treatment is recommended by some

> > > > > > experts. Additionally, when consenting for opioid treatment,

> > > > > > the patient should also be informed about the potential for

opioids

> to drastically lower testosterone levels.

> > > > > > If this discussion took place, many men might elect to avoid

> > > > > > opioids. If men knew that upwards of 80% of those who begin

> > > > > > taking opioids will experience erectile dysfunction from low

> > > > > > testosterone levels, they might want to seek alternative pain

> relieving options.

> > > > > > Those who do agree to opioid pain management despite the risks

> > > > > > should know about testosterone-replacement therapy.

> > > > > > Testosterone-replacement therapy is utilized to treat

> > > > > > opioid-induced testosterone insufficiency. Prior to initiating

> > > > > > testosterone treatment men need to have the prostate specific

> > > > > > antigen level (PSA) test because testosterone can worsen

> > > > > > prostate conditions like cancer and hypertrophy. Additionally,

> > > > > > other conditions could also worsen like heart failure and

> > > > > > sleep apnea. So, not every man is a candidate for testosterone

> > > > > > replacement. Those who are candidates have a few different

> > > > > > modes of replacement like injections, patches, gels and

> > > > > > bio-identicals hormones. One study showed that the

> > > > > > testosterone patch delivering 7.5 mg per day was effective at

> > > > > > normalizing testosterone levels and relieving symptoms of

> > > > > > hypogonadism. In fact, that same study showed that pain

> > > > > > intensity actually improved as the testosterone levels

> > > > > > normalized. Testosterone-replacement therapy is probably the

> most underutilized, yet most often needed adjunct therapy for someone

> who is a long-term opioid user.

> > > > > > Everyone, both men and women need to be more aware of the

> > > > > > long-term effects that opioids have on the human body.

> > > > > > Testosterone and all the hormones related to the

> > > > > > hypothalamic-pituitary axis (thyroid, adrenaline, and sex

> > > > > > hormones) have the potential for becoming abnormally low. At

> > > > > > some point, these hormonal imbalances have the potential to

> > > > > > affect quality of life more than the pain itself. At that

> > > > > > point, the risks of long-term opioid use needs to be re-

> > > > > > evaluated because the risks might outweigh the benefits. At some

> point, opioid pain management might not be worth the price.

> > > > > >

> > > > > > We comply with the HONcode standard for trustworthy health

> > > > > > information: verify here.

> > > > > > About Us |

> > > > > > Contact Us |

> > > > > > Privacy Policy |

> > > > > > Terms of Use |

> > > > > > Security Policy

> > > > > > By using this service, you accept our Terms of Use. Please

> > > > > > read them. The consumer health information on is for

> > > > > > informational purposes only and is not a substitute for

> > > > > > medical advice or treatment for any medical conditions. You

> > > > > > should promptly seek professional medical care if you have any

> > > > > > concern about your health, and you should always consult your

> > > > > > physician before starting a fitness regimen. Copyright © 2012

> > > > > > Remedy Health Media, LLC. .

> > > > > >

> > > > > > Current Opinion in Endocrinology & Diabetes:

> > > > > > June 2006 - Volume 13 - Issue 3 - p 262-266

> > > > > > doi: 10.1097/01.med.0000224806.08824.dc

> > > > > > Androgens

> > > > > > Opioid-induced androgen deficiency l, Harry W & #65532;

> > > > > > Abstract Purpose of review: Opioid-induced androgen deficiency

> > > > > > has become one of the most common causes of testosterone

> > > > > > deficiency among men in many communities. Its increase

> > > > > > parallels the large increase in opioid use. This form of

> > > > > > hypogonadotrophic hypogonadism is present in most men

> > > > > > chronically consuming sustained-action opioids, including

> > > > > > those receiving methadone for heroin addiction and those

> > > > > > consuming opioids for control of either malignant or

> > > > > > non-malignant chronic pain. A similar, but less well defined

> > > > > > illness occurs in women. Opioid-induced androgen deficiency is

not

> widely recognized.

> > > > > > This review examines its pathophysiology, some of its signs

> > > > > > and symptoms, and indicates some areas where current

> > > > > > observations suggest additional investigations would be

fruitful.

> > > > > > Recent findings: Recognition of opioid-induced androgen

> > > > > > deficiency in men not receiving methadone for heroin addiction

> > > > > > is a new observation, and in these men contributes to fatigue,

> > > > > > depression, vasomotor phenomena, anemia, diminished libido,

> > > > > > erectile dysfunction and osteoporosis. These signs and

> > > > > > symptoms improved during testosterone replacement therapy in

> > > > > > several small non-placebo- controlled trials.

> > > > > > Summary: A large majority of men consuming sustained-action

> > > > > > opioids have symptomatic androgen deficiency which apparently

> > > > > > responds to replacement therapy. Opioid-induced androgen

> > > > > > deficiency is frequently overlooked, with its symptoms

> > > > > > attributed to underlying disease states including malignant

> > > > > > disease, chronic back disorders, HIV disease, and psychosocial

> > > > > > illnesses contributing to opioid habituation.

> > > > > > © 2006 Lippincott & Wilkins, Inc.

> > > > > >

> > > > > > - 65 yo super ob., fastidious male - 12mm X 13mm rt.

> > > > > > a.adnoma with previous rt. flank pain. Treating with DASH.

> > > > > > Stats w/o meds = BP 175/90 HR 59 BS 125. D/C Spironolactone

> > > > > > 12/20/2011 due to adverse SX.

> > > > > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2,

> > > > > > Gynecomastia, MDD and PTSD.

> > > > > > Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg

> > > > > > aspirin and Metformin 2000MG. Started washing Spironolactone

> > > > > > 12/20/11 to prepare for AVS.

> > > > > >

> > > > > >

> > > > >

> > > >

> > >

> > >

> > > Reply to sender | Reply to group | Reply via web post | Start a New

> > > Topic Messages in this topic (11) RECENT ACTIVITY:

> >

>

>

>

>

> ------------------------------------

>

>

[Guest guest]

Please remove extra redundant text:

> >

> > Thanks Francis....

> >

> >

> > > > > > >

> > > > > > > > Dr. Grim, do you think being on Oxycodone and Methodone

> > > > > > > > for 5+

> > > > > > years

> > > > > > > > could have any effect on my adverse reaction to

> Spironolactone?

> > > > > > What

> > > > > > > > about street drugs which I don't use? Maybe at the minimum

> > > > > > > > there should be a drug test so you know what may be ahead!

> > > > > > > > Maybe Inspra would be a better choice!

