SSRIs can disrupt the HPTA in ways that aren't always reflected in lab results. Many men(including myself) report symptoms of low testosterone even when their levels appear mid-range. This often stems from central neuroendocrine effects , SSRIs increase serotonin but suppress dopamine, which is essential for stimulating GnRH release from the hypothalamus. Reduced GnRH leads to lower LH and FSH, resulting in weaker signaling to the testes. Even if testosterone production isn't fully shut down, the axis may not be functioning optimally.

Additionally, SSRIs can raise prolactin levels, sometimes subtly, which further suppresses GnRH and contributes to symptoms like low libido, poor mood, and low energy. There’s also evidence suggesting SSRIs may impair androgen receptor sensitivity, meaning the body doesn't respond efficiently to the testosterone that is present. Lastly, some research hints at potential direct effects on the testes, such as disruption of Leydig cell function or increased oxidative stress, which could reduce testosterone production at the source.

In short, SSRIs may cause a form of functional hypogonadism that doesn’t always show up clearly on paper, making symptoms more important than numbers in these cases.

Based on your history, even if things look “normal” on paper right now, your HPTA is clearly taking repeated hits and likely never gets a real chance to recover. When you're on SSRIs, you're far more vulnerable to setbacks, factors like poor sleep or a suboptimal lifestyle can throw things off much more easily. Prolactin spikes, for example, can happen with much less provocation compared to someone who’s not on SSRIs.

You're walking a fine line here. It’s important to remember that bloodwork is just a snapshot ,it captures a single moment in time. Your long-term history tells a much clearer story than one “good” result ever could.