Accutane and Sexual Dysfunction

[B_D_Acc]

Ah, I can't believe I missed this study. I've literally been writing a whole article about possible treatment for sexual sides using growth hormone to increase IGF-1 -> increase PI3K/AKT signalling and thus remove FOXOS.

Have you ever tried a 5HT1A agonist?

Yeah man I had the exact same idea of using GH until I saw that study. Glad I found it because it would have been expensive as shit.

Are there any 5HT1A agonists? Or do you just mean an SSRI to get serotinin up? I'd probably be more reluctant to take an SSRI than I would be to take to take finasteride.

 

[Flynn]

Yeah man I had the exact same idea of using GH until I saw that study. Glad I found it because it would have been expensive as ****.

Are there any 5HT1A agonists? Or do you just mean an SSRI to get serotinin up? I'd probably be more reluctant to take an SSRI than I would be to take to take finasteride.

Yeah bro, I got blood tests for GH, IGF1 etc. expensive as hell but it all contribute to the cause I guess. Will post them soon. But all you need to know is, our problem is not IGF-1, IGFBP-3, GH, thyroid hormones, testosterone. At least not for me.

THe only thing that came in low for me, for the tests I did was low DHEA's.

I don't really know, hard to say if our problems are same as those who have taken SSRI's and have PSSD. I just know that most people on PSSD forums seem to think that a 5HT1A antagonist is the key but I don't think any are available at the moment. This is because SSRI's make the 5HT1A receptor insensitive and reduce SERT whilst overloading synapse with serotonin. Studies of accutane seem to show it does the opposite of an SSRI, but increasing numbers of 5HT1A and increasing SERT. Thus lowering amount of serotonin in the synapse. Given this, I figured maybe a 5HT1A agonist would help (not an SSRI). Of course, the problem here is that jsut because accutane has an effect on serotonin, this may be completely unrelated to its mechanism of giving sexual dysfunction. but I guess, its worth trying anything and everything until we find something that seems to work.

 

[tanedout]

Hi, thats really interesting man. I've never really had a temporary recovery like this. Temporary recovery gives a sign of hope, that the damage is reversible. And you're sure that none of these one off recoveries could have been placebo or down to you being a good mood? Like was the difference really that dramatically different? Obviously if it really was 0-5% to 70%, that is a big change.

How long have you been dealing with accutane induced sexual sides? Have you tried taking trib and GSE together? Also have you ever tried other supplements such as inositol? gingko boa? lithium? etc.

Yeah I see it as positive that it was possible, at least temporarily to return to pretty much normal. Each case was definitely not down to placebo or mood, and the improvement was dramatic - to at least 70, maybe 80% normal. With trib I was pretty worried because initially it gave me massive brain fog which lasted 2 days and I thought it wouldn't go, but then it cleared and much to my surprised I got the libido and sensitivity back on the rebound.

There is a 4th one I should probably mention too, and that's from weed. I found that vaping weed would always result in slightly improved sensitivity and orgasm when under the effects. I did a run of RSO too, and again had some very brief periods of improved libido and sensitivity, but nothing lasting. Weed is supposed to increase dopamine, so always assumed it was due to this.

I've tried probably hundreds of things, and nothing else has given such good results for sexual sides. When I first got into this mess I used gingko and ginseng each day for a few months, and I think that got morning wood back, but nothing else. 7.5 years post-tane.

 

[B_D_Acc]

Yeah bro, I got blood tests for GH, IGF1 etc. expensive as hell but it all contribute to the cause I guess. Will post them soon. But all you need to know is, our problem is not IGF-1, IGFBP-3, GH, thyroid hormones, testosterone. At least not for me.

THe only thing that came in low for me, for the tests I did was low DHEA's.

I don't really know, hard to say if our problems are same as those who have taken SSRI's and have PSSD. I just know that most people on PSSD forums seem to think that a 5HT1A antagonist is the key but I don't think any are available at the moment. This is because SSRI's make the 5HT1A receptor insensitive and reduce SERT whilst overloading synapse with serotonin. Studies of accutane seem to show it does the opposite of an SSRI, but increasing numbers of 5HT1A and increasing SERT. Thus lowering amount of serotonin in the synapse. Given this, I figured maybe a 5HT1A agonist would help (not an SSRI). Of course, the problem here is that jsut because accutane has an effect on serotonin, this may be completely unrelated to its mechanism of giving sexual dysfunction. but I guess, its worth trying anything and everything until we find something that seems to work.

Did you get Progesterone tested?

 

[B_D_Acc]

Another thing, have any of you had any hair loss or thinning as a symptom?

I've had diffuse hair loss on my head and body, but it hasn't affected the areas with thicker hair (facial and pubic). I've lost 70-80% of the hair on the back of my calves and 50% elsewhere. Head has come back now to 80-90% normal but rest has improved much less.

Given that facial and pubic are the most androgenic areas for hair growth, that would be suggestive of something like an amino acid deficiency affecting the root formation and therefore structure of the thinner hairs. Whereas if it were a DHT deficiency, facial or pubic hair would likely be the most affected.

 

[Flynn]

Another thing, have any of you had any hair loss or thinning as a symptom?

I've had diffuse hair loss on my head and body, but it hasn't affected the areas with thicker hair (facial and pubic). I've lost 70-80% of the hair on the back of my calves and 50% elsewhere. Head has come back now to 80-90% normal but rest has improved much less.

Given that facial and pubic are the most androgenic areas for hair growth, that would be suggestive of something like an amino acid deficiency affecting the root formation and therefore structure of the thinner hairs. Whereas if it were a DHT deficiency, facial or pubic hair would likely be the most affected.

No I haven't test progesterone, prolactin DHT, estrogen yet but I intend to. I've noticed that my head hair is thinning and I\m worried I will under go premature balding now. I did notice shedding whilst on accutane but never thought much of it. I have had no hair loss on legs, back, torso, shoulders etc. I have some facial hair but it isn't thick or a fully beard (this is likely family related though as my brother has little facial hair).

 

[Flynn]

Has anyone with accutane induced sexual side effects, ever used L-dopa? or a dopamine agonist. Or dopamine antagonist?

 

[Perene]

Someone mentioned this forum to me and I would like to share my story and blood results:
Repairing the long-term damage from Accutane

Hope that helps...

