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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by LostBoyinNC34 on November 22, 2003, at 16:51:28
Since I got diagnosed with low testosterone, Ive been reading up on drugs that lower testosterone levels in men. Ive found that most of the psychiatric drugs lower testosterone levels and increase estrogen levels...really bad for men. SSRIs increase estrogen, which has indirect effects (negative) on testosterone.
The best psychiatric drugs for testosterone preservation in men are the dopaminergic drugs. I read selegiline is excellent for pushing up testosterone levels. Its time for the pharmaceutical industry and psychiatric profession to start tailoring drugs for male depression...SSRIs arent exactly the best antidepressants for male depression.
Eric
Posted by zenclearer on November 22, 2003, at 18:12:48
In reply to Most psychiatric drugs lower testosterone levels, posted by LostBoyinNC34 on November 22, 2003, at 16:51:28
Have you found any clinical literature citing this association? I know that there is considerable speculation these days that there may be a causal link with antidepressants and T levels, but I am aware of only one study reporting this conclusion.
There are indeed data on neuroletpics, but I am not aware of data on antidepressants.
Please enlighten me. Thanks.
> Since I got diagnosed with low testosterone, Ive been reading up on drugs that lower testosterone levels in men. Ive found that most of the psychiatric drugs lower testosterone levels and increase estrogen levels...really bad for men. SSRIs increase estrogen, which has indirect effects (negative) on testosterone.
>
> The best psychiatric drugs for testosterone preservation in men are the dopaminergic drugs. I read selegiline is excellent for pushing up testosterone levels. Its time for the pharmaceutical industry and psychiatric profession to start tailoring drugs for male depression...SSRIs arent exactly the best antidepressants for male depression.
>
> Eric
>
Posted by linkadge on November 22, 2003, at 18:19:34
In reply to Re: Most psychiatric drugs lower testosterone leve » LostBoyinNC34, posted by zenclearer on November 22, 2003, at 18:12:48
While in general this is true, I had found SSri's to be extremely helpful. With my depression I suffered a mild form of persistant sexual arousal disorder, kind of linking with OCD. SSRi's helped very much to lighten the mood, and make sexual though less intense.
Linkadge
Posted by LostboyinNC34 on November 22, 2003, at 19:08:52
In reply to Re: Most psychiatric drugs lower testosterone leve » LostBoyinNC34, posted by zenclearer on November 22, 2003, at 18:12:48
> Have you found any clinical literature citing this association? I know that there is considerable speculation these days that there may be a causal link with antidepressants and T levels, but I am aware of only one study reporting this conclusion.
>
> There are indeed data on neuroletpics, but I am not aware of data on antidepressants.Benzos and other sedating type drugs will lower testosterone as well, not just neuroleptics.
> Have you found any clinical literature citing this association? I know that there is considerable speculation these days that there may be a causal link with antidepressants and T levels, but I am aware of only one study reporting this conclusion.
Yeah man, plenty of literature is out there associating SSRIs and lowered testosterone levels. Its well known that SSRIs mildly increase prolactin and anytime you do that, you are indirectly decreasing testosterone. Also, in a book I read by a MD named Eugene Shippen titled "The Testosterone Syndrome" in the appendix he lists the SSRIs as medications that increase estrogen. If you will educate yourself, anytime estrogen is increased in males it has negative effects on testosterone. The higher estrogen levels are, the lower testosterone levels are as a general rule. I would HIGHLY recommend this book for a basic understanding of this relationship between estrogen and testosterone.
On the Mayo Clinic website it says many psychiatric drugs lower testosterone levels
http://www.mayoclinic.com/invoke.cfm?objectid=E97FDCB5-E617-4C36-859B911C1A0E9257&dsection=3
And finally in a recent semi-ground breaking clinical trial at Mclean hospital, a biological psychiatrist researcher named Harrison Pope discovered some refractory male depressives may benefit from testosterone replacement. Duh...theyve known that since the forties. The full description of the trial can be found in the January 2003 issue of the "American Journal of Psychiatry." In this article summarizing testosterone for refractory male depression, the researchers say "These observations suggest that low testosterone levels may be unexpectedly common in middle aged men with treatment-resistant major depressive disorder, perhaps because chronic depressive symptoms lead to blunting of the hypothalamic-pituitary-gonadal axis (4) or, possibly, because of effects of the antidepressant medications themselves."
