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Dear Dr. Roach: My son, who is 30 years old, was recently diagnosed with severe obstructive sleep apnea and currently uses a CPAP machine. He says does not want to use this for the rest of his life, therefore, he has researched surgery to correct his OSA. Recently he consulted with a sleep expert, and now has surgery scheduled with that doctor.

My son will have a septoplasty and a palate expansion before a more radical surgery in a year called MMA. My son feels that these surgeries will give him the longest lasting cure for his OSA. I am very concerned about all of these surgeries. I value your objective opinion and hope you can give me some reassurance that these surgeries are worth the pain.

— G.M.

Dear G.M.: Although CPAP (continuous positive airway pressure, which works by using air to keep the airway open) is the usual treatment for obstructive sleep apnea, surgery is another effective way to treat OSA. Surgery is most appropriate for those who wish a surgical solution (some people can't stand the CPAP machine), those who have a surgically correctable problem (see below), and those who are good candidates for surgery; younger age makes surgery seem more reasonable to me.

The specific surgery chosen depends on an individual's unique anatomy. Surgery on the uvula (yes, the dangling thing at the back of the throat), soft palate and pharynx is the most common surgery, but maxillomandibular advancement surgery (MMA) has been shown to be successful in several well-known medical centers in the U.S., such as Mayo Clinic and Stanford. Success rates are high, and some studies have shown surgical cure of obstructive sleep apnea in over half of those who undergo the procedure.

Not knowing your son and not being a surgeon, I can't give an objective opinion for him in particular, but I can say that in appropriate patients, surgical treatment of OSA is reasonable.

Dear Dr. Roach: I'm a 79-year-old male in relatively good health. During the past year, I have lost underarm hair. What could be the cause? And is there a connection with the inability to get an erection?

— A.F.

Dear A.F.: I would be concerned about low testosterone.

Androgens, particularly testosterone, are responsible for growth and maintenance of body hair. Loss of body hair, especially pubic and axillary hair, is not common with low testosterone levels unless the testosterone was very low for a long period of time, usually over a year. Other symptoms of low testosterone include loss of muscle mass, lower energy levels, decreased libido and depression. Not all men will get all symptoms, but having more than one symptom is suggestive of low testosterone, especially in men who have difficulty getting an erection.

Your doctor should check your testosterone. Ideally, the sample should be drawn while fasting between 8 and 10 a.m. when levels are normally highest, and should take into account the age of the person being tested.

Testosterone replacement is appropriate for men with symptoms of low testosterone and clear evidence by laboratory of a repeatedly low level. Testosterone replacement is safe for most men, but is generally not given to men with a history of prostate or breast cancer. Testosterone should be given with caution to men with obstructive sleep apnea and men with symptomatic prostate enlargement.

The data so far suggest that testosterone replacement in deficient men does not increase risk of prostate cancer.

Readers may email questions to ToYourGoodHealth@med.cornell.edu

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