 

[Josh MitoGen]

this is the idea given to me from dr ted achacoso for delayed/absent ejaculation during sex


"I cleared out prolactin-dopamine pathway first, as we are doing with you right now. If we find nothing there or we have no improvement, this regimen is what worked for me (This is my personal regimen now that you can do for 4 to 6 weeks):
1. Growth Hormone subcutaneous injection, 1 IU 20 mins before bedtime.
2. Testosterone enanthate (or cypionate) 100 mg IM weekly morning or 50 mg subcutaneously Mon and Thurs (slower but better rise, newer protocol).
3. IGF-1 subcutaneous injection, 500 mcg on M-W-F mornings. If you can get it in the long-acting form, so much the better. This is important. If you get Mecasermin (short-acting), inject Monday through Friday.
4. Oxytocin sublingual troche, 20 mg under the tongue 1 to hours before sex. This can hasten ejaculation too, as it has prolactin-inhibiting properties

The DHT and estrogen (needed by the male brain for proper signaling to ejaculation) rise should also induce a quicker ejaculatory response. You may need higher values of these to induce receptor response."

 

[Josh MitoGen]

I was convinced this had something to do with accutane affecting androgen receptors. Which made sense in the light of its activation of FOXO transcription factors which negatively regulate/block androgen receptors. Given this, increasing accutane results in increased FOXO activity and decreased androgen receptor activity. However the androgen receptors in my muscles seem to be working fine, as I can gain muscle and I am fairly athletic/strong for my size. I don't see why accutane would affect androgen receptors in the brain and not affect androgen receptors in other parts of the body. For instance, when I took TRT, it greatly increased my strength and athleticism but had little to no effect on my mind/mentality, i.e. little change in sex drive, aggression, drive etc. despite significantly increasing my testosterone levels. The mental effects people should normally feel from TRT are largely related to the effect of testosterone on dopamine and dopaminergic signalling in regions such as the mesolimbic pathway such as the nucleus accumbens. This indicates to me that our problems relate to dopamine signalling versus androgen signalling. I could obviously be completely wrong here.

I now think this is related to dopamine. Retinoic acid regulates the expression of the D2/dopamine receptor in regions of the brain including the nucleus accumbens (the nucleus accumbens is a major player in pleasure centres of brain and sexual drive). I need to spend some time researching this and invite other people to also look into this as I don't have much free time.

An important thing to find out is, did peoples sexual side effects start during accutane treatment or when they stopped taking it? Please respond to this question if you can.

I have two hypotheses with this:

1. By taking excessive levels of 13-cis retinoic acid (accutane) dopamine receptor expression in the brain is increased in response to the excess of 13-cis retinoic acid. However, the retinoic acid receptors in the brain are downregulated to avoid hyperstimulation. When we stop accutane, the retinoic acid receptors remain downregulated and thus the dopamine receptors end up being downregulated in key regions of the brain such as the nucleus accumbens. This would help explain changes in mood, sex drive, pleasure, drive for life etc. As such we may be in a hypodopaminergic state. As such even when you take substances which increase dopamine signalling you may not feel as big of an effect as there are little dopamine receptors available. This makes sense with me, as TRT did little to my mental state, I no longer enjoy dopaminergic drugs such as weed. Bear in mind, I loved smoking weed before accutane and now I don't seem to enjoy it. I also don't seem to get as intense of an effect from other dopamine stimulating drugs compared to my peers.

2. By taking excessive amounts of accutane, it results in increased activation of retinoic acid receptors and a hyper up-regulation of dopamine receptors. As such we sort of fry our dopamine systems or our dopamine systems become de-sensitized to dopamine. The thing is, when we stop accutane, the retinoic acid receptors can't remain activated to the same degree (or can they???), as such dopamine receptor expression would gradually decline and the pathways would be re-sensitised. Which makes me doubt this hypothesis slightly.

The question is, if this is correct (a BIG IF!). How can we increase dopamine receptor expression? How can we bring this system back into homeostasis? One option would be a dopamine antagonist, but these drugs have lots of side effects and could be pretty dangerous. Additionally, if the retinoic acid receptors truly are downregulated, then surely the increased dopamine receptor expression from the dopamine antagonist would eventually decline in the absence of retinoic acid receptor mediated D2 receptor expression, once the dopamine antagonist was stopped.

Is there a way to up regulate retinoic acid receptors? Would they be upregulated if there was a complete absense of retinoic acid in body/diet?

Please reply and share your thoughts. I welcome anyone to destroy these ideas if they can. I simply want to find a treatment for this condition. Pretty sure, if we can figure out the sexual dysfunction most of the other side effects will fall like dominoes. I also feel that focusing on the sexual side effects makes the most sense, as its the easiest to observe/measure.

i agree this is definitely a component. if i have ever regained ability t o ejaculate fast it has only been in completely novel situations, places etc...i agree tho, is it just more dopamine or does environmental enrichment/novel situations increase "receptor" activity...i would wager both

 

[Perene]

Please read this post before what I am going to say next... I don't want to repeat a ton of information.
Repairing the long-term damage from Accutane

More about my case, concerning libido loss:
Repairing the long-term damage from Accutane

I got my last blood test results... any thoughts if further tests are needed?

Spermogram: the urologist said there's nothing wrong. Note: all Google Drive links are from the lab. They are written in portuguese.

Diego-Resultado-Espermograma-9-1-2018.pdf

STD tests taken 2 months after the last time I had sex (I waited all this time to make sure they would be accurate). Herpes igG is positive, but I never had any symptoms - it's only there like it is in 2 thirds of all people.
Exames-de-DST-19-7-2017.pdf

First blood tests from August:
Checkup-Resultados-de-Exames-Endocrinologista-28-8-2017.pdf

Second blood tests from November, 2017 (remember: I took Accutane for months during 2011):
Diego-Resultados-de-Exames-Endocrinologista-28-e-30-11-2017.pdf

And now the last tests:
Diego-Resultados-de-Exames-Endocrinologista-15-1-2018.pdf

From January 15, 2018.

Let's see:

All OK:

Uric Acid, Creatinine, Glucose, Complete Blood Count (why it showed Eosinophilia now? Will check that later), Lipid profile, Free T4, Urea, Aspartate transaminase, Alanine Aminotransferase and Thyroid-Stimulating Hormone (TSH). All of them in the reference ranges from the lab.

*************** RELEVANT RESULTS ***************

1) Total testosterone:
I said 3.09 in the 1st test, and 4.19 in the 2nd after 3 months taking vitamin D. I am still taking, this time 7000 UI/week and not 14000, for another 3 months (but I have plans to stop taking the supplement, and spend more time outside in the morning).

Now: 357 ng/dL. Lab ranges: 175 - 781 ng/dL

2) Free testosterone: 7.21. Lab ranges: Since 2011 it's calculated according to total test. and SHBG levels. According to Vermeulen, A. ET AL., 1999, the ref. ranges are 4.58 - 18.33 ng/dL for men, and 0.03 - 0.95 ng/dL for women.

3) SHBG (1st time I did this test): 32.6 nmol/L. Lab ranges: men from 20 to 50 years old: 13.2 - 89.5 nmol/L.

4) Vitamin D: still at 40's. Now 42.4 ng/mL.

