In my case I spent months treating the acne I had in the back, using Accutane/isotretinoin, this was 2011. For at least 2-3 years I was feeling depressed, then over time this symptom vanished. But the sexual side effects such as low libido still persist to this day. Low testosterone, high prolactin, etc.
What I am going to post next are my recent blood results. Perhaps they will be useful for others suffering from the same issue.
I haven’t received the CORTISOL results that measured my saliva at 8 am, 4 pm and 8 pm, they will be delivered in the next days. My issue is described in this video:
Previous results, from total/free testosterone, and prolactin, only:
The total testosterone change from 240.5 to 380 ng/DL (+ 58%) is not surprising at all. Free T also increased from 5.28 to 8.76 ng/DL. Prolactin remained the same, from 19.3 to 26.3.
And why is that? Because when I did the first test a few weeks or a week before I was indulging in other foods outside my current diet prescribed by a nutritionist (pizza among them) that we all know to be detrimental to testosterone. And I was also not getting enough sleep. Bad diet and bad sleep are two things that can have a huge impact in these results.
Still, 380 is very low and prolactin has always measured in the 20’s. I think I measured prolactin 5 times by now in the last 2 years, and it has never, NEVER MEASURED BELOW 20s. For a man ideal levels are half that number, or perhaps less.
The max total testosterone I measured was 409 I think (1-2 years ago), and only after supplementing with vitamin D-3 (2000 UI a day) for 3 months. This increased T by 35%. And vitamin D for 40’s.
These two blood tests were done after more than a year without any vitamin D-3 being taken as supplement, and without proper exposure to the Sun (since I only go out there covering my body). The 380 ng/DL and 8.76 for free T are not impressive because when I did my first blood test in 2017 the results were:
3.09 for total T and 6.15 for free T. 26 for vitamin D;
Link for the 1st blood test: https://drive.google.com/drive/folders/1dK7ePx-ekFksI8HGkHh7dysuSuZRiMBW
If we add 240 to 380 and divide by 2 then the end result is 310. That means I am back to square one.
Vitamin D measured 31 now. It’s close to the first measure of 26.
So what is interesting and revealing about these blood results? Besides all that?
Zinc: like the first time I measured, it is normal. Many say zinc is responsible for increasing T. Lab range is 60 to 120 for adults and I measured 114.3.
Magnesium: lab range is 1.60 to 2.50 mg/DL and I measured 2.4. Also normal.
Vitamin B-12: lab range is 210 to 980 pg/ML and my result was 599 pg/ML
SHBG: lab range for men is 10-57 nmol/L. My result: 26.1. If this is low or simply normal I can’t tell.
Luteinizing hormone (LH): lab range for normal men is 0.57 to 12.07 and my blood test showed 1.88 mIU/mL;
Follicle-stimulating hormone (FSH): lab range for men is 0.95 to 11.95 and I got 5.09 mIU/mL
LH: this is the first sign (I believe) of something abnormal.
It’s odd, because I measured LUTENIZING HORMONE before and the result was 4.61 and the lab range was 1.24 to 8.62, but this was January 15, 2018. However this was already under the effect of months of vitamin D-3 supplement, and vit-D in this day measured in the 40’s.
Searching the internet I found comments such as these:
“In men, high levels of LH in the blood are a sign of a problem with the testicles. Low levels of LH mean the issue is with the pituitary gland or hypothalmus. Your LH level, by itself, isn’t enough to make a diagnosis. So you may get other tests, too.”
“If you’re a man, abnormally high LH levels along with low levels of testosterone may mean that your testicles aren’t responding to LH’s signal to make more testosterone. Low levels of LH may mean that your pituitary gland isn’t making enough LH. That can lead to too little testosterone production. The normal ranges for men is 1.24 to 7.8 IU/L”
Then there’s estradiol (E2). The lab range for men is 11 - 144 pg/mL and I got 9,00 pg/mL.
At first I thought it was a good thing because I expected this to be high.
Then I found this:
Quick explanation to what low estradiol means for men: https://mantalityhealth.com/dude-estrogen-low/
Testosterone deficiency in men accounts for decreases in lean mass, muscle size, and strength, whereas estrogen deficiency primarily accounts for increases in body fat, according to a new study. Deficiency of both hormones contributes to a decrease in sexual function.
“Our findings support changes in the approach to evaluation and management of hypogonadism in men,” investigators concluded in the New England Journal of Medicine (2013;369:1011-1022).
Low E Not Low T May Be the Problem
Some symptoms traditionally attributed to low testosterone may actually be due to estrogen deficiency, researchers found.
In a small study of men whose hormone levels were altered to mimic low testosterone – and in some cases, to completely inhibit estrogen production – it appeared that androgen deficiency accounted for decreases in lean mass, muscle size, and strength, while a lack of estrogen was responsible for increases in body fat, according to Joel Finkelstein, MD, of Massachusetts General Hospital, and colleagues.
Among men who were blocked from producing estrogen, the researchers saw increases in body fat at all levels of testosterone supplementation – but there was no effect on lean muscle mass, muscle size, or leg strength, the researchers reported.
