Because of legal restrictions, MOMSCIS cannot give specific medical advice. The following information is not a substitute for the personal care or advice of your physician. Please discuss any concerns with your physician regarding your medical care. Physicians in the Physical Medicine & Rehabilitation Department at the University of Missouri-Columbia are available to evaluate patient records, and can set up a clinic visit for a medical evaluation. The PM&R Department does extensive treatment of individuals with spinal cord injuries using a wide variety of physical therapies and state-of-the-art medications. Individuals with spinal cord injuries can be examined and treated on an outpatient or inpatient basis. For more information about the PM&R services available or to schedule a clinic visit, telephone the clinic at (573) 884-0033.

Hormone replacement therapy

Q. I have been hoping to go back to work after my spinal cord injury. However, I find that I am exhausted by just completing the routine activities of daily living. Do you have any suggestions for improving my tolerance of increased activity so I can go back to work?

A. After an individual has a spinal cord injury, their metabolism changes in such a way that they are more prone to experiencing fatigue, as well as having difficulty with limited strength, stamina and/or decreased energy level. Other symptoms that might be associated with this as well, may include a lightheadedness, and dizziness or sleepiness throughout the day, weight loss, decreased appetite, dry skin, difficulty with wound healing, decreased motivation and desire to be active. Sensations of feeling cold or chilled all the time may be related to these metabolic changes that occur after spinal cord injury.

It has been shown that after spinal cord injury, hormone levels decrease. In men, the hormone that decreases is called testosterone. Because of this decrease in hormone level, the symptoms mentioned previously above can be experienced.

For an individual to determine whether they do have decreased hormone level that could result in these symptoms, a simple blood test may be drawn and the result can be compared to a normal range for men in the same age group that the individual with the spinal cord injury is in. For women, it may be appropriate for a treatment with an anabolic steroid, which is a mild form of testosterone medication that can also help in all of these areas.

Studies have shown that 70 percent to 80 percent of men after spinal cord injury have a low testosterone level, and it has been my experience in treating these men with hormone replacement therapy - which is given as a shot once a month - that the majority of these men with the hormone deficiency experience significant benefit in most of the symptoms that are mentioned. The side effects of this hormone replacement is most commonly a change in skin to be more oily and possibly having acne, but otherwise side effects are minimal.

Because these symptoms are common in almost all individuals with spinal cord injury, I recommend simple screening tests that would look at a blood sample to assess the hormone level and other possible nutritional deficiencies that might explain the fatigue or other associated symptoms.