> > > > > > > >

> > > > > > > > Health Information, Tips, Community and More at

> > > > > > > > HealthCentral.com

> > > > > > > > http://www.healthcentral.com/chronic-pain/c/23153/113990/t

> > > > > > > > estosterone/pf/

> > > > > > > > ChronicPainConnection.com

> > > > > > > >

> > > > > > > > See all of our health sites at www.HealthCentral.com

> > > > > > > >

> > > > > > > > Chronic Pain Home >

> > > > > > > > General >

> > > > > > > > Treatment >

> > > > > > > > Alternative Treatment >

> > > > > > > > Chronic Pain Medication Lead to Sexual Dysfunction, Other

> > > > > > > > Problems for Men Testosterone Replacement Therapy for Men

> > > > > > > > in Pain by Lasich, MD Monday, June 14, 2010 How

> > > > > > > > many men would take pain pills if they knew that the pills

> > > > > > might

> > > > > > > > shrink their testicles? Besides testicular size, pain

> > > > > > > > pills can wreck havoc on a man's ability to have sex, make

> > > > > > > > babies, build muscles, and enjoy life. All of these side

> > > > > > > > effects to opioid medications are caused by the fact that

> > > > > > > > chronic opioid use lowers testosterone levels. This fact

> > > > > > > > is not widely known, yet widely experienced.

> > > > > > > > " Opioid-induced androgen deficiency " affects

> > > > > > thousands

> > > > > > > > of men. In a complex process that involves some very

> > > > > > > > important hormones, both men and women can experience

> > > > > > > > symptoms of low testosterone.

> > > > > > > > The most common symptoms from abnormally low testosterone

> > > > > > > > levels - hypogonadism - are:

> > > > > > > > Fatigue

> > > > > > > > Depression

> > > > > > > > Low libido

> > > > > > > > Erectile dysfunction

> > > > > > > > Sexual dysfunction

> > > > > > > > Osteoporosis

> > > > > > > > Low muscle mass

> > > > > > > > Infertility

> > > > > > > > Hot flashes

> > > > > > > > Night sweats

> > > > > > > > Testicular atrophy

> > > > > > > > If any of this sounds familiar, a doctor can order a

> > > > > > > > simple blood test (the Total Testosterone Level) to check

> > > > > > > > your testosterone level. This test is best done early in

> > > > > > > > the morning to get the most accurate reading. Checking

> > > > > > > > baseline hormonal levels, including the testosterone

> > > > > > > > level, before and after initiating opioid treatment

> > > > > > is

> > > > > > > > recommended by some experts. Additionally, when consenting

> > > > > > > > for opioid treatment, the patient should also be informed

> > > > > > > > about the potential for opioids to drastically lower

testosterone

> levels.

> > > > > > > > If this discussion took place, many men might elect to

> > > > > > > > avoid opioids. If men knew that upwards of 80% of those

> > > > > > > > who begin taking opioids will experience erectile

> > > > > > > > dysfunction from low testosterone levels, they might want

> > > > > > > > to seek alternative pain relieving

> > > > > > options.

> > > > > > > > Those who do agree to opioid pain management despite the

> > > > > > > > risks should know about testosterone-replacement therapy.

> > > > > > > > Testosterone-replacement therapy is utilized to treat

> > > > > > > > opioid-

> > > > > > induced

> > > > > > > > testosterone insufficiency. Prior to initiating

> > > > > > > > testosterone treatment men need to have the prostate

> > > > > > > > specific antigen level

> > > > > > (PSA)

> > > > > > > > test because testosterone can worsen prostate conditions

> > > > > > > > like

> > > > > > cancer

> > > > > > > > and hypertrophy. Additionally, other conditions could also

> > > > > > > > worsen like heart failure and sleep apnea. So, not every

> > > > > > > > man is a

> > > > > > candidate

> > > > > > > > for testosterone replacement. Those who are candidates

> > > > > > > > have a few different modes of replacement like injections,

> > > > > > > > patches, gels and bio-identicals hormones. One study

> > > > > > > > showed that the testosterone patch delivering 7.5 mg per

> > > > > > > > day was effective at normalizing testosterone levels and

> > > > > > > > relieving symptoms of hypogonadism. In

> > > > > > fact,

> > > > > > > > that same study showed that pain intensity actually

> > > > > > > > improved as

> > > > > > the

> > > > > > > > testosterone levels normalized. Testosterone-replacement

> > > > > > > > therapy

> > > > > > is

> > > > > > > > probably the most underutilized, yet most often needed

> > > > > > > > adjunct therapy for someone who is a long-term opioid user.

> > > > > > > > Everyone, both men and women need to be more aware of the

> > > > > > > > long-

> > > > > > term

> > > > > > > > effects that opioids have on the human body. Testosterone

> > > > > > > > and all the hormones related to the hypothalamic-pituitary

> > > > > > > > axis (thyroid, adrenaline, and sex hormones) have the

> > > > > > > > potential for becoming abnormally low. At some point,

> > > > > > > > these hormonal imbalances have the potential to affect

> > > > > > > > quality of life more than the pain itself. At that point,

> > > > > > > > the risks of long-term opioid use needs to be re-

> > > > > > > > evaluated because the risks might outweigh the benefits. At

> some point, opioid pain management might not be worth the price.

> > > > > > > >

> > > > > > > > We comply with the HONcode standard for trustworthy health

> > > > > > > > information: verify here.

> > > > > > > > About Us |

> > > > > > > > Contact Us |

> > > > > > > > Privacy Policy |

> > > > > > > > Terms of Use |

> > > > > > > > Security Policy

> > > > > > > > By using this service, you accept our Terms of Use. Please

> > > > > > > > read them. The consumer health information on is for

> > > > > > > > informational purposes only and is not a substitute for

> > > > > > > > medical advice or treatment for any medical conditions.

> > > > > > > > You should promptly seek professional medical care if you

> > > > > > > > have any concern about your

> > > > > > health,

> > > > > > > > and you should always consult your physician before

> > > > > > > > starting a fitness regimen. Copyright C 2012 Remedy Health

> > > > > > > > Media, LLC. .

> > > > > > > >

> > > > > > > > Current Opinion in Endocrinology & Diabetes:

> > > > > > > > June 2006 - Volume 13 - Issue 3 - p 262-266

> > > > > > > > doi: 10.1097/01.med.0000224806.08824.dc

> > > > > > > > Androgens

> > > > > > > > Opioid-induced androgen deficiency l, Harry W

> > > > > > > > & #65532; Abstract Purpose of review: Opioid-induced

> > > > > > > > androgen deficiency has become

> > > > > > one

> > > > > > > > of the most common causes of testosterone deficiency among

> > > > > > > > men in many communities. Its increase parallels the large

> > > > > > > > increase in opioid use. This form of hypogonadotrophic

> > > > > > > > hypogonadism is present in most men chronically consuming

> > > > > > > > sustained-action opioids, including those receiving

> > > > > > > > methadone for heroin addiction and those consuming opioids

> > > > > > > > for control of either malignant or non-malignant chronic

> > > > > > > > pain. A similar, but less well defined illness occurs in

> > > > > > > > women. Opioid-induced androgen deficiency is not widely

> > > > > > recognized.

