testosterone Best answer on the web
by prescription. My reason: libido loss. Dr and I both agree its
stress and other medications Im on for associated depression. NOT hormonal. Testosterone tests are normal-but he gave me testosterone (topical) anyway. Is it safe for a man with
NORMAL levels to take this? Will my testicles shut down sensing too
much??
Should I wait to try this AFTER I try excersise to reduce the other factors
ie stress and depression (and the meds for depression) that I think are
the culprit or start on testosterone, now per urologist
I wish more patients would take the time to question a physician's recommendations when a prescription for care may not be necessary. Kudos to you for being so conscientious!
According to my research, your physician is not necessarily out of line by prescribing topical testosterone. Supplemental testosterone is occasionally given to men starting in their late 40's, even if their testosterone levels are normal. This is considered a preventive measure against the inevitable diminishing testosterone levels which come with andropause, sometimes called "male menopause." The amount of testosterone administered topically should not cause any serious side effects if you follow the correct dosage, and your testicular function should not be affected. However, the shutdown of sperm production is a potential side effect which should not be ignored.
In your case, however, both you and your doctor agree that your diminished libido is likely due to stress as well as a side effect of the medication you are taking for depression. The important question, then, is whether the supplemental testosterone is really a desirable solution to your problem. The answer to that question will likely come down to a personal decision on your part - similar to the decision facing many women who must decide whether they want to take hormone replacement therapy when the uncomfortable effects of menopause begin.
I heartily agree that if other factors tend to be contributing to your loss of libido and your testosterone levels are normal, you might want to follow your gut instinct on this one. Trying to work on the issues relative to the cause of stress and depression in your life might be a good first step. If you find it useful to continue on medication for depression, you might consider consulting your doctor about some of the newer medications for depression that have fewer sexual side effects.
On the realistic side, you must also accept the fact the fact that a gradual loss of libido is quite normal in men (and women) as they age. Thus, if this becomes a significant cause of concern for you, there may be no harm in trying supplemental testosterone. It is just a matter of when (or if) you decide to try it. Do you want to rule the other factors out first, so you have a good idea of whether you can conquer this by relieving the stress in your life? Or, do you want to work on these issues while trying supplemental testosterone?
* One other aspect to consider is that depression is actually one of the symptoms of male andropause!
Again, the decision about what avenue to follow first is strictly up to you. One option might be to take another testosterone test, or at least ask your urologist about the exact method used to measure testosterone in your initial test. As you will see from one of the articles I have referenced below, "Is It Time to Add Testosterone?", test results vary significantly with the type of test administered.
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Since I am not a physician and cannot dispense medical advice, I have provided some information to help you understand more about testosterone levels and aging, the pros and cons of supplementation, other contributing factors to low libido and some natural therapies and remedies.
Read through them and see if they help you reach a decision!
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GENERAL OVERVIEW OF MALE AGING AND TESTOSTERONE LEVELS
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From "Testosterone." WMTV ABC News.
http://www.wmtw.com/Global/story.asp?S=1230183
"As men age, their testosterone levels may slowly decline. This occurrence has been called "viripause", "andropause" or "male menopause." This menopause may be caused by the testosterone receptors becoming less receptive, while the amount of free testosterone in the body decreases. The decrease is due to an increase in a blood protein that binds with the hormone, rendering it useless. The gradual fall in the testosterone levels (from 30 to 40 percent) is common in men between the ages of 48 and 70. As testosterone levels drop, men may experience a loss in muscle strength and function, increase in body fat, decrease in body density and a decrease in sexual function and drive. Of course, your physician first needs to rule out other medical causes for those changes."
Testosterone Replacement Therapy in Men:
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"Some scientists believe that testosterone replacement therapy may help counter the effects of declining testosterone levels in "normal-testosterone producing" older men.
"The side effects of testosterone can include agitation, rapid heart rate, nervousness, and polycythemia (excess of red blood cells), and prostate gland growth. It is recommended that a prostate exam and prostate-specific antigen (PSA) levels be checked before and after therapy to help rule out prostate cancer."
