# Testosterone Anyone?



## SteSteez (Jul 21, 2007)

I read an article recently by experienced neurologists stating that carbamazapine (an anti-epileptic drug) reduces the amount of testosterone in humans.

I take dosages of this during the day and night for my medical condition and this had me thinking: maybe i would have made greater improvements if i was not on this medication?

Now i dont feel less motivated or anything like that, i do however tend to fall asleep when i get home from the gym after some food.

Any recommendations for Testosterone increase?

I did limit my dosage for several days last week and found myself wanting to lift heavier weights with more certainty, but if i quit the meds, im more likely to have a seizure.


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## Ziricote (Feb 18, 2007)

Wanting to fall asleep after having worked out and eaten sounds more like hypoglycemia (still doubt you're actually going hypo though) rather than a lack of testosterone.

Link us to this study you found.


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## SD (Sep 3, 2004)

Falling asleep after the gym is pretty normal I reckon if you have worked hard.

Not knowing how elevated testosterone would affect your current condition all I owuld recommend is ZMA, which will have an effect only if you are zinc deficient.

SD


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## Delhi (Dec 8, 2005)

*DO NOT* stop taking a prescribed medicine to "See if you will gain better". Why not talk it through with your doctor and see if they can prescribe you a *different *medication.


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## SteSteez (Jul 21, 2007)

Thanks for the replies people, much appreciated 

Heres the article that was posted on Epilepsy Actions website.

Carbamazepine (along with phenobarbital, primidone and phenytoin) get the liver <layer id="google-toolbar-hilite-0" style="background-color: Cyan; color: black;">to</layer> speed up its production of sex hormone-binding globulins. These are proteins that float around in the blood and 'stick' <layer id="google-toolbar-hilite-1" style="background-color: Cyan; color: black;">to</layer> testosterone, stopping it from working on other cells. The antiepilepsy drugs noted above also increase the levels of estradiol in the blood. estradiol is a type of estrogen - the female hormone. Normally, when there is too much testosterone in the body, it gets made into estradiol and the brain picks this up as a chemical signal <layer id="google-toolbar-hilite-2" style="background-color: Cyan; color: black;">to</layer> stop making testosterone.

In addition <layer id="google-toolbar-hilite-3" style="background-color: Cyan; color: black;">to</layer> this, carbamazepine acts directly on the testis <layer id="google-toolbar-hilite-4" style="background-color: Cyan; color: black;">to</layer> make less testosterone.

Carbamazepine is associated with a 'higher than expected' percentage of abnormal sperm morphology. It also lowers sperm concentration and motility (moving about).

For the sceptics amongst us:

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References:

Toone BK, Wheeler M, Nanjee M, et al. Sex hormones, sexual activity and plasma anticonvulsant levels in male epileptics. J Neurol Neurosurg Psychiatry. 1983;46:824-826.

Isojarvi JIT, Pakarinen AJ, Ylipalosaari PJ, et al. Serum hormones in male epileptic patients receiving anticonvulsant medication. Arch Neurol. 1990;47:670-676.

Rattya J, Turkka J, Pakarinen AJ, et al. Reproductive endocrine effects of valproate, carbamazepine, and oxcarbazepine in men with epilepsy. Neurology 2001;56:31-36.

Bauer J, Blumenthal S, Reuber M, Stoffel-Wagner B. Epilepsy syndrome, focus location, and treatment choice affect testicular function in men with epilepsy. Neurology 2004;62:243-246.

Isojarvi JI, Lofgren E, Juntunen KST, et al. Effect of epilepsy and antiepileptic drugs on male reproductive health. Neurology 2004;62:247-253.

Davidson JM, Camargo CA, Smith ER. Effects of androgens on sexual behavior in hypogonadal men. J Clin Endocrinol Metab. 1979;48:955.

Herzog AG. Hormonal changes in epilepsy. Epilepsia. 1995;36:323-326.

Kuhn-Velten WN, Herzog AG, Muller MR. Acute effects of anticonvulsant drugs on gonadotropin-stimulated and precursor-supported testicular androgen production. Eur J Pharmacol. 1990;181:151-155.

