How Does Testosterone Replacement Therapy Affect Relationships?
A Questionnaire For Spouses or Partners of Low T Therapy Patients
1. Does your spouse have significant mood swings or a change in his personality that coincides with his testosterone therapy?
2. Do the mood swings and/or personality changes lessen at the end of his dose cycle?
3. Does he perceive that his mood is best just after taking his dose and then gets worse as he progresses through his dose cycle?
4. Do you perceive his mood swings to be just the opposite?
5. Does he become angry, anxious, aggressive and/or impulsive after taking a testosterone product?
6. Has he become more demanding and less considerate in regards to sex?
7. Do you think the testosterone treatment is damaging your relationship?
8. Does your husband deny that the testosterone replacement is damaging your relationship?
9. Does he claim that any damage to the relationship is because you have changed?
10. Has he become violent?
11. Has be become jealous of your relationships with your family and friends?
12. Have you curtailed seeing family, friends or involvement in social activities to please him or because his behavior has become embarrassing?
13. Does he insist on knowing and controlling every aspect of your life?
14. Is he disappointed in most everything you do?
15. Are his friends and family avoiding him or “walking on eggshells” when around him?
16. Does he try to keep his testosterone dosing schedule or dosage amount secret from you?
17. Does he become overly irritable when you want to talk about testosterone therapy?
18. Does he seem to compromise the blood test results by misrepresenting his last dosage, or the day count since his last dose?
19. Do you think he is addicted to testosterone?
20. Does he have a renewed interest in addictive substances from his younger years such as tobacco, alcohol, or recreational drugs?
21. Are you thinking of, or have you already started separation or divorce proceedings because of testosterone therapy?
22. Has he lost a job because of the mood swings or the personality change?
23. Has he been arrested because of irrational behavior brought on by the mood swings or the personality change?
24. Are you afraid he will catch you reading this blog?
Low T Therapy Changes Behavior
Many patients taking a testosterone product report that they feel a euphoric sensation while other patients do not. All seem to agree that after a few or many hours they will have more energy, and feel more confident and powerful. A few patients say they feel irritable or angry but the overall feeling is still good because of the extra energy and confidence. Other people in the patients life are more likely to notice irritability and anger shortly after the dose cycle starts. A general personality change may also be present, as the TRT (Testosterone Replacement Therapy) patient becomes more self-centered, impulsive and aggressive. For most men, the first three days after a shot seems to be the most intense, then the effect gradually lessens over the next week or two until the next dose.
The wife will usually start off with the idea that the doctors know best, and it is medically necessary for the husband to take testosterone. It may also take time for the wife to realize the testosterone is the cause of the mood swings and personality changes, and just how badly these are affecting many aspects of her husbands life. Wives that are reporting the more severe mood swings describe their husbands behavior as being similar to Dr. Jekyll and Mr. Hyde. Their husbands lose their tempers easily, are moody, mean, and often depressed. They are likely to become more impatient and critical of others. They can become very demanding and inconsiderate about sex.
It is typical for the spouse to react to the husbands mood swings by modifying her own behavior. She is likely to try several different tactics in an effort to find a way to save their relationship. She might try being aggressive like her husband, and when that doesn’t work she may try being passive. She may try to sooth her husband by giving him more of her attention, and when that doesn’t work, she may try avoiding him. When she understands that his behavior is being driven by testosterone, she may fluctuate between being tolerant and then sometimes demanding he seek medical help. She may try to find some relief by drinking or taking drugs. She might sleep a little longer in the mornings, or make appointments elsewhere first thing in the mornings if that is when he is most wound-up. When he wants to debate anything and everything, she might try to agree with what he was says and then be quite baffled when he finds something else to argue about. If she just repeats back what he said or just agrees with him, he might be angered because she was patronizing him. She may use his mood swings to improve herself, focusing on her own weakest points in her reactions to him; such as intolerance to rudeness, or being sensitive to criticism, or having to correct him when he was wrong, or not having a sense of humor about it all.
A Yale School of Medicine study shows that a high level of testosterone, such as that caused by the use of steroids to increase muscle mass or for replacement therapy, can lead to a catastrophic loss of brain cells. The senior author of the study, Barbara Ehrlich, is a professor of pharmacology and physiology. She said “Taking large doses of androgens, or steroids, is known to cause hyper-excitability, a highly aggressive nature, and suicidal tendencies. These behavioral changes could be evidence of alterations in neuronal function caused by the steroids. …Next time a muscle-bound guy in a sports car cuts you off on the highway, don’t get mad, just take a deep breath and realize that it might not be his fault.”
