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Mental Health
Possible bipolar
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<blockquote data-quote="madman" data-source="post: 143029" data-attributes="member: 13851"><p><span style="font-size: 22px"><strong>Psychiatric safety of testosterone replacement</strong></span></p><p></p><p></p><p><strong>A few older studies using physiologic doses of testosterone <span style="color: rgb(184, 49, 47)">found a subjective increase in aggression, irritability, and hostility, </span>although these changes were not observed on rating scales for mood and hostility.</strong><a href="https://www.excelmale.com/community/javascript%3Avoid(0);" target="_blank">47</a>, <a href="https://www.excelmale.com/community/javascript%3Avoid(0);" target="_blank">48</a> Naturalistic studies following athletes who abuse steroids have shown significant increases in irritability, aggressiveness, and euphoria and manic symptoms. Steroid withdrawal also has been demonstrated to induce depressive symptoms in some users.<a href="https://www.excelmale.com/community/javascript%3Avoid(0);" target="_blank">49</a> There also is some evidence in the literature to suggest that steroids can lead to dependence or addiction.<a href="https://www.excelmale.com/community/javascript%3Avoid(0);" target="_blank">50</a>, <a href="https://www.excelmale.com/community/javascript%3Avoid(0);" target="_blank">51</a> <strong><span style="color: rgb(184, 49, 47)">In general, steroid use and certainly steroid withdrawal are believed to have the potential to produce adverse psychiatric effects, </span>although these seem to be subtle in physiologic dosing <span style="color: rgb(184, 49, 47)">and more prominent with markedly supraphysiologic doses.</span></strong><span style="color: rgb(184, 49, 47)"><a href="https://www.excelmale.com/community/javascript%3Avoid(0);" target="_blank">49</a></span></p><p></p><p></p><p></p><p></p><p><strong><span style="color: rgb(0, 0, 0)">There are very limited data on </span><span style="color: rgb(184, 49, 47)">the impact that testosterone might have on patients with bipolar disorder. </span><span style="color: rgb(0, 0, 0)">One study found that patients with bipolar disorder and higher physiologic testosterone levels had an increased rate of manic episodes and suicide attempts.</span></strong><span style="color: rgb(0, 0, 0)"><a href="https://www.excelmale.com/community/javascript%3Avoid(0);" target="_blank">52</a> </span>Although the risk is difficult to quantify given the paucity of data, <strong><span style="color: rgb(184, 49, 47)">testosterone’s antidepressant effect might produce an increased risk of mania in an analogous way to other available antidepressant treatments. </span></strong></p><p></p><p></p><p></p><p><strong>None of the testosterone-replacement studies for hypogonadism reviewed systematically evaluated for adverse psychiatric events such as<span style="color: rgb(184, 49, 47)"> irritability, aggression, paranoia, or mania. </span></strong>Depression rating scales such as the HAM-D, PHQ-9, and BDI do not capture these categories of symptoms despite their potential relevance. <strong>It would be useful in future testosterone-replacement studies to look systematically at these potential adverse psychiatric events.</strong></p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p><strong>Conclusion: <span style="color: rgb(184, 49, 47)">clinical implications for psychiatric outpatients </span></strong></p><p></p><p></p><p><strong>It is important to keep in mind that testosterone is more likely to be a factor in depressive symptoms when the <span style="color: rgb(184, 49, 47)">level is substantially below normal, </span></strong>although some men <strong>might have testosterone-responsive depression <span style="color: rgb(184, 49, 47)">even in the borderline low range. </span></strong>There also is evidence that subthreshold depressive symptoms (not meeting full criteria for major depressive disorder) might be more responsive to testosterone. If testosterone is initiated, there is more evidence for the effectiveness of parenteral forms than oral forms of testosterone replacement.</p><p></p><p></p><p></p><p><strong>We recommend that psychiatrists remain involved in the management of patients’ depressive symptoms in collaboration with a urologist or other medical provider experienced in testosterone-replacement therapies. </strong>Specifically, management of antidepressant and opioid medication might be of use to optimize the gonadal axis and to monitor for rare adverse psychiatric effects of testosterone.</p></blockquote><p></p>