If you want to read about SSRI induced prolactin elevations and subsequent decreases in testosterone and elevations in estrogen, I suggest you consult the following source. "Breast enlargement during chronic antidepressant therapy" Journal of Affective Disorders November 1997, J. Amsterdam
Also, even if antidepressants do not DIRECTLY decrease testosterone, they DO increase estrogen. Thats a hard fact. And like I said, anytime you increase estrogen in a male, thats bad news and leads to decreased testosterone levels.
If you believe SSRIs do not cause lowered testosterone levels, you are in denial.
>
> There are indeed data on neuroletpics, but I am not aware of data on antidepressants.
>
> Please enlighten me. Thanks.
>
>No problem...SSRIs will turn you into a girl.
Eric
Posted by LostBoyinNC34 on November 22, 2003, at 19:28:46
In reply to Re: Most psychiatric drugs lower testosterone leve, posted by LostboyinNC34 on November 22, 2003, at 19:08:52
Here is a Medline abstract from the Mayo clinic that talks about prozac elevating prolactin
Eric
Posted by LostboyinNC34 on November 22, 2003, at 19:34:53
In reply to Re: Most psychiatric drugs lower testosterone leve, posted by LostBoyinNC34 on November 22, 2003, at 19:28:46
Here is the link to the Medline abstract I mentioned above by J. Amsterdam...a very prominent psychiatrist with expertise in refractory depression. The abstract says breast enlargement with SSRIs is common...and this trial used women. You know its going to do the same thing with men.
Face it...get your head out of the sand. SSRIs and most serotonergic antidepressants ultimately decrease testosterone levels in men.
Eric
Posted by zenclearer on November 22, 2003, at 19:37:11
In reply to Re: Most psychiatric drugs lower testosterone leve, posted by LostboyinNC34 on November 22, 2003, at 19:08:52
I already am a girl.
I have done searches and have come up with no clinical studies correlating antidepressants with low T levels.
Actually, I am writing some medical materials on T levels and possible correlatins with ssris, and thusly, if there is literature, I will make it known.
There is certainly broad agreement that low T levels may result in depression, but that is symptomatic consequence, not a clearly observed relation between ssris and the potential for low T levels.
Posted by LostBoyinNC34 on November 22, 2003, at 19:58:27
In reply to Re: Most psychiatric drugs lower testosterone leve » LostboyinNC34, posted by zenclearer on November 22, 2003, at 19:37:11
> I already am a girl.
Well good for you...SSRIs are tailor made for you.
>
> I have done searches and have come up with no clinical studies correlating antidepressants with low T levels.Thats because youre stupid and you cant put two and two together. If a drug can increase estrogen levels (SSRIs do this) and also increase prolactin (SSRIs do this also), you have potential to lower testosterone in men. Which for male depression is a bad thing. I already put several medline abstacts up there FOR YOU that specifically said SSRIs increase prolactin, cause breast enlargement, etc. WHAT OTHER EVIDENCE DO YOU NEED?
The real problem here is that you dont want to admit this is a problem and you are biased...thats the real issue with you.
>
> Actually, I am writing some medical materials on T levels and possible correlatins with ssris, and thusly, if there is literature, I will make it known.
>Do you think I give a shit about your so-called "opinion?" After battling severe refractory depression for six years and having my life totally ruined and finally getting diagnosed with low testosterone and getting on Androgel and getting some real relief...I dont need your "expert opinion" on this matter. I know more about it than you do anyway.
> There is certainly broad agreement that low T levels may result in depression, but that is symptomatic consequence, not a clearly observed relation between ssris and the potential for low T levels.How do YOU know? Do you really think the SSRI companies would WANT it to be brought out that SSRIs can lower T levels in men? I dont. Just like these companies dont like to admit that SSRIs cause akathisia or that Paxil had Paxil withdrawal (it took a class action lawsuit to get the company that makes Paxil to admit this finally), its highly unlikely the SSRI companies would publicly admit that SSRIs have the potential to lower testosterone levels in men.