5) Vitamin B-12 (1st time): lag ranges for men: 81 - 488 pg/mL. My result: 449 pg/mL.

6) FSH (1st time): 6.54 mUI/mL. Lag ranges for adult men: 1.27 - 19.26 MUI/ML

7) LH (1st time): 4.61 mUI/mL. Lag ranges for men: 1.24 - 8.62 MUI/ML

8) Gamma-Glutamyl Transferase (GGT) - 1st time: 18 U/L. Ranges: 7 - 45 U/L

9) Prolactin: 28.51 ng/mL. Ranges for men: 2.60 - 13.10 ng/mL. Previous results: 25-25. Once again high prolactin.

10) Zinc (1st time): still waiting for results

Note:

Months ago I also did these two, and they came back OK:

- Abdominal Ultrasound and MRI scan - sella turcica

About additional tests, I am asking if these are necessary to investigate what sort of damage Accutane did, since we are talking about sexual dysfunction:

- Dihydrotestosterone (DHT)
- E2, which measures the amount of estradiol, a form of estrogen
- DHEA-S (dehydroepiandrosterone sulfate)
- Progesterone
- IGF-1 (Insulin-like Growth Factor-1)

Like I said, I am going to get to the bottom of this. I was even thinking of testing for other vitamins besides D-3 and B-12...

However I don't know if doing all or any of these is necessary.

*******
And now I see the Wikipedia article has been updated on this matter:

******* WIKIPEDIA: ACCUTANE *******

Isotretinoin is also associated with sexual side effects, namely erectile dysfunction and reduced libido.

Isotretinoin 20mg capsules - - (eMC)

In October 2017, the UK MHRA issued a Drug Safety Update to physicians in response to reports of these problems.

>>>>>> "Drug Safety Update - Latest advice for medicines users - October 2017" (PDF). MHRA. 3 October 2017.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/655127/DSU-Oct-pdf.pdf

This was in response to an EU review, published in August 2017, which states that a plausible physiological explanation of these side effects "may be a reduction in plasma testosterone".

http://www.ema.europa.eu/docs/en_GB...ate_single_assessment/2017/08/WC500234071.pdf

The review also stated that "the product information should be updated to include ‘sexual dysfunction including erectile dysfunction and decreased libido’ as an undesirable effect with an unknown frequency".

http://www.ema.europa.eu/docs/en_GB/document_library/Minutes/2017/09/WC500235426.pdf

There have also been reports of spermatogenesis disorders, such as oligospermia. 27 cases of sexual dysfunction report either negative dechallenge or positive dechallenge.

http://www.ema.europa.eu/docs/en_GB...ate_single_assessment/2017/08/WC500234071.pdf

******* WIKIPEDIA: ACCUTANE *******

This link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472884/

Says the following:

>>>>>> Diagnosis of Hypogonadism: Clinical Assessments and Laboratory Tests

****** In males, serum testosterone levels show a circadian variation, with the highest levels in the morning and lowest levels in the late afternoon. In young men, the variation in testosterone levels is approximately 35%. Although the normal range for serum testosterone might vary between different laboratories, the normal range for early morning total testosterone in healthy adult males is approximately 300 ng/dL to 1000 ng/dL. ******


If that's the case then my blood tests indicate I have normal levels. But that doesn't mean IDEAL LEVELS, which I assume are in the middle (500, 600), and never 300, 400.

Let's continue:

****** Prepubertal: Secondary hypogonadism is associated with low levels of testosterone and normal to low levels of LH and FSH. ******

****** The signs and symptoms of low testosterone in postpubertal adult males can be more difficult to diagnose and might include loss of libido, erectile dysfunction, diminished intellectual capacity, depression, lethargy, osteoporosis, loss of muscle mass and strength, and some regression of secondary sexual characteristics.

At the initial visit, the first objective is to distinguish between primary gonadal failure, in which low testosterone is accompanied by increased FSH and increased LH, and hypothalamic-pituitary disorders (secondary hypogonadism), with low testosterone and low to normal FSH and LH levels. *******

Do I fit in the latter case? Low testosterone levels and LOW TO NORMAL LH and FSH levels?

******* Initial laboratory testing should include early morning (8:00–10:00 AM) measurement of serum testosterone, prolactin, FSH, and LH levels. For the diagnosis of primary hypogonadism, FSH measurement is particularly important because FSH has a longer half life, is more sensitive, and demonstrates less variability than LH.

The aging male patient can present with signs and symptoms of low testosterone, including loss of libido, erectile dysfunction, diminished intellectual capacity, depression, lethargy, osteoporosis, and loss of muscle mass and strength. At the initial visit, laboratory testing should include early morning (8:00–10:00 AM) measurement of serum testosterone. In elderly men, testosterone levels decrease between 15% and 20% over the course of 24 hours. *******

OK, I did all those tests early in the morning. I had to wake 2 hours earlier (I usually wake at 8:00 AM), but that was not an issue. As for all low testosterone symptoms I don't think I have any of these, including fatigue. Except for loss of libido. And depression was a symptom I had for a few years after the Accutane treatment. Now it's totally gone.

****** Total testosterone levels might be normal with hypogonadism if the SHBG levels are increased. Levels of SHBG increase with age, causing a decrease in bioavailable testosterone. If testosterone levels are low-normal but the clinical symptoms and signs indicate hypogonadism, measurement of serum total testosterone levels should be repeated and an SHBG level should be determined. With the total testosterone and SHBG levels, a bioavailable testosterone value can be calculated. A bioavailable testosterone calculator is available at www.issam.ch/freetesto.htm.

It is usually not necessary to determine FSH or LH levels in the aging male. *********

And the article continues, explaining more about total/free test. and SHBG.

******* In selected patients, FSH, LH, and prolactin can be measured. If the FSH and LH levels are raised, this suggests a primary testicular cause, and if levels are low or normal, a hypothalamic or pituitary cause should be considered. A raised prolactin level suggests that further investigation of the pituitary gland should be undertaken. *******

The FSH and LH levels are not high. So that rules out the first suggestion.

"A hypothalamic or pituitary cause should be considered" (if the levels are low or normal - THEY ARE NORMAL). What kind of tests should I do to investigate this?

"A raised prolactin level suggests that further investigation of the pituitary gland should be undertaken." (3 different blood tests show exactly THAT. Not that high (25), yet still high for a man).

****** Hypothalamic or pituitary deficiency might be transitory or permanent. Transient secondary hypogonadism might be related to malnutrition or stress states and can be diagnosed by physical examination and evaluation of the patient’s growth chart. If permanent hypothalamic or pituitary hormone deficiency is suspected, serum levels of pituitary hormones and magnetic resonance imaging of the brain and pituitary should be obtained to screen for hypothalamic or pituitary disease. ********

Malnutrition or stress states?

