Osteoporosis

[Riverwind (imported)]

Yes once again its time to post on this subject. I think in the past I kind of poo pooed some of the comments made and I want to apology to any I may have offended at that time.

The bone density screening I had is in.

There is a lot of tech talk but the bottom line is I have Osteoporosis of the spine and osteopenia of the hip. Increased risk of spontaneous fracture.

So, I will start a drug that is taken once a week in the morning with water. Don't know the name of the drug yet but will post it when I get it. It must be one hell of a drug that you only take it once a week.

I am glad that I insisted that I have the bone screening and any of you who are eunuchs should do the same on a regular basis. Remember the younger you are the worse it will be.

I will keep all informed as I find out more about the drug and its effect.

[BossTamsin (imported)]

The name of the drug is most likely Fosamax. It's relatively new, and you only take it once a week. Sounds pretty good, actually. A lot better than the daily ones out there. (And possibly cheaper, too.)

From what I've been able to hear, it's pretty damn effective, too.

Sorry to hear about the osteo news though. Take the meds, maybe start a light workout regimen, and definitely start taking those calcium suppliments. Things should start looking up then.

[Christina (imported)]

Hi Riverwind,

I am curious, is the osteoporosis you have something that runs in your family, or is it the result of your recent chemical/physical castration? Other than the fact that you are a eunuch, are there any other reasons that promted you to get a bone density test?

This brings up another question:

At what point should one consider a bone density test after being chemicaly/physicaly castrated?.....6 months, a year, two years?

I am sorry to hear of this recent problem. I hope you have a doctor that will take good care of you.

Huggs

[Riverwind (imported)]

Fosamax is what it is and yes you take it once a week. I am also taking 1000 u of calcium daily. Excersize is in progress with my son bugging me

[Riverwind (imported)]

I just got back the blood test the doctor ran, he checked for everything he could think of and everything checked out OK. My testosterone level is less then 20 which is were the scale starts. I requested the bone density screening and the doctor agreed. The result was that I do have osteoporosis and we will deal with it. It is from the castration or more specific the loss of testosterone.

[BossTamsin (imported)]

Hi Riverwind,

This brings up another question:

At what point should one consider a bone density test after being chemicaly/physicaly castrated?.....6 months, a year, two years?

Ok. My personal recommendation is that you get a bone density screening as soon as you have been castrated. It may not point out any problems immediately, but it will at least give you a baseline to work from.

Once you have done that, even if you keep up with the exercise and calcium, you should probably consider yourself in a 'high risk' category for osteoporosis, and get rescreened on a yearly basis. (Every other year, at the outside.)

Better safe than sorry.

[Andrew (imported)]

Yes once again its time to post on this subject. I think in the past I kind of poo pooed some of the comments made and I want to apology to any I may have offended at that time.

The bone density screening I had is in.

There is a lot of tech talk but the bottom line is I have Osteoporosis of the spine and osteopenia of the hip. Increased risk of spontaneous fracture.

So, I will start a drug that is taken once a week in the morning with water. Don't know the name of the drug yet but will post it when I get it. It must be one hell of a drug that you only take it once a week.

I am glad that I insisted that I have the bone screening and any of you who are eunuchs should do the same on a regular basis. Remember the younger you are the worse it will be.

I will keep all informed as I find out more about the drug and its effect.

I have long insisted that osteoporosis is, or should be, the #1 health concern of us eunuchs as we age. I had my first DEXA bone density scan one month after castration to set up a baseline, and my Physician wants me to have a bone scan every two years, just like her post-menopausal women patients. My secnd DEXA should there fore come in June 2003.



AT that, I would have grave doubts that your osteoporosis was brought on by your hypogonadal situation since starting androcur a year ago. It does not develop THAT fast. You may have other reasons for this problem that should be discussed with a Physician who knows something about menopause.

[Riverwind (imported)]

Andrew said,

I have long insisted that osteoporosis is, or should be, the #1 health concern of us eunuchs as we age.

I totally agree that as soon after castration a bone scan should be taken and then again at least every 2 years but I am sure in my case my doctor may want it again in a year.

I guess what Andrew, IEunuch and now what I am are saying is that this is very real and should be your #1 health concern after castration.

I would like to add that the one pill a week taken with a full glass of water on an empty stomach is not fun, I feel it burning I know right were its at. I am glad I only take this once a week.

River.

[MarriedUnik (imported)]

Riverwind,

Sorry to hear about the osteoperosis, but we're definitely glad to know that you found out now instead of later.

As a eunuch, I have several questions about it.

I was curious to know what the doc's feelings are about how effective the treatments will be. Do they believe that this medication will control it, or reverse the effects? Or just hold it in place from getting any worse?

As a contractor, I have no insurance, all medical expenses are coming out of my pocket. So I was also wondering, what is involved in a bone density scan, and what (roughly) does it cost? Also the cost of the medication?