"Supplementing testosterone to increase athletic performance is harmful. Supplementation can cause abnormal bone growth, premature growth stoppage, nausea, gastrointestinal problems, blood clots, headaches, anxiety, depression, high cholesterol levels, and over a long period of misuse, it may suppress normal testosterone production."
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From "Dealing with Male Menopause," by Christopher J. Gearon. Discovery Health.
http://health.discovery.com/centers/mens/andropause/andropause.html
"Shocking as it may be to some men, male menopause, or andropause, is becoming more widely recognized and accepted by physicians for the changes many middle-aged men experience -from energy loss to depression to loss of libido to sexual dysfunction. And some clinicians are recommending that certain men experiencing these symptoms, along with a host of others such as decreased bone density and weight gain, seek hormone replacement therapy and other treatments."
"It's like puberty in reverse," Jed Diamond, a California psychotherapist and author of "Male Menopause" and the forthcoming book, "Surviving Male Menopause", says of andropause. Like puberty, the changes that andropause wreaks in aging men, Diamond says, are "hormonal, psychological, interpersonal, social, sexual and spiritual."
"Male andropause can be very insidious," explains Dr. Stephen Sinatra, a Manchester, Conn., cardiologist board certified in anti-aging medicine. The loss of testosterone, which can happen to men as young as 35, is gradual, with testosterone levels dropping just 1 percent to 1.5 percent annually. Unlike the precipitous loss of estrogen that women hitting menopause face, the gradual loss of testosterone may take years to exact its mark on men with a host of symptoms not unlike changes menopausal women experience."
"Irritability, fatigue, depression, reduced libido and erection problems are hallmark signs of andropause. "I felt like I didn't want to move," says Cecil Dorsey of Vernon, Conn. The 68-year-old retired truck driver, who discovered via a blood test nearly four years ago that his testosterone levels dropped, said, "I just didn't want to be bothered by anything."
**
"Typically, men suffering from the symptoms of andropause are treated for a specific medical condition. And therein lies the problem, Diamond maintains. For example, an andropausal male may be diagnosed with depression and prescribed an antidepressant, and both doctor and patient think the man's problem has been addressed. However, if that man has other symptoms of male menopause such as loss of libido, the antidepressant will only exaggerate that problem."
**
"Conventional means don't look at it as a pattern," Diamond says, who believes a more holistic approach is needed to address all of the symptoms of andropause. This could include conventional therapies combined with testosterone replacement therapy, psychotherapy, herbs, and diet and exercise."
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Also read and except from the book, "The Andropause Mystery: unraveling truths about the Male Menopause by Robert S. Tan, M.D. (2001) http://www.grandtimes.com/Male_Menopause.html
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UNDERSTAND THE VARIATIONS IN TESTOSTERONE MEASUREMENT TESTS
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According to the following article, "free testosterone" is the most important value to consider when it comes to considering supplementation. This is one reason I suggested the option of taking another testosterone test.
Even so, there are also many other variations in testosterone levels to consider, as well as other underlying conditions which may be a cause of lowered libido.
For a comprehensive overview of tests, results, and other underlying factors contributing to low libido, read:
"Is It Time to Add Testosterone?" by Louanne Cole Weston, PhD. WebMD. (2001)
http://my.webmd.com/content/article/43/1687_51041
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AN OVERVIEW OF TESTOSTERONE SUPPLEMENTATION
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From "TESTOSTERONE THERAPY: ADS DIRECTED TO CONSUMERS PROMISE MUCH," by Maryann Napoli. Center for Medical Consumers. http://www.medicalconsumers.org/pages/testosterone_therapy.html
According to Alvaro Morales, MD, professor of urology at Queens University, Kingston, Ontario, Canada, and author of several research papers on testosterone, "a majority of men will have low levels of testosterone if they live long enough, but that doesn't mean that all will be bothered by symptoms."
