So, about 4-5 years ago I first asked to be tested for low testosterone. It was around 220. I had more testing done by an endocrinologist. They did a testicular ultrasound which was normal. My LH an FSH were tested and were abnormally low, which indicated a pituitary problem. She wanted me to take testosterone, which (it's a long story---will list separately below) I was afraid to try. She did not want to do an MRI which I wanted to do to look for a pituitary tumor.
I am unusual in that I have been on moderate to heavy doses of psychiatric medications since I was 15. Since 15 I have been on Ativan and Paxil. And I am now 32. Since I was 20 I have been on low dose Seroquel. Recently I have begun tapering Ativan, which means I am also taking Valium (I use a step down method).
My current doses are: Paxil: 30 mg Ativan: 3.5 mg Valium 3.5 mg (this is theoretically equivalent to 0.35 mg Ativan) Seroquel: 37.5 mg
I had strong OCD from the time I was 5 or so, and I was very worried and had attachment issues before that. It was at puberty (10th grade) that I switched like a light bulb into a total mess. I didn't have a medical doctor and the only person I ever saw medically was a psychiatrist and his wife who was a nurse practitioner, and without any testing for other issues I was treated with Ativan and Paxil.
I don't know if I ever went through puberty normally. I never developed much face hair and my legs and body are mostly hairless. People constantly ask me if I have just shaved my legs. My testicles are normal size; my penis was on the smaller side and seems to have gotten even smaller over the last 7 years or so. I never could figure out my sexual orientation either. I never had strong sexual feelings. I thought I was gay because I wasn't attracted to women and there were men who I admired and wanted to be like, which made me assume I was gay, but at 32 I am still just sort of more of an "it" then I am very oriented toward men or women. I don't have a real sexual drive.
When I ask my psychiatrist whether the medications I'm on could cause low testosterone, she sort of hems and haws and doesn't say. I know that when I first went on Paxil it impeded my ability to have orgasm. That has changed such that I actually have premature ejaculation even on Paxil. I think being on it for 17 years its effects have changed or been extinguished.
I just got my latest test results and my testosterone level is now 82. It has been in decline for years. The highest it was ever measured was about 5 years ago at 220. Then it went down to 180. Then 110. And now 82.
I did have an MRI once for another reason and it was very traumatic for me. I can't be sedated because I am benzo-tolerant. I also have Tourette's type tics and trouble staying still. I think I could do a better job this time now that I've done it before. The previous MRI, however, had motion blur, and it was a 1T without contrast so it wasn't of much use--it also wasn't specifically looking at the pituitary gland/hypothalamus.
My neurologist did prescribe an MRI for me which unfortunately expired but I'm seeing him tomorrow to get it re-authorized. It's a big deal for me to go do it as it's a long drive and I'm rather agoraphobic--unfortunately claustrophobic as well when it comes to being in that machine. Normally they give people a benzo to go into those machines to relax, but i take benzos several times a day just to keep from being in withdrawal, and I am actually tapering them slowly to get healthier. They unfortunately have don't work and have a paradoxical effect on me when they are tried for sedation--both my dentist and an oral surgeon tried a total of 4-5 times to put me under and used 5x more Versed than usual and it both didn't put me to sleep and paradoxically made me more agitated.
** So my questions are: 1) Can anyone tell me if these medications used for the duration I have used them could cause low testosterone? 2) Besides medication and a pituitary/hypothalamus issue are there other causes I should look into? **
Why I didn't take the testosterone when it was prescribed before
This is sort of ancillary info. When I saw the endocrinologist who prescribed testosterone, she would not order an MRI for me. I was scared to take testosterone because I didn't know what was causing the low numbers. I thought it was a tumor I should fix that rather than treat the symptoms of it. I also read that exogenous testosterone could make the testicles shrink and cause the body to be even less able to make its own testosterone. At the time I was more optimistic at the rate I thought I might be able to get off of the psychiatric drugs. I thought that along with exercise might help. I also had had very traumatic experiences with being jerked around on psychiatric meds in the past. I never wanted to be on any meds. When i was 15 I was terrified of the Paxil and Ativan and when I had to drop out of college due to the anxiety I was tried on so many meds in quick succession, and those meds often left me feeling horrible anxiety so I became terrified to make any changes to the meds. I felt the same about testosterone when I read about how it could cause anxiety. I also wanted the endocrinologist to be more curious and thorough. For example at the time I had read about people using Clomid which forces the body to produce more of its own testosterone naturally but she had not heard of that use. In short I guess I am once bitten twice shy. I wish I had never gotten stuck on these psychiatric meds as a teenager that are still to this day causing me so much trouble and I was afraid of trying one more thing that seemed like it was a life long commitment to take without really understanding what was going on, which is what caused me to go on the psychiatric meds before (with no physical testing, no discovery of the POTS, no psychological testing, no looking at my messed up family dynamics, no curiosity about my OCD, etc.). I didn't want to repeat what happened before and end up stuck on one more thing that might do more harm than good. I know that sounds ironic coming from someone on such deleterious drugs who hasn't managed to get off them faster. I am careful in everything I do to a fault.
Age: 32 Sex: M Height: 6'2" Weight: 250 (it's all in the stomach--I look like a bird that swallowed a bowling ball) Race: W Duration of complaint: Low testosterone perhaps started at puberty, not sure, first tests showing I had it were from 5 years ago Location (Geographic and on body): Southeastern US Any existing relevant medical issues (if any): OCD, anxiety, tourette's-type tics, excess weight, dysautonomia (POTS), sedentary Current medications (if any): Paxil, Seroquel, Ativan, Valium Include a photo if relevant (skin condition for example)
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