Psychiatric Medications That Increase Testosterone Levels
Among psychiatric medications, citalopram and mianserin have been shown to significantly increase serum testosterone concentration, while other psychiatric medications may decrease testosterone or have variable effects.1
Antidepressants and Testosterone
- Citalopram (an SSRI) and mianserin (a tetracyclic antidepressant) can significantly increase serum testosterone concentration based on animal studies 1
- In contrast, imipramine and amitriptyline (tricyclic antidepressants) may reduce the concentration of 5-alpha-dihydrotestosterone, an active metabolite of testosterone 1
- Most SSRIs generally have negative effects on sexual function and can potentially affect semen quality through oxidative damage 2
- Norepinephrine-dopamine reuptake inhibitors (NDRIs) and serotonin agonist/reuptake inhibitors (SARIs) appear to have minimal effects on prolactin levels and sexual side effects compared to other antidepressants 2
Antipsychotics and Testosterone
- Most antipsychotic medications tend to decrease testosterone levels rather than increase them 2, 3
- Antipsychotics typically increase prolactin levels, which can lead to decreased testosterone and increased sexual side effects 2
- Risperidone has been associated with lower testosterone levels compared to olanzapine 3
- Higher BMI and serum insulin levels (common side effects of atypical antipsychotics) are independently associated with decreased plasma testosterone levels 3
Testosterone Replacement in Psychiatric Patients
- In specific cases, such as in a paranoid schizophrenic patient with self-castration, testosterone administration has been shown to improve sexual function without exacerbating psychosis 4
- Testosterone replacement may offer benefit to hypogonadal men with psychiatric symptoms, though long-term studies on efficacy and safety are lacking 5
Impact of Psychiatric Medications on Testosterone-Related Conditions
- Testosterone itself is suspected to worsen sleep apnea, which is a consideration when evaluating psychiatric patients with comorbid sleep disorders 6
- Some psychiatric medications, particularly atypical antipsychotics, can cause weight gain which may indirectly affect testosterone levels 6, 3
Clinical Considerations
- When prescribing psychiatric medications, be aware that higher BMI and increased prolactin are the most prominent factors independently associated with decreased testosterone levels 3
- Manifestations of testosterone deficiency can include depression, anxiety, irritability, insomnia, weakness, diminished libido, and poor memory - symptoms that may overlap with primary psychiatric disorders 5
- The relationship between serum testosterone levels and clinical psychiatric symptoms is complex, as other hormonal changes may be implicated as well 5
Pitfalls and Caveats
- Most studies on psychiatric medications and testosterone have been conducted in animal models or small human samples, limiting the strength of evidence 1, 2
- The effects of psychiatric medications on testosterone may vary significantly between individuals 2, 5
- Long-term effects of psychiatric medications on testosterone levels and related sexual function are not well established 2, 5
- Comprehensive assessment should be part of evaluating complaints of low testosterone in men taking psychiatric medications 5