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[painballer27]

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[birchswing]

<Not the person you wanted to hear from—not a psychiatrist or student>

Writing just because I had read an article about this not too long ago.

Everyone always talks about putting things in the water: SSRIs, metformin, statins. Not a new concept.

Anyhow this was the article:

What antidepressants can do to a brain that is not depressed

med.unsw.edu.au

The results seem to go along with the fact that SSRIs help more severely depressed people than moderately depressed people, who may then be hypothesized to not have the same disease as clinical depression (?).

There is a book on moral enhancement called Love Drugs that explores the ethics of using drugs for moral enhancement and improving relationships you might be interested in. Medications/supplements when used to improve beyond baseline are sometimes called nootropics.

My personal opinion—as already stated above not a doctor—is that SSRIs are not particularly useful for that. They seem to be most effective for severe depression and in higher doses for OCD.

There are however, insular religious sects that essentially keep psychiatrists on retainer, gone into detail in the Love Drugs book that use SSRIs to—they believe—enhance marital fidelity and prevent unwanted sexual acts through the very off-label prescribing of SSRIs in a religious setting—among both adolescents and adults. That's the most I've heard in terms of using them for improving from baseline (what they consider an improvement)--and there is a small cottage industry of doctors doing that, but usually within a geographical setting where these particular groups agglomerate, so it's not an evenly distributed practice obviously or widely known.

Edit:


I wanted to say this is not to downplay the use of drugs for enhancing human experiences and abilities. I frankly think it is bizarre that this hasn't been more the norm, and I also think it's quite ironic that so many medical students suddenly develop ADHD in medical school and use stimulants for the "better than well" that you are describing but then this cognitive enhancement isn't actually practiced in the field of psychiatry, yet it is in so many other fields of medicine where the enhancement (such as cosmetic) is so much more dubious and non-quantifiable than say a stimulant where you can quantify cognitive enhancement. My response was more to SSRIs in particular, which it seems except for certain disorders like severe MDD, seem more limited.

I can't remember where but I once read that SSRIs should have been classified as drugs to treat various sexual dysfunctions (premature ejaculation etc) that sometimes have mood side effects since the sexual effects are more consistent than the mood effects.

 

[futureapppsy2]

Psychologist, not a psychiatrist, but I'd say this is unlikely... the robust evidence for SSRI effectiveness/efficacy in MDD tx is really at the level of severe depression and when you get into the mild range (and arguably the moderate range), it becomes harder to distinguish meaningful effects v. placebo, especially when you add in the therapeutic effects of physician attention. Plus, SSRIs, while safe in that they rarely cause life-threatening/irreversible side effects, aren't side effect-free by any means, so it'd be really hard to argue that the hypothetical benefit outweighs the risk in non-depressed patients. To be frank, I can't see many non-depressed people tolerating, say, sexual disfunction for some very minor potential benefits. When you have someone who is deeply miserable and non-functional, the risk-benefit balance looks very different.

 

[birchswing]

Thank you for your comments.

However, I’m only interested in hearing from MD/DO psychiatry attendings or residents, not from laypeople, premed students, mid level providers, nurses, administrators, etc.

I don't find it understandable. The chances of you finding someone who has read the book you mentioned and its nearly direct present day analogue (the one I mentioned), which has extraordinarily overlapping themes—I have read both, the previous a long time ago), and has the qualifications you desire is probably slim to none. It's not exactly a huge field of study, and I actually referenced a book that does specifically discuss SSRIs for enhancement from baseline, albeit for bizarre reasons (I think there really only are bizarre reasons you would take an SSRI for enhancement from baseline when otherwise not suffering MDD etc). That's what you said you were searching for. Best of luck finding that or something else from the correct person. SSRIs are now old drugs, and Kramer wrote his book closer to their advent. It's understandable why people would have been optimistic then; it's understandable now thirty years later why the most documented enhancement off label effect I'm aware of is for the benefit of their sexual side effects and not for being beyond well. If people were going to take them for the reasons you stated and that Kramer dreamed of, they would have done it by now recreationally—they wouldn't be difficult to obtain. It's probably harder not to be offered an SSRI script unsolicited for almost any reason under the sun than the effort to obtain one for ill-gotten reasons. With so many pills lying around, so many scripts being offered, if there were these supposed benefits, people would be taking them without medical indication en masse. You wouldn't have practitioners cajoling patients into taking them. The supply/push and demand/rejection is balanced out because of their modest effect. Otherwise the nootropics community would be using them. There have been hundreds of millions of prescriptions per year and a species desirous of feeling their best. The clinical experiment has been done. SSRIs are milquetoast except in limited circumstances. You don't even need a high school degree to reason that out or to read a book. This is not just psychiatric; it's anthropological. And you're really asking more of an anthropological question.

