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SSRI Testicle Atrophy

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Okay... I have not found much about this on the internet, BUT...

I started Paxil about 5 weeks ago, and I have been taking 10 mg per day for that entire time. This is the first time I have taken an SSRI in over a decade.

Within the first 48 hours, I noticed the classic sexual side effects. I was prepared for this, and I was willing to take the risk for the sake of my mental health. After a couple of weeks, these side effects did actually improve a bit, so I was mildly optimistic about Paxil.

After about 4 weeks on this medication, my testicles have shrunk to about half of their previous size. It is not in my head. My testicles have shrunk. The only questions are why, and is this permanent? I figure I need to taper off. Should I even bother trying Zoloft?

EDIT: Is it possible that this is due to the fact that I have been masturbating a lot less since starting the Paxil? Do your nuts get smaller when you don't use them as much?

Edited by Caddy
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3 hours ago, argh said:

Maybe this?

Paxil increases prolactin. Elevated prolactin can cause testicles to shrink



I think all SSRIs and subsequently any serotonergic antidepressant increase prolactin via stimulation of 5-HT1A receptors, as well as any medicine that is a 5-HT1A agonist or partial agonist (Viibryd, Trintellix, BuSpar, trazodone, nefazodone, most AAPs, etc.). The beta-blocker pindolol (Visken) is a low intrinsic activity 5-HT1A partial agonist (functional antagonist), but I don't know if it inhibits prolactin release caused by SSRIs, or reverses it to pre-SSRI baseline levels or anything like that...

On top of that, the Seroquel has a probability of increasing prolactin release (albeit very low probability) via D2 inhibition in the tuberoinfundibular dopamine pathway. Any antipsychotic though can do that, especially risperidone and paliperidone; however, the dopamine partial agonists, aripiprazole, brexpiprazole, and cariprazine can actually decrease prolactin levels. They are sometimes used in schizophrenic/schizoaffective patients who have secreting prolactinomas and need dopaminergic medication to regulate prolactin levels.

According to this link, valproic acid (Depakene) (or divalproex sodium (Depakote)) causes a decrease in prolactin but only when there is no prolactinoma present, suggesting that increased GABAergic tone is followed by decrease in plasma prolactin. That could theoretically be advantageous in one who is predisposed to elevated prolactin levels.

All this being said, I have noticed over the years since being medicated that I seem to have possibly experienced some atrophy, but at the same time, I have also gained a significant amount of weight, which, as I am losing, more of them are "reappearing." They still aren't as they were years ago though, could be my imagination.


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