Does that mean if I change my diet (which is not bad, still I have an appointment with a nutritionist this month, to do a complete overhaul - plus another specialist, to do the same for my workout routine, I go to the gym every day in the morning) I can fix this?

And stress might be related to sleeping 1, 2 hours less? If this is the case, then I can't neglect to inform that I was doing this in the past weeks, prior to this blood test.

"can be diagnosed by physical examination and evaluation of the patient’s growth chart" (Growth chart?)

"If permanent hypothalamic or pituitary hormone deficiency is suspected, serum levels of pituitary hormones" (Again, what kind of exam? To check these serum levels of pituitary hormones?)


"and magnetic resonance imaging of the brain and pituitary should be obtained"

Didn't I do that already? I said I did a "magnetic resonance imaging of the sella turcica region". Does that cover this suggestion?

"...to screen for hypothalamic or pituitary disease."

*******
Although the normal range for serum testosterone might vary between different laboratories, the normal range for early morning testosterone in male adults is approximately 300 ng/dL to 1000 ng/dL. An early morning total serum testosterone level of less than 300 ng/dL clearly indicates hypogonadism, and under most circumstances benefit will be derived from testosterone replacement therapy. A healthy male adult patient with a serum testosterone level greater than 400 ng/dL is unlikely to be testosterone deficient, and therefore clinical judgment should be exercised if he has symptoms suggestive of testosterone deficiency.
*******

I get it, I predict my testosterone levels will fall in the range of 400 ng/DL in the coming months when I change my lifestyle and spend more time outside (for vitamin D, since this also raises test. levels). I understand that TRT has a lot of issues and should be THE LAST RESORT. Only when all other options have been eliminated, and for TRT if the levels are even lower than mine. I heard people explaining that it's an artificial increase that will trick the body and prevent a natural improvement, it will probably need to continue for the rest of one's life, and there's the expenses and
dependency of taking another S.HIT.

The thing is: my actual testosterone levels are not OK by a long shot and anyone that says they are should get punched in the face. Testosterone levels now are lower than ever before:
http://thechart.blogs.cnn.com/2011/08/18/modern-life-rough-on-men/

Countless sources will tell that. Meaning we can't say this is OK just because most men are weaklings, because today standards of how masculine (and healthy) we are not the IDEAL ones.

******* Hypogonadism can be of hypothalamic-pituitary origin or of testicular origin, or a combination of both, which is increasingly common in the aging male population. It can be easily diagnosed with measurement of the early morning serum total testosterone level, which should be repeated if the value is low. Follicle-stimulating hormone, LH, and prolactin might also need to be measured. If the clinical signs and symptoms suggest hypogonadism but the serum testosterone level is near normal, then assay of serum testosterone should be repeated in conjunction with SHBG because serum testosterone might be normal in the presence of hypogonadism if the SHBG level is raised, which commonly occurs in elderly male patients. *******

 

[Flynn]

Please read this post before what I am going to say next... I don't want to repeat a ton of information.
Repairing the long-term damage from Accutane

More about my case, concerning libido loss:
Repairing the long-term damage from Accutane

I got my last blood test results... any thoughts if further tests are needed?

Spermogram: the urologist said there's nothing wrong. Note: all Google Drive links are from the lab. They are written in portuguese.

Diego-Resultado-Espermograma-9-1-2018.pdf

STD tests taken 2 months after the last time I had sex (I waited all this time to make sure they would be accurate). Herpes igG is positive, but I never had any symptoms - it's only there like it is in 2 thirds of all people.
Exames-de-DST-19-7-2017.pdf

First blood tests from August:
Checkup-Resultados-de-Exames-Endocrinologista-28-8-2017.pdf

Second blood tests from November, 2017 (remember: I took Accutane for months during 2011):
Diego-Resultados-de-Exames-Endocrinologista-28-e-30-11-2017.pdf

And now the last tests:
Diego-Resultados-de-Exames-Endocrinologista-15-1-2018.pdf

From January 15, 2018.

Let's see:

All OK:

Uric Acid, Creatinine, Glucose, Complete Blood Count (why it showed Eosinophilia now? Will check that later), Lipid profile, Free T4, Urea, Aspartate transaminase, Alanine Aminotransferase and Thyroid-Stimulating Hormone (TSH). All of them in the reference ranges from the lab.

*************** RELEVANT RESULTS ***************

1) Total testosterone:
I said 3.09 in the 1st test, and 4.19 in the 2nd after 3 months taking vitamin D. I am still taking, this time 7000 UI/week and not 14000, for another 3 months (but I have plans to stop taking the supplement, and spend more time outside in the morning).

Now: 357 ng/dL. Lab ranges: 175 - 781 ng/dL

2) Free testosterone: 7.21. Lab ranges: Since 2011 it's calculated according to total test. and SHBG levels. According to Vermeulen, A. ET AL., 1999, the ref. ranges are 4.58 - 18.33 ng/dL for men, and 0.03 - 0.95 ng/dL for women.

3) SHBG (1st time I did this test): 32.6 nmol/L. Lab ranges: men from 20 to 50 years old: 13.2 - 89.5 nmol/L.

4) Vitamin D: still at 40's. Now 42.4 ng/mL.

5) Vitamin B-12 (1st time): lag ranges for men: 81 - 488 pg/mL. My result: 449 pg/mL.

6) FSH (1st time): 6.54 mUI/mL. Lag ranges for adult men: 1.27 - 19.26 MUI/ML

7) LH (1st time): 4.61 mUI/mL. Lag ranges for men: 1.24 - 8.62 MUI/ML

8) Gamma-Glutamyl Transferase (GGT) - 1st time: 18 U/L. Ranges: 7 - 45 U/L

9) Prolactin: 28.51 ng/mL. Ranges for men: 2.60 - 13.10 ng/mL. Previous results: 25-25. Once again high prolactin.

10) Zinc (1st time): still waiting for results

Note:

Months ago I also did these two, and they came back OK:

- Abdominal Ultrasound and MRI scan - sella turcica

About additional tests, I am asking if these are necessary to investigate what sort of damage Accutane did, since we are talking about sexual dysfunction:

- Dihydrotestosterone (DHT)
- E2, which measures the amount of estradiol, a form of estrogen
- DHEA-S (dehydroepiandrosterone sulfate)
- Progesterone
- IGF-1 (Insulin-like Growth Factor-1)

Like I said, I am going to get to the bottom of this. I was even thinking of testing for other vitamins besides D-3 and B-12...

However I don't know if doing all or any of these is necessary.

*******
And now I see the Wikipedia article has been updated on this matter:

******* WIKIPEDIA: ACCUTANE *******

Isotretinoin is also associated with sexual side effects, namely erectile dysfunction and reduced libido.

Isotretinoin 20mg capsules - - (eMC)

In October 2017, the UK MHRA issued a Drug Safety Update to physicians in response to reports of these problems.