Take your "studies" and shove them. Depression treatment is heavily geared for female depression anyway. We need more dopaminergic antidepressants in this country, as those tend to decrease testosterone levels less which is better for male depression.
Eric
Posted by zenclearer on November 22, 2003, at 20:05:04
In reply to Re: Most psychiatric drugs lower testosterone leve, posted by LostBoyinNC34 on November 22, 2003, at 19:58:27
1. I do not work for a company that produces or markets ssris.
2. I am disappointed to see that T-replacement therapy does not address all issues that need addressing.
> > I already am a girl.
>
> Well good for you...SSRIs are tailor made for you.
>
>
> >
> > I have done searches and have come up with no clinical studies correlating antidepressants with low T levels.
>
> Thats because youre stupid and you cant put two and two together. If a drug can increase estrogen levels (SSRIs do this) and also increase prolactin (SSRIs do this also), you have potential to lower testosterone in men. Which for male depression is a bad thing. I already put several medline abstacts up there FOR YOU that specifically said SSRIs increase prolactin, cause breast enlargement, etc. WHAT OTHER EVIDENCE DO YOU NEED?
>
> The real problem here is that you dont want to admit this is a problem and you are biased...thats the real issue with you.
>
> >
> > Actually, I am writing some medical materials on T levels and possible correlatins with ssris, and thusly, if there is literature, I will make it known.
> >
>
> Do you think I give a shit about your so-called "opinion?" After battling severe refractory depression for six years and having my life totally ruined and finally getting diagnosed with low testosterone and getting on Androgel and getting some real relief...I dont need your "expert opinion" on this matter. I know more about it than you do anyway.
>
>
> > There is certainly broad agreement that low T levels may result in depression, but that is symptomatic consequence, not a clearly observed relation between ssris and the potential for low T levels.
>
> How do YOU know? Do you really think the SSRI companies would WANT it to be brought out that SSRIs can lower T levels in men? I dont. Just like these companies dont like to admit that SSRIs cause akathisia or that Paxil had Paxil withdrawal (it took a class action lawsuit to get the company that makes Paxil to admit this finally), its highly unlikely the SSRI companies would publicly admit that SSRIs have the potential to lower testosterone levels in men.
>
> Take your "studies" and shove them. Depression treatment is heavily geared for female depression anyway. We need more dopaminergic antidepressants in this country, as those tend to decrease testosterone levels less which is better for male depression.
>
> Eric
>
>
>
>
>
Posted by LostBoyinNC34 on November 22, 2003, at 20:20:48
In reply to Re: Most psychiatric drugs lower testosterone leve, posted by zenclearer on November 22, 2003, at 20:05:04
> 1. I do not work for a company that produces or markets ssris.
I dont give a shit who you work for
>
> 2. I am disappointed to see that T-replacement therapy does not address all issues that need addressing.See...there you go bad mouthing testosterone. A lot of people do it. My T levels were below that of a 60 year old man at age 34. Gee, in my real life offline EVERYBODY is complimenting me on how Ive changed on Testosterone. I was in the grocery store today and felt so nicer to everyone but more focused and assertive. Like a MAN. Not some clinically depressed, wussified, withdrawn sissy.
I had an identical testosterone blood draw done last December when I had been off all antidepressants for about six weeks. My testosterone test came back normal. Then, less than one year later after having been on the SSRI Zoloft for about six months, I have the EXACT SAME TEST, at the same doctors office, using the same lab, blood drawn at the same time of the day. I flunked it bigtime. WHY? Why is that? Do you think it maybe had something to do with the Zoloft? I think there is that possibility.
Like I said, I presented a bunch of credible sources for you. Its a hard fact if a drug can increase estrogen or prolactin (SSRIs do this) then testosterone levels can go down. Go ahead and deny this, I could give a shit. All I know is Im going to be going back to work soon cause I got the dx of low testosterone from my internal med doctor and go on Androgel and a huge burden will be taken off myself and my poor, financially strapped family (cause psychiatry is piss poor at fixing severe mental illness and they are scared of developing REAL drugs that actually work).Eric
>
>
Posted by psychlover on November 22, 2003, at 23:35:57
In reply to Re: Most psychiatric drugs lower testosterone leve, posted by LostBoyinNC34 on November 22, 2003, at 20:20:48
Jeez, there is no reason to be so nasty and insulting. Could it be all that extra testosterone is making you a bit... testy? ;-)
Posted by linkadge on November 23, 2003, at 6:45:06
In reply to Re: Most psychiatric drugs lower testosterone leve, posted by psychlover on November 22, 2003, at 23:35:57
One of the biochemical characteristics of violent male criminals described in the book "The Brain" baised on the 12 part PBS miniseries, was *excessive* testosterone coupled with low serotonin levles. Making them *extremely* irritable with very little lack of impulse control.
