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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by doxogenic boy on September 22, 2013, at 17:58:58
Hello,
I have recently got the results of a lot of blood tests I took, some of them to check that my liver is ok because of the agomelatine, which it is. But the tests showed that I have low testosterone levels, the lowest I have ever had.The normal range for testosterone is from 6,7 to 31,9,(I don't know what unit of measurement it is) and my testosterone level is 5,9. Also the luteinizing hormone is low.
( http://en.wikipedia.org/wiki/Luteinizing_hormone )Could this be medication induced, and is it due to some of the drugs, or because of the combo as a whole, and its interactions? (See my meds in my signature below.)
I have no sexual desire, but I have experienced that also when I have been medication free. I am not depressed now.
Should I use testosterone injections to combat the lack of sexual desire, or can testosteron injections cause depression in the long run? Have any of you got low testosterone levels because of your meds? (It can happen to both men and women.)
Are there other hormones I should check with blood tests? My psychiatrist suspect high cortisol levels, and I probably will take blood tests for that, but how can cortisol levels be high when I feel calm and euthymic?
My former doctor prescribed testosterone injections in 2001/2002, and it had some effect for my libido, but it lost its effect completely when my depression worsened April 2002 because of a breakup.
Here is the article "Antidepressant-Induced Sexual Dysfunction Associated with Low Serum Free Testosterone":
http://www.mental-health-today.com/rx/testos.htmExcerpt:
In the course of an evaluation for treatment of antidepressant induced sexual dysfunction (ASD) with a new agent, an unforeseen pattern emerged in the pre-treatment laboratory assessment. Free serum testosterone levels in both men and women study subjects were found to be below the normal ranges in 75 percent of subjects in this small study. There were no other consistent laboratory findings that could account for such a high percentage correlation. Further inquiries into the possible causes for decreased serum testosterone and its association with ASD seems warranted.
--------------------I would greatly appreciate any response to my questions above.
- doxogenic
Posted by doxogenic boy on September 23, 2013, at 10:46:07
In reply to Low testosterone level - medication-induced?, posted by doxogenic boy on September 22, 2013, at 17:58:58
Aren't there anyone out there who have low testosterone level when using psychotropic drugs?I am not depressed now, so I would like to know if I risk depression as a long term side effect (or withdrawal, if or when I stop using it) if I get testosterone injections to treat hypoactive sexual desire.
Any response will be greatly appreciated.
- doxogenic
Posted by Hugh on September 25, 2013, at 18:02:33
In reply to Re: Low testosterone level - medication-induced?, posted by doxogenic boy on September 23, 2013, at 10:46:07
Raising testosterone through injections or the patch or the gel frequently elevates mood. Have you had your estradiol level checked? High estrogen can drive down free testosterone levels, even if you're taking supplemental testosterone.
Posted by doxogenic boy on September 26, 2013, at 7:24:36
In reply to Re: Low testosterone level - medication-induced?, posted by Hugh on September 25, 2013, at 18:02:33
> Raising testosterone through injections or the patch or the gel frequently elevates mood. Have you had your estradiol level checked? High estrogen can drive down free testosterone levels, even if you're taking supplemental testosterone.
Thanks for your reply.
I am going to check my estradiol levels tomorrow. If I have too high estradiol levels, how can that be treated?I haven't started with testosterone injections yet, but that will be considered when the new test results are available.
Also these will be checked tomorrow:
luteinizing hormone
follicle stimulating hormone
prolactin
dihydrotestosterone
sex hormone binding globulin
cortisol (morning levels)Testosteron and luteinizing hormone will be checked too, to find out if they still are too low. I hope this isn't medication-induced, because I am very satisfied with my meds - I am not depressed. The only reason for me to take testosterone injections, is to treat hypoactive sexual desire.
Or are there more reasons to take testosterone when the levels are too low?
- doxogenic
Posted by Hugh on September 26, 2013, at 13:23:13
In reply to Re: Low testosterone level - medication-induced? » Hugh, posted by doxogenic boy on September 26, 2013, at 7:24:36
> I am going to check my estradiol levels tomorrow. If I have too high estradiol levels, how can that be treated?