These are concerns that have haunted me in the back of my mind ever since I first decided to go through with the castration, but I was so determined at the time to "just do it" that I pushed all that aside in my mind, telling myself, "we'll cross that bridge when we come to it". The desire to be castrated was too strong to let anything like that dissuade me at the time. Now, however, I must face these issues, instead of ignoring them. I've researched a lot about osteoperosis, but still have lots of questions. Same as with castration: no matter how much you research it, experiencing the reality is far more than words on paper from a "research publication".

Tammie and I are both wishing you the best, and hoping that you will come through this OK, happy and healthy.

[JeffEunuch (imported)]

There seems to be a lot o' ignorance re. osteoporosis out there. Firstly, it doesn't just crop up suddenly upon castration. If individuals are suffering from it that have recently been castrated, the disease undoubtedly commenced long ago. It might occur in individuals suffering from hypogonadism (low testosterone) that might have preceded their castration by years if not decades. I've known even young guys suffering from osteoporosis that are intact with 2 functioning gonads and even adequate testosterone levels (congenital in that case).

However, those who've been castrated would be advised to get tested. Nothing like a little preventive medicine, and castration undoubtedly adds to one's risk levels. I was tested last year and was 110% of a 21 y.o. female, the standard. My bones are healthy, but they advise that I repeat the test every 2 years. It cost C$26 at the Osteoporosis Society of BC.

[daifu-orchid (imported)]

Pardon the necropostia, but I just went for my annual physical, and the doc considered that I should do without T, as he thinks it caused a genital dysphoria. He denied the importance of T to bone health, and thought that if I lacked energy to exercise, I should be started on an antidepressant.

I was greatly surprised at this view, as it seems out of keeping with current views here, and the bone health thread above.

Has best practice changed recently, or did I just find an unusual opinion?

I like my bones, and hope they stay good!

How is it with you?

[Wolf-Pup (imported)]

When I was Low T for however many years, it led to Osteopenia which is one step above osteoporosis. I went on bone pills (Boniva) and Testosterone. Took a few years, but my bones returned to normal. I still take T and calcium supplements.

At a minimum, I'd get a second opinion.

[JesusA]

Antidepressants will not increase bone mineral density. If one is castrated, then they become deficient in not just T, but also estradiol (E2). It is primarily E2 and not T that protects the bones from demineralization and becoming fragile (i.e., osteoporosis).

When women go through menopause, their E2 levels naturally drop...and their risk of osteoporosis goes up.

Men have E2 in their bodies too, which the aromatase enzyme in our bodies makes directly from T. So, when a male is T deprived—as, say, a prostate cancer patient on androgen deprivation therapy or as a voluntary eunuch—he doesn't have enough T to convert to E2 to protect the bones.

A solution here can be taking a bit of add-back E2 through the skin to replace the E2 that would be produced from T. There are E2 cutaneous patches and gel products primarily sold to menopausal women. But they can also be used by men at risk of osteoporosis. [Note: one should avoid oral estrogens as they increase the risk of blood clots. Taking E2 through the skin appears to be safer.]

Granted one can also take oral drugs like Fosamax (bisphosphonates), but drugs of that class have their own side effects. And there are other oral agents (e.g., Denosumab—trade names Prolia and Xgeva) that can be used to treat osteoporosis. Again, they have side effects.

One other thing that helps protect the skeleton from become fragile is exercise that involves impact loading. That is sports like running, tennis, racquet ball. But one should check with their MDs about whether it is safe to exercise.

Exercising is easier if one has others to do it with.

The merits of exercise for androgen-deprived males is discussed in the book Androgen Deprivation Therapy. There is a whole chapter on exercise there; e.g., what are safe ones do to, what is a reasonable level.

Exercise also helps with mood. I thus would recommend getting to the gym and working hard enough to sweat as an alternative to taking anti-depressants. But if one is too depressed to get to the gym, then one could take an anti-depressant to help get oneself activated. But, to cycle back to where this started anti-depressants alone will not protect bone.

[daifu-orchid (imported)]

Fortunately, I am active, exercise, and currently I believe, well.

I posted the good Dr's advice as it seemed to differ significantly from "received wisdom", and what I remembered of 17-ketosteroid chemistry and physiology a long time ago.

(Not generally a great fan of Wikis for reliability, but here is a wonderful but terse summary of Testosterone, chemistry, physiology, including normal levels:

https://en.wikipedia.org/wiki/Testosterone )

Reluctantly, I suspect that the core of this encounter was the reluctance of my good Leech to deal with issues so freely discussed here on EA. Special thanks to all the crew of EA for making this unique meeting place possible!

