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:
- 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
- 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
- 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
- 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.