[QUOTE="madman, post: 143029, member: 13851"] [SIZE=22px][B]Psychiatric safety of testosterone replacement[/B][/SIZE] [B]A few older studies using physiologic doses of testosterone [COLOR=rgb(184, 49, 47)]found a subjective increase in aggression, irritability, and hostility, [/COLOR]although these changes were not observed on rating scales for mood and hostility.[/B][URL='https://www.excelmale.com/community/javascript%3Avoid(0);']47[/URL], [URL='https://www.excelmale.com/community/javascript%3Avoid(0);']48[/URL] Naturalistic studies following athletes who abuse steroids have shown significant increases in irritability, aggressiveness, and euphoria and manic symptoms. Steroid withdrawal also has been demonstrated to induce depressive symptoms in some users.[URL='https://www.excelmale.com/community/javascript%3Avoid(0);']49[/URL] There also is some evidence in the literature to suggest that steroids can lead to dependence or addiction.[URL='https://www.excelmale.com/community/javascript%3Avoid(0);']50[/URL], [URL='https://www.excelmale.com/community/javascript%3Avoid(0);']51[/URL] [B][COLOR=rgb(184, 49, 47)]In general, steroid use and certainly steroid withdrawal are believed to have the potential to produce adverse psychiatric effects, [/COLOR]although these seem to be subtle in physiologic dosing [COLOR=rgb(184, 49, 47)]and more prominent with markedly supraphysiologic doses.[/COLOR][/B][COLOR=rgb(184, 49, 47)][URL='https://www.excelmale.com/community/javascript%3Avoid(0);']49[/URL][/COLOR] [B][COLOR=rgb(0, 0, 0)]There are very limited data on [/COLOR][COLOR=rgb(184, 49, 47)]the impact that testosterone might have on patients with bipolar disorder. [/COLOR][COLOR=rgb(0, 0, 0)]One study found that patients with bipolar disorder and higher physiologic testosterone levels had an increased rate of manic episodes and suicide attempts.[/COLOR][/B][COLOR=rgb(0, 0, 0)][URL='https://www.excelmale.com/community/javascript%3Avoid(0);']52[/URL] [/COLOR]Although the risk is difficult to quantify given the paucity of data, [B][COLOR=rgb(184, 49, 47)]testosterone’s antidepressant effect might produce an increased risk of mania in an analogous way to other available antidepressant treatments. [/COLOR][/B] [B]None of the testosterone-replacement studies for hypogonadism reviewed systematically evaluated for adverse psychiatric events such as[COLOR=rgb(184, 49, 47)] irritability, aggression, paranoia, or mania. [/COLOR][/B]Depression rating scales such as the HAM-D, PHQ-9, and BDI do not capture these categories of symptoms despite their potential relevance. [B]It would be useful in future testosterone-replacement studies to look systematically at these potential adverse psychiatric events.[/B] [B]Conclusion: [COLOR=rgb(184, 49, 47)]clinical implications for psychiatric outpatients [/COLOR][/B] [B]It is important to keep in mind that testosterone is more likely to be a factor in depressive symptoms when the [COLOR=rgb(184, 49, 47)]level is substantially below normal, [/COLOR][/B]although some men [B]might have testosterone-responsive depression [COLOR=rgb(184, 49, 47)]even in the borderline low range. [/COLOR][/B]There also is evidence that subthreshold depressive symptoms (not meeting full criteria for major depressive disorder) might be more responsive to testosterone. If testosterone is initiated, there is more evidence for the effectiveness of parenteral forms than oral forms of testosterone replacement. [B]We recommend that psychiatrists remain involved in the management of patients’ depressive symptoms in collaboration with a urologist or other medical provider experienced in testosterone-replacement therapies. [/B]Specifically, management of antidepressant and opioid medication might be of use to optimize the gonadal axis and to monitor for rare adverse psychiatric effects of testosterone. [/QUOTE]
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