> > > > > > > > This review examines its pathophysiology, some of its

> > > > > > > > signs and symptoms, and indicates some areas where current

> > > > > > > > observations suggest additional investigations would be

fruitful.

> > > > > > > > Recent findings: Recognition of opioid-induced androgen

> > > > > > > > deficiency in men not receiving methadone for heroin

> > > > > > > > addiction is a new observation, and in these men

> > > > > > > > contributes to fatigue, depression, vasomotor phenomena,

> > > > > > > > anemia, diminished libido, erectile

> > > > > > dysfunction

> > > > > > > > and osteoporosis. These signs and symptoms improved during

> > > > > > > > testosterone replacement therapy in several small

> > > > > > > > non-placebo- controlled trials.

> > > > > > > > Summary: A large majority of men consuming

> > > > > > > > sustained-action

> > > > > > opioids

> > > > > > > > have symptomatic androgen deficiency which apparently

> > > > > > > > responds to replacement therapy. Opioid-induced androgen

> > > > > > > > deficiency is frequently overlooked, with its symptoms

> > > > > > > > attributed to underlying disease states including

> > > > > > > > malignant disease, chronic back

> > > > > > disorders,

> > > > > > > > HIV disease, and psychosocial illnesses contributing to

> > > > > > > > opioid habituation.

> > > > > > > > C 2006 Lippincott & Wilkins, Inc.

> > > > > > > >

> > > > > > > > - 65 yo super ob., fastidious male - 12mm X 13mm rt.

> > > > > > > > a.adnoma with previous rt. flank pain. Treating with DASH.

> > > > > > > > Stats w/o meds = BP 175/90 HR 59 BS 125. D/C

> > > > > > > > Spironolactone 12/20/2011 due to

> > > > > > adverse

> > > > > > > > SX.

> > > > > > > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19,

> > > > > > > > DM2, Gynecomastia, MDD and PTSD.

> > > > > > > > Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG,

> > > > > > > > 81mg

> > > > > > aspirin

> > > > > > > > and Metformin 2000MG. Started washing Spironolactone

> > > > > > > > 12/20/11 to prepare for AVS.

> > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

>

>

>

> ------------------------------------

>

>

[Guest guest]

, For those who receive messages in digest form, leaving all the extraneous information at the bottom makes the digest unreadable. You're supposed to leave a bit so people know what you're talking about, but leaving rows and rows of >>>>>>>>>>>>>>>>> is not necessary. No one reads any of that anyway. Trimming your messages is simply common courtesy. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of First, Let me ask that You Do Not Hijack my thread! If you want to reopen the cropping discussion that happened back between Nov. 15 and Nov 21 feel free to do so and use your own thread! The consenses in November was that we were not making changes because sometimes what you decide is is not necessary is often needed for a responder or a new reader. (Do a search with " cropping " in the title to review that discussion.)>> Please delete all redundant extra repeated text from your posts...the> following text is to be deleted:

[Guest guest]

Well, you know, Study Circle -- I don't mind the "redundant posts" -- that way I don't have to look at every single email that hits my account from this very busy group. I am simply able to look at the most recent email that has the same subject -- opening it once and scrolling down and reading all the comments -- then I can just click and delete all of the earlier posted ones (without even opening them).

Just saying, that the redundancies work for me.

From: Study Circle <studycircle@...>hyperaldosteronism Sent: Monday, January 23, 2012 9:33 AMSubject: RE: Re: Testosterone Where Did It Go!

Following lines of text are redundant in posts:> > May your pressure be low!> >> > CE Grim MS, MD> > Specializing in Difficult> > Hypertension> >> > On Jan 22, 2012, at 18:47, Francis Bill SUSPECTED PA <georgewbill@...>> wrote:> >> > > Not sure what the VA would do if they found your testosterone or> androgen a bit low.> > >> > > I just got a update of my records seems in my case they over look afew> abnormal tests. Also there interpretation of what I say can be muchdifferent> from what I am saying. They also put answers to questions that I am never> asked.> > >> > > > > > > >> > > > > > Dr. Grim, do you think being on Oxycodone and Methodone for 5+> > > > > > years could have any effect on my adverse reaction to> > > > > > Spironolactone? What about street drugs which I don't use?> > > > > > Maybe at the minimum there should be a drug test so you know> > > > > > what may be ahead! Maybe Inspra would be a better choice!> > > > > >> > > > > > Health Information, Tips, Community and More at> > > > > >

HealthCentral.com> > > > > > http://www.healthcentral.com/chronic-pain/c/23153/113990/testo> > > > > > sterone/pf/> > > > > > ChronicPainConnection.com> > > > > >> > > > > > See all of our health sites at www.HealthCentral.com> > > > > >> > > > > > Chronic Pain Home >> > > > > > General >> > > > > > Treatment >> > > > > > Alternative Treatment >> > > > > > Chronic Pain Medication Lead to Sexual Dysfunction, Other> > > > > > Problems for Men Testosterone Replacement Therapy for Men in> > > > > > Pain by Lasich, MD Monday, June 14,

2010 How many> > > > > > men would take pain pills if they knew that the pills might> > > > > > shrink their testicles? Besides testicular size, pain pills> > > > > > can wreck havoc on a man's ability to have sex, make babies,> > > > > > build muscles, and enjoy life. All of these side effects to> > > > > > opioid medications are caused by the fact that chronic opioid> > > > > > use lowers testosterone levels. This fact is not widely known,> > > > > > yet widely experienced. "Opioid-induced androgen deficiency"> > > > > > affects thousands of men. In a complex process that involves> > > > > > some very important hormones, both men and women can> > > > > > experience symptoms of low testosterone.> > > > > > The most

common symptoms from abnormally low testosterone> > > > > > levels - hypogonadism - are:> > > > > > Fatigue> > > > > > Depression> > > > > > Low libido> > > > > > Erectile dysfunction> > > > > > Sexual dysfunction> > > > > > Osteoporosis> > > > > > Low muscle mass> > > > > > Infertility> > > > > > Hot flashes> > > > > > Night sweats> > > > > > Testicular atrophy> > > > > > If any of this sounds familiar, a doctor can order a simple> > > > > > blood test (the Total Testosterone Level) to check your> > > > > > testosterone level. This test is best done early in the> > > > > > morning to get the most accurate

reading. Checking baseline> > > > > > hormonal levels, including the testosterone level, before and> > > > > > after initiating opioid treatment is recommended by some> > > > > > experts. Additionally, when consenting for opioid treatment,> > > > > > the patient should also be informed about the potential foropioids> to drastically lower testosterone levels.> > > > > > If this discussion took place, many men might elect to avoid> > > > > > opioids. If men knew that upwards of 80% of those who begin> > > > > > taking opioids will experience erectile dysfunction from low> > > > > > testosterone levels, they might want to seek alternative pain> relieving options.> > > > > > Those who do agree to opioid pain management despite the risks>

> > > > > should know about testosterone-replacement therapy.> > > > > > Testosterone-replacement therapy is utilized to treat> > > > > > opioid-induced testosterone insufficiency. Prior to initiating> > > > > > testosterone treatment men need to have the prostate specific> > > > > > antigen level (PSA) test because testosterone can worsen> > > > > > prostate conditions like cancer and hypertrophy. Additionally,> > > > > > other conditions could also worsen like heart failure and> > > > > > sleep apnea. So, not every man is a candidate for testosterone> > > > > > replacement. Those who are candidates have a few different> > > > > > modes of replacement like injections, patches, gels and> > > > > > bio-identicals hormones.