[Begoneboy (imported)]

Way back when I was still extremely physical with the everyday endurance issues of blue water cruising after removal of the testes et all I began to notice loss of some of that endurance and stamina as I've shared before. As well as some diminished strength so began thinking of the possibility of bone density loss while pondering how to regain those other attributes I felt quietly slipping behind in the waves. I read a good bit of what the "T" levels didn't do for bone density and how it was a certain amount of "E" produced in all humans male or female that aided in keeping bone density at youthful levels. Hence, I began daily taking some "E" and to my surprise those attributes that had slipped behind began returning. So I reasoned with myself that I shouldn't be overly concerned about loss of bone density as long as I kept up with taking some "E". OK, full disclosure, I perhaps overdid the "E" which certainly brought about other physical and maybe even mental change over time. However, my most recent DEXA results indicated my bone density was that of a young adult as had the couple DEXA results I had previously. So yes, it is something that we should all be concerned with whether castrated or not. As age is not very kind to the many functions of our bodies.

[seanthomas (imported)]

Special thanks to all the crew of EA for making this unique meeting place possible!

Ditto daifu-orchid, although there is plenty of "fluff" here it's a tremendous resource for all things castration related. I had actually created my own blog before finding EA primarily because none of the real questions I had when deciding to undergo castration were answered elsewhere. No matter the source it was the same generic information and even my doctor seemed to simply plagiarize Wikipedia.

Disappointing that my urologist never mentioned bone density loss when he took me off TRT, but then as always I did my own research. As a no-testosterone Eunuch I take 1000IU of calcium daily and do my best to work out at least twice a week and walk at least a mile each day to stave off bone density loss. Although castrated only a few years ago I was probably androgen deficient several years before. I suppose that means I had better schedule the bone density test pretty soon.

[Wolf-Pup (imported)]

EA is great you get personal experience (me) with book knowledge (Jesus) as well as others. Most other sites you will get a bunch of guess and hearsay

[kastranja (imported)]

[Note: one should avoid oral estrogens as they increase the risk of blood clots. Taking E2 through the skin appears to be safer.]

Thanks Jesus for this good and comprehensive summary.

One thing I would like to add: According to newer trials and surveys, the risk for blood clots taking newer pharmaceutical forms of estradiol (E2) does not seem to be higher than without estradiol replacement.

The higher risk obviously was connected to taking ethinyl estradiol, a variant used widely before ca. 2005. It has a higher potency and different pharmacokinetic properties. It is more widely used in contraceptiva and has received some attention and controversy due to blood clots, embolism and maybe deths of women taking it for birth control.

Newer forms like estradiol hemihydrate (unconjugated estrogen, also called 17beta-estradiol or E2) do not show a much increased risk for venous thrombosis events. See https://doi.org/10.1016/j.jcte.2015.02.003 and other papers on the topic of HRT in transgender patients. It looks also (according to that paper) as though there might be a predisposition for higher thrombosis risk on estradiol stemming from a specific genetic defect.

I myself am taking 1-2 mg oral 17beta-estradiolhemihydrate since about 24 months, after I had been castrated 28 months ago now. I had a bone density scan done shortly after the castration and am planning to get the next one towards the end of this year. I mainly started the estrogen because of the severe hot flashes which prevented me from sleeping about three months after the castration. I am also welcoming the feminizing effects, although I consider myself non-binary and not trans female.

I am currently trying to get a prescription from an endocrinologist, but that is a bit difficult as long as you do not identify as m2f, at least in Germany.

[Fixet (imported)]

I have Osteoporosis, lumbar T -3.4 and hip -2.5

I started to using estradiol patch (systen 50), and my last dexa scan using estradiol for 11 months i hadgood improvement.

my lumbar is -3.0 and hip -2.4 overall 8% improvement i believe.

[Jan_Linde (imported)]

After I had been castrated I got a lecture from my doctor about the risk of osteoporosis, part of the reason I now take low dose testosterone replacement. He also recommended weight bearing exercises and running as a way to keep up bone density.

[wishtobe (imported)]

Hi one and all.

When I was castrated in 2010, my endocrinologue wanted me to have bone scan straight away so that he had a base line to work with.

Every year I have yearly check up with complete blood work and he checks my T levels. I am on Sustanon 250 1 injection (1ml) every 3 weeks.

2 years ago, he wanted me to have a bone scan to see where I was. All was still ok.

On my last blood test I told him that I was still to horny and that I had cut the dose in 2. .5ml every 3 weeks. I told him that I did not want the Sustanon and that I would prefer a very low dose of E, but he did not like the idea.

For the time being I have stopped my injections since the last 3 months, and I feel even better without the T. But I guess that I will either have to go back on the T or find a way that I can have a low amount of E.

Bottom line... A eunuch is like an elderly woman and must watch out and get checked up on a regular basis for osteroporosis.

[daifu-orchid (imported)]

I am sure this is right, but my recently ex-PCP could see no connection between bones and HRT. Fortunately my endo has the more accepted view.