If you actually care about this and not the person (AKA hominem), the studies on cognition, talk about how the cognitive benefits of SSRIs are in depressed patient—not the general public:
A meta-analysis of the effects of antidepressants on cognitive functioning in depressed and non-depressed samples - PubMed Someone else can you send you the link if it's too gauche coming from me.

I do recall Trintellix making nootropic type claims, but again those studies were within depressed patients, which is where SSRIs have demonstrable effects.

Frankly Tylenol has more evidence for the type of every day social confidence you are talking about—seriously—you can look that up.

 

[Sikrouf]

I have no problems prescribing a very low dose of a liquid formulation of an SSRI to oupatient who are clinicaly impaired but dont meet criteria for a formal dms 5 diagnosis and dont have acess to an evidence-based therapy

I ve seen it work wonders and its directly linked to the strenght of the relationship i have with patients

I m not sure you were asking for the placebo effect though so maybe I m missing something

 

[calvnandhobbs68]

Remember that this book was written when SSRIs were really just coming onto the market, prozac had only been around for 6 years (although Kramer is still a big med proponent in general), so much less was known about wide scale efficacy and side effects and he didn't have the decades of additional RCTs, observational trials and meta-analyses that we have now about SSRIs. In that respect, there was a lot of hope about this whole new class of medications that would be much more tolerable for patients without the SE profile of MAOIs and TCAs.

I don't think these concerns about feeling "better than well" (which is basically his term for performance enhancement) was ever born out very well in clinical practice. As @futureapppsy2 notes above, the difference between SSRI and placebo gets smaller and smaller the less severe your depressive sx and I don't know of any evidence that SSRIs confer any kind of cognitive enhancement, increased sociability, etc in patients without clear symptoms to target. Only one I can think of that might fit that bill is Wellbutrin, which is of course because it's basically a mild stimulant.

That being said, remember there are DSM diagnoses of "other specified depressive d/o" or "other specified anxiety d/o" for instance, so technically it's very hard to NOT meet DSM criteria for SOMETHING if you've gotten to the point you're walking into a psychiatrists office (one of the criticisms of DSM of course lol) . So yes, I've absolutely given SSRIs to patients who seem to have impairing depressive or anxiety symptoms that just might not meet full criteria for MDD or GAD or whatever and I've also had patients benefit from this.

I'll say that the setting you probably see this the most actually is primary care. People come in, score high on a GAD-7 or PHQ-9 or something or come in like "doc I'm feeling depressed"...bam here's some Lexapro. So there's probably more people than we think out there who don't actually meet MDD criteria who get put on an SSRI for "depression".

 

[hallowmann]

Medications have adverse effects, and some are very problematic or significantly affect quality of life. About 30% of patients who take SSRIs report sexual side effects for instance (the exception really being escitalopram where it's closer to 15%). SSRIs can also cause clinically significant weight gain. The idea of medicating people who do not have clinically significant disorders just seems problematic to me.

Now as others have said, the DSM is not necessarily perfect, and patient's with clinically significant depressive or anxiety symptoms that don't necessarily meet criteria for say GAD or MDD certainly might benefit from SRIs in therapeutic or even low doses. It's always a risk/benefit discussion though. The idea of medicating someone without clinically significant symptoms for "enhancement" just seems more likely to cause harm than benefit.

 

[Alemo]

Here’s a succinct way I’ve thought about it…there’s no pill for a sprained ankle, mild deconditioning, and adjustment disorder or mild depression.

What there IS is a short course of physical therapy, moderate conditioning/exercise, dietary adjustments, and everyone’s least favorite not totally monetizable (at least for “hospital administrators”) intervention, PSYCHOTHERAPY!!

You can’t paint a picture with an exterior paint spray gun. You can repaint a wall, but if you want wellness, you’ve got to get out the detail brushes, so to speak.

(“But it’s slow and boring!! Who has time for that? We have antibiotics! Why can’t we have…”)

 

[rjs2131]

It always comes down to risk vs benefit for me, as well as the fact that for most people you can gauge some sense of benefit after 6-8 weeks.

