By R Carter
If you’re male, age fifty or above, a chronic pain patient on long term treatment with opioids and haven’t had your testosterone levels checked you may want to consider doing so. If you Google Low-T symptoms nearly every link is about low sex drive, difficulty with an erection, hair loss, fatigue, loss of muscle mass, increased body fat, alterations in mood, memory loss and or loss of bone mass.
While you may have one or more of these symptoms there are others which occur less frequently, one in particular is insomnia, difficulty falling asleep, waking after only a few hours of sleep and not being able to fall back to sleep. In this age of opiate hysteria, if you complain to your PCP about these they’re likely to dismiss those complaints as symptoms of long term opiate treatment. Let’s face it, once you’re identified as a CPP in a doctor’s office, everything is seen through that filter and often doctors can’t see past it, nor do they want to. Just the fact that you’re setting there puts them on the defensive and suddenly that twelve year education gets washed away by fear and paranoia that at any moment, you’re going to ask for more pain medication. If you don’t there’s a sigh and a quick departure from the exam room followed by, I don’t know what causing your problem…. A good clinician will make an effort to investigate alternative causes for your complaint, but more often than not, a doctor has to be pushed into doing so in this age of managed care.
This is my story, after moving to Ohio I was immediately force tapered to half of what I was previously taking despite the fact that I was already within state guidelines on the higher amount. Three months later I started having problems with insomnia, so much so that I lost my job over it and could not get rehired because of it. Now three years later I’m living on assistance when I should be building my retirement after having raised my family.
At first I assumed I was having more breakthrough pain which is why I couldn’t sleep. But six months into this new dosage my breakthrough pain was no worse but my sleep patterns had become far worse.
I began keeping a sleep log, when I fell asleep, when I woke up, how long I slept and after another six months I was averaging five hours of sleep every thirty hours. Sometimes I would go forty-eight to sixty hours before falling asleep and do that twice in one week. After several weeks of this you can imagine the side effects. You start becoming neurotic and may start seeing little blue devils dancing around people heads. For sure it becomes nearly impossible to tell the difference between pain from your chronic pain problem and the generalize fatigue and ache that goes with a lack of sleep and rest.
I kept complaining to doctors about this only to be told that sleep disturbances were normal for CPP’s and yet no one put a definition around that; qualifying how much sleep loss I should expect. Final I took matters into my own hands and began reading every research article on Low-T I could find; eventually finding some that included insomnia as one of the chief complaints.
I printed the articles and took them back to my PCP and asked to be tested, having to argue past the denials and educate the doctor about the side effects of long term opiates. Finally just saying please do so for my peace of mind did the trick and a blood test was ordered.
In general, the normal range in males is about 270-1070 ng/dL with the average level being 679 ng/dL, mine came back at 128 ng/dL. This is three years after having my daily pain med dosage cut in half, so I had probably been low for several years but hadn’t noticed because I wasn’t having the other symptoms that typically go with the findings to any great degree.I had noticed muscle loss but assumed it was due to age.
I was started on a topical preparation which you apply to your skin, but at $275 per month, most can’t afford the cost for the convenience of such a preparation, so I request injections. Testosterone cypionate is an oil based preparation given twice a month by deep intramuscular injection and the cost for both the medication and syringes is between $24- $36/month.
At the end of six weeks I started getting the benefits I was looking for, I fell asleep easier, I would still awake four to five hours after falling asleep with breakthrough pain, but I could take half a pain pill and fall back to sleep in thirty to forty-five minutes, sleeping another two to four hours. For the next couple of months I was getting seven to nine hours of sleep a night, but when waking I felt hungover, that typical type you feel after being awake for more than 24 hours and sleeping 8-9 hours afterwards. I assumed that’s to be expected as I refill my tank on the needed rest I had lost over the previous three years. Eventually I’m hoping to get back to seven or eight hours of sleep and waking refreshed. And regarding the generalize ache and fatigue I felt from the insomnia, those symptoms are gone and the lower dosage of pain medication I’m on now is doing the job it’s supposed to do.