Low Testosterone and Depression: A First Responder’s Story

This episode includes discussion of PTSD, suicidal ideation, and alcohol use. Garrett spent 18 years as a deputy sheriff and police officer, all of it on night shift. Over that career he was part of about a dozen calls involving dead children. He gave CPR to an eight week old and lost. He never took a day for any of it. There was no policy in his agency that offered one, and no version of asking that did not feel like a risk to his badge. It caught up with him when he had his own kids. He would hold his baby and start to come apart. He describes the thought that stayed with him: if a monster broke into my house I would destroy that monster, so what happens when you are the monster in the house. He says plainly that he was getting suicidal. His wife gave him an ultimatum, and he spent the next four years in therapy without telling his agency, his parents, or anyone but her. He refused psychiatric medication the whole way. Partly the fear of feeling like a zombie, partly that his dreams were already bad enough that he would not gamble on what a medication might do to them, and partly something prescribers rarely think about. He carried a firearm, and nobody could tell him what being on something would mean for a drug screen after a critical incident or a fitness for duty review. Somewhere in there his primary care ran a testosterone level and told him he was fine. Nobody mentioned there was a second number. Nobody drew a free testosterone. He closed that door and left it closed for years. When he and Nico Misleh, MSN, FNP-C finally met, the fuller workup came back with low vitamin D, very low B vitamins, and a testosterone level Nico described to him at the time as lower than a 75 year old man would carry. Nico walks his read of why. Years of head trauma from martial arts, football, car accidents with airbags, and the physical side of the job. Inflammation that started acute and became chronic. Eighteen years of nights. Sleep the PTSD was already wrecking, so no recovery anywhere in the system. His conclusion is that the signaling between the brain and the testicles had been degraded by all of it at once, which is exactly the picture a single total testosterone will not show you. Garrett is honest about the timeline. He expected to wake up a racehorse and the first weeks were quieter than that. What shifted first was not energy, it was the dreams. Four to five years on he says he has not had one of the bad ones in about a year, and he credits the testosterone, the vitamin repletion, and the therapy together, not any one alone. Nico is equally clear on the limits. This is a tool, not a cure, and he has watched it go the other direction in men who are not doing the work on the other side. Garrett has the plainest line in the episode, and it is aimed at providers. Most of these guys and girls are not trying to get jacked. They just want to be able to sleep at night. Male testosterone therapy is module two of the HRT University Master Course. The Master Course is jointly accredited through Pinnacle Conference, LLC (ACCME, ACPE, ANCC). Earn 30 CE hours, including 12 hours of pharmacology. Master Course: https://hrtuniversity.com/hrtcourse/ More episodes: https://hrtuniversity.com/hrtu-podcast/ The Second Opinion Newsletter: https://nicomislehnp.kit.com/8050eeea5f Provider community: https://www.facebook.com/groups/1179376819949373/