DEAR DR. ROACH: I am an 84-year-old Asian American taking trazodone, sertraline and temazepam as needed, as well as daily vitamins, and I weigh 130 pounds. My blood pressure ranges from 98 to 111 over 60. Four years ago, I had kidney cancer resulting in the removal of my right kidney. Two years ago, I had prostate cancer and underwent nine weeks of radiation treatments. My doctor gave me midodrine for blood pressure, but that has not helped.
My problem is, I am always tired and have no energy. My testosterone level is 0.03, and my PSA is 0.1 ng/mL. I eat a lot of carbs, but cannot put on any weight. My doctor will not prescribe any medication that might affect my PSA. Can you suggest anything I can do to help my situation? — D.E.
ANSWER: If you are using the standard units for testosterone (ng/dL), that number is very low. Testosterone works on many bodily functions, and very low testosterone can cause loss of muscle and bone. Your symptoms of fatigue and low energy are compatible with low testosterone, but are not specific for it.
There are many other additional causes, and I’m sure your doctor has looked for them (such as anemia and thyroid disease). One that deserves mention due to your symptoms and having had kidney surgery is low adrenal gland function (adrenal insufficiency), which requires special testing.
The issue of testosterone replacement in men with a history of prostate cancer is complex. Several small studies have shown that testosterone given to men with prostate cancer in remission did not worsen outcomes, although these trials are too small to provide confidence that the risk is negligible. Given the effect on your quality of life, it seems worthwhile to reconsider testosterone replacement, at least as a trial of effectiveness. It sounds like these symptoms are having a very significant negative effect.
DEAR DR. ROACH: I am 65 and in good health. I have worked out at the gym on and off for the last 35 years. I am able to lift or push the maximum weight on a half dozen weight machines at my gym. Should I begin to reduce weight settings as I age, or continue to push the limit? I had Achilles tendinitis after doing calf exercises a couple times, so I wonder if lifting heavy weights could lead to other problems down the road. What’s most important for overall health? — B.G.
ANSWER: I don’t know that there are data, so I have to give you my best judgment. I would say that reducing the amount of weight you lift will not reduce the benefits to your overall health, but will significantly reduce your risk of a muscle or tendon injury. There is strong evidence that weightlifting provides additional health benefits to aerobic exercise, but you certainly do not need to lift the stack to get health benefits. Any kind of weightlifting helps improve balance and reduces fall risk.
Weightlifting also helps with bone strength. Maximal weight lifting leads to greater strength increases, but since your goal is health, not competition, taking some weight off might reduce your risk of injury, even if it is small.
* * *
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
(c) 2023 North America Syndicate Inc.
All Rights Reserved

Copy the Story Link