Testosterone is a crucial hormone for men’s health. It helps maintain muscle mass and bone density, promotes libido, and supports a positive mood. Unfortunately, some medications can interfere with testosterone production and signaling, leading to a drop in testosterone levels.
There are many reasons why a man’s testosterone levels may be lower than normal. Age, lifestyle factors, underlying health conditions, and certain medications can all play a role.
This article will explore some of the common medications and drugs that lower testosterone levels in males. We’ll also discuss their mechanisms of action and their clinical implications.
If you’re concerned about low testosterone, it’s important to talk with your doctor. They can help you determine the cause of your low testosterone and recommend the best course of treatment, especially if you’re taking medications that might be affecting your testosterone levels.
Testosterone and Low Testosterone (Low T)
What is Testosterone?
Testosterone is the main male sex hormone. It’s an androgen hormone, which means it’s what spurs the development of masculine characteristics. But it also impacts a lot of other functions in the body.
Testosterone is mainly made in the Leydig cells, which are in the testes.
Symptoms of Low Testosterone (Low T)
When a man’s testosterone levels are low, he may experience:
- decreased sex drive
- erectile dysfunction
- fatigue
- reduced muscle mass
- increased body fat
- mood changes
- decreased bone density
It’s important to remember that the symptoms of low testosterone vary quite a bit from person to person. The severity of the symptoms, along with how they appear, can depend on what’s causing the low testosterone.
Diagnosing Low Testosterone
Doctors usually diagnose low testosterone with blood tests that measure how much total testosterone is present.
Normal testosterone levels are usually between 300 and 1000 ng/dL. A diagnosis of low testosterone is usually given when a person’s total testosterone level is below 300 mg/dL on two separate blood tests.
Testosterone Endocrinology: A Primer
Before we dive into specific medications that can lower testosterone, it’s helpful to understand how testosterone works in the body.
The Hypothalamic-Pituitary-Testicular (HPT) Axis
Testosterone production is managed by a complex system called the HPT axis. It works like this: the hypothalamus (a region in the brain) releases gonadotropin-releasing hormone (GnRH). GnRH then signals the pituitary gland (another brain region) to release luteinizing hormone (LH). Finally, LH travels to the testicles and stimulates Leydig cells to produce testosterone.
Testosterone Conversion: 5-alpha Reductase and Aromatase
Testosterone doesn’t just float around in its original form. An enzyme called 5-alpha reductase converts some testosterone into dihydrotestosterone (DHT). DHT is a more potent androgen than testosterone itself and plays a role in things like prostate health and hair growth, which is why some men consider DHT blockers. Another enzyme, aromatase, converts some testosterone into estradiol, a type of estrogen that’s important for bone health and even libido in men.
Sex Hormone-Binding Globulin (SHBG)
Much of the testosterone in your bloodstream is bound to a protein called sex hormone-binding globulin (SHBG). When testosterone is bound to SHBG, it’s not able to attach to androgen receptors and exert its effects. So, we often talk about total testosterone (the total amount in your blood), free testosterone (the amount not bound to SHBG), and bioavailable testosterone (the sum of free testosterone and testosterone bound to albumin, another protein). Free and bioavailable testosterone are the forms that are readily available for your body to use.
Prescription medications that can lower testosterone
It’s not just lifestyle factors that impact your testosterone levels. Certain prescription medications can also send your T levels plummeting.
Opioid pain medications
It’s well-documented that opioid use, especially long-term use, can lead to lower testosterone. Opioids can suppress the hypothalamic-pituitary-testicular (HPT) axis, which is crucial for testosterone production. The longer you take opioids, the more likely you are to experience low T.
Opioids can lower testosterone by inhibiting the release of gonadotropin-releasing hormone (GnRH) and by directly affecting the function of Leydig cells, which are responsible for producing testosterone in the testicles. Long-acting opioids carry a higher risk of lowering your T levels.
Antidepressants and selective serotonin reuptake inhibitors (SSRIs)
Antidepressants, particularly SSRIs, can also affect testosterone levels, and some research suggests similar effects from stimulants like Adderall on male fertility. SSRIs can increase prolactin levels, which, like opioids, can suppress the HPT axis and reduce testosterone production. Plus, SSRIs are known to cause sexual side effects, including decreased libido, erectile dysfunction, and delayed ejaculation.
High blood pressure medications
Different types of antihypertensive drugs can have varying effects on testosterone levels. For example, spironolactone is known to lower testosterone. Studies involving multiple beta-blockers (like metoprolol and propranolol) have shown effects on both total and free testosterone. Research also suggests that thiazide diuretics may decrease bioavailable testosterone levels.
Statins
The evidence is mixed when it comes to statins and testosterone. Some studies suggest that statins might slightly reduce testosterone, but it’s not clear if this reduction is clinically significant. Statins may interfere with cholesterol metabolism, which is essential for testosterone production. Because of this, some researchers believe they can interfere with T levels.
Chemotherapy
Chemotherapy drugs can damage the testicles and affect testosterone production. Cytotoxic chemotherapy can directly damage Leydig cells, leading to reduced testosterone levels.
Cancer surgery, such as prostate cancer surgery or testicle removal (orchiectomy) for testicular cancer or benign disease, can also significantly lower testosterone levels.
Specific medications
Certain specific medications are known to lower testosterone. Ketoconazole, an antifungal medication, can induce castrate levels of testosterone. Cimetidine, a histamine H2 receptor antagonist used to treat ulcers, can also lower testosterone levels. As mentioned earlier, spironolactone is also known to lower testosterone.