By no means, am I trying to say this describes you, what I am trying to say is that for many men, (myself included), our testosterone is in the higher range of normal, but we still are depressed.
When I was depressed, I was still very assertive, agressive, angry and irritable, low mood, and constantly regretting my actions. I was competitive, dominant, chronically jealous, and superficial. My testosterone levels were fine. Dopimanergics made things much worse. Infact, SSRI's and lithium, were the only things that enabled me to stop and think things through rationally. They irradicated my irritability.
I would agree with you that many depressed baby boomers probably have low T but....
to say something like low T is "MALE" depression is extrodinarily narrowmined.
And if you didn't ask for my opinnion, you wouldn't have opened this message :)
Linkadge
Posted by Larry Hoover on November 23, 2003, at 6:55:40
In reply to Re: Most psychiatric drugs lower testosterone leve, posted by psychlover on November 22, 2003, at 23:35:57
> Jeez, there is no reason to be so nasty and insulting. Could it be all that extra testosterone is making you a bit... testy? ;-)
I have known Eric for many years. He has always been this way.
Posted by LostBoyinNC34 on November 23, 2003, at 8:40:43
In reply to Many men need T *decrease*, posted by linkadge on November 23, 2003, at 6:45:06
One of the excluding criteria for that recent testosterone clinical trial at Mclean I posted about, was a diagnosis of bipolar I or bipolar II disorder. Arent you bipolar? I remember you as the person who said they respond well to lithium and said they had too high a sex drive.
Let me tell you something, there is no male alive with unipolar major depression who has "too high a sex drive." Men with unipolar major depression have TOO LOW of a sex drive.
> One of the biochemical characteristics of violent male criminals described in the book "The Brain" baised on the 12 part PBS miniseries, was *excessive* testosterone coupled with low serotonin levles. Making them *extremely* irritable with very little lack of impulse control.
But Im not talking about criminals here dude. Im talking about a demographic of men 30 and over who are severely refractorily depressed, disabled, candidates for ECT or MAOIs and basically are shot to shit in a sense. Super severe, refractory, UNIPOLAR depression. Im not talking about a group of guys who go around robbing banks or committing crimes.
Plus, the whole idea of using testosterone for TRD is to add it to the existing regimen of antidepressants. This makes some antidepressants work better than before. Although, there are some men who seem to do OK on just testosterone by itself. And there is even a clinical trial at Columbia psychiatry that uses nothing but testosterone for refractory depression in men. Again, Im talking about men who formally scored abnormally LOW on testosterone lab tests. Not high testosterone guys here, remember that.
> By no means, am I trying to say this describes you, what I am trying to say is that for many men, (myself included), our testosterone is in the higher range of normal, but we still are depressed.One of the things Ive recently read is that low testosterone levels are associated with low dopamine levels. If you do a search on yahoo or Google, you will find that Neurologists are experimenting with testosterone to combat many of the nonmotor side effects of parkinsons disease. There are many more clinical trials using T in parkinsons disease than there are to treat refractory male depression.
Nobody with low dopamine levels is going to be "impulsive and a criminal." In fact, if dopamine levels are low, the odds are serotonin levels are going to be low as well. Personality characteristics of low dopamine can include obsessiveness, rigidity, "muleheadedness" and excess conservatism.
>
> When I was depressed, I was still very assertive, agressive, angry and irritable, low mood, and constantly regretting my actions. I was competitive, dominant, chronically jealous, and superficial.Definitely doesnt sound like normal depression. Definitely some form of bipolar disorder. No unipolar depressives are "competitive."
>My testosterone levels were fine. Dopimanergics made things much worse. Infact, SSRI's and lithium, were the only things that enabled me to stop and think things through rationally. They irradicated my irritability.