Arimidex will get estradiol levels way down, even too low if you take too much. It's a breast cancer drug, but bodybuilders take a much lower dose -- 0.25 or 0.5 mg, two or three times a week -- to get their estrogen down and their free testosterone up. If your estradiol level is fine, the beta blocker nebivolol causes a significant increase in testosterone.
Posted by doxogenic boy on September 27, 2013, at 4:38:37
In reply to Re: Low testosterone level - medication-induced? » doxogenic boy, posted by Hugh on September 26, 2013, at 13:23:13
> > I am going to check my estradiol levels tomorrow. If I have too high estradiol levels, how can that be treated?
>
> Arimidex will get estradiol levels way down, even too low if you take too much. It's a breast cancer drug, but bodybuilders take a much lower dose -- 0.25 or 0.5 mg, two or three times a week -- to get their estrogen down and their free testosterone up. If your estradiol level is fine, the beta blocker nebivolol causes a significant increase in testosterone.
--------------
Thank you very much for interesting information! I have forwarded it to my psychiatrist. Do endocrinologists prescribe Arimidex and/or nebivolol to patients with pathological estradiol or testosterone levels if they have psychiatric symptoms?Today I took the blood tests of estradiol and the other things I mentioned. I will post it here when I have the results.
I wonder if my low testosterone levels are part of the effect of my meds, since I have very little aggression. In 1996 I took my first testosterone blood test, and it was low already then. I used psychotropic drugs at that time too.
- doxogenic
Posted by Hugh on September 27, 2013, at 13:22:10
In reply to Re: Low testosterone level - medication-induced? » Hugh, posted by doxogenic boy on September 27, 2013, at 4:38:37
> Do endocrinologists prescribe Arimidex and/or nebivolol to patients with pathological estradiol or testosterone levels if they have psychiatric symptoms?
I would guess that most of them don't know about the off-label uses of these drugs.
Posted by jrbecker76 on October 1, 2013, at 6:36:53
In reply to Low testosterone level - medication-induced?, posted by doxogenic boy on September 22, 2013, at 17:58:58
> Hello,
> I have recently got the results of a lot of blood tests I took, some of them to check that my liver is ok because of the agomelatine, which it is. But the tests showed that I have low testosterone levels, the lowest I have ever had.
>
> The normal range for testosterone is from 6,7 to 31,9,(I don't know what unit of measurement it is) and my testosterone level is 5,9. Also the luteinizing hormone is low.
> ( http://en.wikipedia.org/wiki/Luteinizing_hormone )
>
> Could this be medication induced, and is it due to some of the drugs, or because of the combo as a whole, and its interactions? (See my meds in my signature below.)
>
> I have no sexual desire, but I have experienced that also when I have been medication free. I am not depressed now.
>
> Should I use testosterone injections to combat the lack of sexual desire, or can testosteron injections cause depression in the long run? Have any of you got low testosterone levels because of your meds? (It can happen to both men and women.)
>
> Are there other hormones I should check with blood tests? My psychiatrist suspect high cortisol levels, and I probably will take blood tests for that, but how can cortisol levels be high when I feel calm and euthymic?
>
> My former doctor prescribed testosterone injections in 2001/2002, and it had some effect for my libido, but it lost its effect completely when my depression worsened April 2002 because of a breakup.
>
> Here is the article "Antidepressant-Induced Sexual Dysfunction Associated with Low Serum Free Testosterone":
> http://www.mental-health-today.com/rx/testos.htm
>
> Excerpt:
> In the course of an evaluation for treatment of antidepressant induced sexual dysfunction (ASD) with a new agent, an unforeseen pattern emerged in the pre-treatment laboratory assessment. Free serum testosterone levels in both men and women study subjects were found to be below the normal ranges in 75 percent of subjects in this small study. There were no other consistent laboratory findings that could account for such a high percentage correlation. Further inquiries into the possible causes for decreased serum testosterone and its association with ASD seems warranted.
> --------------------
>
> I would greatly appreciate any response to my questions above.