Isojarvi JIT, Repo M, Pakarinen AJ, et al. Carbamazepine, phenytoin, sex hormones and sexual dysfunction in men with epilepsy. Epilepsia. 1995;36:364-368.

Herzog AG, Levesque L, Drislane F, et al. Phenytoin-induced elevations of serum estradiol and reproductive dysfunction in men with epilepsy. Epilepsia. 1991;32:550-553.

Murialdo G, Galimberti CA, Fonzi S, et al. Sex hormones and pituitary function in male epileptic patients with altered or normal sexuality. Epilepsia. 1995;36:364-368.

The research recommends the following endocrine tests should be administered <layer id="google-toolbar-hilite-5" style="background-color: Cyan; color: black;">to</layer> men who are receiving epilepsy drugs who are experiencing 'difficulties':

•	total testosterone, Sex Hormone Binding Globulin (SHBG), free testosterone and estradiol levels

•	bioactive testosterone level for patients with 'normal' levels of total testosterone and free testosterone

• serum Luteinising Hormone and Follicle Stimulating Hormone, <layer id="google-toolbar-hilite-6" style="background-color: Cyan; color: black;">to</layer> evaluate the possibility of a condition with the hypothalamus (in the brain) called hypothalmic hypogonadism

These can be done in a simple blood test taken by your GP.

If the results show that you have:

•	Usually normal (or occasionally even elevated) serum total testosterone

•	reduced Free Testosterone or biologically active testosterone elevated SHBG

•	elevated SHBG

•	often elevated estradiol levels

Then you may need <layer id="google-toolbar-hilite-7" style="background-color: Cyan; color: black;">to</layer> have treatment specifically <layer id="google-toolbar-hilite-8" style="background-color: Cyan; color: black;">to</layer> reduce these symptoms.

Treatment of AED-related hyposexuality

Treatment is usually successful. There are several choices:

1. Changing epilepsy drugs from the 'hepatic enzyme-inducing' category <layer id="google-toolbar-hilite-9" style="background-color: Cyan; color: black;">to</layer> 'hepatic enzyme-inhibiting' ones such as sodium valproate. In patients with previously hard-<layer id="google-toolbar-hilite-10" style="background-color: Cyan; color: black;">to</layer>-control seizures that are well controlled with the hyposexuality-causing AEDs, however, changing AEDs may not be desirable.

2. In those patients, treatment with testosterone would be the first step. This means injections every 2 <layer id="google-toolbar-hilite-11" style="background-color: Cyan; color: black;">to</layer> 3 weeks, or a skin patch, applied daily. (Rarely, aggressive tendencies may develop with testosterone.) Not all patients respond <layer id="google-toolbar-hilite-12" style="background-color: Cyan; color: black;">to</layer> testosterone treatment. It is common for initial improvements <layer id="google-toolbar-hilite-13" style="background-color: Cyan; color: black;">to</layer> be followed by a relapse due <layer id="google-toolbar-hilite-14" style="background-color: Cyan; color: black;">to</layer> rising levels estradiol, because more testosterone is available for conversion <layer id="google-toolbar-hilite-15" style="background-color: Cyan; color: black;">to</layer> estradiol.

3. If a relapse occurs, testolactone/"teslac" pills plus the testosterone reatment will lower estradiol levels and restore normal libido and potency. In some patients, lowering estradiol levels with testolactone has improved seizure control.

4. Another drug, letrozole (used for breast cancer treatment) has been used with good effect for both seizure reduction and restoration of testosterone level.

5.	Clomiphene, an antiestrogen may restore sexuality as well as improve seizure control.

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P.S...

Klein P, Jacobs AR, Herzog AG. A comparison of testosterone versus testosterone and testolactone in the treatment of reproductive/sexual dysfunction in men with epilepsy and hypogonadism. Neurology. 1996;46:177.

Herzog AG. Seizure control with clomiphene therapy: a case report. Arch Neurol. 1988;45:209-210.

Login IS, Dreifuss FE. Anticonvulsant activity of clomiphene. Arch Neurol. 1983;40:525.


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