From the ScienceDaily article : “Elevated Testosterone Kills Nerve Cells” by MLA APA Chicago, Yale University, ScienceDaily, 27 September 2006, author Barbara Ehrlich and co-authors Manuel Estrada and Anurag Varshney, “The researchers showed that high levels of testosterone triggered programmed cell death in nerve cells in culture. Cell death, or apoptosis, is critical in many life processes, including development and disease. It is characterized by membrane instability, activation of caspases, which are the executioner proteins in apoptosis, change in membrane potential, and DNA fragmentation.”
How is Low Testosterone Diagnosed?
A low testosterone level for one man may be normal for others. A man’s levels will usually peak during his late teens and early twenties and then levels normally fall by only 1 to 2 percent per year after age thirty or forty. There is little evidence that an age-related reduction of testosterone levels in men causes specific symptoms. The Endocrine Society states that low testosterone, otherwise known as hypogonadism, should be diagnosed “…only in men with consistent symptoms and signs and unequivocally low serum testosterone levels, …the threshold testosterone level below which symptoms of androgen deficiency and adverse health outcomes occur and administration improves outcomes in the general population is not known.”
Hypogonadism that is not related to the normal aging process is divided into two types, primary and secondary. Primary originates from a problem in the testicles while secondary indicates a problem with the hypothalamus or pituitary glands, the parts of the brain that signal the testicles to produce testosterone. Either type of hypogonadism may be caused by an inherited trait or by injury or an infection. At times, primary and secondary hypogonadism can occur together. Therefore, a complete diagnosis for starting Testosterone Replacement Therapy (TRT) should include an examination of the testicles and an MRI of the brain to check if the pituitary and hypothalamus glands are normal.
Testosterone levels decrease with the weight gain from a sedentary life style; even fifteen pounds can make a huge difference. Overweight men should lose their extra weight to see if that corrects the problem before they resort to TRT. The use of certain drugs, such as opiate pain medications and some hormones can lower testosterone production. If a man is up all night, the next day his testosterone will be very low. If he eats a big meal, that can also affect his testosterone level. Any kind of underlying disease can lower his level. The reproductive system can temporarily shut down due to the physical stress of an illness or surgery, as well as during significant emotional stress.
Testosterone levels fluctuate throughout the day and are usually at the highest in the morning. The test values may fluctuate by a few hundred na/dls (nano grams per deciliter) in any given day. Fifteen percent of healthy young men will have a testosterone level below the normal range in any 24 hour period. That is why the Endocrine Society, in its clinical practice guideline: “Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes” emphasizes that “…day-to-day variations in serum testosterone concentrations were found to be sufficiently large so that single testosterone measurements were inadequate to characterize an individual’s levels, and at least two testosterone measurements were needed to diagnose androgen deficiency with greater confidence.”
The serum total testosterone concentration decreases from an average of about 600 ng/dL at 30 years of age to an average of about 400 ng/dL at 80 years. The normal range is large at all ages, and the high and low values decrease as a man ages. In younger men, the low end of the normal range is generally considered to be around 300 ng/dL, and that is often the level recommended as the point to start therapy by those advertising a cure for Low T. That value is not taking into consideration the natural decline for age. Many in the medical field believe a healthy range spans between 250 to 1,100 ng/dl for a young and healthy male. It was estimated in the British Medical Journal that only 0.1 percent of men in their forties, 0.6 percent in their fifties, 3.2 percent in their sixties and 5.1 percent in their seventies would meet the criteria for the diagnosis. Many of those meeting the criteria for testosterone deficiencies are not due to aging, but are caused by primary or secondary hypogonadism.
Doctors advise that men at risk for low testosterone would have low libido, sexual dysfunction, osteoporosis, and/or new breast sensitivity. Their testosterone levels should be measured two or three times and confirmatory tests should be taken to measure other hormones that regulate testosterone and sperm production in the testicles.
