Testosterone and Antipsychotics
Antipsychotic drugs can be life-saving for many men with bipolar, schizophrenic,
manic and other disorders. Unfortunately, they can also negatively impact
testosterone levels and sexual function in a variety of ways. This should
not be surprising as psychotropic drugs of any sort are very powerful
medications and hormones are often impacted.
Antipsychotic medications are a very involved subject and one can't help but
wonder how well understood they are by even the experts. However, there
are several key categories of these drugs, which helps in understanding their
potential impact on testosterone. One category are the "typical
antipsychotics," which have a relatively common side effect of Parkinson-like
symtpoms, including tremors and rigidity since they block dopamine receptors in
the brain. (NOTE: These symptoms can become permanent.)
The atypical, second generation antipsychotics do not have the advantage of
avoiding Parkinson-like symptoms, but, of course, have a separate set of nasty
side effects that pateints must be aware of and watch out for, including
diabetes, movement disorders and stroke just for starters.
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It is the typical antipsychotics that were known for potentially lowering
testosterone. The reason is that these medications can lead to
hyperprolactinemia, or elevated prolactin levels. As you hopefully know
from my link on Prolactin and Prolactinomas,
overly high prolactin levels can hammer your testosterone.
One study showed that in females testosterone was strongly affected by these
medications, but in males not as much.  Another study on male schizophrenics
found that switching from the typicals to the atypicals did, indeed, lower
prolactin levels. However, testosterone levels remained largely unchanged.
 In other words, these typical medications likely lower testosterone a
little, but not enough to make a significant difference.
CAUTION: This is informational only. Do not go off or change any medication without consulting your
Or is that really the whole story? Actually, some of these drugs have been
found to lower testosterone. For example, the second generation antipsychotic
Risperdal (risperidone) was shown to lower testosterone in rats. 
Interestingly enough, it not affect leutinizing hormone, but still lowered
testosterone through some other mechanism. In addition, the drug
carbamazepine (Carbatrol, Tegretol, Equetro, Epitol) used for bipolar and manic
disorders has also been shown to increase clearance of testosterone and thus
likely decrease plasma testosterone levels. 
NOTE: Antidepressants also are known for negatively impacting sexual
function. Increased seratonin is associated with decreased sexual desire
for starters. In addition, the above study shows these drugs lower free
testosterone levels as well. 
Regardless of short term affects on testosterone according to the studies, it is
unlikely that these drugs will do anything but lower testosterone in the long
term. Consider these risk factors for lower testosterone that are
generally negatively impaced:
1. Dopamine. Decreased levels of dopamine lead to sexual dysfunction
and decreased sexual desire. This will likely lead to less sexual activity
and less sexual activity will tend to decrease testosterone.
2. Diabetes and Metabolic Disorders. A significant risk factor for
erectile dysfunction is type II (adult onset) diabetes. This is no
surprise as diabetes is incredibly hard on the body and ages many tissues at an
accelerated rate. The atypical antipsychotics are known to increase risk for
diabetes.  Follow up research has verified this affect across a wide variety
of the atypicals.  Blood sugar disorders will do nothing but lower
testosterone, potentially total and free testosterone with time, due to the
increased oxidative and inflammatory load placed on the body.
3. Prolactin. Elevated prolactin levels are a known libido killer in
and of itself.  Again, this will tend to lead to decreased sex and sexual
interest, which will probably lower testosterone long term (and even short term
as mentioned above).
Therefore, long term studies my show other decreases in testosterone levels as
Journal of Clinical Psychopharmacology, 2002, 22:109-114, "The effects of
anti-psychotic induced hyperprolactinaemia on the hypothalamic-pituitary-gonadal
2) Neuroendocrinology Letters, Nos.1/2, Feb-Apr Vol.25, 2004, "Impact of a switch
from typical to atypical antipsychotic drugs on quality of life and gonadal
hormones in male patients with schizophrenia"
3) J Psychopharmacol, Jun 2007, 21(4):428-434, "The effect of chronic
antipsychotic treatment on sexual behaviour, hormones and organ size in the male
5) Am J Psychiatry, Apr 2002, 159:561-566, "Association of Diabetes Mellitus With
Use of Atypical Neuroleptics in the Treatment of Schizophrenia"
6) Psychopharmacol Bull, 2009; 42(1):1-21, "Atypical Antipsychotic Drugs and
Diabetes Mellitus in the US Food and Drug Administration Adverse Event Database:
A Systematic Bayesian Signal Detection Analysis"
7) Journal of Endocrinology, 2003, 179:357–365, "Effects of acute prolactin
manipulation on sexual drive and function in males"