I’ll try to keep this short. I took antidepressants for a year about 3.5 years ago. I experienced sexual sides while on the drugs, but the real sexual function began after discontinuing them. I’ve since experienced nearly non-existent libido, some ED, and of course mood issues. Prior to starting these drugs, even in my worst states of anxiety and depression, I had zero issues with sexual function. In fact, I was extremely sexual as a normal, healthy 21-year-old should be.
I’ve read a significant amount of literature regarding hormones, both from journals and anecdotal reports from sites like these. It’s my understanding that SSRIs are capable of causing epigenetic changes to androgen receptor (AR) and estrogen receptor (ER) expression – the signaling of which is essential to male sexual function and libido.
I’ve taken a significant amount of bloodwork over the past couple years, and I’ve mapped sexual improvements to increases in T/DHT levels. With that said, even when I’ve boosted my testosterone to decent numbers through great diet, exercise, and sleep + OTC T-boosters (ginseng, boron, etc.) I’ve only felt “okay” sexually (i.e., I’ve had some libido and erections have been pretty good, but I’m still a far cry from my former glory days).
My highest numbers – during which I felt the best sexually – were the following:
Total T - 763 ng/dl [264 - 916]
Free T - 21.7 pg/ml [9.3 - 26.5]
SHBG - 48.1 [16 - 56]
LH - 5.6
FSH - 3.2
E2 - 28 pg/ml [7.6 - 42]
Prolactin - 7 [4 - 15.2]
ACTH - 32 [7.2 - 63]
Cortisol - 12.4 [6.2 - 19.4]
IGF-1 266 [115 - 355]
DHT - 68 [30-85]
DHT, free 6.66 [.54 - 2.58] High
DHEA-S - 541 [138.5 - 475.2] High
Pregnenolone - 168 [ < 151]
In addition to all these hormones checked, I’ve had thyroid panels, CBCs, and all the other standard bloodwork done.
My sexual function has fluctuated quite a lot over the last few years, from being completely impotent and lacking any libido to performing fairly well (relatively). The only trend I can find is that higher T levels map on to better function, and I attribute this to higher levels of androgens autoregulating androgens in important areas of the brain, such as the mPOA.
My doctor has agreed to try high doses of TRT (try to get to perhaps 1200-1500 and see how I feel) if I’m willing to accept the risks. Obviously I’m not a normal case, considering anyone else with these numbers should feel fine sexually.
Should I make the jump? If so, what would you recommend as a starting regimen?