T Nation

Partial Androgen Insensitivity Due to SSRIs

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?

While I posted my “best” labs, I should mention that my normal T levels hover at around 500-650 TT and 10-15 FT. My sexual function at these typical levels is not good, and when I got my free T ~2x higher, I felt significantly better in many regards (mood, sexuality, sleep, etc.). However, it was still far from my pre-drug baseline. I am guessing if I pushed my total T over 1000 and free T to 25-30, I would see an even greater decrease in negative symptoms.

I almost cringe when I hear these stories and especially so when they come in while still taking these meds. I’ve met psychiatrists at medical conferences looking to turn to TRT to help guys with depression because of the 1) side effects and/or 2) lack of effectiveness of the drugs. Good for them, even better for the patients.

To answer your questions, yes, and I wouldn’t mess around, 200mg a week.

2 Likes

@naiverat
I had very similar circumstances and blood work to you before TRT. TRT was the answer to them and many others (including problems I didn’t even realize I had until they were fixed.

This.

1 Like

I was unfortunately 21 and naive when I started these drugs. I was very aware of the possibility that SSRIs could cause sexual dysfunction while on the drug, but no way in hell would I have touched the poison if I knew it could cause lasting dysfunction among other pleasant symptoms.

Anyway, thank you for the reply.

This is encouraging to hear. Thank you for the replies. Post-SSRI Sexual Dysfunction (PSSD) and PFS seem to share a lot of traits, if not very similar etiologies. I’m following the other threads and glad those guys are having success with this route as well. What a nightmare.

How should I divide up the 200mg to start? 100 mg 2x/wk? ~67 mg 3x/wk? For reference, my SHBG tends to be fairly high (has clocked just outside the upper range a few times) and my aromatase activity seems to be fairly low (I have relatively low body fight).

Should I include a low dose of hCG (perhaps 250iu/wk) to avoid complete shutdown, or is it throwing in too many variables?

I don’t particularly like the idea of hCG, but if for some reason high T doesn’t offer any benefit and I eventually decide to come off (and I understand it can take a lot of experimentation to “dial in,” which I am committed to), I want PCT to be as easy as possible. I can’t afford to lose anymore ground with regard to my already limited sexual function.

I’d start with Mon/Wed/Fri IM injections. Either 65mg/65mg/70mg respectively or just do 67/67/67mg if that’s easier. Shouldn’t really matter either way.

What ester would you suggest? My doc is pretty much open to anything.

Cypionate, but I’m not convinced it matters.

SSRIs have only benefited me, and I have PFS. Two sides to every coin I suppose.

I mean, most return to normal after discontinuing SSRIs, just as most return to normal after discontinuing fin. Unfortunately, those lucky few don’t. It’s not worth the risk.

I personally like more frequent injections myself but it’s one of those things you’ll have to figure out on your own. Whatever you choose make sure you stick with it for a full 8 weeks. There may be a time where you don’t feel like you think you should yet and if that time comes just remember it’s normal and that it takes 8 weeks to really START feeling any of the good shit. It only takes making a minor change too early to completely restart that clock and have to start all over.

2 Likes

Do the docs say this also
Or just us ?

Say what? That it takes months to have a real effect? It’s kind of like antidepressants. They tell you that it’ll take a couple months to have a real effect and that you may not feel great at first but wait it out to get the true effect.

I… I think I got the true effect

So my proposed regimen is 200mg test C 3x per week at 65/65/70 per dose. This should hopefully lower SHBG and get FT up. I plan to also add a low dose of hCG (200-400 iu) – likely divided into two smaller injections – in order to avoid testicular atrophy and remain producing some level of neurosteroids.

I know hCG is often frowned upon, but it appears neurosteroids are implicated in PFS and PSSD. Plus, our bodies are extremely sensitive and prone to “crashes,” so I have to hedge against these risks a bit more than “normal” TRT users do.

I plan to start without any AIs until I take blood work after several weeks to see where my e2 is. From my understanding, it is often better to let the body reach a settling point rather than using AIs and causing e2 peaks and valleys.

I will likely start this protocol come summer. (I’m in grad school, so this period of downtime will allow me to experiment more freely and won’t be a huge hinderance if I respond adversely initially).

How does this protocol sound?

Pick a consistent number for 3x weekly. You can’t do it like this. Just do 65 3x.

Idk if HCG is frowned upon as much as it’s more about dialing in test first. At the end of your protocol, If things aren’t aligned, how do you know to drop the HCG or increase/decrease the test dose.

Yes, you can. 5mg isn’t a big deal. Do the 70mg on the day that has a 2 day gap, ie Friday if doing mon/wed/fri protocol.

i don’t agree man.

Because if he can get away with it in this situation, then wouldn’t it be consistent in other situations?

Can one do this with twice weekly injections, daily injections, weekly?

We wouldn’t recommend or do this with other medications, regardless of the slight differences.

I think that 5mg difference is enough to be a hindrance, especially coupled with the a MWF regimen where there is already an inconsistent day.

I don’t agree that it matters that much for most people. Some? Maybe.

Exactly. Too many variables = poo poo. @naiverat Start with T get that right and then later add HCG once you know how the T dose/protocol makes you feel. I know all too well that feeling of “let’s do it all right the first time” but it rarely ends with the user reporting ideal results. Learn from the mistakes those before you have made. After all that’s basically what the forum is for.