Hello, fredboy-ga!
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.
==
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!
=======================================================
GENERAL OVERVIEW OF MALE AGING AND TESTOSTERONE LEVELS
=======================================================
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:
----------------------------------------
"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."
==
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 [of treatment] 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."
==
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
============================================================
UNDERSTAND THE VARIATIONS IN TESTOSTERONE MEASUREMENT TESTS
============================================================
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
============================================
AN OVERVIEW OF TESTOSTERONE SUPPLEMENTATION
============================================
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
[advanced] prostate cancer, and we see all those symptoms in men after
the testicles are removed, but this is artificial [whereas,] the
natural version [of testosterone deprivation] 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."
=================================================
TOPICAL TESTOSTERONE AND POTENTIAL RISK FACTORS
=================================================
Topical Testosterone. Drug Guide
http://yalenewhavenhealth.org/Library/HealthGuide/DrugGuide/topic.asp?hwid=multumd04273a1
==
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."
==
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."
==
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."
==========================
DIET, VITAMINS AND HERBS
==========================
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."
==
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.....
========================================================================
REDUCED FREE TESTOSTERONE AND ANTIDEPRESSANT-INDUCED SEXUAL DYSFUNCTION
========================================================================
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...
========================================================
WHICH ANTIDEPRESSANT HAS THE LEAST SEXUAL SIDE EFFECTS?
========================================================
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%."
=============================
WEANING OFF ANTIDEPRESSANTS
=============================
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.
====================
ADDITIONAL READING
====================
"Testosterone Replacement and Aging in Men," by John E. Morley, M.B., B.C.
http://www.renewman.com/Article5_0319.htm
=
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
=
"Testosterone in depression?" by Robert W. Griffith, MD. June 29, 1999
(Reviewed: October 2, 2002) http://www.healthandage.com/PHome/gid2=344
=
"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."
====
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
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