>
> - doxogenic
You might have low T to begin with but melatonergic drugs can definitely lower testosterone. I've had quite a bit of experience with agomelatine, rozerem and OTC melatonin. They had a mild impact on my sexual functioning, including a noticeable impact on the size of my testicles while taking them! On the upside, I find melatonin and drugs like it to be fantastic mood stabilizers.I've had experience with exogenous testosterone (both gels and injections), actually around the same time you did in '01-'02. My experience with it though was it helps erections but not necessarily libido or other issues. And plus, taking exogenous T creates a negative feedback loop that results in lowered T of your own. As you probably know, this has all sorts of backfiring side effects like shrunken testicles, etc. And on top of it all, the T enhancement did not help my depression and energy issues.
Posted by doxogenic boy on October 1, 2013, at 12:23:50
In reply to Re: Low testosterone level - medication-induced?, posted by jrbecker76 on October 1, 2013, at 6:36:53
> You might have low T to begin with but melatonergic drugs can definitely lower testosterone. I've had quite a bit of experience with agomelatine, rozerem and OTC melatonin. They had a mild impact on my sexual functioning, including a noticeable impact on the size of my testicles while taking them!
---
Thank you very much for this information! I didn't know this. Did agomelatine lower your libido, and what other impact did it have on your sexual functioning? (And the testicles became not bigger I suppose?) I have heard that agomelatine should have no sexual side effect, so this is disappointing.
>On the upside, I find melatonin and drugs like it to be fantastic mood stabilizers.
---
I have been very stable since I started with agomelatine March 2010, but the improvement started before this.> I've had experience with exogenous testosterone (both gels and injections), actually around the same time you did in '01-'02. My experience with it though was it helps erections but not necessarily libido or other issues. And plus, taking exogenous T creates a negative feedback loop that results in lowered T of your own. As you probably know, this has all sorts of backfiring side effects like shrunken testicles, etc. And on top of it all, the T enhancement did not help my depression and energy issues.
---I will take these problems into consideration when I and my psychiatrist discuss this when I get the results from the blood tests I took Friday.
(albumin
testosterone
luteinizing hormone
follicle stimulating hormone
prolactin
dihydrotestosterone
sex hormone binding globulin
cortisol (morning levels))My psychiatrist will consult with an endocrinologist.
And thank you very much for sharing your experiences about this!
- doxogenic
Posted by doxogenic boy on October 3, 2013, at 7:43:59
In reply to Re: Low testosterone level - medication-induced?, posted by Hugh on September 27, 2013, at 13:22:10
This time, my testosterone level was 16,4. The normal range is 6,7 - 31,9. Last time testosterone was 5,9. Is it normal that testosterone changes so much? I have heard that testosterone levels are higher in the morning, and this time I took the blood test at 9.25 AM, a few hours earlier than the time before.
However, could my medication cause such fluctuations in testosterone levels, from 5,9 to 16,4 - nearly three-fold?
My psychiatrist said today that all my blood tests were normal, and that includes estradiol. I don't know yet if estradiol was in the higher or lower part of the normal range; I will get the details later.
See what blood tests I took in this message:
http://www.dr-bob.org/babble/20130930/msgs/1051498.html
- doxogenic
Posted by doxogenic boy on October 3, 2013, at 7:52:24
In reply to Re: Low testosterone level - medication-induced?, posted by jrbecker76 on October 1, 2013, at 6:36:53
It seems like I don't need to take testosterone injections, since my testosterone level was normal and considerably higher this time. (5.9 vs 16,4) The lack of sexual desire is probably due to my medication.
Could the big fluctuations in testosterone levels be due to my medication too?
- doxogenic
Posted by Hugh on October 9, 2013, at 10:07:16
In reply to Re: Low testosterone level - medication-induced? » Hugh, posted by doxogenic boy on October 3, 2013, at 7:43:59
Testosterone levels can fluctuate, but that is a very dramatic shift. You're on a lot of meds, so it could be that your low libido is being caused by one or more of them.
Posted by doxogenic boy on October 11, 2013, at 7:17:28
In reply to Re: Low testosterone level - medication-induced?, posted by Hugh on October 9, 2013, at 10:07:16
> Testosterone levels can fluctuate, but that is a very dramatic shift. You're on a lot of meds, so it could be that your low libido is being caused by one or more of them.
