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Testosterone and Drugs

Of course, alchohol and recreational drugs can lower testosterone, something I cover in my links on Alcohol and T, Beer and T and Marijuana and T.  However, what few men know is that legitimate, FDA-approved pharmaceuticals can also significantly lower testosterone as well.  Making matters worse, most doctors do not know about this side effect and, even if they do, will very rarely give their male patients any forewarning. 

It is very common for men over 40 to be on more than one medication and many of these will negatively alter hormone status, including one's androgens.  Let's go through some of the major classes of drugs that can decrease baseline testosterone levels:

CAUTION:  Do NOT discontinue any medication without discussing it first with your doctor.  In many cases, dosage can be reduced or an alternative medication found but this should be discussed with your physician first.

 

1.  Antipsychotics.  These are especially hard on testosterone through a variety of pathways but are notorious for raising prolactin levels.  Of course, prolactin fights testosterone and libido and if it goes too high will lead to sexual dysfunction in many ways. For more information, see my link on Testosterone and the Antipsychotics.

2.  Arrythmias (Amiodarone).  This drug for heart arrthymia has high iodine content and can interfere with thyroid function. [1]

3.  Lithium.  Of course, lithium can be a life saver for someone with bipolar disorder.  [2]  However, this can interfere with the thyroid and lead to hypothyroisim, which in turn can interfere with testosterone production. [1]

4.  Diabetic (Sulfonylurea). These drugs sometimes used to treat type II diabetes can result in hypothyroidism and, therefore, potentially, a drop in testosterone. [2]

 

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5.  Oxycodone (Oxycontin).  This pain medication tends to raise prolactin and in some men may lower testosterone. [3] It also can have a side effect of very significantly lowering testosterone in some sensitive men as well.

6.  Opiate Pain Killers (Percocet, Vicodin, Morphine, etc.).  These all will tend to lower testosterone via inhibition of LH (leutinizing hormone), the molecule released by the pituitary to signal the testes to increase testosterone production.  One review noted that "a large majority of men consuming sustained-action opioids have symptomatic androgen deficiency which apparently responds to replacement therapy. Opioid-induced androgen deficiency is frequently overlooked." [4]

7.  Dopamine Antagonists (Chlorpromazine, Compazine, etc.).  Anything that interferes with dopamine levels can easily diminish T levels.  These psychotropics are no exceptions.

NOTE:  I cover some of the famous "anti-aphrodisiac", libido-reducing medications at the bottom of my link on Male Libido Supplements.

8.  Antihypertensives (Beta Blockers).  Several studies have shown that beta blockers, a very common class of medications for high blood pressure can lower testosterone. For example one study found that atenolol, metoprolol, pindolol and propranolol all led to decreased testosterone levels.  Propranolol was found the above study to be the worst. [5][7]

9.  Valium (Diazepam). One theme you may have noticed:  almost any medication that affects the brain and/or brain function significantly tends to lower testosterone. Valium, the famous tranqualizer, is no exception and appears to tranqulized the testes as well. [6] 

CAUTION:  There are a wide variety of toxins, pesticides, endocrine disruptors, xenoestrogens, excitotoxins and other chemicals that can be considered "drugs" even though they are not pharmaceuticals.  I give significant coverage to these on my site at this link on Nasty Chemicals That Can Lower Testosterone.

10. Anticonvulsants. These drugs commonly used to treat epilepsy lead to an interesting phenomenon: an increase in total testosterone but a decrease in free testosterone. [8] This situation arises from an increase in SHBG. So who wins?  The increased total T or the decreased free?  Unfortunately, in the above study, the loss of free testosterone correlated well with decreased sexual activity levels.

11.  Antifungal (Nizoral or Ketoconazole). Even something as simple as trying to get rid of a fungal infection can lower T levels appreciably. [9]

12.  Tagamet (Cimitidine).  Strange as it may seem, this H2 Agonist Blocker for stomach issues actually directly lowers testosterone production. [10] In fact, one animal study labelled it as an antiandrogen. [11] Can't be any more clear that that, eh?

13.  Antidepressants (SSRI's).  SSRI's are notorious for lowering libido and leading to sexual dysfunction in both men and women.  Depression itself is notorious for lowering testosterone, something I discuss in my link on Depression and Testosterone, likely due to its increase in cortisol levels as a stressor.  This makes it difficult to tease out if SSRI's actually lower testosterone, since it is a side effect of the very illness these medicaitons are trying to treat.  And, indeed, one study actually found that SSRI's may increase T levels in men. [12]

However, more recent research showed very much the opposite.  Some studies have shown that most SSRI's significantly affect liver enzymes and thus some postulate that they slow down the time to clear estrogen (estradiol), i.e. allow for estradiol to build up. [13] One report noticed a wide variety of SSRI's that resulted in lower free T levels as well. [14]

But the most damning evidence came from studies on Prozac, which shows that, particularly in those who use it longer term, that testosterone levels do tend to drop.  See my page on Testosterone and Prozac for more information.

 

CAUTION: If you have a medical condition or are on any medications, please discuss any changes with your doctor first. Certain supplements, foods and even juices can alter absorption rates of certain medications for example. Play it safe.

REFERENCES:

1) http://www.umm.edu/patiented/articles/ what_causes_hypothyroidism_000038_2.htm

2) http://health.nytimes.com/health/guides/disease/drug-induced-hypothyroidism/overview.html

3) Journal of Pain and Symptom Management, Feb 1994, 9(2):126–131, "Altered sexual function and decreased testosterone in patients receiving intraspinal opioids"

4) Current Opinion in Endocrinology & Diabetes, Jun 2006, 13(3):262-266, "Opioid-induced androgen deficiency"

5) http://www.jpathology.com/Issues/Previous%20Articles/9(3).html

6) Systems Biology in Reproductive Medicine, 1979, 3(1):31-35, "Effect of diazepam on serum testosterone and the ventral prostate gland in male rats"

7) Arch Sex Behav, 1988 Jun, 17(3):241-55, "Beta-blocker effects on sexual function in normal males"

8) J Neurol Neurosurg Psychiatry, 1983, 46:824-826, "Sex hormones, sexual activity and plasma anticonvulsant levels in male epileptics"

9) Eur J Clin Pharmacol, 1985, 29(4):489-93, "Effect of a single administration of ketoconazole on total and physiologically free plasma testosterone and 17 beta-oestradiol levels in healthy male volunteers"

10) Arch Intern Med. 1985;145(5):920-922, "Cimetidine Blocks Testosterone Synthesis"

11) Gastroenterology, 1979, 76(3):504-508, "Cimetidine is an antiandrogen in the rat"

12) Journal of psychosomatic research, 03/2012, 72(3):205-13, "Salivary testosterone: associations with depression, anxiety disorders, and antidepressant use in a large cohort study"

13) European Neuropsychopharmacology, Apr 2006, 16(3):178–186, "The effect of tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs) and newer antidepressant drugs on the activity and level of rat CYP3A"

14) http://www.mental-health-today.com/rx/testos.htm

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