One study showed that the> > > > > > testosterone patch delivering 7.5 mg per day was effective at> > > > > > normalizing testosterone levels and relieving symptoms of> > > > > > hypogonadism. In fact, that same study showed that pain> > > > > > intensity actually improved as the testosterone levels> > > > > > normalized. Testosterone-replacement therapy is probably the> most underutilized, yet most often needed adjunct therapy for someone> who is a long-term opioid user.> > > > > > Everyone, both men and women need to be more aware of the> > > > > > long-term effects that opioids have on the human body.> > > > > > Testosterone and all the hormones related to the> > > > > > hypothalamic-pituitary axis (thyroid, adrenaline, and sex> >

> > > > hormones) have the potential for becoming abnormally low. At> > > > > > some point, these hormonal imbalances have the potential to> > > > > > affect quality of life more than the pain itself. At that> > > > > > point, the risks of long-term opioid use needs to be re-> > > > > > evaluated because the risks might outweigh the benefits. At some> point, opioid pain management might not be worth the price.> > > > > >> > > > > > We comply with the HONcode standard for trustworthy health> > > > > > information: verify here.> > > > > > About Us |> > > > > > Contact Us |> > > > > > Privacy Policy |> > > > > > Terms of Use |> > > > > > Security Policy> > > >

> > By using this service, you accept our Terms of Use. Please> > > > > > read them. The consumer health information on is for> > > > > > informational purposes only and is not a substitute for> > > > > > medical advice or treatment for any medical conditions. You> > > > > > should promptly seek professional medical care if you have any> > > > > > concern about your health, and you should always consult your> > > > > > physician before starting a fitness regimen. Copyright © 2012> > > > > > Remedy Health Media, LLC. .> > > > > >> > > > > > Current Opinion in Endocrinology & Diabetes:> > > > > > June 2006 - Volume 13 - Issue 3 - p 262-266> > > > > > doi:

10.1097/01.med.0000224806.08824.dc> > > > > > Androgens> > > > > > Opioid-induced androgen deficiency l, Harry W & #65532;> > > > > > Abstract Purpose of review: Opioid-induced androgen deficiency> > > > > > has become one of the most common causes of testosterone> > > > > > deficiency among men in many communities. Its increase> > > > > > parallels the large increase in opioid use. This form of> > > > > > hypogonadotrophic hypogonadism is present in most men> > > > > > chronically consuming sustained-action opioids, including> > > > > > those receiving methadone for heroin addiction and those> > > > > > consuming opioids for control of either malignant or> > > > > > non-malignant chronic pain. A similar,

but less well defined> > > > > > illness occurs in women. Opioid-induced androgen deficiency isnot> widely recognized.> > > > > > This review examines its pathophysiology, some of its signs> > > > > > and symptoms, and indicates some areas where current> > > > > > observations suggest additional investigations would befruitful.> > > > > > Recent findings: Recognition of opioid-induced androgen> > > > > > deficiency in men not receiving methadone for heroin addiction> > > > > > is a new observation, and in these men contributes to fatigue,> > > > > > depression, vasomotor phenomena, anemia, diminished libido,> > > > > > erectile dysfunction and osteoporosis. These signs and> > > > > > symptoms improved during testosterone

replacement therapy in> > > > > > several small non-placebo- controlled trials.> > > > > > Summary: A large majority of men consuming sustained-action> > > > > > opioids have symptomatic androgen deficiency which apparently> > > > > > responds to replacement therapy. Opioid-induced androgen> > > > > > deficiency is frequently overlooked, with its symptoms> > > > > > attributed to underlying disease states including malignant> > > > > > disease, chronic back disorders, HIV disease, and psychosocial> > > > > > illnesses contributing to opioid habituation.> > > > > > © 2006 Lippincott & Wilkins, Inc.> > > > > >> > > > > > - 65 yo super ob., fastidious male - 12mm X 13mm rt.> > > >

> > a.adnoma with previous rt. flank pain. Treating with DASH.> > > > > > Stats w/o meds = BP 175/90 HR 59 BS 125. D/C Spironolactone> > > > > > 12/20/2011 due to adverse SX.> > > > > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2,> > > > > > Gynecomastia, MDD and PTSD.> > > > > > Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg> > > > > > aspirin and Metformin 2000MG. Started washing Spironolactone> > > > > > 12/20/11 to prepare for AVS.> > > > > >> > > > > >> > > > >> > > >> > >> > >> > > Reply to sender | Reply to group | Reply via web post | Start a New> > > Topic Messages in this topic (11) RECENT ACTIVITY:> >>

> > > > ------------------------------------> >

[Guest guest]

Well, you know, Study Circle -- I don't mind the "redundant posts" -- that way I don't have to look at every single email that hits my account from this very busy group. I am simply able to look at the most recent email that has the same subject -- opening it once and scrolling down and reading all the comments -- then I can just click and delete all of the earlier posted ones (without even opening them).

Just saying, that the redundancies work for me.

From: Study Circle <studycircle@...>hyperaldosteronism Sent: Monday, January 23, 2012 9:33 AMSubject: RE: Re: Testosterone Where Did It Go!