Non-prescription substances that can lower testosterone
It’s not just prescription drugs that can mess with your hormone levels. Plenty of over-the-counter substances and even lifestyle choices can have a significant impact on your testosterone.
Alcohol
Chronic alcohol consumption is a well-known testosterone killer. Excessive alcohol intake can suppress testosterone production while simultaneously boosting estrogen levels. This is a double whammy for guys trying to maintain healthy T levels.
How does it work? Alcohol can directly damage the Leydig cells in the testicles, which are responsible for producing testosterone. It can also interfere with the hypothalamic-pituitary-testicular (HPT) axis, the complex communication system that regulates hormone production.
Marijuana and THC Products
The research on marijuana and THC’s impact on testosterone is a bit of a mixed bag. Some studies suggest that marijuana use can lower testosterone, while others show no significant effect. It’s not as clear-cut as the alcohol situation.
The potential mechanism? THC, the active ingredient in marijuana, can bind to receptors in the hypothalamus and pituitary gland. This could potentially affect the release of gonadotropin-releasing hormone (GnRH) and luteinizing hormone (LH), both crucial for testosterone production.
In my clinical experience, I’ve anecdotally observed a correlation between regular marijuana use and lower testosterone levels in some individuals. However, it’s important to remember that correlation doesn’t equal causation, and more research is definitely needed.
Anabolic Steroids
This one’s a bit of a no-brainer. Anabolic steroid use is notorious for shutting down natural testosterone production. When you introduce synthetic testosterone into your system, your body gets the signal that it doesn’t need to produce its own anymore.
The problem is, the HPT axis may not fully recover after prolonged anabolic steroid use, leading to persistent low testosterone levels even after you stop taking the drugs. This can result in long-term hypogonadism, a condition where the body doesn’t produce enough testosterone on its own.
Clinical implications and management
If you suspect that a medication is causing low testosterone, there are several steps you can take. It’s important to work closely with your healthcare provider to determine the best course of action.
Recognition of low T symptoms
It’s important to recognize the potential symptoms of low testosterone, which can include:
- low sex drive
- erectile dysfunction
- fatigue
- loss of muscle mass
- mood changes
You also may experience physical signs, such as gynecomastia (enlarged breasts).
Diagnostic testing
If you’re concerned about low testosterone, your doctor can order blood tests to evaluate your hormone levels. These tests may include:
- total testosterone
- free testosterone
- sex hormone-binding globulin (SHBG)
- luteinizing hormone (LH)
- follicle-stimulating hormone (FSH)
Doctors may diagnose low testosterone if you have two total testosterone levels below 300 ng/dL.
Treatment options for low T patients on drugs that may lower testosterone
One approach is a “drug holiday,” where you temporarily stop taking the medication under medical supervision to see if testosterone levels improve. It’s important to carefully consider the risks and benefits of discontinuing the medication and monitor your health closely.
Your doctor may also be able to prescribe alternative medications that have less impact on testosterone levels.
The timeline for testosterone levels to recover after stopping the medication can vary. It’s important to have a comprehensive approach that considers your overall health and medical needs.
Testosterone replacement therapy (TRT)
Testosterone replacement therapy (TRT) may be an option for some men with low testosterone, or some may use other medications like Cialis for ED to improve libido, energy levels, muscle mass, and bone density.
However, TRT also has potential risks, including prostate enlargement, increased risk of prostate cancer, and cardiovascular events.
TRT is available in different formulations, including injections, topical gels, patches, and oral medications.
Lifestyle modifications
Lifestyle modifications can also support healthy testosterone levels. Regular exercise, a balanced diet, adequate sleep, and stress management can all help.
Frequently Asked Questions
What is the #1 testosterone killer?
There isn’t one single “testosterone killer,” but several factors can significantly lower testosterone levels. These include obesity, chronic stress, lack of sleep, certain medical conditions (like hypogonadism), and some medications. Aging also naturally causes testosterone to decline.
What do most doctors prescribe for low testosterone?
If low testosterone (low-T) is diagnosed and causing symptoms, doctors often prescribe testosterone replacement therapy (TRT). This can be administered through injections, topical gels, patches, or oral medications. The specific method depends on individual needs and preferences, as well as potential side effects.
Should a 60 year old man take testosterone?
Whether a 60-year-old man should take testosterone is a complex decision that should be made in consultation with a healthcare professional. While TRT can alleviate symptoms of low-T, it also carries potential risks and side effects. The benefits and risks need to be carefully weighed based on the individual’s health history and goals.
What to do if a man has high testosterone?
If a man has high testosterone levels, it’s essential to determine the underlying cause. In some cases, it may be due to certain medical conditions or the use of anabolic steroids. Treatment will depend on the cause and may involve medications or lifestyle changes.
What does a urologist prescribe for low testosterone?
A urologist, specializing in the male reproductive system, can prescribe various forms of testosterone replacement therapy (TRT) for low testosterone. This may include testosterone injections, topical gels, patches, or oral medications, depending on the patient’s specific needs and medical history. Urologists will also monitor hormone levels and adjust treatment as needed.
In Conclusion
As you’ve seen, a variety of prescription and over-the-counter drugs could potentially lower testosterone levels in men. The effects of these substances will depend on many factors, including the dose and the individual.
If you’re concerned about low testosterone or are taking medications that might lower your T levels, it’s a good idea to talk with your healthcare provider. They can help you figure out what’s going on and what to do about it.
Managing low testosterone requires a comprehensive approach, including:
- diagnostic testing
- lifestyle changes
- medication management
- possibly testosterone replacement therapy
If you’re a man, it’s a good idea to take an active role in monitoring and managing your testosterone levels. By taking these steps, you can optimize your health and well-being.