Worth noting is that the men in the study had to have a morning total testosterone level of 350 ng/dl or less, which is clinically low to begin with. The study establishes no connection between SSRI meds and low testosterone.
This was posted at Brain Posts.
Selective serotonin reuptake inhibitor antidepressants (SSRIs) such as fluoxetine (Prozac) continue to be a common first-line treatment for major depression and a variety of anxiety disorders. Although generally well tolerated, sexual side effects are common in both men and women taking SSRIs.There are a variety of options for managing sexual side effects. These can include reducing the dose of the SSRI, switching (or augmenting) with antidepressants without sexual side effects or in men considering a trial of an erectile dysfunction drug such as sildenafil (Viagra).Now a small clinical trial suggests that testosterone gel may be another option for men with SSRI-related sexual dysfunction.A team of researchers from Israel and the United States combined to perform a randomized placebo-controlled trial of testosterone gel in men with low or low-normal serum testosterone levels. The key elements of this randomized trial published in The Journal of Sex and Marital Therapy include:
- Male subjects with DSM-IV major depression currently or within last year
- Taking one of eight SSRI drugs
- Current HAM-D depression severity rating scale of twelve or greater
- Morning total testosterone levels less than or equal to 350 ng/dl
- Randomized to receive testosterone gel (5 gram/day) versus placebo gel
- Primary sexual function outcome measured by the International Index of Erectile Function (IIEF)It should be noted this present study was a secondary analysis from data collected to determine if testosterone augmentation would improve depression in men partially responsive to SSRI treatment. This explains the requirement that at least moderate depressive symptoms were required for participation in the study. The second reference below is the results manuscript for the testosterone augmentation in depression study. This study found limited support for testosterone augmentation in depression.The testosterone augmentation group showed an improvement in IIEF scores in a variety of domains compared to the placebo group. This included improvement in subscales in the domains of sexual desire, erectile function and orgasmic function.The authors were unable to demonstrate a correlation between testosterone levels and improved sexual functioning ratings. Of note, some of the participants with low screening testosterone on more accurate testing later on admission samples showed normal testosterone levels. These individuals appeared to have as much improvement in sexual function measures as men with low serum testosterone levels.The authors note they were unable to distinguish whether impaired sexual function in this sample of subjects was due to SSRI treatment, major depression or a pre-existing hypothalamic-pituitary-gonadal functioning. Nevertheless, they note their study supports "the need for systematic clinical research to determine the therapeutic utility--including the effect on sexual function--of androgen replacement in depressed men, and the proper sequence of treatment".It should be noted that although testosterone gel is approved for use in hypogonadism in men, it is not approved for sexual dysfunction in men with normal serum testosterone levels. Testosterone therapy poses significant risk and should only be considered in the context of a medical evaluation by a physician. Testosterone supplementation may increase risk for prostate cancer. Subjects in the study described here were required to have normal prostate specific antigen levels (PSA less than 4.0 ng/ml) to participate in the study.Photo of green sea turtle from Loggerhead Marinelife Center of Juno Beach, Florida from author's personal file.
Amiaz R, Pope HG Jr, Mahne T, Kelly JF, Brennan BP, Kanayama G, Weiser M, Hudson JI, & Seidman SN (2011). Testosterone gel replacement improves sexual function in depressed men taking serotonergic antidepressants: a randomized, placebo-controlled clinical trial. Journal of sex & marital therapy, 37 (4), 243-54 PMID: 21707327
Pope HG Jr, Amiaz R, Brennan BP, Orr G, Weiser M, Kelly JF, Kanayama G, Siegel A, Hudson JI, & Seidman SN (2010). Parallel-group placebo-controlled trial of testosterone gel in men with major depressive disorder displaying an incomplete response to standard antidepressant treatment. Journal of clinical psychopharmacology, 30 (2), 126-34 PMID: 20520285