Q. My husband takes atorvastatin (10 mg) to control his cholesterol level, which is now 150.

He is on Seroquel for anxiety and depression, thyroid hormone, and Androgel. Why doesn’t the doctor take him off atorvastatin? The cardiologist says it’s good insurance to prevent a heart attack. An angiogram of his heart was normal.

A. You are not the only person to inquire about topical testosterone (Androderm, Androgel, Axiron, Fortesta, Testim).

Here are just a few comments:

 “I’m a 76 year old man and my libido was very low. I am taking Cymbalta for peripheral neuropathy and experienced ED as a side effect of the drug. I had a testosterone blood test; it was 1/3 what the minimum should be. So I’m taking Androgel to raise testosterone levels. It is magic. I have a great libido now and I am working on minimizing the Cymbalta pills, but in the meantime have been prescribed Cialis for the ED.  Each pill solves a particular problem for a couple of days.” R.H.


“I have been taking 40 mg of Crestor for about 6 years now.  I’m 47 years old and in fairly good physical condition, except for my very high cholesterol, which runs in my family.  I work out regularly and have for years, but I no longer have any sex drive nor am I able to maintain an erection.  I ask my doctors if this could be a side effect of Crestor and they both tell me absolutely not.  It’s just getting older.  I disagree, as I’m not that old for this to occur.

“My testosterone levels dropped into the low 200’s and now they put me on Androgel. It’s just brought me over 300, which isn’t great.” Rich


The issue of drug-induced sexual side effects has been controversial for years. When readers of our newspaper column first reported that antidepressants like Prozac could lower libido and impede orgasm, many clinicians denied there was a connection. Now, almost everyone agrees that SSRI-type antidepressants have a negative impact on human sexuality.

There is also controversy around statins and sexual side effects. The official prescribing information of some statins (lovastatin, simvastatin and pitavastatin [Livalo]) do mention this complication. Simvastatin, for example, notes that erectile dysfunction was discovered after the drug went on the market. There is, however, nothing in the prescribing information of Crestor to suggest that erectile dysfunction or low libido could be a problem.

That said, we did receive this message over a year ago:

“I am a very active Army Physical Training Instructor. I am 45 years old and always had a great sex drive until I started taking Crestor six months ago to lower my cholesterol.

“My sex drive has totally disappeared. I am unable to maintain an erection and feel tired all the time. It has been causing me a great deal of stress and anguish. Is Crestor causing my ED and libido problems?” S.A.

 

Just as we have learned that antidepressants really do have a negative impact on sexuality, statins may impact sexual function by lowering testosterone levels (Journal of Sexual Medicine, April, 2010). A study published in Drug Safety (July, 2009) reported that cholesterol-lowering drugs may alter testosterone and trigger or worsen erectile dysfunction).

Adding testosterone to counteract this potential side effect may not be the best solution. A study published in the journal PLoS One reported that men over 65 who take extra testosterone up their risk of a heart attack.

As a result of this study and other research that also raised warning flags, the FDA announced last week that it will investigate the possibility that testosterone supplements taken for “low-T” may increase the risk for heart attacks, strokes and death. In typical FDA fashion, the agency has hemmed and hawed a bit, acknowledging that it doesn’t actually know if there is a risk and advising men not to stop taking testosterone at this time.

This leaves them in limbo. The FDA has raised a warning flag, but says there is not enough information to make a firm decision.

We actually think that it would be better if the FDA encouraged research to find out why so many men have low-T. If statins are a possible contributing factor, that needs to be researched. If statins do lower testosterone and lead to sexual side effects, adding testosterone in the form of a gel doesn’t seem the best solution to us.

One final point about statins. Although these drugs are clearly indicated for people who have had a heart attack, stent or clear signs of heart disease, the benefits remain controversial for those with clear coronary arteries. As the question at the top of this page notes, her husband’s angiogram was fine. And the cardiologist who says a statin is “good insurance to prevent a heart attack,” hasn’t been reading the literature.

People who are at low risk for cardiovascular disease (despite elevated cholesterol levels) do not get much benefit from statins. According to analysis in the journal BMJ, doctors would have to treat 140 such people for five years for one to be saved from a heart attack or a stroke. That means 139 people would be taking a statin for years with no measurable benefit but significant likelihood of harm.

STATIN SIDE EFFECTS:

  • Headache



  • Muscle aches, muscle cramps, muscle pain, spasms:
(anywhere in the body, including legs, shoulders, back, arms or neck)


  • Fatigue, weakness



  • Arthritis, joint pain, joint stiffness

  • Abdominal pain, digestive upset, nausea, diarrhea

, flatulence

  • Blood sugar elevation, diabetes



  • Sore throat, flu symptoms, sinusitis



  • Dizziness



  • Itching, rash

, hives

  • Liver damage, liver failure, kidney damage



  • Insomnia, sleeping difficulties, nightmares



  • Forgetfulness, memory problems, amnesia, confusion

, cognitive dysfunction
  • 
 Peripheral neuropathy, nerve tingling, nerve burning



  •  Pancreatitis



  • Cataracts

  •  Sexual problems, erectile dysfunction, low libido

 TOPICAL TESTOSTERONE SIDE EFFECTS:

  • Skin irritation where applied
  • Enlarged prostate, difficulty urinating, elevated PSA
  • Breast growth, breast pain
  • Emotional outbreaks, anger management issues, depression
  • Headache
  • Anxiety, nervousness
  • High blood pressure
  • Elevated lipid and cholesterol levels
  • Changes in libido

Share your own statin story below. Have you been able to tolerate drugs like atorvastatin or simvatstatin without side effects or have you suffered some of the complaints mentioned above. Tell us about your testosterone story too. Others would benefit from your experience.

