Testosterone, Free Testosterone, Non—Sex Hormone-Binding Globulin-Bound Testosterone, and Free Androgen Index: Which Testosterone Measurement Is Most Relevant to Reproductive and Sexual Function in Men With Epilepsy?-Reply

In Reply.  —In his letter, Herzog brings attention to the question about the most relevant testosterone measurement with regard to reproductive and sexual function in men with epilepsy. The question is important. It is well known that men with epilepsy suffer from reproductive dysfunction and hyposexuality more often than the average population of similar age.^1-4 Both epilepsy per se and the antiseizure medications have been attributed as etiologic factors.^3-5It seems clear that antiseizure medications are associated with the development of hyposexuality in patients with epilepsy. Impotence or decreased libido were found in 11% to 22% of patients with epilepsy after starting single-drug treatment with carbamazepine, phenytoin, phenobarbital, or primidone, suggesting a drug-induced hyposexuality.⁶It seems clear that antiseizure medications are associated with the development of hyposexuality in patients with epilepsy. Impotence or decreased libido were found in 11% to 22% of patients with epilepsy after starting single-drug treatment with carbamazepine, phenytoin,