Lower testosterone in older men may be a positive benefit because the body of an older man may not be able to withstand the abuse that a younger, more aggressive man with higher testosterone levels could handle. According to the American Association of Clinical Endocrinologists, “…as many as 30 percent of men older than 75 have a testosterone level that’s below the normal range of testosterone in younger men. Whether treatment is necessary remains a matter of debate. Science has not proven that TRT for age-related testosterone decline is of any medical value. Yet, the pharmaceutical companies have turned an age-related hormone decline into a disease.”
General Information on Low T and Testosterone
In 1889 neurologist Charles-Edouard Brown-Sequard announced that injections of liquified pig and dog testicles improved his strength and health.
Because of misleading advertisements, those affected by TRT need to learn about Low T Therapy, it’s side effects, and what the lab tests mean. The pharmaceutical companies use questionnaires on promotional websites and in the doctors’ offices. The questions asked are very general, leading the persons taking the test to believe they may be at risk for Low T simply because they do not sleep well and are often tired. Unfortunately many doctors are not aware that testosterone is causing havoc in their patients lives. They do not monitor the patients blood tests close or often enough, and are using guidelines for the test results that have very little scientific verification. The male that is now feeling younger and stronger is unlikely to complain to his doctor about the problems he is experiencing at home or in other aspects of his life. The drug companies might know, but they are making billions of dollars. They barely mention the psychological side effects of their testosterone products. Testosterone Cypionate adverse reactions for the nervous system only lists “increased or decreased libido, headache, anxiety, depression, and generalized paresthesia”.
With all these circumstances in place, it is hard for the patient or his wife to find reliable information on TRT. A normal 60 year old male should have testosterone blood levels that are much lower than what a 20 year old would have. Yet the test results from the laboratories frequently do not even consider age. They also do not explain to us that there is no scientific proof of any particular blood level value that defines when testosterone is too low. What will cause discomfort in one man will not be the same for another. Men that have had surgical removal of their testicles have been able to quit taking testosterone therapy without any medical harm.
The New York Times “F.D.A. Panel Backs Limits on Testosterone Drugs”, September 17, 2014 by Sabrina Tavernise
“An expert panel voted overwhelmingly on Wednesday for the Food and Drug Administration to impose strict new limitations on the multibillion-dollar testosterone drug industry, recommending that the agency tighten labels for the medicines so they are not prescribed to men who only have problems related to aging, such as low energy and libido. The F.D.A. often takes the advice of such panels…Panelists said the label should be limited to men with serious medical conditions, such as pituitary gland problems. A fifth to a quarter of men who are prescribed testosterone have not had a baseline test of their testosterone level. And 60 percent of the prescribing is done by primary care doctors, while just 20 percent of the drugs are prescribed by specialists like endocrinologists and urologists.”
The Pharmaceutical Companies Pharmaceutical Company journal ads promote not only products but also its hundreds of thousands of subsidized “educational opportunities” to doctors. Drug and medical-device makers spend $2 billion annually for more than 300,000 seminars and training opportunities, often held in the Bahamas or the Caribbean. This is an observation made by Marcia Angell, MD, professor of social medicine at the Harvard Medical School, former editor-in-chief of the New England Journal of Medicine (NEJM), and the author in 2004 of “The Truth About the Drug Companies: How They Deceive Us and What to Do About It”. The Abbott drug company developed an ad using a self-evaluation test on a website for Low T. The symptoms listed on the test were generally the complaints most elderly people experience. Most people would assume by the results that they were experiencing Low T. Abbott didn’t put its own or its product’s name on the website. One of the advantages of taking the unbranded route for advertising AndroGel is that the company does not have to warn consumers quite so prominently about AndroGel’s side effects.
In the Huffington Post article “Testosterone Marketing Frenzy Draws Skepticism”, Matthew Perrone wrote: “Welcome to the latest big marketing push by U.S. drug companies. In this case, it’s a web page for Abbott Laboratories’ AndroGel, a billion-dollar selling testosterone gel used by millions of American men struggling with the symptoms of growing older that are associated with low testosterone, such as poor sex drive, weight gain and fatigue.” The article goes on to state, “…’The problem is that we don’t have any evidence that prescribing testosterone to older men with relatively low testosterone levels does any good,’ says Dr. Sergei Romashkan, who oversees clinical trials for the National Institute on Aging, a part of the National Institutes of Health conglomerate of research centers.”