Like I said, being a bipolar youd be excluded from the trial and also since you dont have low testosterone, there is no need to even take testosterone. Im talking about the large numbers of 30 plus men with UNIPOLAR severe refractory depression here, who have scored low on testosterone tests.
>
> I would agree with you that many depressed baby boomers probably have low T but....
>
> to say something like low T is "MALE" depression is extrodinarily narrowmined.Not if you are unipolar depressed male its not.
>
> And if you didn't ask for my opinnion, you wouldn't have opened this message :)Well, I will be honest with you I dont think your opinions are worth much. Arent you the fellow who put together your own rTMS machine? LOL Thats a pretty manic thing to do.
I was in the rTMS clinical trials in 1999 and I wasnt very impressed with rTMS. I dont think its ever going to be FDA approved. Its so safe...if there was anything to it as far as effectiveness for severe mood disorders, I expect it would be FDA approved by now.
An article by Dr. Mark George in the September 2003 issue of Scientific American said rTMS doesnt even penetrate deeply into the brain like ECT does. It doesnt stimulate those "deep brain structures" like ECT does.
Testosterone is far better for severe, unipolar, refractory depression in men compared to rTMS.
Eric
Posted by linkadge on November 23, 2003, at 10:46:46
In reply to Re: Many men need T *decrease*, posted by LostBoyinNC34 on November 23, 2003, at 8:40:43
Psychquackery, is that you ??
Anyhow, your statement about low dopamine levels correlating with low serotonin levels isn't entirely acurate. Implulsive, agressive, and antisocial people tend to have high levels of dopamine, and low levels of serotonin. SSRI's are particularly effective for these people, because they tend to indirectly *lower* dopamine.
Other people may not feel particulatly helpless, but chronically sad or blue. For these people SSRI's tend to be effective as they indirecly lower sypathetic amines such as dopamine, and norepinephrine, this is described at biopsychiatry.com as kind of a ssri induced parasympathetic responce.Infact there were a few studies that showed that response to SSRI's directly correlated with with dopamine *decrease*. The apathy effect that some people have with ssri's never happened with me. For me, it was a releif to be able to let things go for the first time.
SSRI's are often very effective in depression with OCD features. These people often have a high sex drive with constant obessions with sex, religiion, supersition etc. Stimulation of the 5ht2a receptor is purported to be the theraputic response with SSRI's for these people. The relief from the obsessions again correlates with decrease in dopamine.I don't know where you got the idea that I was bipolar. Lithium oftentimes is used as an augmenting agent to SSRI's, that is why the doctor perscribed it to me (as far as I know at least!)
As far as building my own rTMS machiene, I personally thought that was quite clever!. Some others thought so too, tons have emailed me for building instuctions. CTV had enough guts to devote most of their show to rTMs's implications, expecially its ability to increase grey matter, and neurotrophic factors. And even if it isn't effective, I find it to be a pretty good placebo!
I fully agree with you when you say there may be a substantial portion of depressed males over 30 who have borderline testosterone, and who may benefit from it.But on the other side of the coin, excess testosterone can easily lead to depression, irritability, and anxiety on its own. Certainly you learned this from anti-steroids day in high school gym class.
I would argue that there is also a substantial portion of males who have quite normal testosterone, and who respond to SSRI's well.
Thats all
Whatever works for you, good luck,
LinkadgeLinkadge
Posted by zeugma on November 23, 2003, at 12:30:50
In reply to Re: Many men need T *decrease*, posted by linkadge on November 23, 2003, at 10:46:46
> Psychquackery, is that you ??
I had the same hypothesis.
>
>
> Anyhow, your statement about low dopamine levels correlating with low serotonin levels isn't entirely acurate. Implulsive, agressive, and antisocial people tend to have high levels of dopamine, and low levels of serotonin. SSRI's are particularly effective for these people, because they tend to indirectly *lower* dopamine.
> Other people may not feel particulatly helpless, but chronically sad or blue. For these people SSRI's tend to be effective as they indirecly lower sypathetic amines such as dopamine, and norepinephrine, this is described at biopsychiatry.com as kind of a ssri induced parasympathetic responce.So on this account, TCA's would raise sympathetic amines, and help with the anhedonic, chronically helpless side of depression, right?
