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Originally Posted by SteveJohn1965 I am 41 years old male and started having problem with libido and erection about two years ago after quiting Paxil. I took Paxil for about 3 months for premature ejaculation, 1st month 10mg/day and then 5mg/day for another two months. I waited for side effect to go away, but had extreme hangover and my sex drive went to zero. I stopped taking Paxil, but my hangover and other side effect did not go away. That was two years ago.
Since then, I have seen many Drs and all sort of test, everything seems to be normal, except the percentage of free testosterone. My Total T is about 600ng/dL and free T is about 1.2ng/dL. The percentage is about 0.2%, the normal range is from 0.33% to 0.48%.
Many Drs felt my Testosterone were normal and did not put me on TRT. No one could explain the role of Paxil. I was put on Antidepressant, Wellbutrin, for about 6 months thinking this might be some sort of depression. Did not help with my ED.
Came of Wellbutrin, and after few months seeing a new Dr, he put me on Clomid. It boosted my Total T to 980 and my free T to 2.3. I felt normal again and did not have to use any medication for ED and my sex drive went back to normal.
After about two months, I felt loss of libido and problem with ED returned. I felt fatigue and tired, and other symthom of low T. The blood test showed my Total T had gone up to 1120ng/dL, but my free T is back to 1.4. (percentage T less than 0.13% !!!). Somehow my body is downregulating the amount of my free T.
Currently due to Clomid, my LH is high, 13.2. My SHBG is in normal range. Please advise. Why my free T is falling. What other test I could do?
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SteveJohn |
Premature ejaculation may occur when serotonin levels in the brain are not high enough to slow down the sympathetic nervous system's triggering of orgasm.
Paxil may help to delay orgasm by increasing serotonin levels.
If excessive serotonin levels are present, sexual dysfunction with lack of libido and erectile dysfunction occur. Factors include the high serotonin levels which cause subsequent lowered dopamine levels in the brain.
Paxil is mostly out of the body by a week. Withdrawal effects generally last 2 weeks, sometimes longer, but not two years. Other problems would be suspected.
Tests may be "normal" but that is up to interpretation. For example, most physicians order a TSH and a Free
T4 to determine thyroid function. But often these can be "normal" but a person suffers from signs and symptoms of hypothyroidism. What most physicians do not order is the Free T3 - which is a better indicator of thyroid hormone activity than the other two (those the Free
T4 and TSH are still valuable in the interpretation).
When a person has lack of energy, hypothyroidism and adrenal fatigue are the most important conditions to evaluate for and treat. Insulin resistance is next. And low testosterone is fourth.
The neurotransmitters and hormones in the body have an extensive interaction - essentially a three dimensional web of influences on each other. When one is changed, other changes in the other chemical messengers occur in a cascade.
Testosterone is interesting in that it can both increase thyroid function and reduce thyroid function, depending on the dose. It is possible for high doses to cause fatigue as a result. Testosterone also can increase
growth hormone production and slow adrenal function. Growth hormone itself can slow adrenal function. These result in a loss of energy.
Thyroid hormone does numerous things. It increases brain serotonin production - thus having a calming effect and possibly reducing premature ejaculation. It increases the number and size of mitochondria in all cells of the body, thus increasing metabolism and improving the function of every organ - including the adrenal glands. If adrenal fatigue is present, however, higher thyroid hormone levels may worsen fatigue since thyroid hormone places a demand on adrenal function. Thyroid hormone increases testicular steroid hormone production - increasing testosterone production in the process. If there is one hormone that is most important premature ejactulation, reduce depression, improve energy, and improve sexual function - it is thyroid hormone. Cortisol (from the adrenals) and testosterone are second.
Wellbutrin increases norepinephrine levels to reduce depression. When used to treat erectile dysfunction, it is important to use low doses. For this, regular-release Wellbutrin works better - at doses of around 37.5 to 75 mg a day. Higher doses risk causing adrenal fatigue - which would then contribute to eretile dysfunction or sexual dysfunction, and loss of energy.
The body regulates free testosterone by the production of SHBG. Higher SHBG reduces free testosterone. SHBG is reduced by testosterone and other androgens, insulin, and
growth hormone. SHBG is increased by estrogens, thyroid hormone, and progesterone. The balance of these factors determines the total SHBG production. Testosterone can also be destroyed more quickly if liver enzymes for it are stimulated in activity - such as in some drugs which induce certain liver enzymes.
Free testosterone, however, is not that great an indicator of testosterone's function. One can have normal or high free testosterone and still have multiple problems associated with low testosterone levels and other hormone imbalances.
Total testosterone is better to gauge testosterone's level. If it is too low or too high, problems can occur. If it is at a good level, then other hormone or neurotransmitter imbalances may be present to cause the problems.