The Drugwatch website states that “The U.S. Food and Drug Administration (FDA) approved AndroGel to treat hypogonadism, but the drugmaker allegedly recruited doctors to help AndroGel ride (the) coattails of Viagra by encouraging them to screen patients seeking Viagra for low testosterone. A former sales manager involved in the lawsuit attributes AndroGel’s high sales to the company’s decision to promote the drug for off-label uses even though it isn’t approved to treat erectile dysfunction (ED) like Viagra is.”
Citations and Recommended Reading:
It is important that a spouse inform her husbands’ doctor about changes in his behavior. Many doctors are sensitive about the accuracy of their diagnosis, but much useful information can be conveyed in the form of questions. It is best to become as educated as possible before a visit to the doctor. The medical community is divided in regards to how they diagnose Low T and how it should be treated. Often the doctors will not agree on the answers to many of the following sample questions. The answers they give will show what side of the Low T controversy they are on, if any. Their answers can also be used as an indication of their level of expertise regarding TRT and hypogonadism. It is perfectly valid to ask questions you already feel you know the answer to. These questions may also benefit the Low T patient by contradicting the misleading advertising they have heard.
If the doctor gives a logical medical reason for something that you don’t agree with, it is important to be courteous and ask more detailed questions, take notes, and keep an open mind. This may be something you need to research further. Many times the Low T patient is under the impression that the Low T therapy is a medical necessity or that he must adhere to it for the rest of his life. Many times if the patients’ partner can ask the doctor about this necessity, it will dispel that belief. If a doctor answers questions in a patronizing way or does not address your concerns, it may be time to find a new doctor or get a second opinion.
Some doctors accept money from pharmaceutical companies and that tends to create a conflict of interest. To see if your doctors are accepting money or gifts from the drug companies, check their names at the “Dollars for Docs” page at the web site http://projects.propublica.org/docdollars/ . For information on malpractice lawsuits, contact your state’s medical board and search through posted information. If choosing a new doctor, you can usually find some biographical information about him or her on the doctors’ own website. The description of his practice will sometimes show that the treatments for Low T patients are being heavily promoted. The doctors specialty does not indicate what his own beliefs will be on the topic.
There are Low T clinics in some states, most significantly Texas, that do not have doctors on staff and routinely sell their clients a testosterone product using only a blood test to diagnose Low T. They are not concerned with family history of cancer, heart problems, prior addictions, testing for PSA, or evaluating the rest of the endocrine system.
Sample Questions for the Doctors
1. Is long term use of testosterone dangerous?
2. Does the patient continue Low T Therapy if he gets prostrate cancer?
3. Under what circumstances should therapy be discontinued?
4. What is the danger from stroke and heart attack?
5. At what blood testosterone level is the TRT recommended?
6. Has the patients own glands quit producing to the point it is medically necessary or is he going through the natural age related decline?
7. What are the appropriate test results for the patients’ age?
8. Is an MRI to check the pituitary and hypothalamus glands advisable?
9. How do drugs such as opiates affect testosterone blood levels?
10. How does being 15 pounds or more over weight affect testosterone blood levels?
11. How does missing sleep affect testosterone blood levels?
12. Is testosterone use addictive?
13. If a person has had previous problems with drugs or alcohol, is that an indication that they may become addicted to testosterone?
14. What are the indications that a person has become addicted?
15. Is the illegal use of testosterone by body builders ever considered as an addiction?
16. How long should a patient remain on Low T Therapy?
17. Do the testicles quite making testosterone when it is given medically?
18. Do the testicles start making testosterone again when treatment is discontinued?
19. How long does it take after Low T Therapy has been stopped before the testicles are at their full production again?
20. Do other glands make testosterone?
A forum at medhelp.org under the string of “How Much Testosterone is Too Much” has comments and advice from both wives and Low T patients. Wives are experiencing problems with the mood and personality changes of their spouses or significant others during treatment. Low T therapy patients on the forum are also seeking help for the mood swings they experienced. The male participants told of feeling addicted and loosing perspective of what was happening to themselves. Their craving for testosterone had impaired their ability to see the damage that this drug had done until it was pointed out to them or they had lost someone very dear to them.