If a low-dose SSRI improves an individuals quality of life and seems to benefit sub-threshold symptoms of anxiety/depression, I’m all for it. I’ve also seen bumping the dose for a period of time (I.e. someone with a baseline of MDD or GAD and worsening 2/2 psychosocial change) help a patient better handle distress and better maintain stability.

All medications have risks, but there is also the very real risk of no treatment and how that impacts an individuals life. Medications aren’t a replacement for therapy/skills, but if it helps get someone from A —> B without causing harm and puts them in a place to better engage with therapy, that’s a win.

 

[PsyDr]

Thank you for your comments.

However, I’m only interested in hearing from MD/DO psychiatry attendings or residents, not from laypeople, premed students, mid level providers, nurses, administrators, etc.

I'm commenting simply because you said this.

 

[deleted456421]

I'm commenting simply because you said this.

Thanks for your input?

 

[deleted456421]

I find myself using pregabalin and propranolol for this population. That is, people who have anxious symptoms but don't meet full criteria for MDD or GAD. Adverse effects are generally <<< placebo effects. Plus, there's at least some literature for pregabalin in anxiety disorders.

Edit: I know very well that propranolol has limited systematic evidence. However, many patients demand that I do something and I find it helpful for reducing sympathetic activation (sweating, increased heart rate, etc.).

 

[birchswing]

I find myself using pregabalin and propranolol for this population. That is, people who have anxious symptoms but don't meet full criteria for MDD or GAD. Adverse effects are generally <<< placebo effects. Plus, there's at least some literature for pregabalin in anxiety disorders.

Edit: I know very well that propranolol has limited systematic evidence. However, many patients demand that I do something and I find it helpful for reducing sympathetic activation (sweating, increased heart rate, etc.).

<Again not a doctor medical student>

Why would you describe the effects as placebo and then say there is "some" evidence? Pregabalin is first-line for anxiety in Europe. There must be good evidence.

And the withdrawal from gabapentin/pregabalin has been described as fairly severe.

Either way, I don't see how this is related to the question of enhancement beyond normal baseline, but if I understand correctly, it seems like you use a controlled substance (pregabalin) for cases you deem less severe than those that rise to the level of being diagnostic? I find it all confusing. It's a controlled substance with documented anxiolytic effects, but you make it sound like it pulls less of a punch than an SSRI and that its effects are placebo-like.

 

[deleted456421]

<Again not a doctor medical student>

Why would you describe the effects as placebo and then say there is "some" evidence? Pregabalin is first-line for anxiety in Europe. There must be good evidence.

And the withdrawal from gabapentin/pregabalin has been described as fairly severe.

Either way, I don't see how this is related to the question of enhancement beyond normal baseline, but if I understand correctly, it seems like you use a controlled substance (pregabalin) for cases you deem less severe than those that rise to the level of being diagnostic? I find it all confusing. It's a controlled substance with documented anxiolytic effects, but you make it sound like it pulls less of a punch than an SSRI and that its effects are placebo-like.

I said that propranolol has limited evidence. I'm very aware of pregabalin's first line use in Europe per Maudsley.

What I'm saying is this: people present to my office desiring medication options for symptoms that don't meet DSM criteria. I then offer psychotherapy while also describing pharmacological options, always mentioning the evidence base. Many people want something and accept the risks/benefits of propranolol or pregabalin.

The risks, including whatever withdrawal you describe, are generally much less than those of SSRIs. Never had anyone complain after abruptly stopping propranolol ER 60 mg or pregabalin 50 mg TID.

Some people don't meet DSM criteria and need "enhancement," so that's what I offer.

 

[calvnandhobbs68]

I said that propranolol has limited evidence. I'm very aware of pregabalin's first line use in Europe per Maudsley.

What I'm saying is this: people present to my office desiring medication options for symptoms that don't meet DSM criteria. I then offer psychotherapy while also describing pharmacological options, always mentioning the evidence base. Many people want something and accept the risks/benefits of propranolol or pregabalin.

The risks, including whatever withdrawal you describe, are generally much less than those of SSRIs. Never had anyone complain after abruptly stopping propranolol ER 60 mg or pregabalin 50 mg TID.

Some people don't meet DSM criteria and need "enhancement," so that's what I offer.

