Q:  Low Testosterone Levels & Celexa

Dear Dr Phelps,
I am writing to ask you if you know of a link between celexa and drastically low testosterone levels. Can celexa cause testosterone levels to drop? Is low testosterone a side effect of Bipolar or depression? I can't seem to get a concrete answer. I was diagnosed with BP2 about three years ago and since then have been on Celexa (40mg) and have been on and off tegretol. Generally I am doing quite well, but recently it was discovered that I have very low testosterone levels. This concerned an endocrinologist to the point that I was taken off tegretol because that was believed to be the offender. However, my testosterone remained low. So it was assumed it was the celexa. I was unwilling to come of the celexa at this time, so I undertook hormone replacement therapy to get my testosterone levels back to the normal range. I do not like the idea of taking testosterone, especially because no professionals I speak to seem to think that Celexa is the likely cause. If you could clear this up for me I would feel so releived. 


Dear A' --

Interesting. Low testosterone levels. I run into this fairly often. I wish I knew how many people who are having no problems with fatigue or mood are running around out there with "low testosterone levels". I have a suspicion that there might be quite a few.

In other words, I am not sure whether "low testosterone levels" really mean something, compared to -- for example -- low thyroid, or low white blood cell counts. So I did a literature search. In men, low testosterone levels have been associated with increased mortality from a variety of causes, the association seems strongest with metabolic syndrome, which is known to lower testosterone levels (e.g. Google low testosterone levels risk).  (I couldn't tell your gender, for sure, from your name)

But as for your question, about citalopram (Celexa) and low testosterone levels, I searched that in Pub Med. There is one study from 1987 indicating that citalopram increases bloodstream testosterone levels.^Przegalinski Perhaps also relevant: one article describes two patients who had sexual side effects on other antidepressants, but did not on citalopram.^Pallanti

So, searching the medical literature I do not find the link between citalopram and low testosterone levels. How about depression itself and low testosterone levels? One recent study found that, among the elderly, women with low testosterone levels had more depressive symptoms -- but not men.^Morsink After a quick look around, I found more evidence associating obesity and metabolic syndrome with low testosterone, than depression.

The sentence in your comment which struck me the most was: "generally I am doing quite well".  Under those circumstances, and given that testosterone is a steroid and that at least some steroids have the capacity to make bipolar disorder worse, it would seem that your caution ("I do not like the idea of taking testosterone") might be warranted. I hope some of the information here may prove useful in your further considerations and discussions with your physicians.

Dr. Phelps



Published March, 2008