From the Guidelines
Amphetamine use can potentially lower testosterone levels in men, and if symptoms of low testosterone are present, consultation with a healthcare provider for testosterone testing is recommended. The relationship between amphetamine and low testosterone involves the disruption of the hypothalamic-pituitary-gonadal axis, leading to reduced testosterone production 1. Additionally, amphetamines can increase cortisol levels, which can further suppress testosterone. If low testosterone is confirmed, healthcare providers might consider adjusting amphetamine dosage, recommending lifestyle modifications such as improved sleep, regular exercise, and stress reduction, or prescribing testosterone replacement therapy.
Key Considerations
- Testosterone replacement therapy is typically approved for men with primary or secondary hypogonadism caused by disorders of the hypothalamus, pituitary gland, or testes 1.
- The long-term efficacy and safety of testosterone therapy in men without well-established medical conditions known to cause hypogonadism are unknown 1.
- Regular monitoring of both conditions is essential for optimal management, as finding the right balance between treating ADHD symptoms and maintaining healthy hormone levels is key.
Management Options
- Adjustment of amphetamine dosage
- Lifestyle modifications: improved sleep, regular exercise, stress reduction
- Testosterone replacement therapy, typically starting at 50-100mg weekly for injections, or daily applications for gels like AndroGel 1.62% at 40.5mg
- Avoid self-medicating with testosterone supplements and never stop prescribed amphetamines without medical guidance.
From the FDA Drug Label
Endocrine: Impotence, changes in libido. Amphetamine may be associated with endocrine effects, including impotence and changes in libido, which could be related to low testosterone levels.
- Impotence can be a symptom of low testosterone.
- Changes in libido may also be associated with hormonal imbalances, including low testosterone. However, the label does not directly state that amphetamine causes low testosterone, only that it may cause related symptoms 2.
From the Research
Amphetamine and Low Testosterone
- The relationship between amphetamine use and low testosterone levels has been explored in several studies 3.
- A national claims database analysis found that long-term use of ADHD stimulant medications, including amphetamines, was associated with an increased risk of testicular hypofunction, a condition characterized by low testosterone levels 3.
- The study found that men with long-term ADHD stimulant medication use were more likely to be diagnosed with testicular hypofunction compared to those without ADHD or stimulant medication use 3.
- The exact mechanism by which amphetamines affect testosterone levels is unclear, but it is thought that long-term use may lead to hypogonadism, a condition in which the testes do not produce enough testosterone 3.
- Other studies have focused on the efficacy and safety of amphetamines in treating ADHD, but have not specifically examined their effects on testosterone levels 4, 5, 6, 7.
Key Findings
- A study of 17,224 men found that long-term ADHD stimulant medication use was associated with a 1.78-fold increased risk of testicular hypofunction compared to those with ADHD without stimulant medication use 3.
- The same study found that men with long-term ADHD stimulant medication use were more likely to be diagnosed with testicular hypofunction compared to those without ADHD or stimulant medication use 3.
- Amphetamines have been shown to be effective in reducing ADHD symptoms in both children and adults, but their effects on testosterone levels are not well understood 4, 5, 7.
Study Limitations
- The studies examined did not specifically investigate the effects of amphetamines on testosterone levels, but rather explored their efficacy and safety in treating ADHD 4, 5, 6, 7.
- The national claims database analysis had a large sample size, but was limited by its reliance on diagnostic codes and prescription data 3.