I mean not gonna lie it’s a little odd though.
This is the “give me antibiotics for my URI” of psychiatry….another option is just say no, come back or we can talk about it when you’ve done 3-4 months of psychotherapy if you’re really so concerned about it. There’s also a difference between a persistent anxiety disorder that doesn’t quite meet GAD criteria vs an adjustment disorder or “doc I get kinda anxious sometimes can you give me a pill for it”.

Also don’t know how you manage to get insurance coverage for pregabalin for “unspecified anxiety d/o” considering I’ve almost never been able to script it without a prior auth or outright rejection.

 

[deleted456421]

I mean not gonna lie it’s a little odd though.
This is the “give me antibiotics for my URI” of psychiatry….another option is just say no, come back or we can talk about it when you’ve done 3-4 months of psychotherapy if you’re really so concerned about it. There’s also a difference between a persistent anxiety disorder that doesn’t quite meet GAD criteria vs an adjustment disorder or “doc I get kinda anxious sometimes can you give me a pill for it”.

Also don’t know how you manage to get insurance coverage for pregabalin for “unspecified anxiety d/o” considering I’ve almost never been able to script it without a prior auth or outright rejection.

Someone comes in with social anxiety or excessive worry without the necessary GAD-7 score for GAD and agrees to start psychotherapy? What's the harm in these meds?

I've literally never had insurance problems with pregabalin.

This is the problem with psychiatry. I'm not going to give you a full case conference about my patients on an anonymous forum. I'm simply saying that there are times whem I'll start a medication despite the lack of full DSM-5 criteria. We all agree the phenomenology is questionable at best so why be so rigid about our medications?

If someone has sympathetic symptoms of anxiety (e.g. increased heart rate, diaphoresis, headache), I think propranolol makes sense. If someone has chronic pain and anxiety not otherwise specified, then pregabalin can be useful.

 

[Candidate2017]

Do you think that, hypothetically, if someone who does not meet criteria for MDD, GAD, or any other psychiatric disorder started an SSRI, could this confer some benefit to them such as resilience to everyday stresses, increased sociability/confidence, decreased overall neuroticism, or "feeling better than well" as Kramer puts it?

Sounds like this hypothetical person just needs an adult beverage. None of what you describe are psychiatric illnesses, for which psychiatric medications are indicated.

In reality though, anyone who presents to psychiatry for help will likely meet criteria for a diagnosis that requires medication and/or psychotherapy.

 

[birchswing]

Sounds like this hypothetical person just needs an adult beverage. None of what you describe are psychiatric illnesses, for which psychiatric medications are indicated.

In reality though, anyone who presents to psychiatry for help will likely meet criteria for a diagnosis that requires medication and/or psychotherapy.

That was the point of that book (and others since then though): Why should psychiatry be different than, say, sports medicine which helps athletes compete at the highest levels, or cosmetic surgery, which (obviously not objectively or quantifiably) enhances aesthetics? The doctors who help Olympics athletes are not helping people who have illnesses. They are performing prevention and interventions that allow them to most safely compete at levels far better than the average human. Why couldn't there be something like that for assisting, say, cancer researchers or pandemic virus researchers perform at higher levels? Obviously the answer is not SSRIs. But stimulants come to mind as a present day solution. This is hypothetical, though, mostly. But if you take the average person and try to improve their state of being you might also find some answers for mental illness along the way. Or it could be that mechanisms that improve other areas of the brain (such as intelligence) better allow a person to cope with a mental illness. People with higher intelligence pre-onset are known to cope with schizophrenia better, for example. You could theoretically find ways to both help the average person increase intelligence that might spill over to help patients with schizophrenia. I'm not sure if there is a lack of interest in enhancing humans cognitively, socially, and morally, or if there's some belief that it's unethical. My personal view is that it's unethical not to pursue any potential avenues that might be open to doing so. I understand that's different than clinical practice today, but that's not really what these books are about.

 

[SeniorWrangler]

SSRIs don’t seem to work that way, based on my clinical experience.

Also, there was a recent big (non-academic) survey of nootropics published on Astral Codex and SSRIs weren’t noted at all. Stimulants and exercise seemed to be the most popular in the survey group.

 

[birchswing]

<Again not a doctor or medical student>

I won't respond directly by quoting since you don't want to hear from me in particular, but I think your example gives the answer you are looking for.