"He does, however, see a clear role for testosterone therapy in certain men with symptoms, such as decreased sexual desire, ED, irritability, lack of sleep, while acknowledging that it is hard to differentiate these symptoms from those associated with normal aging. "We tend to focus on sexual dysfunction, but anemia, loss of muscle mass, osteoporosis, fatigue, and depression are also symptoms of hypogonadism," said Dr. Morales. "We urologists castrate men to treat prostate cancer, and we see all those symptoms in men after the testicles are removed, but this is artificial the natural version is more subtle."
"Not all the symptoms must be present, according to Dr. Morales. "When a man comes to me, I get a clinical picture of the signs and symptoms and send him for a blood test. If the blood test documents his levels as below normal, then the patient should have a three-month trial of testosterone supplementation. As for the choice of testosterone therapy, that depends on patient preference, cost, and efficacy--it doesn't matter which type--skin patch, rub-on gel, injectable--of testosterone." Each has advantages and drawbacks, he said. "In the USA, you don't have a safe oral version that other countries do."
....
"These topical products are approved by the FDA on the basis of how well they increase blood levels of testosterone, but many men will be interested in how effective they are at increasing sexual activity. The FDA-approved drug labels are vague on this important point. For example, the Testim 1% label refers to the 90-day trial in which men taking this drug reported a 59% increase in sexual activity compared to baseline, but nowhere is it explained what the baseline was for any of the study participants."
"We can only guess that the sexual activity level of men entering such a trial was low. Here's what 59% increase in sexuality activity can mean: If the men in the Testim group reported an average of three days of sexual activity in three months before starting the clinical trial, then the 59% increase would mean that they went from three days of sexual activity in the three-month period to four or five days."
"Testosterone is a safe, natural compound," said Dr. Morales, though he followed this statement with cautions. "Once you start replacing it in older men, there is potential for adverse effects, and physicians should monitor them very carefully. I follow them every three months in the first year,' he said. "If anything bad is going to happen, it is usually in the first year, and prostate safety is the biggest concern," he continued, referring to evidence that increasing testosterone levels could stimulate the growth of a latent prostate cancer in elderly men or cause the prostate to enlarge."
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TOPICAL TESTOSTERONE AND POTENTIAL RISK FACTORS
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Topical Testosterone. Drug Guide
http://yalenewhavenhealth.org/Library/HealthGuide/DrugGuide/topic.asp?hwid=multumd04273a1
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Excerpt about potential risks from:
"Is It Time to Add Testosterone?" by Louanne Cole Weston, PhD. WebMD. (2001) http://my.webmd.com/content/article/43/1687_51041
"Taking testosterone is dangerous only if you have certain medical conditions. For starters, it's important to check your liver function before, and at regular intervals during, a testosterone-supplementation program. If there is a negative impact to the liver, it can be reversed by discontinuing the testosterone, says Gould."
"According to Ritter, prostate cancer either in your own history or your immediate family history rules out taking testosterone. An enlarged prostate that isn't cancerous, however, is not a deal-breaker -- a PSA test will let you know where you stand. The other tests help rule out other hormone problems: An abnormal LH test or prolactin level, says Gould, will alert your physician to check your pituitary for a malfunction or tumor. FSH testing can help determine if your sperm production is low."
"Other potential risks: So far, no study provides solid evidence that taking testosterone will cause hypertension or a substantial increase in cholesterol levels. It may cause a slight rise in blood pressure or "bad" cholesterol (low-density lipoprotein), but generally not to levels that are significant or irreversible."
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From "TESTOSTERONE TRANSDERMAL GEL." Advance Therapy Network.
http://advancetherapynetwork.com/testosterone-gel.html
"The goal of testosterone replacement therapy is to achieve normal to optimal levels of testosterone. For most patients, testosterone replacement therapy is safe. Possible side effects, however, include water retention, male pattern baldness, gynecomastia (enlarged breasts). The oral forms are also associated with liver problems. The use of large doses of testosterone (in bodybuilding, for example) increases the risks of side effects."
"Decreased normal testosterone production, prolonged or excessive testosterone therapy prompts the pituitary gland to stop producing the hormone gonadotropin. This in turn, surpresses normal testosterone and sperm production, accompanied by shrinkage of the testicles and frequent or continuing (and sometimes painful) erections. Because of this, testosterone replacement therapy is usually prescribed in cycles. After a 2- or 3-month period, the patient takes a different drug (such as HCG) that stimulates the testicles to begin production of natural testosterone again."
