Why are my total and free testosterone levels so high?

Question

Hello doctor,

I am a 36 year old male. I suddenly developed sexual dysfunction, I have reduced interest, arousal, plateau, and orgasm. The triggering event seems to be the discontinuation of 150 mg Bupropion because of adverse effects. I switched to 20 mg Citalopram, and over the course of six months, I reduced Citalopram to less than 1.5 mg. However, the sexual dysfunction has remained unchanged. I previously took Citalopram in doses ranging from 10 to 20 mg, depending on the external stress, for six years, and this did not cause significant sexual side effects, except delayed orgasm. While on Bupropion, my semen production stopped, but there were no marked changes in sexual desire, arousal, or behavior. The Citalopram and Bupropion had been prescribed for anxiety and depression, which have been well controlled for many years. Six months after the onset of the sexual dysfunction, a testosterone test revealed total testosterone in the 400s and free testosterone beyond the laboratory's ability to measure it (highly elevated >100). I do not use androgen supplements and illegal or recreational drug. There is no history of alcohol addiction or nicotine use. There is no neurological history, history of an endocrine disease, or surgery. I currently take Fexofenadine, antihistamines, and steroid nasal sprays.

Answer 1

Hello,

Welcome to icliniq.com.

I just read your query and from the history you gave and the levels of testosterone you mentioned, it is very high level of serum testosterone. There are usually some males who normally have high testosterone levels without any major underlying disease. I will discuss that later on. Regarding the reduced interest, arousal, plateau, and orgasm they are called as erectile dysfunction altogether. In this case, you were initially taking Bupropion, which is not known to cause sexual dysfunction, in fact in rare cases it does cause an increased libido. Albeit the anxiety and depression, which you had right from the start, definitely, contribute towards developing erectile dysfunction and are known to be a major cause for it. Citalopram is known to cause ejaculation disorder in 6 % of cases, impotence in 3 %, and decreased libido in 2 % of patients, so it might be another reason for erectile dysfunction. The cause for raised testosterone, both total and free could be one of the following in your case.

Antidepressants or antianxiety medications are known to cause increased testosterone levels.
Adrenal tumors, these are glands located just above the kidneys and they sometimes cause an increased testosterone secretion. So, I would suggest you have an MRI of the adrenals done to make sure they are not enlarged.
Prolonged use of steroid nasal sprays also contributes to making increased testosterone in the long run.

I would suggest you do the following.

Some blood tests such as serum prolactin, FSH (follicle stimulating hormone), prostate specific antigen, and liver function test.
MRI (magnetic resonance imaging) of adrenals.
Ultrasound of the pelvis, to rule out any testicular causes.

Do get back to me after you have done these. Hope my advice is of some benefit to you.

Why are my total and free testosterone levels so high?

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