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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 2 of 2. This is the beginning of the thread.
Posted by Jota on May 30, 2003, at 22:20:32
I'm trying to decide whether to do testosterone supplementation. Low testosterone levels turn out to be rather common in men with depression, especially treatment resistant depression (Pope et. al., American Journal of Psychiatry, January 2003). While the link between depression and low testosterone may be new to the psychiatric literature, it appears to be better-known in the endocrinology literature (see http://www.hormone.org/publications/low_testo/low_testo_0.html).
I am currently recovering from an initially treatment resistant depression. It was a "breakthrough" depression as it developed notwithstanding an aggressive long-term antidepressant regimen of 80 mg Paxil plus 200 mg Wellbutrin. I had been on that combination with good success for about two years. Previously I had been on a combination of approximately 200mg Effexor plus 200 mg Wellbutrin with good success for about five years until it also started to poop out.
My current regimen, arrived with a psychiatrist whom I think is pretty good along with consultation with a top national pharmacological researcher: Lexapro 40 mg, Wellbutrin 300 mg, Strattera 80 mg, Carbatrol 600 mg, Lamictal 150 mg, T3 (cytomel) 25 mg, folic acid 2 mg, and fish oil delivering 950 mg EPA.
The last 3 weeks I've been feeling quite a bit better. I am now back to work full-time following a month of sporadic attendance following three months of mostly nonattendance. I attribute the improvement to the Lamictal, which I've been building up on over the past six weeks at the rate of 25 mg per week (because of the Carbatrol, which increases liver function and therefore decreases blood serum levels of Lamictal, I can tritate up faster than the 12.5 mg per week recommended by some). Nevertheless I still have significant symptoms including night sweats, impaired memory, headaches, low sexual interest, early-morning wakening, and a mood that is slightly below normal. Some of these may no doubt be side effects. But given my experience over the past 10 years, I believe that the memory, headaches, and early morning wakening are probably primary.
So back to my original question: do I do the testosterone supplementation? The downside of it is that using it for more than a few months may suppress my own, apparently meager, testosterone production. Both the endocrinologist and the consulting psychopharmacologist suggest treating symptoms rather than lab results. Hence my tentative plan is to wait and see if things continue to get better. I can hold the testosterone supplementation in reserve in case my improvement stalls or in the future if the medicines again appear to be fading.
With all this background, my question is, has anyone here had any experience with testosterone supplementation?
Posted by davpet on May 30, 2003, at 23:03:16
In reply to Testosterone Supplementation?, posted by Jota on May 30, 2003, at 22:20:32
High cortisol levels prevent testosterone attaching to their receptor sites . Corticotropin-Releasing-Hormone (precursor of cortisol) also block Luteinizing Hormone and gonadotrophic hormone (precursor to testosterone) .
In other words the body says their is no need for reproduction under chronic stress.
This is the end of the thread.
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