#MIDDLEBURY
By Keith Roach, M.D.
DEAR DR. ROACH: I had my prostate removed for prostate cancer in 2009 at age 70. I waited until now to start taking testosterone to feel better, because I was feeling very listless, with no sex drive. My cancer surgeon and urologist approved, and they are monitoring me every 60 to 90 days.
It is working very nicely. The injections are monthly. For many years I could not get to sleep, so for the past three years I have been using zolpidem 10 mg, and two months ago, I reduced it gradually to 5 mg. Is the testosterone responsible for my sleeping better, and can I gradually decrease the dose to stop it completely? Do you have any suggestions in addition, to help this effort? I am very physically active with aerobics and weights. – D.D.
ANSWER: First off, let me comment on taking testosterone with a history of prostate cancer. You probably do have an increased risk of prostate cancer recurrence due to testosterone treatment, but clearly your doctors and you have discussed it and they are watching you carefully. I have always believed that sometimes-risky treatments can be appropriate as long as you understand the risk, and it may be reasonable to take the testosterone given the symptoms you were having.
The effects of testosterone on sleep are variable. Sleep apnea (not breathing properly during sleep, often but not always related to being overweight) may get worse for some men taking testosterone. However, many men report an improvement in sleep quality, so it is possible that the testosterone is helping you.
As far as zolpidem goes, I strongly believe that most people should use the least amount of sleeping medication possible. I think it would be a good idea to try to get off it completely. Zolpidem, like virtually all sleeping medications, increases risk of falls, as well as having other possible side effects.
DEAR DR. ROACH: After an extreme case of vertigo, including vomiting and being taken to the emergency room, my unsteadiness remains. Over a week later, I need to use a walker to be safe. I am 79, and this happened once four years ago, but without the aftereffects. Any suggestions? – M.W.
ANSWER: The major causes of vertigo, acute labyrinthitis and benign paroxysmal positional vertigo, often continue to produce attacks that tend to lessen in severity up to a month after the initial severe attack. A walker may be a useful precaution while recovering. If the problem persists, I strongly recommend a visit with a physical and/or occupational therapist for vestibular rehabilitation, which is physical therapy to restore balance. It also might be necessary to revisit your doctor to make sure of the original diagnosis.
The booklet on vertigo explains this disruptive condition in detail and outlines its treatment. Readers can order a copy by writing: Dr. Roach, No. 801W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
Dr. Roach regrets 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. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803.
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