>>>>>> "Drug Safety Update - Latest advice for medicines users - October 2017" (PDF). MHRA. 3 October 2017.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/655127/DSU-Oct-pdf.pdf

This was in response to an EU review, published in August 2017, which states that a plausible physiological explanation of these side effects "may be a reduction in plasma testosterone".

http://www.ema.europa.eu/docs/en_GB...ate_single_assessment/2017/08/WC500234071.pdf

The review also stated that "the product information should be updated to include ‘sexual dysfunction including erectile dysfunction and decreased libido’ as an undesirable effect with an unknown frequency".

http://www.ema.europa.eu/docs/en_GB/document_library/Minutes/2017/09/WC500235426.pdf

There have also been reports of spermatogenesis disorders, such as oligospermia. 27 cases of sexual dysfunction report either negative dechallenge or positive dechallenge.

http://www.ema.europa.eu/docs/en_GB...ate_single_assessment/2017/08/WC500234071.pdf

******* WIKIPEDIA: ACCUTANE *******

This link:
Diagnosis of Hypogonadism: Clinical Assessments and Laboratory Tests

Says the following:

>>>>>> Diagnosis of Hypogonadism: Clinical Assessments and Laboratory Tests

****** In males, serum testosterone levels show a circadian variation, with the highest levels in the morning and lowest levels in the late afternoon. In young men, the variation in testosterone levels is approximately 35%. Although the normal range for serum testosterone might vary between different laboratories, the normal range for early morning total testosterone in healthy adult males is approximately 300 ng/dL to 1000 ng/dL. ******


If that's the case then my blood tests indicate I have normal levels. But that doesn't mean IDEAL LEVELS, which I assume are in the middle (500, 600), and never 300, 400.

Let's continue:

****** Prepubertal: Secondary hypogonadism is associated with low levels of testosterone and normal to low levels of LH and FSH. ******

****** The signs and symptoms of low testosterone in postpubertal adult males can be more difficult to diagnose and might include loss of libido, erectile dysfunction, diminished intellectual capacity, depression, lethargy, osteoporosis, loss of muscle mass and strength, and some regression of secondary sexual characteristics.

At the initial visit, the first objective is to distinguish between primary gonadal failure, in which low testosterone is accompanied by increased FSH and increased LH, and hypothalamic-pituitary disorders (secondary hypogonadism), with low testosterone and low to normal FSH and LH levels. *******

Do I fit in the latter case? Low testosterone levels and LOW TO NORMAL LH and FSH levels?

******* Initial laboratory testing should include early morning (8:00–10:00 AM) measurement of serum testosterone, prolactin, FSH, and LH levels. For the diagnosis of primary hypogonadism, FSH measurement is particularly important because FSH has a longer half life, is more sensitive, and demonstrates less variability than LH.

The aging male patient can present with signs and symptoms of low testosterone, including loss of libido, erectile dysfunction, diminished intellectual capacity, depression, lethargy, osteoporosis, and loss of muscle mass and strength. At the initial visit, laboratory testing should include early morning (8:00–10:00 AM) measurement of serum testosterone. In elderly men, testosterone levels decrease between 15% and 20% over the course of 24 hours. *******

OK, I did all those tests early in the morning. I had to wake 2 hours earlier (I usually wake at 8:00 AM), but that was not an issue. As for all low testosterone symptoms I don't think I have any of these, including fatigue. Except for loss of libido. And depression was a symptom I had for a few years after the Accutane treatment. Now it's totally gone.

****** Total testosterone levels might be normal with hypogonadism if the SHBG levels are increased. Levels of SHBG increase with age, causing a decrease in bioavailable testosterone. If testosterone levels are low-normal but the clinical symptoms and signs indicate hypogonadism, measurement of serum total testosterone levels should be repeated and an SHBG level should be determined. With the total testosterone and SHBG levels, a bioavailable testosterone value can be calculated. A bioavailable testosterone calculator is available at www.issam.ch/freetesto.htm.

It is usually not necessary to determine FSH or LH levels in the aging male. *********

And the article continues, explaining more about total/free test. and SHBG.

******* In selected patients, FSH, LH, and prolactin can be measured. If the FSH and LH levels are raised, this suggests a primary testicular cause, and if levels are low or normal, a hypothalamic or pituitary cause should be considered. A raised prolactin level suggests that further investigation of the pituitary gland should be undertaken. *******

The FSH and LH levels are not high. So that rules out the first suggestion.

"A hypothalamic or pituitary cause should be considered" (if the levels are low or normal - THEY ARE NORMAL). What kind of tests should I do to investigate this?

"A raised prolactin level suggests that further investigation of the pituitary gland should be undertaken." (3 different blood tests show exactly THAT. Not that high (25), yet still high for a man).

****** Hypothalamic or pituitary deficiency might be transitory or permanent. Transient secondary hypogonadism might be related to malnutrition or stress states and can be diagnosed by physical examination and evaluation of the patient’s growth chart. If permanent hypothalamic or pituitary hormone deficiency is suspected, serum levels of pituitary hormones and magnetic resonance imaging of the brain and pituitary should be obtained to screen for hypothalamic or pituitary disease. ********

Malnutrition or stress states?

Does that mean if I change my diet (which is not bad, still I have an appointment with a nutritionist this month, to do a complete overhaul - plus another specialist, to do the same for my workout routine, I go to the gym every day in the morning) I can fix this?

And stress might be related to sleeping 1, 2 hours less? If this is the case, then I can't neglect to inform that I was doing this in the past weeks, prior to this blood test.

"can be diagnosed by physical examination and evaluation of the patient’s growth chart" (Growth chart?)

"If permanent hypothalamic or pituitary hormone deficiency is suspected, serum levels of pituitary hormones" (Again, what kind of exam? To check these serum levels of pituitary hormones?)


"and magnetic resonance imaging of the brain and pituitary should be obtained"

Didn't I do that already? I said I did a "magnetic resonance imaging of the sella turcica region". Does that cover this suggestion?

"...to screen for hypothalamic or pituitary disease."

*******
Although the normal range for serum testosterone might vary between different laboratories, the normal range for early morning testosterone in male adults is approximately 300 ng/dL to 1000 ng/dL. An early morning total serum testosterone level of less than 300 ng/dL clearly indicates hypogonadism, and under most circumstances benefit will be derived from testosterone replacement therapy. A healthy male adult patient with a serum testosterone level greater than 400 ng/dL is unlikely to be testosterone deficient, and therefore clinical judgment should be exercised if he has symptoms suggestive of testosterone deficiency.
*******

I get it, I predict my testosterone levels will fall in the range of 400 ng/DL in the coming months when I change my lifestyle and spend more time outside (for vitamin D, since this also raises test. levels). I understand that TRT has a lot of issues and should be THE LAST RESORT. Only when all other options have been eliminated, and for TRT if the levels are even lower than mine. I heard people explaining that it's an artificial increase that will trick the body and prevent a natural improvement, it will probably need to continue for the rest of one's life, and there's the expenses and
dependency of taking another S.HIT.