There are a lot of quacks who will unnecessarily prescribe testosterone despite it lowering endogenous testosterone production, increasing cardiovascular risks, etc., when there are safer alternatives for even frank low testosterone (like Clomid). And there are as you said a a lot of people willing to take this TRT regardless of need. And it is classified as performance-enhancing. So end of experiment. It works. Has risks. But it works. So it's used off-label.

But the entire field of medicine, not just the cottage industry as with TRT, essentially has SSRIs sitting in candy bowls, and no one is taking it for any of the übermensch qualities you mentioned.

As far as subtherapeutic doses, Paxil is offered in some branded form (forget the name) in a really small dose for hot flashes/night. It *barely* had an appreciable improvement over placebo (placebo had like a 50% improvement rate in hot flashes) and was still approved by the FDA in a new branded form for some microdose (can't remember the dose now).

The reason they used a low dose was not that higher doses didn't work but due to the side effects.

I am sure this is one of the most studied classes of drugs, and if any improvements were found in small doses like that, they would have been noted. But they noted side effects, as almost anyone who has taken an SSRI can tell you about. As I mentioned, even Tylenol has been studied for these small effects. As an aside, lithium does seem to have some good evidence at very low doses.

Also, the types of effects you mention are ones that the owners of the originator drug patents would have loved to find because even if they didn't match an official indication, the drug reps would have been sure to mention, "Oh, btw, a sprinkle of Prozac works perfectly for improving your average run of the mill patient with regard to mood, cognition, etc." They constantly share those little tidbits of what it can help with regardless of what it is approved for. The question of whether everyone should be on Prozac was raised many, many times (I remember the Newsweek/Time magazine articles on this back in the 90s), and virtually everyone was on Prozac or another SSRI, I'm sure many at subtherapeutic doses, which is why I said the experiment has been run, whether or not official studies were. It would have made itself known by now.

In addition, the indication for who could take it while officially diagnosed with MDD kept expanding with the removal of the bereavement exclusion, for example.

This was the result of a deliberate attempt of SSRI companies to chip away at any limitation in prescribing their meds:

https://www.washingtonpost.com/business/economy/antidepressants-to-treat-grief-psychiatry-panelists-with-ties-to-drug-industry-say-yes/2012/12/26/ca09cde6-3d60-11e2-ae43-cf491b837f7b_story.html

Not that there was any actual limitation. It could have of course been prescribed off-label.

All this is to say that is if there is anything else they could find—beyond death of a loved one to hot flashes—they would have made sure psychiatrists knew about it by now.

My former psychiatrist loved all these little tidbits she'd get from the reps. She bought them hook, line, and sinker.

I can recall walking in one day, and she said, "Would you like to be smarter?"

(That was the beginning of a spiel for Trintellix.)

No, I want to be dumber! Please stop. (Probably what I was thinking.)

 

[nexus73]

Must remember that psychiatric diagnoses are imaginary boxes to organize complex human experience. Someone who is neurotic probably meets some GAD criteria, and if having dysfunction could probably be diagnosed with other specified anxiety disorder even if they don't have full GAD criteria. Similary someone with other specified depressive disorder may not meet full criteria for MDD. In these patients, counseling would defintiely be first line if patient will do it. But I wouldn't be opposed to offering an SSRI if patient is interested and provides informed consent. If meds help great, and if meds don't help, or cause problems, I would recommend stopping them. I wouldn't prescribe meds to someone who had no symptoms and was functioning well.

I don't think SSRIs would lead to a "better than well" mental state (excluding induction of mania), because I've seen plenty of patients with depression go into remission, and I would expect if the antidepressant could induce a "better than well" state it could do it in these people. I've never seen such patients turn into uber confident, resilient, effective humans. They just become like the normal person they were before depression.

 

[Evidence Based]

Yeah would just agree that Listening to Prozac is quite dated. Plenty of folks come to my office after being prescribed an SRI for "depression" by a PCP, and just as often as not I deperscribe it and the patient feels better given little to no benefit and significant side effects. I've also never seen an antidepressant make someone feel "better than well," but certainly see plenty of people worse off than before due to anorgasmia or another SRI side effect

 

[hallowmann]

Yeah would just agree that Listening to Prozac is quite dated. Plenty of folks come to my office after being prescribed an SRI for "depression" by a PCP, and just as often as not I deperscribe it and the patient feels better given little to no benefit and significant side effects. I've also never seen an antidepressant make someone feel "better than well," but certainly see plenty of people worse off than before due to anorgasmia or another SRI side effect

I mean, I've seen people describe feeling "better than well" on SRIs, but they were profoundly depressed prior to prescription and their definition of "better than well" is euthymia because they haven't experienced it consistently in a long time.

