T Nation

Sit and Wait, HRT or a Restart?


#1

Just got my blood tests back and would appreciate any input from you guys â?? I value it far more than my urologistâ??s opinion who is not up to date on HRT.

31 yearâ??s old, male, 180cm and 80kg. Have taken citalopram and fluoxetine (both SSRIs) on and off for almost 5 years due to anxiety that occasionally triggers a depressive episode when under stress. Now I have low stress and have been on fluoxetine 40mg for a year and now am tapering off it completely (down to 10mg at the moment).

Symptoms in order of importance:

Fatigue during the day
Almost zero libido (no erectile dysfunction)
Lack of muscle strength in gym
Fat accumulation abdomen
Apathy and lack of ambition

Felt they were textbook low testosterone symptoms â?? had levels checked and especially the bio/free level came in at the bottom of the range. I am aware that a number of these symptoms will be caused by down regulation of dopamine function due to the SSRI ( would selegiline help with this â?? I have heard some men have used it to improve test levels as well when their dopaminergic functioning has been down regulated as mine probably has)

Urologist put me down for a trial of Nebido - Hardasnails and various other informed forumites recommended I check thyroid and cortisol levels as well as various vitamins before embarking on HRT. Would welcome opinions on the blood tests (particularly cortisol and thyroid) but to me apart from the low test, only the low Vit D stood out (will be supplementing this as well as the whole Vit B complex)

As I see it I have three options:
1) Taper off fluoxetine ASAP. Optimise sleep/diet/weight lifting for several months and see if symptoms have improved/ testosterone gone to better levels.
2) Start the Nebido HRT to see if low testosterone is causing these problems. Try to convince the doc in a month to add HCG and more or less follow Crisler HRT protocol.
3) Attempt a restart of system with clomid and HCG, see how it goes there.

Any advice on which course of action to take would be greatly appreciated.


#2

I would look at all options - once you start TRT, you're on it for good. Coming off/restarting is the pits.


#3

Pretty steep drop in prolactin?


#4

Nebido is a bad option, it is meant to last for months and if things are not to your liking, you can't stop it.

Where are you located?

Your prolactin level is good, selegiline not needed for that and prolactin should not be holding down dopamine. If you get clean of the SSRI and then introduce selegiline and feel better, that confirms a dopamine issue. Small doses are effective. Try 2.5mg EOD or 5mg EOD. It is a MAO-B inhibitor. Know what that means and note that this can amplify the effects of any mono amine neural transmitters. This can amplify the effects of any AD meds, this can be good or bad and there are implications for smaller doses of things.

Some of your problems can be from the SSRI. Wellbutrin does not have sexual side effects and does not mess with one's mind like the SSRI's.

Suggest fish oil, others sources of EFA's and olive oil.

What is your iodine intake?


#5

Thanks to everyone for the replies - especially KSMAN, great information there.

From the advice i've been given here and another forum, if I did HRT in the future, I would substitute the Nebido for TEST CYP/ENAN due to the much shorter half life.

On the advice of others I will be supplementing

10,000 IU/day Vitamin D (deficiency here, could contribute to fatigue)
Vitamin B complex
2g Omega 3 (DHA+ EPA, already using this for years)

After 5 years of SSRIs I consider them to be poisonous to the male system - so much evidence of sexual dysfunction, lowered testosterone etc. If you can manage without them, I would reccommend any man slowly come off them - I myself am tapering off fluoxetine.

I really do suspect a dopamine issue - it ties in with the apathy/lack of ambition/anorgasmia as well as the lowering of testosterone levels. Do any of you have much experience with selegiline?

Wellbutrin would be foremost in my mind if I decided to get on another AD - SSRIs I cant reccommend for men.

Is there anypoint in attempting a restart of T levels with clomid/hcg or hcg monotherapy - or are they not low enough to be worth the bother? Are the levels low enough to trial HRT (I would like to consider HRT as a last resort)