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    Serotonin and Sex Drive
    mbuch73 posted:
    I am a 39 year old male who is diagnosed with anxiety disorder, bi-polar disorder, and OCD. I also have low testosterone Levels. For a while, I have been experiencing lack of sex drive, erections, etc... About 1 year ago, I began to receive injections of testosterone (every 3 weeks). In recently taking 40 mg daily of paxil i had a full erection and sex drive, along with normal ejaculation. The problem is, paxil caused me to maintain and gain weight. I recently got back in to shape and switched to lexapro (because I dont want to gain weight). Needless to say, I no longer have the sex drive and erections that I had recently. My doctor has no real answers and keeps having me try different medications. What could be causing this and is there a simpler answer?

    Secondly, what is the relation of Serotonin to Sex Drive?
    counterso responded:
    Until you are able to live without anxiety medications, it is likely you will continue to have erectile/libido issues. There's really no way around it. Supplementing hormones is a very, very bad idea, a last resort, and should ONLY be undertaken with the monthly supervision of an endocrinologist who monitors 6-8 of your hormone levels. You absolutely cannot treat one without watching the balance of the others.

    As for being diagnosed with low T, what test did they conduct to determine this? Blood test or saliva test? If the former, you've gotten erroneous information. A saliva test measures 3x more accurately than a blood test, because it measures three factors, not just one isolated one.

    Asking what relationship one hormone has to libido is like asking what one body feature has to do with attractiveness. Your hormones are NEVER in isolation. Libido is modified by over a dozen factors, including several hormones. The most dramatic effect on libido is fatigue. If you don't have extra energy, you won't have any libido. Understand that testosterone only affects libido in a limited way. Your body does not use your brain to govern libido. If your body does not feel safe, rested, energized, (read as when your body is stressed) it shuts down your reproductive system because it interprets those environmental conditions as unsafe for reproduction and raising of an infant. Chronic stress, anxiety, fatigue, etcetera will have a more dramatic effect on your libido because your physical/emotional state indicates your environment is not safe/nurturing, and therefore you shouldn't have children. It has nothing to do with sex appeal. It has everything to do with procreation. Your body is not listening to your psychologist.
    mbuch73 replied to counterso's response:
    Thank you ever so much for taking the time to respond to my posting. It was a blood test that determined my testosterone level. What would be the best way to attack and solve this problem (or atleast get me back to having normal erections and ejaculation)? Secondly, what can an Endocrinologist tell me that my Dr. cannot? ...I am unfamiliar with Endocrinology. In explaining all of these things to my PCP, he does not take much time to listen to or understand me. Or, is there any other
    health care professional that I would want to see regarding this?
    counterso replied to mbuch73's response:
    Well, this gets far away from urology at this point, so I'll just be brief. You need a saliva test for testosterone, so your regular doctor has already made an outdated judgement there. An endocrinologist is going to understand the BALANCE of hormones (there are over 600, not just testosterone and estrogen, although there are 6 major ones paid the most attention). And the thing to restore your erectile function and libido is to solve the underlying/root cause of your anxiety. As long as you are medicated for it, your hormone balance attempts are not likely to be able to overcome the Paxil or other drugs. That your PCP doesn't listen is the first and most important reason to drop him/her. The endocrinologist is going to help you understand and manage what might be low testosterone.

    The rest, your psychiatrist is going to have to work on with you. With a complex diagnosis like yours, discuss the importance of different quality of life issues with your psychiatrist. You are likely going to have to prioritize treating the anxiety versus sex drive. They are not always able to be reconciled at the same time, although there are some medications that have less dramatic effects on erections, such as Wellbutrin. Only your psychiatrist is going to be able to tell you whether a different medication is right for your situation.

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