Following lines of text are redundant in posts:> > May your pressure be low!> >> > CE Grim MS, MD> > Specializing in Difficult> > Hypertension> >> > On Jan 22, 2012, at 18:47, Francis Bill SUSPECTED PA <georgewbill@...>> wrote:> >> > > Not sure what the VA would do if they found your testosterone or> androgen a bit low.> > >> > > I just got a update of my records seems in my case they over look afew> abnormal tests. Also there interpretation of what I say can be muchdifferent> from what I am saying. They also put answers to questions that I am never> asked.> > >> > > > > > > >> > > > > > Dr. Grim, do you think being on Oxycodone and Methodone for 5+> > > > > > years could have any effect on my adverse reaction to> > > > > > Spironolactone? What about street drugs which I don't use?> > > > > > Maybe at the minimum there should be a drug test so you know> > > > > > what may be ahead! Maybe Inspra would be a better choice!> > > > > >> > > > > > Health Information, Tips, Community and More at> > > > > >

HealthCentral.com> > > > > > http://www.healthcentral.com/chronic-pain/c/23153/113990/testo> > > > > > sterone/pf/> > > > > > ChronicPainConnection.com> > > > > >> > > > > > See all of our health sites at www.HealthCentral.com> > > > > >> > > > > > Chronic Pain Home >> > > > > > General >> > > > > > Treatment >> > > > > > Alternative Treatment >> > > > > > Chronic Pain Medication Lead to Sexual Dysfunction, Other> > > > > > Problems for Men Testosterone Replacement Therapy for Men in> > > > > > Pain by Lasich, MD Monday, June 14,

2010 How many> > > > > > men would take pain pills if they knew that the pills might> > > > > > shrink their testicles? Besides testicular size, pain pills> > > > > > can wreck havoc on a man's ability to have sex, make babies,> > > > > > build muscles, and enjoy life. All of these side effects to> > > > > > opioid medications are caused by the fact that chronic opioid> > > > > > use lowers testosterone levels. This fact is not widely known,> > > > > > yet widely experienced. "Opioid-induced androgen deficiency"> > > > > > affects thousands of men. In a complex process that involves> > > > > > some very important hormones, both men and women can> > > > > > experience symptoms of low testosterone.> > > > > > The most

common symptoms from abnormally low testosterone> > > > > > levels - hypogonadism - are:> > > > > > Fatigue> > > > > > Depression> > > > > > Low libido> > > > > > Erectile dysfunction> > > > > > Sexual dysfunction> > > > > > Osteoporosis> > > > > > Low muscle mass> > > > > > Infertility> > > > > > Hot flashes> > > > > > Night sweats> > > > > > Testicular atrophy> > > > > > If any of this sounds familiar, a doctor can order a simple> > > > > > blood test (the Total Testosterone Level) to check your> > > > > > testosterone level. This test is best done early in the> > > > > > morning to get the most accurate

reading. Checking baseline> > > > > > hormonal levels, including the testosterone level, before and> > > > > > after initiating opioid treatment is recommended by some> > > > > > experts. Additionally, when consenting for opioid treatment,> > > > > > the patient should also be informed about the potential foropioids> to drastically lower testosterone levels.> > > > > > If this discussion took place, many men might elect to avoid> > > > > > opioids. If men knew that upwards of 80% of those who begin> > > > > > taking opioids will experience erectile dysfunction from low> > > > > > testosterone levels, they might want to seek alternative pain> relieving options.> > > > > > Those who do agree to opioid pain management despite the risks>

> > > > > should know about testosterone-replacement therapy.> > > > > > Testosterone-replacement therapy is utilized to treat> > > > > > opioid-induced testosterone insufficiency. Prior to initiating> > > > > > testosterone treatment men need to have the prostate specific> > > > > > antigen level (PSA) test because testosterone can worsen> > > > > > prostate conditions like cancer and hypertrophy. Additionally,> > > > > > other conditions could also worsen like heart failure and> > > > > > sleep apnea. So, not every man is a candidate for testosterone> > > > > > replacement. Those who are candidates have a few different> > > > > > modes of replacement like injections, patches, gels and> > > > > > bio-identicals hormones.

One study showed that the> > > > > > testosterone patch delivering 7.5 mg per day was effective at> > > > > > normalizing testosterone levels and relieving symptoms of> > > > > > hypogonadism. In fact, that same study showed that pain> > > > > > intensity actually improved as the testosterone levels> > > > > > normalized. Testosterone-replacement therapy is probably the> most underutilized, yet most often needed adjunct therapy for someone> who is a long-term opioid user.> > > > > > Everyone, both men and women need to be more aware of the> > > > > > long-term effects that opioids have on the human body.> > > > > > Testosterone and all the hormones related to the> > > > > > hypothalamic-pituitary axis (thyroid, adrenaline, and sex> >

> > > > hormones) have the potential for becoming abnormally low. At> > > > > > some point, these hormonal imbalances have the potential to> > > > > > affect quality of life more than the pain itself. At that> > > > > > point, the risks of long-term opioid use needs to be re-> > > > > > evaluated because the risks might outweigh the benefits. At some> point, opioid pain management might not be worth the price.> > > > > >> > > > > > We comply with the HONcode standard for trustworthy health> > > > > > information: verify here.> > > > > > About Us |> > > > > > Contact Us |> > > > > > Privacy Policy |> > > > > > Terms of Use |> > > > > > Security Policy> > > >

> > By using this service, you accept our Terms of Use. Please> > > > > > read them. The consumer health information on is for> > > > > > informational purposes only and is not a substitute for> > > > > > medical advice or treatment for any medical conditions. You> > > > > > should promptly seek professional medical care if you have any> > > > > > concern about your health, and you should always consult your> > > > > > physician before starting a fitness regimen. Copyright © 2012> > > > > > Remedy Health Media, LLC. .> > > > > >> > > > > > Current Opinion in Endocrinology & Diabetes:> > > > > > June 2006 - Volume 13 - Issue 3 - p 262-266> > > > > > doi:

10.1097/01.med.0000224806.08824.dc> > > > > > Androgens> > > > > > Opioid-induced androgen deficiency l, Harry W & #65532;> > > > > > Abstract Purpose of review: Opioid-induced androgen deficiency> > > > > > has become one of the most common causes of testosterone> > > > > > deficiency among men in many communities. Its increase> > > > > > parallels the large increase in opioid use. This form of> > > > > > hypogonadotrophic hypogonadism is present in most men> > > > > > chronically consuming sustained-action opioids, including> > > > > > those receiving methadone for heroin addiction and those> > > > > > consuming opioids for control of either malignant or> > > > > > non-malignant chronic pain. A similar,

but less well defined> > > > > > illness occurs in women. Opioid-induced androgen deficiency isnot> widely recognized.> > > > > > This review examines its pathophysiology, some of its signs> > > > > > and symptoms, and indicates some areas where current> > > > > > observations suggest additional investigations would befruitful.> > > > > > Recent findings: Recognition of opioid-induced androgen> > > > > > deficiency in men not receiving methadone for heroin addiction> > > > > > is a new observation, and in these men contributes to fatigue,> > > > > > depression, vasomotor phenomena, anemia, diminished libido,> > > > > > erectile dysfunction and osteoporosis. These signs and> > > > > > symptoms improved during testosterone

replacement therapy in> > > > > > several small non-placebo- controlled trials.> > > > > > Summary: A large majority of men consuming sustained-action> > > > > > opioids have symptomatic androgen deficiency which apparently> > > > > > responds to replacement therapy. Opioid-induced androgen> > > > > > deficiency is frequently overlooked, with its symptoms> > > > > > attributed to underlying disease states including malignant> > > > > > disease, chronic back disorders, HIV disease, and psychosocial> > > > > > illnesses contributing to opioid habituation.> > > > > > © 2006 Lippincott & Wilkins, Inc.> > > > > >> > > > > > - 65 yo super ob., fastidious male - 12mm X 13mm rt.> > > >