 

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  1. DRD
    Reply

    I am in my 40s and took zocor for about 3 years. I switched to Crestor a month ago and developed profound fatigue, loss of libido and soft erections – I have never had ED in my life – very distressing – I stopped it 4 days ago – hope it improves soon.

  2. Dr. Judi
    Reply

    Why on earth does someone with depression take Seroquel? It is an anti-psychotic, and it has many side effects.

  3. crandreww
    Reply

    @fjk Diltiazem, Losartan, and Terazosin can cause Erectile Dysfunction…All of these drugs listed Erectile Dysfunction as possible side effects..

  4. fjk
    Reply

    My husband takes diltiazem, losartan and terazosin for his BP which is now normal.. Would these contribute to ED?
    People’s Pharmacy response: Diltiazem, losartan and terazosin are all listed as causing “impotence.” He should discuss this with his doctor.

  5. Art
    Reply

    I’m a strong proponent of Sublingual Vitamin B-12 2500mcg supplementation, obtainable at most pharmacies in a nice cherry flavor. Regarding the the post-surgical side effects, that issue perhaps, would be best answered by an Endocrinologist who’s a specialist in that field. My recommendation would also be a good Holistic Physician who’s also an MD, for a general assessment, if that’s something that would be acceptable to you.

  6. R W
    Reply

    I was on 20mg of atorvastatin for over a year. My sex drive was at an all time low and I did not have a full erection after taking it. I was also feeling tired.
    My doctor who put me on on the 20mg suggested I have my testosterone tested which was below a normal level, but not much. He recommended me to a specialist who paid no attention to the fact that prostate cancer ran in my family. Without checking my prostate gland he only looked at my PSA which was 2.3. He placed me on the lowest level of Androgel. Carefully, I followed the instructions and noticed after a month my sex drive and erection were back…like being in my 20s again. I was able to workout and do my chores without feeling rundown.
    After being on the Androgel for three months, my PSA was read at 5.8. At that point I scheduled an appointment with a urologist who does surgery for sampling my prostate gland. He stopped the Androgel immediately. Twelve drill samples later, the doctor told me I had no cancer in 11 samples, but one was atypical which meant I needed to be re-tested 6 months later.
    Meanwhile my younger brother was placed on hospice with stage 4 prostate cancer. Two weeks after he passed, I went in for another biopsy and had 15 samples taken. They turned out negative, to my relief.
    My wife had read about statins and the problems associated with them and I instructed my doctor to prescribe 10mg which put everything back to normal. Lesson learned. Find the cause of the problem without having doctors prescribe medicines that are not needed.

  7. paul43
    Reply

    I would like to hear more about the side effects fo statins.

  8. mary
    Reply

    Good morning, Feb, 4, 2014. I have written you before re: vit B12 deficiency in friend, estrogen replacement for women post hysterectomy and bil ovary removal. Facial hair growth is a problem in women, post oophorectomy, finally have swallowed my embarrassment, and spoke to my internist.
    He suggested spironolactone 25 mgm to suppress the adrenals glands from over producing testosterone, which possibly is causing hair growth. Any information and or comments about this would sure be appreciated, as I have always hesitated before starting new med. without info re: side effects/ contraindications.
    All your previous info re: above concerns in the past, have several friends and started good conversations. My doctor did not check to see testosterone levels, or labs about adrenal efficiency, but, please comment to me if there is time. Thanking you all in advance once again. mary

  9. crandreww
    Reply

    “The cardiologist says it’s good insurance to prevent a heart attack” I would encourage your husband to ask his cardiologist, how a less than 1% absolute risk reduction is good insurance?
    Ask also why he bases his prescribing on relative risk reductions…I am sorry to hear of another person. Remember MOST prescribers base their prescribing happy habits on information from the Drug Sales rep, who will most often brag about a relative risk reduction of 30+ percent…when in FACT the BEST ANY statin study has shown, was a less than 0.5 percent absolute risk reduction.
    Google seatch Relative risk reduction and Absolute Risk Reduction, ans see for yourselves the Lies, Damn Lies and Statistics….

  10. T.H.
    Reply

    I have been on Crestor for several years and mentally have sex drive, but can’t maintain an erection. I can understand not being able to have sex when I’m 95, but not at 65.
    Are there any natural substances I could take that would cure this problem?

  11. Donnie
    Reply

    For so many of these prescription drugs, the only real benefit is for the drug company’s profits, and the prescribing doctor’s bank account. At the patients expense. Do the research on prescription drug risks as well as benefits, and maybe like with other drugs, ‘Just Say NO’.

  12. Louie b.Free
    Reply

    my first concern would be, why the depression and anxiety?? and, try a vegan diet for the cholesterol

  13. S.J.
    Reply

    No worries, simply change doctor and find one that would not fill you up with tons of medication to compensate the problems caused by one. Seroquel may be the cause of the decreased libido though, it is a powerful psychotropic medication that has several side effects.

  14. John B.
    Reply

    I am 80 years old and have taken weekly depo testosterone 200 shots for 10 years. This has been life changing for me because my libido went from zero to very good and I still enjoy sex. Also, my energy level went up and stronger muscles as well. I have no problem having an erection since the testosterone treatment was started.
    By taking viagra 30 minutes before sex on an empty stomach, I will have a very good erection. Taking viagra on a full stomach has no effect on my erection. I also take atorvastatin for cholesterol control and I have no noticeable side effects. I have recently developed type II diabetes and will start taking metformin tab 500 mg next week.
    I have recently deleted sugary foods from my diet to help minimize blood sugar spikes. I am happy with my life and will stay ahead of problems as they come up.

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