The thing is: my actual testosterone levels are not OK by a long shot and anyone that says they are should get punched in the face. Testosterone levels now are lower than ever before:
Modern life rough on men

Countless sources will tell that. Meaning we can't say this is OK just because most men are weaklings, because today standards of how masculine (and healthy) we are not the IDEAL ones.

******* Hypogonadism can be of hypothalamic-pituitary origin or of testicular origin, or a combination of both, which is increasingly common in the aging male population. It can be easily diagnosed with measurement of the early morning serum total testosterone level, which should be repeated if the value is low. Follicle-stimulating hormone, LH, and prolactin might also need to be measured. If the clinical signs and symptoms suggest hypogonadism but the serum testosterone level is near normal, then assay of serum testosterone should be repeated in conjunction with SHBG because serum testosterone might be normal in the presence of hypogonadism if the SHBG level is raised, which commonly occurs in elderly male patients. *******

Its good that you've gotten blood tests and you're taking action. Here is my take on this. I highly doubt testosterone levels are the cause of this. I would not recommend steroids yet. I say this because I and other PAS people have tried steroids, using relatively high doses with no alleviation of symptoms. Despite being able to gain muscle mass and strength rapidly, little to no improvement in sexual sides. The only person I've found who got a increased libido on steroids was @Willylong98.

What I suspect is far more likely the cause than hormone levels is receptor expression. It's possible receptors for androgen have been downregulated in the brain. I still think this is improbable but has to be taken into consideration. Can I ask what other symptoms you have if you have any others? Have you experienced less desire to be involved in social events? are you less sociable? are you more apathetic? do you have anhedonia (unable to gain as much pleasure from usually pleasurable things? Or do you just have loss of libido etc.? I know thats quite a lot of questions but its very useful to know if these symptoms always present with sexual dysfunction or not.

I also doubt this is due to pituitary problems, those tests are expensive. I've have my IGF-1, IGFBP-3 and growth hormone measured they all look fine.

Given my thoughts on receptor expression, I strongly recommend that rather than spend money on steroids or even any more expensive blood tests. You give RU-486 protocol a try. It's not a cheap drug to get. But if our problem is related to receptor expression, RU-486 should work in several beneficial ways to potentially enhance expression of androgen receptors, glucocorticoid receptors and correct progesterone signalling. Note that many users with PFS have reported improvements after using RU-486 whilst I haven't found any PAS sufferers with sexual problems give RU-486 a try, so right now it looks like one of the most promising things to be trailed.

However I will say that you're prolactin does look very high, given the normal range. It may be worth trying Cabergoline to see if that has any effect.

 

[Perene]

@Flynn in my case the only side effect I am sure of having is the one described. I don't think I have all others from low testosterone, such as:

- Low semen volume (at least the tests didn't show this. If they are accurate, that is. I did the spermogram correctly, although I am not sure if the slightest mistake could alter significantly the results. Will try to find out in my next urologist visit. My opinion? There's nothing wrong in this area).

- Hair loss (granted I had more hair at least until 2012, my treatment was in 2011, yet I am not losing now, with 33 years old. And I always leave mine short. Yep, no)

- Fatigue, decrease in energy levels (I don't think I have this problem. But nowadays I have less energy while on the gym, however I strongly believe that with a proper diet + workout routine and enough sleep I'll be in perfect shape. Less disposition than in the old days is not proof. Also ruled out)

- Loss of muscle mass (no)

- Increased body fat

"Men with low T may also experience increases in body fat. In particular, they sometimes develop gynecomastia, or enlarged breast tissue. This effect is believed to occur due to an imbalance between testosterone and estrogen within men."

Also no. When I visit the nutritionist I'll get my measures. I lost weight since the Accutane treatment, in 2012-13 I had 176 lbs and now I have 143.

- Decreased bone mass. No

- Mood changes

"Men with low T can experience changes in mood. Because testosterone influences many physical processes in the body, it can also influence mood and mental capacity. Research suggests that men with low T are more likely to face depression, irritability, or a lack of focus."

That explanation also suggests that men with low T have cognitive impairment. And this link says:
Are Low Testosterone Levels Affecting Your Brain? • Renew Me Today

********
While most men are aware that Testosterone is a critical hormone for muscle building and sexual health, mounting evidence shows how essential this hormone is for brain health as well. The link between testosterone and healthy brain function strengthens the case for hormone replacement therapy in men who have levels of testosterone falling below the normal range of 300-1000 ng/dL
********

Since I have between 350-400 ng/dL I don't need TRT or have this issue.

About the loss of libido:

It would be incredibly difficult to blame Accutane 100% for this side effect if you consider my personal life. In fact if you could see all of it in a flash you would seriously doubt it could affect me at all.

I like saying that all my life I behaved just like Mr. Spock from Star Trek. Vulcans are not born the way you see Spock in the show, as this text explains:

*******
Beginning in the 4th century, Vulcan philosophy revolved around the concept of logic. The highest objective of a traditional Vulcan life was to either control or suppress all emotion, thus rendering a purely logical being. This difficult task was attained through meditation and discipline. As Vulcans approached or reached maturity, it was customary to train under the tutelage of a Vulcan master in the Kolinahr ritual, to purge themselves of any remaining lack of emotional control.
*******

That means they can become violent or emotional at some point in their lives, these traits are not absent from their essence, that's what I am trying to say. So we always see Spock calm and collected in the screen, and not interested in human goals and objectives. That's what I always were. Until the treatment in 2011.

If you ask me what sort of traits I always had, I would mention these from the "schizoid personality disorder":
Schizoid personality disorder - Wikipedia

- Consistent preference for solitary activities.
- Very few, if any, close friends or personal relationship, and a lack of desire for such. (never had any need for this)
- Indifference to either praise or criticism. (to be perfectly honest I am not indifferent, yet most of the time I don't care)

- Little interest in having sexual experiences with another person (taking age into account). (I had interest, despite never having approached any woman. I lost it completely only AFTER the Accutane treatment).

- Taking pleasure in few, if any, activities. (I take pleasure in activities that do not involve interacting with others)

- Indifference to social norms and conventions. (I respect them, it's just that I do not follow or care about them blindly)

- Preoccupation with fantasy and introspection. (this is a trait more seen in schizotypal personality. What is true is that I care more about my world and doing things on my own instead of the REAL world. For example I prefer to write all this stuff and post in this thread instead of meeting and spending any time with real people)

In 2012 I began acting EXACTLY like Spock in this particular episode:
THE NAKED TIME

That was when the crew caught a virus that removed their inhibitions.