> > a.adnoma with previous rt. flank pain. Treating with DASH.> > > > > > Stats w/o meds = BP 175/90 HR 59 BS 125. D/C Spironolactone> > > > > > 12/20/2011 due to adverse SX.> > > > > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2,> > > > > > Gynecomastia, MDD and PTSD.> > > > > > Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg> > > > > > aspirin and Metformin 2000MG. Started washing Spironolactone> > > > > > 12/20/11 to prepare for AVS.> > > > > >> > > > > >> > > > >> > > >> > >> > >> > > Reply to sender | Reply to group | Reply via web post | Start a New> > > Topic Messages in this topic (11) RECENT ACTIVITY:> >>

> > > > ------------------------------------> >

[Guest guest]

Are you the Group Moderator?

From: Study Circle <studycircle@...>hyperaldosteronism Sent: Monday, January 23, 2012 9:22 AMSubject: RE: Re: Testosterone Where Did It Go!

Please delete all redundant extra repeated text from your posts...the following text is to be deleted:

> >

> >

> > > > > >

> > > > > > > Dr. Grim, do you think being on Oxycodone and Methodone for

> > > > > > > 5+

> > > > > years

> > > > > > > could have any effect on my adverse reaction to Spironolactone?

> > > > > What

> > > > > > > about street drugs which I don't use? Maybe at the minimum

> > > > > > > there should be a drug test so you know what may be ahead!

> > > > > > > Maybe Inspra would be a better choice!

> > > > > > >

> > > > > > > Health Information, Tips, Community and More at

> > > > > > > HealthCentral.com

> > > > > > > http://www.healthcentral.com/chronic-pain/c/23153/113990/tes

> > > > > > > tosterone/pf/

> > > > > > > ChronicPainConnection.com

> > > > > > >

> > > > > > > See all of our health sites at www.HealthCentral.com

> > > > > > >

> > > > > > > Chronic Pain Home >

> > > > > > > General >

> > > > > > > Treatment >

> > > > > > > Alternative Treatment >

> > > > > > > Chronic Pain Medication Lead to Sexual Dysfunction, Other

> > > > > > > Problems for Men Testosterone Replacement Therapy for Men in

> > > > > > > Pain by Lasich, MD Monday, June 14, 2010 How many

> > > > > > > men would take pain pills if they knew that the pills

> > > > > might

> > > > > > > shrink their testicles? Besides testicular size, pain pills

> > > > > > > can wreck havoc on a man's ability to have sex, make babies,

> > > > > > > build muscles, and enjoy life. All of these side effects to

> > > > > > > opioid medications are caused by the fact that chronic

> > > > > > > opioid use lowers testosterone levels. This fact is not

> > > > > > > widely known, yet widely experienced. "Opioid-induced

> > > > > > > androgen deficiency" affects

> > > > > thousands

> > > > > > > of men. In a complex process that involves some very

> > > > > > > important hormones, both men and women can experience

> > > > > > > symptoms of low testosterone.

> > > > > > > The most common symptoms from abnormally low testosterone

> > > > > > > levels - hypogonadism - are:

> > > > > > > Fatigue

> > > > > > > Depression

> > > > > > > Low libido

> > > > > > > Erectile dysfunction

> > > > > > > Sexual dysfunction

> > > > > > > Osteoporosis

> > > > > > > Low muscle mass

> > > > > > > Infertility

> > > > > > > Hot flashes

> > > > > > > Night sweats

> > > > > > > Testicular atrophy

> > > > > > > If any of this sounds familiar, a doctor can order a simple

> > > > > > > blood test (the Total Testosterone Level) to check your

> > > > > > > testosterone level. This test is best done early in the

> > > > > > > morning to get the most accurate reading. Checking baseline

> > > > > > > hormonal levels, including the testosterone level, before

> > > > > > > and after initiating opioid treatment

> > > > > is

> > > > > > > recommended by some experts. Additionally, when consenting

> > > > > > > for opioid treatment, the patient should also be informed

> > > > > > > about the potential for opioids to drastically lower testosterone

> levels.

> > > > > > > If this discussion took place, many men might elect to avoid

> > > > > > > opioids. If men knew that upwards of 80% of those who begin

> > > > > > > taking opioids will experience erectile dysfunction from low

> > > > > > > testosterone levels, they might want to seek alternative

> > > > > > > pain relieving

> > > > > options.

> > > > > > > Those who do agree to opioid pain management despite the

> > > > > > > risks should know about testosterone-replacement therapy.

> > > > > > > Testosterone-replacement therapy is utilized to treat

> > > > > > > opioid-

> > > > > induced

> > > > > > > testosterone insufficiency. Prior to initiating testosterone

> > > > > > > treatment men need to have the prostate specific antigen

> > > > > > > level

> > > > > (PSA)

> > > > > > > test because testosterone can worsen prostate conditions

> > > > > > > like

> > > > > cancer

> > > > > > > and hypertrophy. Additionally, other conditions could also

> > > > > > > worsen like heart failure and sleep apnea. So, not every man

> > > > > > > is a

> > > > > candidate

> > > > > > > for testosterone replacement. Those who are candidates have

> > > > > > > a few different modes of replacement like injections,

> > > > > > > patches, gels and bio-identicals hormones. One study showed

> > > > > > > that the testosterone patch delivering 7.5 mg per day was

> > > > > > > effective at normalizing testosterone levels and relieving

> > > > > > > symptoms of hypogonadism. In

> > > > > fact,

> > > > > > > that same study showed that pain intensity actually improved

> > > > > > > as

> > > > > the

> > > > > > > testosterone levels normalized. Testosterone-replacement

> > > > > > > therapy

> > > > > is

> > > > > > > probably the most underutilized, yet most often needed

> > > > > > > adjunct therapy for someone who is a long-term opioid user.

> > > > > > > Everyone, both men and women need to be more aware of the

> > > > > > > long-

> > > > > term

> > > > > > > effects that opioids have on the human body. Testosterone

> > > > > > > and all the hormones related to the hypothalamic-pituitary

> > > > > > > axis (thyroid, adrenaline, and sex hormones) have the

> > > > > > > potential for becoming abnormally low. At some point, these

> > > > > > > hormonal imbalances have the potential to affect quality of

> > > > > > > life more than the pain itself. At that point, the risks of

> > > > > > > long-term opioid use needs to be re- evaluated because the

> > > > > > > risks might outweigh the benefits. At some point, opioid pain

> management might not be worth the price.

