I was put on risperidone for bipolar disorder in 2022. Within three months, everything changed. My libido went from normal to absolutely zero. Not reduced -- zero. I stopped thinking about sex entirely, which at 28 was alarming. Erections became unreliable, then rare. I gained 15 pounds without changing my diet.
The worst part was the fatigue. I would sleep 10 hours and wake up feeling like I had slept two. Coffee stopped working. I would sit at my desk at work and just stare at the screen, unable to initiate any task. My psychiatrist said it was the depression. My GP said it was stress. Nobody checked my prolactin for two years.
By 2024 I had also developed mild gynecomastia -- enough that I noticed a difference in the mirror. One morning I squeezed my nipple out of curiosity and clear fluid came out. That was the moment I knew something hormonal was wrong.
I demanded a blood panel. Prolactin came back at 89 ng/mL. My testosterone was 198 ng/dL -- less than half the bottom of the normal range. My psychiatrist switched me to aripiprazole. Within six weeks, prolactin normalized to 8 ng/mL, testosterone climbed to 485 ng/dL, and I felt like a completely different person. Libido returned. Energy returned. The fog lifted. The gynecomastia slowly resolved over about four months.
The thing that makes me angry is how long it took. Two years of my life, attributing everything to depression, when a $30 blood test would have shown the answer immediately. If you are on an antipsychotic and experiencing these symptoms, demand a prolactin level. Do not let anyone tell you it is "just the depression."