Could my meds be the reason why I got such a dramatic shift in testosterone levels, or are there other possible explanations? It is very likely that my low libido is being caused by escitalopram (and maybe trimipramine) but it still doesn't explain low libido when I have been medication free. Could it be the earlier depression that caused it? I am not depressed now, so now it must be the meds that cause it.
Tianeptine and agomelatine are said to have little or no sexual side effects, could those prevent sexual side effects from SSRIs?
- doxogenic
Posted by Hugh on October 11, 2013, at 20:59:07
In reply to Re: Low testosterone level - medication-induced? » Hugh, posted by doxogenic boy on October 11, 2013, at 7:17:28
It could be that your low libido isn't testosterone-related. Dopamine plays an important role in libido. Or it's possible that it's Post-SSRI Sexual Dysfunction.
Posted by doxogenic boy on October 12, 2013, at 7:46:47
In reply to Re: Low testosterone level - medication-induced? » doxogenic boy, posted by Hugh on October 11, 2013, at 20:59:07
> It could be that your low libido isn't testosterone-related. Dopamine plays an important role in libido. Or it's possible that it's Post-SSRI Sexual Dysfunction.
Thank you for your thoughts.
So when I have been medication-free, it could have been a Post-SSRI Sexual Dysfunction? Can that last for half a year or more after tapering off SSRIs?- doxogenic
Posted by Hugh on October 14, 2013, at 12:20:48
In reply to Re: Low testosterone level - medication-induced? » Hugh, posted by doxogenic boy on October 12, 2013, at 7:46:47
> So when I have been medication-free, it could have been a Post-SSRI Sexual Dysfunction? Can that last for half a year or more after tapering off SSRIs?
It could last for months or years, IF that's what you have.
Posted by doxogenic boy on October 18, 2013, at 8:17:17
In reply to Re: Low testosterone level - medication-induced? » doxogenic boy, posted by Hugh on October 14, 2013, at 12:20:48
> > So when I have been medication-free, it could have been a Post-SSRI Sexual Dysfunction? Can that last for half a year or more after tapering off SSRIs?
>
> It could last for months or years, IF that's what you have.I have been on psychotropic medication most of the time since March 1994, so then it is difficult to say if it is the depression or SSRIs that causes my hypoactive sexual desire.
Here are the results of the blood tests that I took 27 September 2013: (The normal ranges are in parentheses. I think "IE" is "IU" in English)luteinizing hormone: 1,2 IE/L (0,8 - 7,6)
follicle stimulating hormone: 1,4 IE/L (0,7 - 11,1)
prolactin: 208 mIE/L (53 - 360)
sex hormone-binding globulin 42 nmol/L (13-71)
testosterone 16,0 nmol/L (6,7 - 31,9)
estradiol: 78 pmol/L (20 - 130)
cortisol morning 227 nmol/L (120 - 600)
albumin 48 g/L (39 - 50)Here are the results from the blood tests 11 september 2013:
luteinizing hormone 0,5 IE/L (0,8 - 7,6)
follicle stimulating hormone: 1,0 IE/L (0,7 - 11,1)
prolactin 267 mIE/L (53 - 360)
testosterone 5,9 nmol/L (6,7 - 31,9)Do you have comments to these results?
- doxogenic
Posted by Hugh on October 28, 2013, at 18:10:05
In reply to Re: Low testosterone level - medication-induced? » Hugh, posted by doxogenic boy on October 18, 2013, at 8:17:17
These are some of the better articles I've read about the subject:
http://www.lef.org/protocols/male_reproductive/male_hormone_restoration_01.htm
http://www.lef.org/magazine/mag2012/jun2012_Testosterone-Controversy_01.htm
Posted by doxogenic boy on October 29, 2013, at 16:42:30
In reply to Re: Low testosterone level - medication-induced? » doxogenic boy, posted by Hugh on October 28, 2013, at 18:10:05
> These are some of the better articles I've read about the subject:
>
> http://www.lef.org/protocols/male_reproductive/male_hormone_restoration_01.htm
>
> http://www.lef.org/magazine/mag2012/jun2012_Testosterone-Controversy_01.htmThanks for this information. The units of measurement which Life Extension uses are different from those from the laboratory that analyzed my blood tests. Life Extension says these are the optimal ranges for estradiol, total testosterone and free testosterone:
Estradiol: 20-30 pg/mL
Total Testosterone: 700-900 ng/dL
Free Testosterone: 20-25 pg/mLThe laboratory that analyzed my blood tests says these are the normal ranges for testosterone and estradiol:
testosterone: 6,7 - 31,9 nmol/L
(I had 5,9 on the first - and 16,0 nmol/L on the second test)estradiol: 20 - 130 pmol/L
(I had 78 pmol/L)I found this table for converting conventional units to SI units:
http://www.unc.edu/~rowlett/units/scales/clinical_data.htmlFor testosterone, the table shows how to convert from ng/dL to nmol/L and for estradiol how to convert from pg/mL to pmol/L.
