Did My Medications Cause A Low Testosterone?

QUESTION:

Dear Doctor,

My name is John. I'm 33, 6'3", 250lbs w/ 12% body fat. I have been on 20 to 40 mg of Prozac and 1800mg of lithium for the past 12yrs due to being bipolar. Until very recently I have had no problems tolerating these meds. With in the last year my Testosterone levels keep coming back in the low 200 hundreds. I have been having problems with maintaining and erection, as well as not recuperating from my workouts. I lift weights 3 to 4 times a week, don't smoke or drink.

My doctor believes that all of the years of taking my meds has had an effect on my T-level. He has started me on 10g of Androgel in the hope of boosting my T level.

My questions are:
1.How long before I notice results? (I would like to get my levels back up to 800/1000 range.)
2.Do you think I should change my meds around? And in general any suggestions you have would be very welcomed.

Thank you.

ANSWER:

It is extraordinarily unlikely that lithium or Prozac caused the low testosterone. It's due to pituitary or testicular failure. The blood FSH, LH, and prolactin levels would explain which was present. Sometimes this problem just happens to men, and I've seen quite a few. Hypothalamus problems are commonly seen in people with mood swing disorders, particularly the borderline disorder (BPD), and this may be the underlying reason. If you are stable and doing well on these medications changing them could cause you untold grief.

If Androgel works it should work within a few weeks. I usually give shots to get the level up and then begin the gel or patch.