 

[Merovinge]

Yeah, I mean, I get that they aren't indicated. They are indicated for psychiatric conditions. I am specifically asking about using them when they are not technically indicated.

Let me give an example using another relatively common treatment: Testosterone replacement therapy. A normal testosterone level in men ranges from 300-1000. Let's say a 40 year old guy has his testosterone levels checked and its 400. Technically he does not have hypogonadism and treatment is not indicated. But I bet if he started TRT and got levels up to 750 or so, he would experience noticeable effects (energy level, sex drive, ability to gain lean mass, mood, etc.) and there are plenty of men who do this. I am essentially asking the same question regarding SSRIs, perhaps even at sub-therapeutic dosages.

So your example is actually (ironically) common folklore. I heard this asked to one of the premier urology fertility specialists in the country and they noted no evidence for increases in energy level/sex drive/mood/muscle building shifting between different levels of normal testosterone. Now supratheraputic levels certainly can do that on a time limited basis and going from below normal to normal will as well but not supplementing in the normal range. Exogenous T, except in people who have a real deficit, is an intervention where risk>>reward.

 

[erg923]

I recently came an old book, Listening to Prozac by Peter Kramer, and found it interesting and wanted to get some opinions from practicing psychiatrists. Do you think that, hypothetically, if someone who does not meet criteria for MDD, GAD, or any other psychiatric disorder started an SSRI, could this confer some benefit to them such as resilience to everyday stresses, increased sociability/confidence, decreased overall neuroticism, or "feeling better than well" as Kramer puts it? Are there any studies or anecdotes on this? Thanks

This is a psychiatrist....and he sees no potential problems with promoting psychoactive medications as a way of dealing with "life" and a primary way to promote "healthy living?" Really? This book just HAD to have been written in the heart of the "Decade of the Brain" right?! LOL!

Take as few medications as possible for as long as possible, if you ask me. Your internal locus of control/self-efficacy and liver will thank you later. Eat a balanced diet, exercise, be part of a social group, healthy coping skills and activities, strive to be resilient. Life (even if not totally or completely satisfying) if you are not mentally disordered, poor, or an ex-con is actually not that ****ing complicated.

Also, I'm not a Buddhist or anything, but isn't it "The Wanting" that creates the most problems in life?

As an aside, beyond "success stories" in terms of remission from a depressive episode or a depressive episode with comorbid anxiety , I've never heard of Prozac or any other SSRI to induce any kind of sustained "better than well" state of being. What does that even look like? Are you feeling like a 90's Abercrombie model now or something? What if you are black? Does it have the same effect? Or maybe it was just a middle to upper-class SES thing once you have conquered all else? Frankly, regarding SSRIs, I mostly just hear complaints about side-effects, non-compliance due to side-effects, and low-level disappointment. Where did this guy's idea of this even come from? Does he have any empirical literature to support this idea?

 

[erg923]

I would say his idea came from his own clinical experience which is why he wrote the book.

Why did you read this book?

 

[calvnandhobbs68]

Why did you read this book?

It's a pretty famous book written by a very well known psychiatrist...

Also why the deletion of the OP and literally every one of your answers in this thread OP?

 

[painballer27]

It's a pretty famous book written by a very well known psychiatrist...

Also why the deletion of the OP and literally every one of your answers in this thread OP?

No one seemed to enjoy the topic.

 

[VA Hopeful Dr]

I'll say that the setting you probably see this the most actually is primary care. People come in, score high on a GAD-7 or PHQ-9 or something or come in like "doc I'm feeling depressed"...bam here's some Lexapro. So there's probably more people than we think out there who don't actually meet MDD criteria who get put on an SSRI for "depression".

You've just described a solid 25% of my day.

 

[michaelrack]

So your example is actually (ironically) common folklore. I heard this asked to one of the premier urology fertility specialists in the country and they noted no evidence for increases in energy level/sex drive/mood/muscle building shifting between different levels of normal testosterone. Now supratheraputic levels certainly can do that on a time limited basis and going from below normal to normal will as well but not supplementing in the normal range. Exogenous T, except in people who have a real deficit, is an intervention where risk>>reward.

Muscle building is pretty much the only benefit for persons without real deficiency who take exogenous T