Dr Pezzi – Science of Sex
While there are many drugs that interfere with one or more aspects of sexuality while the user is taking them, with few exceptions all of these problems resolve once the drug is discontinued. One drug that can permanently affect libido and sexual pleasure in some people is Accutane® (isotretinoin) used in the treatment of severe recalcitrant nodular acne.
Roche Laboratories, the manufacturer of Accutane, claims to be unaware of any such adverse effects. However, I have firsthand knowledge that their ignorance of this matter is, well, fishy. I called Roche in January of 1991 to discuss this problem, and they claimed to have never heard of any link between Accutane and long-term sexual dysfunction. When I called again in March of 1999 I was told the same thing, which caused me to question their credibility. They’d never heard of it? Bull. I’ve heard of several cases, and I am not exactly the clearinghouse for the adverse effects of Accutane. Roche states that the “exact mechanism of action of Accutane is unknown.” Well, if they don’t even know how it suppresses acne, perhaps they are equally unaware of how it affects the body in other ways. The case that I presented to Roche in 1991 was one that should have caused them to seriously consider that Accutane’s sexual effects were a cause for concern. In this case, the patient took several courses of Accutane over a period of years. With each course of treatment, the patient experienced reduced libido and altered sexual sensation. Instead of being pleasant, his sexual sensation was markedly unpleasant and felt similar to the sensation that people perceive when they strike their “funny bone” (ulnar nerve at the elbow). These symptoms would decrease somewhat when the patient stopped taking Accutane, but they never totally resolved. The patient concluded that the problems would abate entirely once he had been off Accutane for a longer time. The patient took additional courses of Accutane over the following years to control his acne, each time experiencing an exacerbation of the symptoms while on the Accutane and a reduction in the symptoms after discontinuing Accutane. After the final course of Accutane, the patient was alarmed that the symptoms persisted for more than a decade.
Whenever a scientist is presented with a case in which reintroduction of a drug induced problems that had abated once the drug was discontinued, and this concordance between symptoms and drug use continued over a number of cycles, it is virtually impossible to conclude that there is no connection between the drug and the problem. Therefore, Roche should not have dismissed or ignored the case I reported to them. While I know of several cases linking Accutane and long-term sexual dysfunction, I am certain there are many cases that have not yet come to my attention. Besides me, there are millions of other doctors in the world who may have fielded similar reports from their patients.
Furthermore, I think that many people just suffer in silence if they have a sexual problem since it can be very difficult to discuss your sex life with someone even if he is a physician. The patient discussed above waited eight years before he mustered the courage to discuss his problem, and he is probably not the only one who is reluctant to discuss sexual dysfunction. I would like to hear from you (see the Contact Me information on page 6) if you have experienced any sexual problems related to the use of Accutane. I will present a comprehensive report to Roche, and I will keep you updated on the search to find a solution to this problem. Additional information on this topic will be posted on my web site (www.sexualtips.net). The mechanism by which Accutane causes sexual dysfunction is not known, but I suspect that it has multiple modes of action. I think it interferes with the proper functioning of some sensory peripheral nerves, or their receptors, or the brain’s response to the nerve data, thus greatly distorting tactile fidelity (a subject I will discuss in detail later in this chapter). This disturbance of fidelity is not necessarily confined to the genitals; Accutane has been associated with a dysesthetic tingling on nongenital skin, the course and intensity of which seems to parallel the unpleasant sexual “hit your funny bone” tingling. These dysesthesias may persist for a few seconds after the inciting stimulus is removed. If you lightly touch your skin, for example, the sensation usually ends when the contact ceases. In contrast, Accutane-induced dysesthesias may take seconds to fade away.
I think that Accutane decreases responsiveness to testosterone, at least in those areas of the brain that control libido. What is the treatment?
- Discontinue Accutane now. I understand that it can be a difficult decision to choose between clear skin or a satisfying sex life. I cannot make this decision for you, but I can tell you what I would do: stop the Accutane. Physicians have many other ways to treat acne besides Accutane. I would rather use a less powerful therapy and spare my sex life. Every year, I hear from many patients who wish they’d done the same thing.
- Try relatively high-dose supplemental vitamin B6 (but avoid excessive doses that may induce a peripheral neuropathy; see the vitamin B6 section for more information).
- Try other supplements, herbs, and drugs, as discussed elsewhere in this book.
- Stringently avoid other things that may decrease the testosterone level or effect (such as phytoestrogens and antiandrogens).
- Consider using supplemental testosterone. It is useless to use your blood testosterone level to gauge whether or not this is necessary. Judging from tests conducted on people with Accutane-induced sexual dysfunction, Accutane does not seem to appreciably lower the blood testosterone level. What it apparently does is partially block some of the effects of testosterone. This decreased responsiveness is analogous to someone who is hard of hearing. To some extent, you can compensate for their disability by speaking louder. A partially deaf ear needs more sound, and someone who is less responsive to testosterone needs more testosterone. Of course, there are drawbacks to the use of supplemental testosterone. Because the testosterone susceptibility of most areas of the body is not affected, increasing the testosterone level enough to restore libido and sexual sensation may trigger unwanted changes elsewhere, such as alopecia and acne (ha isn't that IRONIC!! - Acne!)
- If you are a man, avoid things that increase your estrogen level.
- Avoid things that increase sex hormone binding globulin.
Be patient. The dysesthesias tend to diminish in time, although it may take years. Your perception of sexual pleasure will likely increase, too, although it may not return to your pre-Accutane zenith. The elimination half-life (that is, the time it takes for half of an administered drug to be excreted) suggests that Accutane does not persist in the body for a long time. The drug may not stick around for long, but its effects do. It is as if Accutane flips some switches in the body. This is true for its intended effect (the long-term suppression of acne), and its sexual side effects. Once flipped, those effects are permanent, or at least very long lasting.
Hence, you should think twice before using Accutane. There is no way to know in advance if your use of Accutane will trigger dysesthesias and reduced sensation. You may take it for a while without any problems, and then wake up with enough sensory abnormalities to make you wonder if your spinal cord was mashed in a vice while you slept. Being cheated out of life’s greatest pleasure is a terrible fate. Are you willing to take that risk?



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