No kidding. That was what happened and this change was anything but normal. I spent years at home and going out in rare cases, ever since I quit school. From 2000 until 2011 I didn't change anything substantial in my life, except that after 2009 I began to be more concerned about myself. Probably after I did this personality disorder test. After I decided to go to a gym for the first time (this was 2012, after the Accutane treatment was over for almost a year) I became a lot more emotional and my libido increased, along with a depression that I never had BEFORE.

If I were to put into numbers, I would say my libido was normal BEFORE 2011, and it was 6, 7. A normal person would have these levels or even more. Let's say for the sake of argument mine was normal to high, yet 6, 7, and a horny man is 8, 9, close to 10.

In 2012 my libido increased (and for a woman that I never even talked before, we just bumped, and she wasn't even attractive) to at least 9, 10 (current 2018 levels are 1, 2). At the same time (since I was feeling depressed - I even cried all of sudden for days/weeks, I wanted to get rid of that situation) that same libido was dropping and if I am not mistaken for the first time EVER (I started in 1996, at 11 years old) I spent months without masturbation. In June 9, 2012 I had an erection in public by just looking directly at a woman. That embarassing situation would never happen if I were in my normal state.

(Note: In 2017 I broke a record of not masturbating that lasted more than a year. MORE THAN A YEAR. Is this proof enough?)

Just like Spock in the aforementioned episode I was TOTALLY OUT OF CHARACTER.

Nimoy is completely stone faced with an undercurrent of suppressed emotion, that peeks out occasionally. That loneliness was a huge part of the character's popularity as many people could identify with being an awkward outsider, to one degree or another.

I left that place and decided to go back to school and finish it (after all these years), and probably 3, 4 years after the treatment the depression was totally GONE.

But over time the loss of libido increased. Right now I don't have any need to have sex, FAP or care about any woman. NONE AT ALL.

Someone might argue that my views on women (for example: I read The "Manipulated Man" from Esther Vilar, and other MGTOW thinkers even before 2011) preclude me from having any desire, or that I got fed up with porn.

The changes I had AFTER THE TREATMENT were definitely because of it, and are not mostly due to psychological reasons.

It's extremely hard (in my case, at least) to blame Accutane for the state in which I am today, because if someone understands HOW I think and sees what I've been through it will think that only a psychiatry will fix my sex life.

I don't mind not having a libido. What I most care about is NOT HAVING ANY SYMPTOM OF LOW TESTOSTERONE, any impairment besides the need to have sex/fap/get involved with women.

All these things are not necessary for a healthy life, if someone here thinks that it must also conclude that priests and nuns are ill. Looking back I consider all of them as not part of my life anymore, just like fast food for someone that follows a strict diet. And when I stick to a diet or way of life I don't (occasionally) eat food that is not on the list or do anything that jeopardize my goals.

It makes no sense to think that someone that behaves this way would look at unhealthy food and see it as a necessity. That kind of person doesn't even think about the food for a second.

In other words I am not complaining the Accutane treatment caused this side effect. The thing is, lowering testosterone levels can affect us in other ways, too. I know that Jesse Jones guy (that commited suicide as a result of his depression) said he didn't care about women, too, and "used to think about them all the time". Maybe I should care more about them or sex.

I don't, and see no reason for it. In fact I am fully convinced of the opposite, since I don't want my past sex life to go back. It would hinder the way I do things or what I am NOW. I am sorry for the people who felt their lives were ruined due to this side effect, even though I am not one of them. This didn't affect my life at all. It might have helped.

Still that doesn't justify not informing the patients of this side effect in the leaflet, and everyone that prescribed this drug for non-severe cases should go to jail. And Roche should pay for their negligence. Everyone has warned them and many others for decades and it's criminal that only now they are considering adding this information for new users.

Right now that the damage is done.

What I am doing is to improve my health in any way I can, to increase these testosterone levels. Don't you think this is the main issue with the loss of libido? I didn't measure my testosterone before 2017, so I have no idea how the levels changed.

 

[Flynn]

Ok fair enough.

No I don't think its as simple as testosterone. In fact I know it isn't because I have altered my testosterone significantly with little to no effect. Either the testosterone signal isn't being received due to downregulated testosterone receptors in the brain. Or there is something wrong with the neural pathways which are usually activated by testosterone to signal the message, namely dopamine. There is lots of evidence to show that accutane affects the dopamine pathways by for instance increasing the expression of D2. however there is no research investigating whether these effects persist after you stop accutane.

 

[Perene]

Whatever Accutane does, the question is: can it be reverted by taking meds that deal with high prolactin? I am aware of many things we can do on a daily basis to try increasing testosterone levels (and I am doing them), but to deal with loss of libido, like it was said, it seems to me only taking another drug the changes in the body can be significant.

Just like what happened after I started taking vitamin D, and testosterone levels increased after months. I know I always neglected this part and never spent much time outside, so in this regard I was never that healthy.

The thing is: solving this and doing other things to benefit my health won't fix this PERMANENT SIDE EFFECT from the Accutane treatment.

Look at this message:
Prolactinoma hasn't shrunk after cabergoline.HELP!

********
My understanding is that carbergoline shrinks tumors in only some cases. In many cases, it doesn't shrink the tumor at all but it does regulate the prolactin, and you need to stay on the drugs indefinitely. You can go up much higher on dosage if you tolerate the side effects. I take 1 mg twice a week, and might go up more, because my tumor is resistant to the meds.

If your prolactin is in the normal range, you should be able to get pregnant. You just need to stay on the meds.

Be sure you're seeing a doctor with experience in prolatinomas--a reproductive endocrinologist or an endocrinologist that specializes in pituitary tumors. If he's telling you that the carbergoline should definitely shrink the tumor...that doesn't sound right to me....

*******

"Indefinitely".

S.HIT, I knew there was a catch. And I don't expect at least the doctor I am going in to prescribe, he will certainly say 25 is high for a man, but not THAT high.

I saw a scientific article stating the same about how long we need to treat it... can't find the exact link now, yet look at this:

Hyperprolactinemia Medication: Dopamine agonists

Then there's this thread where prolactin is discussed, and right in the first page someone has a theory of how Accutane causes the aforementioned sexual dysfunction that doesn't seem to go away.

So, bottom line: most people that lost their libido have high prolactin or I am the only case presented so far? If most of them have high prolactin then we already know the answer to what needs to be done to fix it.

P.S. Someone at:
Man - 21 - High prolactin levels? - Men's Health - MedHelp

Suggested this link:
Male Enhancement: How to Reduce Recovery Time

Which says the following:

"Vitamin B6 and zinc work hand in hand to manage metabolic processes and to lower prolactin levels"

Do I need to consider taking more supplements besides D-3? That's a very good question and maybe falls under that advice from Dr. Pezzi (book THE SCIENCE OF SEX):

- Try relatively high-dose supplemental vitamin B-6 (but avoid excessive doses that may induce a peripheral neuropathy; see the vitamin B 6 section for more information).