They also noted that the adverse effects on sexual function became more obvious when estrogen was suppressed.
Finkelstein and colleagues concluded that the results imply testosterone levels regulate lean body mass, muscle size and strength, while estrogen levels regulate fat accumulation – and that sexual function appears to be regulated by both hormones .
Men Low Sex Drive: Low Estrogen May Be The Cause, Study Says
Well, well, well! Very interesting.
Does that explain the abdominal fat I have for years and that has never vanished?
Who would have thought? So this is also another confirmation, besides high prolactin, that I have low libido?
Dihydrotestosterone (DHT) - lab range between 135 and 1365 pg/mL \r for men, and old ranges were between 250 to 1600 pg/mL. My result? 183 pg/mL
Low DHT? Is this another side effect of… Accutane?
Isotretinoin, used to treat severe acne, has been shown to induce hormonal changes, especially to reduce 5 alpha-reductase in the production of the tissue-derived dihydrotestosterone (DHT) metabolite 3 alpha-Adiol G.
However, the effects of isotretinoin on other pituitary, adrenal or gonadal hormones have not been thoroughly elucidated. In the present study, isotretinoin administered at a dose of 0.5 mg/kg/day for 4 weeks caused no marked changes in the serum levels of pituitary, adrenal or gonadal hormones or 3 alpha-Adiol G in patients with severe papulopustulotic acne (n = 19).
After 12 weeks of therapy, there was a decrease in the levels of the precursor androgens androstenedione, testosterone and 3 alpha-Adiol G in 6/9 patients. Acne improved after 4.5 months in all but 2 male patients, who had very low serum hormone binding globulins (SHBG) and a high free androgen index (FAI). Isotretinoin did not affect the elevated LH/FSH ratio in a patient with the polycystic ovarian syndrome (PCOS); nor did it change the high FAI or low SHBG in the male patients.
For comparison, tetracycline had no effects on the serum hormonal levels of patients with mild acne (n = 19) after 7 days of treatment. This study confirms that the effects of isotretinoin on the serum hormone levels are small and unlikely to be of relevance for the resolution of acne or the suppression of sebum excretion .
5α-Reductase inhibitors (5-ARIs), also known as dihydrotestosterone (DHT) blockers, are a class of medications with antiandrogenic effects which are used primarily in the treatment of enlarged prostate and scalp hair loss. They are also sometimes used to treat excess hair growth in women and as a component of hormone therapy for transgender women.
These agents inhibit the enzyme 5α-reductase, which is involved in the metabolic transformations of a variety of endogenous steroids. 5-ARIs are most known for preventing conversion of testosterone, the major androgen sex hormone, to the more potent androgen dihydrotestosterone (DHT), in certain androgen-associated disorders.
5-ARIs are generally well-tolerated in both men and women and produce few side effects. However, they have been found to have some risks in studies with men, including slightly increased risks of decreased libido, erectile dysfunction, ejaculatory dysfunction, infertility, breast tenderness, gynecomastia, depression, anxiety, self-harm, and dementia.
In addition, while 5-ARIs decrease the overall risk of developing prostate cancer, they have been found to increase the risk of developing certain rare but high-grade forms of prostate cancer. As a result, the FDA has notified healthcare professionals that the Warnings and Precautions section of the labels for the 5-ARI class of drugs has been revised to include new safety information about the increased risk of being diagnosed with these rare but more serious forms of prostate cancer. Finasteride has also been associated with intraoperative floppy iris syndrome and cataract formation. Depressive symptoms and suicidality has been reported .
Sexual dysfunction, including erectile dysfunction, loss of libido, and reduced ejaculate, may occur in 3.4 to 15.8% of men treated with finasteride or dutasteride. This is linked to lower quality of life and can cause stress in relationships. There is also an association with lowered sexual desire. It has been reported that in a subset of men, these adverse sexual side effects may persist even after discontinuation of finasteride or dutasteride.
Mine is clearly low, otherwise it would be at least in the middle of that lab range.
Homocysteine was also measured. Lab ranges between 5.46 to 16.20 umol/L for men, and mine was 7.3.
Insulin blood test lab ranges: 1,90 to 23,00 MICRO UI/mL, mine: 5.19.
TGO, TGP, TSH and T4 and others = all within the lab ranges
To increase DHT all the recomendations I am already following, which is modify the diet and a new workout routine instead of the not demanding one I always had:
What I am interested to know is if my results are somehow helpful in discovering what Accutane did in the first place.
P.S. What I am currently trying is this, besides a new diet/workout routine:
Vitamin B-6 (P5P), 25 mg a day in 1 pill at breakfast.
Ashwagandha KSM-66, Vitacost, in 1 pill at breakfast.
Vitamin D-3 (2000 UI) + E (200 UI), 1 pill at lunch
Omega 3 fish oil, 1000 mg - 180/120, 3 pills at the same time, at dinner
ZMA (I know, many say it’s not needed, but I bought anyway), 2 pills at the same time, 30-60 minutes after last meal and 30-60 before going to sleep. Mine has 256 mg of magnesium, 7 mg of zinc and 1.3 of vitamin B-6 in this ammount.
After months I’ll do a new blood test to measure everything again.