> > > > > > >

> > > > > > > We comply with the HONcode standard for trustworthy health

> > > > > > > information: verify here.

> > > > > > > About Us |

> > > > > > > Contact Us |

> > > > > > > Privacy Policy |

> > > > > > > Terms of Use |

> > > > > > > Security Policy

> > > > > > > By using this service, you accept our Terms of Use. Please

> > > > > > > read them. The consumer health information on is for

> > > > > > > informational purposes only and is not a substitute for

> > > > > > > medical advice or treatment for any medical conditions. You

> > > > > > > should promptly seek professional medical care if you have

> > > > > > > any concern about your

> > > > > health,

> > > > > > > and you should always consult your physician before starting

> > > > > > > a fitness regimen. Copyright © 2012 Remedy Health Media,

> > > > > > > LLC. .

> > > > > > >

> > > > > > > Current Opinion in Endocrinology & Diabetes:

> > > > > > > June 2006 - Volume 13 - Issue 3 - p 262-266

> > > > > > > doi: 10.1097/01.med.0000224806.08824.dc

> > > > > > > Androgens

> > > > > > > Opioid-induced androgen deficiency l, Harry W & #65532;

> > > > > > > Abstract Purpose of review: Opioid-induced androgen

> > > > > > > deficiency has become

> > > > > one

> > > > > > > of the most common causes of testosterone deficiency among

> > > > > > > men in many communities. Its increase parallels the large

> > > > > > > increase in opioid use. This form of hypogonadotrophic

> > > > > > > hypogonadism is present in most men chronically consuming

> > > > > > > sustained-action opioids, including those receiving

> > > > > > > methadone for heroin addiction and those consuming opioids

> > > > > > > for control of either malignant or non-malignant chronic

> > > > > > > pain. A similar, but less well defined illness occurs in

> > > > > > > women. Opioid-induced androgen deficiency is not widely

> > > > > recognized.

> > > > > > > This review examines its pathophysiology, some of its signs

> > > > > > > and symptoms, and indicates some areas where current

> > > > > > > observations suggest additional investigations would be fruitful.

> > > > > > > Recent findings: Recognition of opioid-induced androgen

> > > > > > > deficiency in men not receiving methadone for heroin

> > > > > > > addiction is a new observation, and in these men contributes

> > > > > > > to fatigue, depression, vasomotor phenomena, anemia,

> > > > > > > diminished libido, erectile

> > > > > dysfunction

> > > > > > > and osteoporosis. These signs and symptoms improved during

> > > > > > > testosterone replacement therapy in several small

> > > > > > > non-placebo- controlled trials.

> > > > > > > Summary: A large majority of men consuming sustained-action

> > > > > opioids

> > > > > > > have symptomatic androgen deficiency which apparently

> > > > > > > responds to replacement therapy. Opioid-induced androgen

> > > > > > > deficiency is frequently overlooked, with its symptoms

> > > > > > > attributed to underlying disease states including malignant

> > > > > > > disease, chronic back

> > > > > disorders,

> > > > > > > HIV disease, and psychosocial illnesses contributing to

> > > > > > > opioid habituation.

> > > > > > > © 2006 Lippincott & Wilkins, Inc.

> > > > > > >

> > > > > > > - 65 yo super ob., fastidious male - 12mm X 13mm rt.

> > > > > > > a.adnoma with previous rt. flank pain. Treating with DASH.

> > > > > > > Stats w/o meds = BP 175/90 HR 59 BS 125. D/C Spironolactone

> > > > > > > 12/20/2011 due to

> > > > > adverse

> > > > > > > SX.

> > > > > > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19,

> > > > > > > DM2, Gynecomastia, MDD and PTSD.

> > > > > > > Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg

> > > > > aspirin

> > > > > > > and Metformin 2000MG. Started washing Spironolactone

> > > > > > > 12/20/11 to prepare for AVS.

> > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > > >

> > > >

> > >

> >

>

>

>

>

> ------------------------------------

>

>

[Guest guest]

Scroll down to see answer to your question:

Are you the Group Moderator?

From: Study Circle <studycircle@...>

hyperaldosteronism

Sent: Monday, January 23, 2012 9:22 AM

Subject: RE: Re: Testosterone Where Did It Go!

Please delete all redundant extra repeated text from your posts...the following

text is to be deleted:

> >

> >

> > > > > >

> > > > > > > Dr. Grim, do you think being on Oxycodone and Methodone for

> > > > > > > 5+

> > > > > years

> > > > > > > could have any effect on my adverse reaction to Spironolactone?

> > > > > What

> > > > > > > about street drugs which I don't use? Maybe at the minimum

> > > > > > > there should be a drug test so you know what may be ahead!

> > > > > > > Maybe Inspra would be a better choice!

> > > > > > >

> > > > > > > Health Information, Tips, Community and More at

> > > > > > > HealthCentral.com

> > > > > > > http://www.healthcentral.com/chronic-pain/c/23153/113990/tes

> > > > > > > tosterone/pf/

> > > > > > > ChronicPainConnection.com

> > > > > > >

> > > > > > > See all of our health sites at www.HealthCentral.com

> > > > > > >

> > > > > > > Chronic Pain Home >

> > > > > > > General >

> > > > > > > Treatment >

> > > > > > > Alternative Treatment >

> > > > > > > Chronic Pain Medication Lead to Sexual Dysfunction, Other

> > > > > > > Problems for Men Testosterone Replacement Therapy for Men in

> > > > > > > Pain by Lasich, MD Monday, June 14, 2010 How many

> > > > > > > men would take pain pills if they knew that the pills

> > > > > might

> > > > > > > shrink their testicles? Besides testicular size, pain pills

> > > > > > > can wreck havoc on a man's ability to have sex, make babies,

> > > > > > > build muscles, and enjoy life. All of these side effects to

> > > > > > > opioid medications are caused by the fact that chronic

> > > > > > > opioid use lowers testosterone levels. This fact is not

> > > > > > > widely known, yet widely experienced. " Opioid-induced

> > > > > > > androgen deficiency " affects

> > > > > thousands

> > > > > > > of men. In a complex process that involves some very

> > > > > > > important hormones, both men and women can experience

> > > > > > > symptoms of low testosterone.