I have calculated that I had 21,247 pg/mL estradiol on the blood test, which is in the low end of the Life Extension optimal range (20-30), and 170 and 461 ng/dL total testosterone, far below the Life Extension optimal range for total testosterone (700-900). That is, if the laboratory test was for total testosterone. It didn't say if it was total or free testosterone, and they only have one type of testosterone test.
This means that I need testosterone replacement therapy to come up to 700 - 900 ng/dL total testosterone, but it may be difficult to find a doctor who will prescribe testosterone gel or injections when my testosterone levels (on the second test) were normal according to the laboratory that analyzed it.
- doxogenic
Posted by Riloal on October 29, 2013, at 19:32:12
In reply to Re: Low testosterone level - medication-induced? » Hugh, posted by doxogenic boy on October 29, 2013, at 16:42:30
Doxogenic, your estradiol is low. Low estradiol also causes low libido. Search info about HCG monotherapy for HTR, it increases testosterone without loopback.
Posted by doxogenic boy on October 29, 2013, at 19:50:28
In reply to Re: Low testosterone level - medication-induced?, posted by Riloal on October 29, 2013, at 19:32:12
> Doxogenic, your estradiol is low. Low estradiol also causes low libido. Search info about HCG monotherapy for HTR, it increases testosterone without loopback.
Thanks for your advice, I will do.
- doxogenic
Posted by Hugh on November 1, 2013, at 11:38:15
In reply to Re: Low testosterone level - medication-induced? » Hugh, posted by doxogenic boy on October 29, 2013, at 16:42:30
> I have calculated that I had 21,247 pg/mL estradiol on the blood test, which is in the low end of the Life Extension optimal range (20-30)
Your estradiol is fairly low, but bodybuilders aim for an even lower level -- 15 or 16. If you start testosterone replacement therapy, it may increase your estradiol level.
Posted by doxogenic boy on November 2, 2013, at 8:14:06
In reply to Re: Low testosterone level - medication-induced? » doxogenic boy, posted by Hugh on November 1, 2013, at 11:38:15
> > I have calculated that I had 21,247 pg/mL estradiol on the blood test, which is in the low end of the Life Extension optimal range (20-30)
>
> Your estradiol is fairly low, but bodybuilders aim for an even lower level -- 15 or 16. If you start testosterone replacement therapy, it may increase your estradiol level.Ok. But aren't there side effects with testosterone replacement therapy? Is it true that it will shut down the body's own testosterone production and make you addicted to TRT?
Can Tribulus Terrestris stimulate the body's testosterone production naturally? I have read that fighting, exercise and regular sex also can boost testosterone production.
- doxogenic
Posted by Hugh on November 3, 2013, at 16:21:35
In reply to Re: Low testosterone level - medication-induced? » Hugh, posted by doxogenic boy on November 2, 2013, at 8:14:06
There are some potentially unpleasant side effects associated with testosterone replacement therapy. Before resorting to it, it might be best to try the supplements mentioned in the articles from LEF. Or try nebivolol.
Posted by doxogenic boy on November 4, 2013, at 10:38:27
In reply to Re: Low testosterone level - medication-induced?, posted by Hugh on November 3, 2013, at 16:21:35
Ok. Thanks for your advice.
- doxogenic
This is the end of the thread.
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