That Medhelp link has some comments saying doctors usually disregard these high prolactin levels... when for a man the range should be between 1 and 17, and the optimal in ng / mL is < 6.

I appreciate any input about this subject... assuming, of course, most Accutane users affected by the same problem also present high levels, and I am not the only case. Somehow I doubt that, considering the explanation given in that Wikipedia article:

********** "This was in response to an EU review, published in August 2017, which states that a plausible physiological explanation of these side effects "may be a reduction in plasma testosterone". **********

How can this happen if prolactin isn't high in all the affected?

 

[Canari]

If you ask me what sort of traits I always had, I would mention these from the "schizoid personality disorder":
Schizoid personality disorder - Wikipedia

- Consistent preference for solitary activities.
- Very few, if any, close friends or personal relationship, and a lack of desire for such. (never had any need for this)
- Indifference to either praise or criticism. (to be perfectly honest I am not indifferent, yet most of the time I don't care)

- Little interest in having sexual experiences with another person (taking age into account). (I had interest, despite never having approached any woman. I lost it completely only AFTER the Accutane treatment).

- Taking pleasure in few, if any, activities. (I take pleasure in activities that do not involve interacting with others)

- Indifference to social norms and conventions. (I respect them, it's just that I do not follow or care about them blindly)

- Preoccupation with fantasy and introspection. (this is a trait more seen in schizotypal personality. What is true is that I care more about my world and doing things on my own instead of the REAL world. For example I prefer to write all this stuff and post in this thread instead of meeting and spending any time with real people)

Psychiatry has made things too difficult, and separated cases instead of finding common roots! This article does not even mention the autonomic nervous system. All those traits are just part of dissociation. Dissociation is caused by whatever disrupt the alternate balance between sympathetic and parasympathetic activity, resulting in a form of calmness involving both. The normal relaxed/calm state is produced by the ventral vagal system, which allows to be present and socially engaged. The dissociative state is produced by the dorsal vagal system, and covers the sympathetic activation without this last being lowered! This is an emergency state, and when you know that this part of the system is already present in the fetus, while the ventral branch is developed only when we are 6 months of age... That is why we rely so much on grown-ups, and that is why there is much more dissociative states than we think! Just because what we consider as trauma is only the top part of the iceberg. The cause of a tendency to dissociate plus a tendency to be numb, stoic or socially un at ease can be found in having had a difficult birth, early surgery, mother's accident during pregnancy, and more. Some people can have those accidents and not get any dissociation symptom, and they become even strong persons with a lot of resilience, and the difference is just simple: when our ventral vagal system is not finished, we rely on the one of the mother... So your recovery depends on the inner nervous strength of the main caregiver. My brother with early surgery who stayed 5 months in hospital from birth, has almost no symptom, because he was super cared by many different nurses, and escaped a tired and stressed mother at the time out grand-mother was dying. I even think he was lucky to be at hospital...

When you do not know this basis, which is a breakthrough from the last 40 years only, then you get lost into details and do not understand what causes what! 40 years is not enough for this to have generalised into mainstream practise... It takes a generation to change things, but when you learn about it, you can be part of the pioneering before others...

Then when you know that the best external sign to know about your inner balance of sympathetic and parasympathetic system is sex beheviour, and when you know that the autonomic nervous system or ANS is the one responsable for releasing hormones... The period when you got aroused too much correspond to a high sympathetic state, due to the loss of the dorsal vagal induced dissociation you had before! That is when you could FEEL the depression. Other people have mentonned having had, before loosing libido, a more than average libido, and this can perfecty come as an excess of sympathetic activation. Then whatever stresses the body more, such as taking even prescription drugs, and maybe linked to some personal events and too much stress at a time, can make the body turn to a dissociation response. Of course people will have different reactions that will affect different part of their body systems, and according to all other circumstances in their lifes, but the common basis is absolutely simple, if you watch it with a wide and broad view, you will see the common points. If you look with a microscope, you can get lost into details and loose the broad view. Of course accutane is responsible, but the different reactions of different accutane users prooves that accutane alone is not enough to create all this. You have to find the interactions, and if you look at the ANS, then you have a clear route that can help you along with any treatment.

 

[Shadow]

Yeah bro, I got blood tests for GH, IGF1 etc. expensive as hell but it all contribute to the cause I guess. Will post them soon. But all you need to know is, our problem is not IGF-1, IGFBP-3, GH, thyroid hormones, testosterone. At least not for me.

THe only thing that came in low for me, for the tests I did was low DHEA's.

I don't really know, hard to say if our problems are same as those who have taken SSRI's and have PSSD. I just know that most people on PSSD forums seem to think that a 5HT1A antagonist is the key but I don't think any are available at the moment. This is because SSRI's make the 5HT1A receptor insensitive and reduce SERT whilst overloading synapse with serotonin. Studies of accutane seem to show it does the opposite of an SSRI, but increasing numbers of 5HT1A and increasing SERT. Thus lowering amount of serotonin in the synapse. Given this, I figured maybe a 5HT1A agonist would help (not an SSRI). Of course, the problem here is that jsut because accutane has an effect on serotonin, this may be completely unrelated to its mechanism of giving sexual dysfunction. but I guess, its worth trying anything and everything until we find something that seems to work.

A user from PSSD Forum tried a 5HT1A antagonist:

Based on my experiences I don't think that 5-ht1a ligands have any use in PSSD or/and SSRI emotional blunting. Personally, I've tested robalzotan - orally bioavailable clinically researched 5-ht1a antagonist using dosages from depression trial. Gave me only some mild mental stimulation ( similar to cholinergics like huperzine ) and some strange light-headedness alike zolpidem. No effect on emotion processing (priority) or any action on sexual side ( not very important for me )

 

[cnb30]

Hey guys, it’s cnb30 from the Acne.org group. Has anybody (male) noticed that their sex drive wanes and waxes every couple weeks. I’m not sure this is natural because I never experienced this waning/waxing before Accutane.

 

[Flynn]

Hey guys, it’s cnb30 from the Acne.org group. Has anybody (male) noticed that their sex drive wanes and waxes every couple weeks. I’m not sure this is natural because I never experienced this waning/waxing before Accutane.

Could you elaborate? do you mean it goes up and down over time?

 

[Willylong98]

@Flynn I think im going to be self administering testosterone and staying on that for life. I dont think my test levels from 8 months of anabolic abuse are going to recover. I am going to use RU while on TRT. I will get bloodwork before i administer TRT and while I am on, I know you were interested in figuring out why it helps my libido.