If you are the spouse of a patient that is having the mood swings caused by Low T therapy, you are in a stressful relationship; so be kind to yourself. You are bound to be pushed past your breaking point occasionally, forgive yourself. Take good care of yourself; eat right, get enough sleep and have some fun time. With the changes in personality making the husband more demanding, controlling and possessive, it is harder for the spouse to do anything for herself. But that just makes it more important to have support from friends, family, a church group, a counselor or some sort of support group. The Al Anon groups for Alcoholics Anonymous or Narcotics Anonymous deal with addiction and domestic problems. They are available in most any community at no cost for anyone who wants to attend. Roid-rage is dangerous; the kind, good man you used to be with may not be able to control it. Have an exit strategy to find a safe place in case the situation threatens to turn violent.
Body Building, Steroids and Roid-Rage
Body builders typically use a combination of anabolic steroids that are synthetic substances similar to the male hormone testosterone. They may be taken as a pill, as a shot into a muscle, or as a gel or cream rubbed onto the skin. Common anabolic steroid medicines include fluoxymesterone with the brand name Halotestin and nandrolone with the brand name of Durabolin. Some people take legal dietary supplements that have certain steroid hormones also made by the human body. One such supplement is dehydroepiandrosterone (DHEA). The body can turn DHEA into other steroid hormones, including testosterone, estrogen, and cortisol. The doctors, pharmacies, and pharmaceutical companies do not inform us that anabolic steroids and testosterone have addictive qualities. Awareness of addiction problems are becoming most evident where the doses of testosterone are at the most extreme; within the body building community. Not all body builders use steroids, but those who do are known for their increased aggression.
The Tragic Story of Taylor Hooton
Taylor Hooton was a star pitcher on his high school team. He was a handsome teenager who had everything going for him until his steroid use caught up with him and he took his own life. It took a while for his parents to connect 16 year old Taylor’s rapid weight and muscle increases with his uncharacteristic mood swings and his random violent, angry behavior. They didn’t know that these and other symptoms, like the acne he had developed on his back, were signs of steroids use.
Taylor had always been a great son, a terrific athlete and had his act together. Taylor just wanted to make the varsity baseball team, and steroids had been recommended to him by some of his high school teammates as a way to get bigger faster.
Taylor Hooton’s parents and a doctor familiar with the case said they believe that Taylor’s death was related to depression that he felt after discontinuing the use of anabolic steroids. “It’s a pretty strong case that he was withdrawing from steroids and his suicide was directly related to that,” said Dr. Larry W. Gibbons, former president and medical director of the Cooper Aerobics Center, a leading preventive medicine clinic in Dallas. “This is a kid who was well liked, had a lot of good friends, no serious emotional problems. He had a bright future.”
While there are relatively few professional athletes that use steroids, recent studies estimate that as many as 2 million high school students admit to using anabolic steroids. Taylor’s father, Don Hooton, formed a non-profit foundation to raise awareness about the the scope of the steroid problem among America’s youth and to educate youth and their adult influencers. Today, the foundation is widely recognized as the national leader on the topic of youth usage of anabolic steroids and other Appearance and Performance Enhancing Drugs (APEDs). The foundation believes that parents, administrators and coaches need to become better educated and need to confront the issue more forcefully so that another tragedy may be prevented.
“Don’t tell me it’s not a problem, my kid just died”, said Don Hooton, who retired from his position as former director of worldwide marketing for HP’s telecom division in order to lead the foundation. The taylorhooton.org website is an exceptional resource for obtaining information on programs and events about steroids, the real stories of the victims of steroid abuse and much more.
A Wikipedia article for Anabolic Steroids, subheading “Neuropsychiatric”, states that,
“…A 2005 review in CNS Drugs determined that significant psychiatric symptoms including aggression and violence, mania, and less frequently psychosis and suicide have been associated with steroid abuse. Long-term steroid abusers may develop symptoms of dependence and withdrawal on discontinuation of AAS. High concentrations of AAS, comparable to those likely sustained by many recreational AAS users, produce apoptotic effects on neurons, raising the specter of possibly irreversible neuropsychiatric toxicity. Recreational AAS use appears to be associated with a range of potentially prolonged psychiatric effects, including dependence syndromes, mood disorders, and progression to other forms of substance abuse, but the prevalence and severity of these various effects remains poorly understood”.
For a complete list of anabolic steroids, how they are used, what side affects have been reported and much more, the following Wikipedia article is very comprehensive. For those of us that are not interested in its chemical structure, skip the first few paragraphs or use the sidebar as a shortcut to the topics most relevant.
Citations and Recommended Reading: