Should older men ask for testosterone treatment?
DEAR DR. DONOHUE: I am in my mid-80s and looking more like a coat hanger every day. I’d like to slow the muscle loss down to a slow walk or at least hold my own. My doctor has no problem with me exercising, because I am pain-free and have no heart trouble. I work with weights and would like your advice about what exercises to do. In my opinion, a shot of testosterone would give me some of my muscles back. I don’t have a prostate gland anymore. It was surgically removed. I asked the surgeon about testosterone, and he said it might bring the cancer back. Back from where? The prostate gland has been in a landfill for 15 years. — W.J.
ANSWER: I’d give you a list of exercises for your upper and lower body, but the descriptions would be long and almost incomprehensible. Visit the sport section of a local bookstore, and you’ll find books with pictures galore on the proper techniques of weightlifting. These books are relatively inexpensive.
Your second remark is a topic much discussed by doctors. Younger males with testosterone deficiency definitely need to receive testosterone supplementation. For older men, arguments for and against its use are heated.
Around age 40, the output of testosterone begins to wane. By age 70, about 30 percent of men have a lower-than-normal blood testosterone level. Should these men be getting testosterone replacement?
Those who say yes cite a cessation of muscle loss and an increase in muscle size, an increase in bone strength and a restoration of sex drive as benefits from supplemental hormone. Realize, however, it doesn’t turn older men into 20-year-olds; it doesn’t stop men from aging; it doesn’t produce miracles.
Those who are against its use say it might increase prostate size and make urinating difficult. It could enhance the growth of undetected prostate cancer. In your case, neither of these is a huge risk, since your gland was removed. Some cancer cells might still be in your body, but the danger is not great. Advocates say that the side effects of testosterone replacement are not a huge health consequence if the dose of hormone only restores normal but not super-normal levels. Why not discuss this again with your doctor?
DEAR DR. DONOHUE: I am a veteran of submarine warfare and had both knees replaced 13 years ago. Charles Atlas inspired me to begin exercising in 1943, and I haven’t let up. At 83, I work out at a gym three days a week and walk the golf course three other days. I am 5 feet 9 inches tall and weigh 143 pounds. I do 15 minutes of heart exercise on a stationary bike and six different abdominal exercises of 150 reps each. Why has my waist ballooned from 29 inches to 35 inches? Is there any hope? — L.S.
ANSWER: There’s always hope. I don’t know why fat makes a beeline for the abdomen and not to other body sites. You’re not overweight, and I am not going to tell you to diet. You exercise more rigorously than do men half your age. I am continuing to look for an answer, and beg anyone out there who has one to send it to me. Most men are in the boat with you, L.S.
DEAR DR. DONOHUE: I write out of concern for the health of millions of people who are dieting to lose weight. On television, they show exercises, like treadmills and weights, that are totally wrong for these people and threaten their hearts. They want to lose weight and not their lives. — C.C.
ANSWER: At older ages, exercises, of any sort, can be a health threat unless people have obtained their doctor’s approval for them.
However, treadmill exercise is an excellent way to keep the heart healthy. Weightlifting is recommended even to those in their 90s.
Could you be a little more specific about your concerns?
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.