Statins and Testosterone levels
What is your opinion on the effect of statin medications on testosterone levels and their potential for lowering one's quality of life? Backstory: I am a 36yoM, family doc in Michigan. I put myself on rosuvastatin 20mg + zetia 10mg following an apoB measurement of 134 in May of 2022. Previous to this it had hovered around 100. This combo dropped my apoB down to 50. I was happy with this, especially given that my father passed from an MI at that age of 58. I don't actually have many other RFs for ASCVD besides this limited fam hx. I workout 6 days a week, weights, cardio, rucking (my ALMI is 9.63 kg/m2), my VAT is 0.25 lbs). I had never checked my testosterone levels. I did so out of curiosity as well as an insidious issue of maintaining erections. The results were shocking - testosterone total - 271; free T - 8.3; SHBG - 29.1 I decided to stop my crestor and keep the zetia on board. Recheck 6 weeks later Total T - 414; Free T - 14.6; SHBG - 31.3. That's a 57% inc. in my free T. And my erection issue - vanished. I felt like I was 25 again, not 18, but probably 25. Also, I ran LCMS and ELISA side by side for the second draw just to confirm. I have been looking for literature on the topic of statins and testosterone reduction but it is scant at best. Cochrane study - https://www.cochrane.org/CD013211/HTN_what-effect-atorvastatin-testosterone-and-other-hormone-levels-men-and-women Systematic Review from 2013 - https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-11-57 Allan Sniderman opinion paper - https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-11-58 Of course, I think Allan does the best job explaining that this could actually be significant in certain individuals. I have one other patient my own age who is on the same medication - rosuvastatin 20mg because of a sig fam hx and a personal attribute of having lp(a) excess. He has expressed very similar side effects - less energy in the gym and less virility in general. This returned to normal when he stopped his statin. No myalgias, no intolerance to the medication, just lower quality of life. As an aside, I really hate asking this question. With all of the anti-statin rhetoric out there, I think I get a video a day from my patients demonizing statins, I don't want to add to the pile. But I think this is an important nuance for clinicians to know when prescribing statins to so many people. Maybe this means we need to try more low-dose statins with zetia or other drug combinations that don't result in this lowered quality of life?
53 year old male white 6foot1-1/2inchs 188 pounds. type 1 diabetic Hy blood pressure who had colon cancer 2020 radiation 28 times with capecitabine then 2 rounds of oxaliplatin with capecitabine then colo rectal resection bag for 4months then removed 2022 September. did a sprint triathlon 8/8/2023 finished 2hours 40 minutes. my anemia never went away was 3.65 million should be 4 million. 1 of my many test a ct showed minor calcification of the coronary artery and Vanstaverens'. recent lipid panel showed trygricerides 155 LDL 101. glucose spikes after breakfast upto 170 which i exercise off within a 1/2hour back to 90 or below a1c5 . ive been on glucose control and eating salads for last 3 weeks have been on a carb restricted diet for 3 years lost 90 pounds in 2020 and am now restricting saturated fats. im taking less and less tresiba every day down to 10 units 1 dailey at 12noon. with 1 unit of humalog for breakfast 1 for lunch and 1 for dinner.
What gene test do i do for coronary artery disease with relation to lipids? have been on atkins diet in the past.