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From "Dealing with Male Menopause," by Christopher J. Gearon. Discovery Health.
http://health.discovery.com/centers/mens/andropause/andropause.html
"But testosterone replacement therapy is "not a benign treatment," warns Dr. Michael A. Werner, a White Plains, N.Y., urologist with specialized training in male reproductive medicine and surgery and male erectile dysfunction.
Specialists say that men considering testosterone replacement therapy - whether by injection, patches, cream, gel or oral form - should get their PSA levels checked as testosterone replacement therapy could increase the risk of prostate cancer. (A PSA blood test identifies a man's risk for prostate cancer.) Other risks associated with hormone supplementation, particularly with injections, include the risk of stroke, an increase in liver toxicity and breast development. Ironically, testosterone supplementation also shuts down the production of sperm, Werner says."
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DIET, VITAMINS AND HERBS
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From "Dealing with Male Menopause," by Christopher J. Gearon. Discovery Health.
http://health.discovery.com/centers/mens/andropause/andropause.html
"To help increase testosterone production, Sinatra, who heads the New England Heart and Longevity Center in Manchester, Conn., suggests men take zinc and vitamins C and E. Sinatra also suggests herbs, such as muira puama, and L-arginine to increase a man's libido."
"Sinatra does a blood screen for all his male patients older than age 50 to check their testosterone levels. While testosterone replacement therapy is the standard for treating men with declining levels of testosterone - which can set off symptoms ranging from depression and fatigue to sexual dysfunction - some experts advocate a more holistic approach to andropause, including diet and exercise."
"Loss of libido, for example, can be treated with the vasodilator ginkgo biloba, suggests Jed Diamond, author of "Male Menopause." For men hitting midlife, Diamond recommends, eat soy products, lower fat foods, vegetables and tomato products, the last of which can reduce the risk of prostate cancer. Furthermore, drinking plenty of water is a key component for healthy living."
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From "Male Libido." Armenian Medical Network
http://www.dental.am/eng/libido/3.html
"The cause of a lack of libido may be psychological or organic (85 - 90%) in nature. Men may seek medical attention when there is a problem in getting or maintaining an erection sufficient to permit satisfactory sexual intercourse (impotence), premature ejaculation or the inability to ejaculate. An estimated 20 million men in North America suffer from erectile dysfunction. It affects at least 25% of all men over the age of 50. Men should be able to maintain their sexual virility well into their 80's."
"Some of the more common organic causes of impotence include peripheral vascular disease, hardening of the penile arteries, diabetes, prostate enlargement, depression, over 200 prescription or over-the-counter drugs, alcohol, cigarette smoking and mumps as an adult. Other causes include psychological or emotional stress. A thorough medical evaluation is important to rule out any treatable organic conditions."
"There are many safe and effective natural therapies to enhance libido. These can and should be used as complementary to conventional medical care. Psychotherapy may be vital in some cases but most of the medical and nutritional therapies will work without it. Deep breathing exercises, meditation, visualization and yoga are all methods that can enhance sexual energy. A balanced diet low in animal fats, fried foods, sugar, caffeine, white flour products, alcohol and junk foods is important. A University of Michigan Medical Center study showed that vigorous exercise, hot tubs and saunas may result in lower production of hormones involved in potency, fertility and the sex drive. Avoiding heavy exercise, severe stress, hot tub baths and saunas may make a significant difference for some men."
"Natural supplements that are helpful in increasing potency and the sex drive include arginine, vitamin E, zinc, vitamin C, octacosanol, flax seed oil, vitamin A, Beta-carotene, vitamin B complex and vitamin B6. All these nutrients are either important to increase the sperm count, improve prostate gland function, enhance sperm motility, increase male hormone production by the body or create a healthier nervous system."
(Read more.....
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REDUCED FREE TESTOSTERONE AND ANTIDEPRESSANT-INDUCED SEXUAL DYSFUNCTION
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The following article is extremely interesting!
