Question about psychiatric drugs and testosterone

[birchswing]

If this is construed as asking for medical advice, please disregard. It is regarding a case of mine, but I don't want to ask for diagnosis or prognosis, only a question of what is possible (TL;DR: can psychiatric drugs affect testosterone levels?).

So, the short of it is that I am 32 and throughout my 20s felt crummy in excess of what I thought could be ascribed to my psychiatric conditions. I asked to have my testosterone and Vitamin D tested due to chronic achiness, weakness, bone pain. My Vitamin D level was 12. Through supplementation it's now 39.

My testosterone was initially 110. It has varied. The highest it's been in the years since I first had it tested, which was 4 years ago, is 220. It usually fluctuates between 110-170.

I saw an endocrinologist who wanted to put me on testosterone. I insisted that she perform a testicular ultrasound and run a LH and FSH test. My testicles turned out to be normal. My LH and FSH are well below normal--almost nonexistent.

That means that my pituitary gland isn't sending out the signal to make testosterone. So naturally I wanted an MRI to check for a tumor. The endocrinologist refused and wanted me to take testosterone, which I refused.

My primary care doctor has been unable to write an MRI because he thinks the insurance will deny it and basically describes getting it approved as something beyond his abilities. He believes that if I get off my medications, my testosterone will go up. My psychiatrist says that it's impossible for my medications to make my testosterone low. This is what is known as arguing about facts. One of them is right; one of them is wrong.

Since I have had diplopia I finally thought I would just go see a neurologist who agreed to set up an MRI for me to check out the diplopia while looking at my pituitary gland at the same time. I wish I had thought of trying that route sooner because it's been 4 years without the MRI I think that I need, and the neurologist had no trouble getting it approved.

I just saw my primary care doctor this week and I mentioned to him that I'm going in for the MRI to have my pituitary gland looked at. He pulled up my previous lab results and was shocked at how low my LH and FSH were and seemed to all of a sudden have a change of heart and think that maybe I do have a pituitary tumor (he theoretically already knew those numbers but I'm not sure if he had really looked at them).

One great problem is that I will have a lot of difficulty staying still with my anxiety and Tourette's. The scheduler called and told me as if she was letting me on a secret to have my doctor prescribe a 1 time benzodiazepine. I didn't go on to explain to her that I can't be put under conscious sedation even because I am so tolerant to benzodiazepines.

I guess I'll have my answer in a couple months' time regarding whether I have a tumor or not, assuming I can stay still enough in the machine, but in the mean time I had this thought: I bet no one has studied someone like me. I've been on benzodiazepines since I was 14 on a regular, daily basis at a fairly high dose. I've been on Paxil most of that time, as well, and Seroquel for the last 12 years.

Is there any way to know what effect that would have on testosterone? I started thinking maybe no one could know since who would have anticipated a child in early puberty taking benzodiazepines daily and for life. My psychiatrist is quite sure that they have not affected my testosterone, but I obviously had enough testosterone at some point to go through puberty, so I'm really not quite sure. It feels to me as if I had more earlier effects of puberty before beginning the medications and that I didn't have the later effects (no chest or body hair, very little facial hair, my face does not look virilized in its structure--very soft features).

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[slappy]

I guess I'll have my answer in a couple months' time regarding whether I have a tumor or not

Yes, do wait it out, or get an official second opinion, for I don't think the question is going to be answered here. It is asking for medical advice.

 

[birchswing]

Yes, do wait it out, or get an official second opinion, for I don't think the question is going to be answered here. It is asking for medical advice.

Yes, I can see how it can be construed that way, especially when I gave so much background information. The simpler question of whether psychiatric drugs can decrease testosterone levels is more a question of medical information rather than advice, but I tend to be rather verbose. I guess in a way it seemed less like advice-seeking in that I wanted to know if it's in the realm of what is possible not whether it's causative in my case, in the same way a person might ask if exercise is a possible cause of sore muscles not whether exercising caused a particular person's sore muscles. Or how a person might ask if lack of Vitamin C could cause scurvy. But I understood it might not be seen that way.

It also occurred to me that if such information were known (I'm not sure that it is), it would save the healthcare industry a lot of money. For example, if it were a known fact that my hormone levels are expected given the medications I'm on, it's possible that a normal work-up would not then include an MRI, which is quite expensive. In my case, I feel as if I'm a bit of a mystery to my doctors, but I'm not sure if that's based on lack of their knowledge in particular or lack of knowledge by everyone on the effects of these drugs with regard to hormones.

 

[hamstergang]

If a certain medication is known to have caused a specific side effect is something that should be simple to look up on google.

 

[birchswing]

If a certain medication is known to have caused a specific side effect is something that should be simple to look up on google.

That's true to an extent. And I have tried doing that.

But when medications are approved they aren't studied for every scenario. And doctors don't prescribe them for the duration or to the population they are necessarily approved for. I don't know a lot about it, but I believe benzodiazepines were studied for a therapy duration that was measured in weeks and not years. I also recall there was a conspiracy with one of the manufacturers in which data that showed no benefit to patients after a short period of time was destroyed by a pharmaceutical company.

I doubt Ativan has ever been studied for its effect on pubescent males who continue to take it for 18 years.

I don't think that long-term benzodiazepine use has been studied much generally. The person who is most known for her research, Professor Heather Ashton, wasn't ever able to even get funding for MRI studies. More interesting is that long-term benzodiazepine use has a high all-cause mortality risk. People who take benzodiazepines for a long period of time die younger, but people don't know why. So unfortunately not everything is a Google search away.

I thought that perhaps if someone had an intricate understanding of how these drugs work they might be able to postulate an effect they could potentially have on hormone production or have some more esoteric knowledge on research than I do, which is why I asked, but as I mentioned before, I understand it could be construed as seeking medical advice.