>
> Infact there were a few studies that showed that response to SSRI's directly correlated with with dopamine *decrease*. The apathy effect that some people have with ssri's never happened with me. For me, it was a releif to be able to let things go for the first time.Apathy would occur in someone who probably would have responded better to a non-SSRI in the first place- someone who is already tipping towards apathy in his or her depression and needs a boost in the sympathetic amine side of things.
>
>
> SSRI's are often very effective in depression with OCD features. These people often have a high sex drive with constant obessions with sex, religiion, supersition etc. Stimulation of the 5ht2a receptor is purported to be the theraputic response with SSRI's for these people. The relief from the obsessions again correlates with decrease in dopamine.
>
I find this particularily interesting. Some TCA's, such as amitriptyline and nortriptyline, Serzone, trazodone, and Periactin are 5HT-2A blockers, as are many typical and atypical neuroloeptics. The 'negative symptoms' of deopression and schizophrenia are apathy, anhedonia, loss of interest in contact with others including sex, etc. So perhaps there are 'negative-dominant' and 'positive-dominant' depressives who needs either sympathetic-amine enhancing meds, and those who need SSRI's. THis theorizing is very crude, of course, but I am clearly a 'negative-dominant' depressive who loves to isolate, to sleep all day, and is given to feelings of chronic helplessness. My depression is TCA-responsive.> I don't know where you got the idea that I was bipolar. Lithium oftentimes is used as an augmenting agent to SSRI's, that is why the doctor perscribed it to me (as far as I know at least!)
>
> As far as building my own rTMS machiene, I personally thought that was quite clever!. Some others thought so too, tons have emailed me for building instuctions. CTV had enough guts to devote most of their show to rTMs's implications, expecially its ability to increase grey matter, and neurotrophic factors. And even if it isn't effective, I find it to be a pretty good placebo!
>
>
> I fully agree with you when you say there may be a substantial portion of depressed males over 30 who have borderline testosterone, and who may benefit from it.
It isn't clear that ALL AD's would lower testoterone. Wouldn't NE reuptake blockers raise it indirectly through the interaction of DA with the NE transporter? NE reuptake blockers have been shown to substantially raise DA levels in such areas as the prefrontal cortex. 5-HT 2A antagonism might be another way TCA's might raise DA levels.
>
> But on the other side of the coin, excess testosterone can easily lead to depression, irritability, and anxiety on its own. Certainly you learned this from anti-steroids day in high school gym class.
>
> I would argue that there is also a substantial portion of males who have quite normal testosterone, and who respond to SSRI's well.
>
> Thats all
>
>
> Whatever works for you, good luck,
>
>
> Linkadge
>
>
>
> Linkadge
>
Posted by loolot on November 23, 2003, at 12:42:15
In reply to Re: Many men need T *decrease* » linkadge, posted by zeugma on November 23, 2003, at 12:30:50
Posted by linkadge on November 23, 2003, at 14:24:45
In reply to Re: Many men need T *decrease* » linkadge, posted by zeugma on November 23, 2003, at 12:30:50
I think you're right on cue.
It really depends on your initial symptoms.I felt emotion very intensly to begin with.
After my burst of anger, and irritability, I would cry bitterly at a sad song. I hated the person I was. I just couldn't find any restraint, to both my emotions and my mood.
SSRI's really helped dampen my emotion, they stoped the songs going through my head like a broken record. They helped me to sleep. They mainly helped me because for the first time I was laughing, and that really relaxed me.
But you are right, some people are the exact opposite. They are apathetic, they don't really care, they oversleep and overeat. They respond better to things like TCA's, effexor, parnate, Wellbutrin etc.
It really depends on your initial state.
My main point is that everybody is different, and that it would be a mistake to make dogmatic broad-spectrum statements.
Take care, and I hope you find what works for you.
Linkadge
Posted by crazychickuk on November 24, 2003, at 2:38:45
In reply to Most psychiatric drugs lower testosterone levels, posted by LostBoyinNC34 on November 22, 2003, at 16:51:28
Well i am a woman with a high testosterone level... i am on remeron.... still got high testosterone even when i was on ssri's snri's trylics etc..
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
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Script revised: February 4, 2008
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