From "Antidepressant-Induced Sexual Dysfunction Associated with Low Serum Free Testosterone." Presented by Alan J. Cohen, M.D., Private Practice and Assistant Clinic Professor of Psychiatry, UCSF (revised 10/2000) http://www.mhsanctuary.com/rx/testos.htm
Summary:
"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."
Read more...
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WHICH ANTIDEPRESSANT HAS THE LEAST SEXUAL SIDE EFFECTS?
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It is a well-known fact that antidepressants can reduce sex drive in men and women. You may want to talk to your doctor about trying another medication.
From "Got the Bedroom Blues?" by Nancy Schimelpfening. Depression. About.com
http://depression.about.com/cs/sexualdysfunction/a/bedroomblues.htm
"A study out of the University of Virginia examining the prevalence of sexual dysfunction among antidepressant users reveals that while the drug classes known as selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) were associated with a higher rate of sexual dysfunction, other antidepressants were associated with significantly lower rates, namely bupropion and nefazodone. These data suggest that sexual dysfunction may be related to serotonergic antidepressant therapy."
"Wellbutrin, the brand name of bupropion, had the lowest overall rate of sexual dysfunction. It was associated with a rate of 22% of the overall population. The sustained release formulation fared almost as well with a rate of 25%. In contrast, the SSRIs (Prozac, Paxil, Zoloft and Celexa), venlafaxine (Effexor) and mirtazapine (Remeron) averaged about 40%. When subjects were removed who had other probable causes of sexual dysfunction, the results were even better. Wellbutrin's rate dropped to 7% with the other medications dropping to between 23-30%."
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WEANING OFF ANTIDEPRESSANTS
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If you decide, at some point, that you want to reduce your medication or stop it altogether, please work with your doctor to accomplish this in a safe manner. The following article provides some tips:
"Getting Off Antidepressants -Withdrawal Side Effects of SSRIs Emerging," by Rebecca Raphael. ABC News. http://abcnews.go.com/onair/2020/2020_000825_SSRIwithdrawal_feature.html
Please see the list of tips at the bottom of the article.
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ADDITIONAL READING
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"Testosterone Replacement and Aging in Men," by John E. Morley, M.B., B.C.
http://www.renewman.com/Article5_0319.htm
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A short questionnaire to help determine whether you are going through Andropause may be found in the following article:
"Male Menopause - Fact or Fiction?" by Mark Swircenski, PA-C. Medically Speaking. http://www.alaskawellness.com/mar-apr01/medical.htm
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"Testosterone in depression?" by Robert W. Griffith, MD. June 29, 1999 (Reviewed: October 2, 2002) http://www.healthandage.com/PHome/gid2=344
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"Testosterone levels may be connected with depression among elderly men, study finds." Provided by FaxWatch Inc. (2/6/2004) http://healthy.net/asp/templates/news.asp?Id=8441
"Testosterone may be associated with depression among elderly men, according to a new study that found men with low levels of the hormone have a four-fold chance of developing depression as compared with men whose hormone levels are normal."
"The two-year trial included 278 men aged 45 years and older. Of these men, 23 were diagnosed with hypogonadism, a condition marked by testosterone deficiency as well as reduced muscle strength, loss of bone mass, fatigue and a diminished interest in intercourse, or libido."
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I must say.....I have to take issue with that last article calling those of us who are past the age of 45 "elderly."
With that said, I hope the information I have provided allows you to make a more informed decision about the course of action you might want to take. If I can provide any further help, please don't hesitate to ask for clarification before rating my answer. I will be happy to help if I can.
Sincerely,
umiat
Google Search Strategy
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I think I want to try excersise to reduce depression and stress which will then allow me to decrease the medications...knocking out 1 by 1 - 3 known contributors to libido loss! IF after trying this, I still have libido probs I will start supplimentation. If I do both simultaneously-Ill never know WHICH did it- !
Thank you very much for your generous rating and tip. It sounds like you are on the right track. I wish you all the best! umiat
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July 30th, 2010 edit