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        Cluster Headache Help and Support >> Medications, Treatments, Therapies >> Testosterone lack of progress note
        
(Message started by: Squanto on Mar 24^th, 2007, 7:30am)

Title: Testosterone lack of progress note
Post by Squanto on Mar 24^th, 2007, 7:30am

Hey,

A few months ago there were several threads here about use of testosterone supplement(s) and CH.

Here's a personal up-date:

After an unsuccessful trial of Lithium (no benefit and too many side effects) my neurologist (the only local "headache expert") declared he'd run out of therapeutic options. I'd previously brought up with him the possibility of trying testosterone. He was still reluctant to prescribe it (not much to go on from the journal article, and possible adverse effects.)

I talked to my endocrinologist (who's treating me for low TSH without symptoms.) After some blood work (my serum testosterone was found to be low normal, my PSA normal) , normal prostate exam, and no contra-indications she prescribed Androgel 2.5 mg applied daily.

I've been using it a month now.

Results: NO BENEFIT headaches are the same intensity and frequency (I'm chronic) as before beginning the testosterone.
Side effects:
(I'm joking here) more dark hair on my knuckles, urge to burp and fart in public, I'm telling more sexist jokes and spring football practice interests me more than it ever did before.
Actually, I haven't noticed any effect(s) at all.

Endocrinologist suggests I stay on the testosterone for 3 months to give it a good try. Personally, I think if I haven't notice any benefit after a month - it's likely I won't have any.

So, I'm striking off another therapy.

Seriously considering going on a trip to Amsterdam.

Squanto

Title: Re: Testosterone lack of progress note
Post by BB on Mar 24^th, 2007, 7:51am

Androgel 2.5 mg topical daily maybe too low. The dose I have seen the neurologists here use is 100mg injection weekly until the level is good again, usually for 4-6 weeks. There is a possibility that your endocrinologist doesnt know much about CH and has not prescribed the correct dose.

Also studies show that testosterone supplement for CH is more effective in those who have very low level, not so much for those with only slightly low level.

Annette

Title: Re: Testosterone lack of progress note
Post by nani on Mar 24^th, 2007, 7:56am

on 03/24/07 at 07:51:08, BB wrote:

The dose I have seen the neurologists here use is 100mg injection weekly until the level is good again, usually for 4-6 weeks.

Eur Neurol. 1985;24(1):53-6. Related Articles, Links

Use of testosterone in the treatment of cluster headache.

Klimek A.

The study was carried out on 15 men suffering from the episodic form (12 patients) and the chronic one (3 patients) of cluster headache. Before treatment the patients did not receive any drugs, and after determining the index of attacks the treatment was commenced. For 7-10 days patients were given testosteronum propionicum (25 mg) once a day intramuscularly, and then for the same period of time testosterone (10 mg). Before treatment the index of attacks was 3.66 (total number of attacks 30. In the 1st week of treatment the index decreased to 1.11 (total number of attacks 94) and to 0.16 in the 2nd week. In 3 patients with the chronic form of cluster headache testosterone was ineffective.

PMID: 3967676 [PubMed - indexed for MEDLINE]

Testosterone Replacement Therapy for Treatment Refractory Cluster Headache
Mark J. Stillman, MD
Objectives.—To describe the clinical characteristics and laboratory findings of cluster headache patients whose headaches responded to testosterone replacement therapy.

Background.—Current evidence points to hypothalamic dysfunction, with increased metabolic hyperactivity in the region of the suprachiasmatic nucleus, as being important in the genesis of cluster headaches. This is clinically borne out in the circadian and diurnal behavior of these headaches. For years it has been recognized that male cluster headache patients appear overmasculinized. Recent neuroendocrine and sleep studies now point to an association between gonadotropin and corticotropin levels and hypothalamically entrained pineal secretion of melatonin.

Results.—Seven male and 2 female patients, seen between July 2004 and February 2005, and between the ages of 32 and 56, are reported with histories of treatment resistant cluster headaches accompanied by borderline low or low serum testosterone levels. The patients failed to respond to individually tailored medical regimens, including melatonin doses of 12 mg a day or higher, high flow oxygen, maximally tolerated verapamil, antiepileptic agents, and parenteral serotonin agonists. Seven of the 9 patients met 2004 International Classification for the Diagnosis of Headache criteria for chronic cluster headaches; the other 2 patients had episodic cluster headaches of several months duration. After neurological and physical examination all patients had laboratory investigations including fasting lipid panel, PSA (where indicated), LH, FSH, and testosterone levels (both free and total). All 9 patients demonstrated either abnormally low or low, normal testosterone levels. After supplementation with either pure testosterone in 5 of 7 male patients or combination testosterone/estrogen therapy in both female patients, the patients achieved cluster headache freedom for the first 24 hours. Four male chronic cluster patients, all with abnormally low testosterone levels, achieved remission.

Conclusions.—Abnormal testosterone levels in patients with episodic or chronic cluster headaches refractory to maximal medical management may predict a therapeutic response to testosterone replacement therapy. In the described cases, diurnal variation of attacks, a seasonal cluster pattern, and previous, transient responsiveness to melatonin therapy pointed to the hypothalamus as the site of neurological dysfunction. Prospective studies pairing hormone levels and polysomnographic data are needed.

(Headache 2006;46:925-933)

Sorry it didn't work Squanto. Maybe a trip to the islands would be helpful? Busting is legal on some of them.
hugs, nani

Title: Re: Testosterone lack of progress note
Post by BB on Mar 24^th, 2007, 10:20am

on 03/24/07 at 07:56:25, nani wrote:

For 7-10 days patients were given testosteronum propionicum (25 mg) once a day intramuscularly, and then for the same period of time testosterone (10 mg). nani

25 mg of injection per day for 10 days is 250 mg plus 10mg a day for 10 days is another 100 mg, totalling 350mg, compared to what I have seen used here of 100mg per week for an average of 4 weeks which totals 400 mg of testosterone, the numbers are roughly the same and is much higher than the 2.5 mg topical per day.

Androgel is applied to the skin and the rate of absorption through the skin is much lower than that of an intramuscular injection dose.

I havent heard of testosterone treatment for CH via skin application hence my question whether the endocrinologist is familiar with CH.

Annette