> > > > > > > The most common symptoms from abnormally low testosterone

> > > > > > > levels - hypogonadism - are:

> > > > > > > Fatigue

> > > > > > > Depression

> > > > > > > Low libido

> > > > > > > Erectile dysfunction

> > > > > > > Sexual dysfunction

> > > > > > > Osteoporosis

> > > > > > > Low muscle mass

> > > > > > > Infertility

> > > > > > > Hot flashes

> > > > > > > Night sweats

> > > > > > > Testicular atrophy

> > > > > > > If any of this sounds familiar, a doctor can order a simple

> > > > > > > blood test (the Total Testosterone Level) to check your

> > > > > > > testosterone level. This test is best done early in the

> > > > > > > morning to get the most accurate reading. Checking baseline

> > > > > > > hormonal levels, including the testosterone level, before

> > > > > > > and after initiating opioid treatment

> > > > > is

> > > > > > > recommended by some experts. Additionally, when consenting

> > > > > > > for opioid treatment, the patient should also be informed

> > > > > > > about the potential for opioids to drastically lower testosterone

> levels.

> > > > > > > If this discussion took place, many men might elect to avoid

> > > > > > > opioids. If men knew that upwards of 80% of those who begin

> > > > > > > taking opioids will experience erectile dysfunction from low

> > > > > > > testosterone levels, they might want to seek alternative

> > > > > > > pain relieving

> > > > > options.

> > > > > > > Those who do agree to opioid pain management despite the

> > > > > > > risks should know about testosterone-replacement therapy.

> > > > > > > Testosterone-replacement therapy is utilized to treat

> > > > > > > opioid-

> > > > > induced

> > > > > > > testosterone insufficiency. Prior to initiating testosterone

> > > > > > > treatment men need to have the prostate specific antigen

> > > > > > > level

> > > > > (PSA)

> > > > > > > test because testosterone can worsen prostate conditions

> > > > > > > like

> > > > > cancer

> > > > > > > and hypertrophy. Additionally, other conditions could also

> > > > > > > worsen like heart failure and sleep apnea. So, not every man

> > > > > > > is a

> > > > > candidate

> > > > > > > for testosterone replacement. Those who are candidates have

> > > > > > > a few different modes of replacement like injections,

> > > > > > > patches, gels and bio-identicals hormones. One study showed

> > > > > > > that the testosterone patch delivering 7.5 mg per day was

> > > > > > > effective at normalizing testosterone levels and relieving

> > > > > > > symptoms of hypogonadism. In

> > > > > fact,

> > > > > > > that same study showed that pain intensity actually improved

> > > > > > > as

> > > > > the

> > > > > > > testosterone levels normalized. Testosterone-replacement

> > > > > > > therapy

> > > > > is

> > > > > > > probably the most underutilized, yet most often needed

> > > > > > > adjunct therapy for someone who is a long-term opioid user.

> > > > > > > Everyone, both men and women need to be more aware of the

> > > > > > > long-

> > > > > term

> > > > > > > effects that opioids have on the human body. Testosterone

> > > > > > > and all the hormones related to the hypothalamic-pituitary

> > > > > > > axis (thyroid, adrenaline, and sex hormones) have the

> > > > > > > potential for becoming abnormally low. At some point, these

> > > > > > > hormonal imbalances have the potential to affect quality of

> > > > > > > life more than the pain itself. At that point, the risks of

> > > > > > > long-term opioid use needs to be re- evaluated because the

> > > > > > > risks might outweigh the benefits. At some point, opioid pain

> management might not be worth the price.

> > > > > > >

> > > > > > > We comply with the HONcode standard for trustworthy health

> > > > > > > information: verify here.

> > > > > > > About Us |

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> > > > > > > By using this service, you accept our Terms of Use. Please

> > > > > > > read them. The consumer health information on is for

> > > > > > > informational purposes only and is not a substitute for

> > > > > > > medical advice or treatment for any medical conditions. You

> > > > > > > should promptly seek professional medical care if you have

> > > > > > > any concern about your

> > > > > health,

> > > > > > > and you should always consult your physician before starting

> > > > > > > a fitness regimen. Copyright © 2012 Remedy Health Media,

> > > > > > > LLC. .

> > > > > > >

> > > > > > > Current Opinion in Endocrinology & Diabetes:

> > > > > > > June 2006 - Volume 13 - Issue 3 - p 262-266

> > > > > > > doi: 10.1097/01.med.0000224806.08824.dc

> > > > > > > Androgens

> > > > > > > Opioid-induced androgen deficiency l, Harry W & #65532;

> > > > > > > Abstract Purpose of review: Opioid-induced androgen

> > > > > > > deficiency has become

> > > > > one

> > > > > > > of the most common causes of testosterone deficiency among

> > > > > > > men in many communities. Its increase parallels the large

> > > > > > > increase in opioid use. This form of hypogonadotrophic

> > > > > > > hypogonadism is present in most men chronically consuming

> > > > > > > sustained-action opioids, including those receiving

> > > > > > > methadone for heroin addiction and those consuming opioids

> > > > > > > for control of either malignant or non-malignant chronic

> > > > > > > pain. A similar, but less well defined illness occurs in

> > > > > > > women. Opioid-induced androgen deficiency is not widely

> > > > > recognized.

> > > > > > > This review examines its pathophysiology, some of its signs

> > > > > > > and symptoms, and indicates some areas where current

> > > > > > > observations suggest additional investigations would be fruitful.

> > > > > > > Recent findings: Recognition of opioid-induced androgen

> > > > > > > deficiency in men not receiving methadone for heroin

> > > > > > > addiction is a new observation, and in these men contributes

> > > > > > > to fatigue, depression, vasomotor phenomena, anemia,

> > > > > > > diminished libido, erectile

> > > > > dysfunction

> > > > > > > and osteoporosis. These signs and symptoms improved during

> > > > > > > testosterone replacement therapy in several small

> > > > > > > non-placebo- controlled trials.

> > > > > > > Summary: A large majority of men consuming sustained-action

> > > > > opioids

> > > > > > > have symptomatic androgen deficiency which apparently

> > > > > > > responds to replacement therapy. Opioid-induced androgen

> > > > > > > deficiency is frequently overlooked, with its symptoms

> > > > > > > attributed to underlying disease states including malignant

> > > > > > > disease, chronic back

> > > > > disorders,

> > > > > > > HIV disease, and psychosocial illnesses contributing to

> > > > > > > opioid habituation.

> > > > > > > © 2006 Lippincott & Wilkins, Inc.

> > > > > > >

> > > > > > > - 65 yo super ob., fastidious male - 12mm X 13mm rt.

> > > > > > > a.adnoma with previous rt. flank pain. Treating with DASH.

> > > > > > > Stats w/o meds = BP 175/90 HR 59 BS 125. D/C Spironolactone

> > > > > > > 12/20/2011 due to

> > > > > adverse

> > > > > > > SX.

> > > > > > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19,

> > > > > > > DM2, Gynecomastia, MDD and PTSD.

> > > > > > > Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg

> > > > > aspirin

> > > > > > > and Metformin 2000MG. Started washing Spironolactone

> > > > > > > 12/20/11 to prepare for AVS.

> > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > > >

> > > >

> > >

> >

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