Just starting TRT. Having a rough start with anxiety and insomnia.

BUD987

New Member
Hello. Thank you for all the work this forum does. I just started TRT for low libido and energy about 1wk ago (protocol below). I will do my best to limit this post to pertinent info and not write an intro novella.

ACUTE ISSUES/CONCERNS :
The day after my second 70mg Test E, I experienced rather severe anxiety starting early afternoon and insomnia later that night. The anxiety occurred spontaneously in a relaxing, low stress setting (boat). It was just an amped up, nervous, non-specific, anxious/exhausted energy that was not at all pleasant. I am also noticing that my penis and scrotum are, subjectively at least, cooler and ‘heavier’ than I’m used to. I don’t have a significant hx of anxiety.

Overall these last few days I have felt like total smeared dog s**t. Very discouraging and concerning. I hope I’m just experiencing some relatable bumpy start issues and not indications of a terminal, TRT-resistant flaw in my Finasteride-altered physiology.

Of note I am a former propecia user who got sides. Any people here former Propecia users and had an improvement from TRT? There’s too much noise online about it.

MOST RECENT LABS:
On NO Rx. Previous baseline labs were all similar [can post], but these were the lowest-TT. FT. Lh.
QUEST:
- TT - LC/MS - 358 - [250-110 ng/dl]
- FT - dialysis - 61 - [35-155 pg/ml]
- LH - 1.4 - [1.5-9.3 miu/ml]
- E2 - 33 - [<39] . Standard assay. Not ultrasensitive.
- SHBG in late April ranged btwn 28-33 – [10-50 nnmol/L].
Thyroid panel and Prolactin and other basic/trt labs norm.
- ? Btw What would be ideal FT range with this range/test method?

PROTOCOL:
All from Hallandale Pharmacy, FL. Known/Reliable?
- M/TH: 70mg (0.35ml) 2x/wk -Test Enanthate. Compounded with Vit D 10000IU/ml.
- 0.5mg Anast 2xWk. [1mg ttl/wk]
- 500Iu HCG 2xWk. [1000iu ttl/wk]
- At this time, I have only taken my Mon and Thur doses of 70 mg, 0.25mg of Anast x1 and 350iu of HCG x1. Pharmacy had compounding delay.
-? My Test E is compounded with Vit D – could the vitD and compounding source be a factor? Should I switch to a non-compounded formula ie: Pfizer, Sandoz etc? Test cyp?

————

I'm a 39yo physician. My HOPE is that this is transient and manageable and helps me learn more about the art of TRT so I can help myself and other similarly affected patients.

Thoughts, similar experience and /or suggestions? Please don’t hesitate to be direct.

Many thanks.
-
 
Last edited:

Fortunate

Active Member
Sorry to hear about your struggles. I have had my own, but I have learned a few things along the way.

First, you may have started too much too quickly. For example, hCG is very smart to maintain endogenous production, but some people experience anxiety from it alone. I think it gave me headaches.

Also, most recommend strongly against anastrozole unless it is absolutely necessary. I would discontinue that and follow the rest of your protocol for a while until you get labs. If a combination of your labs and a feeling of high estrogen symptoms warrant taking anastrozole, then so be it. But, it typically shouldn’t be taken automatically solely based on the fact that you have started treatment.

In general, they say here “go low and slow“. You could potentially reduce the enanthate dose to see how you feel.

I have found that Natesto, a nasal gel, is the gentleness and least obnoxious form of TRT and the least likely to shut down endogenous production and/or cause other unwanted downstream homeostasis disruptions.
 

BUD987

New Member
Thank you -- spoke with doc, will lower to 50mg 2xwk. I will also follow your advice regarding holding ancillaries as well. I have yet to bank some sperm but will order the DADI at home kit asap as I will not be on hcg for now.

Ive scoured the site but is there any consensus regarding the late Dr Crislers assertion that 80mg Test Subcu yields similar levels and sx alleviation as 100? I am all about keeping things slow and simple. Would be happy to start at 40mg sc 2xwk and see labs in 4-6wk. Thoughts?

Just in it for the libido and energy benefits. Are most of you happy with your results in those areas? I see too many posts about flagging libido even on TRT. Im learning from this site that trt optimization is as much a dynamic art as a science .

I just wonder if its almost always fixable with application of enough logic and critical thinking or if for a large portion of people libido is actually unfixable. Thats all I care about. Miss that sexual hunger.
 
Last edited:

Fortunate

Active Member
Splitting doses is less likely to push your estrogen up and I think just make sense (smoother peaks and valleys). The pharmacokinetics are different when you split the doses and can help with free T.

Anecdotally, I once used a compounded Test with some vitamin incorporated, and I recall not liking it.

I have used cream on and off. Without question, it boosted my libido. It’s known for that. However, I had trouble getting sustained benefit from cream, which others have reported. Currently waiting to hear from @Nelson Vergel to see how is cream protocol is going.
 

Nelson Vergel

Founder, ExcelMale.com
The scrotal hydrogel cream has worked well. I attained 880 mg/dl (4 clicks once per day).


We are discussing hypothesis (no data to prove it) on why some men may have anxiety on TRT while others feel great. Please read this thread:

 

madman

Super Moderator
Hello. Thank you for all the work this forum does. I just started TRT for low libido and energy about 1wk ago (protocol below). I will do my best to limit this post to pertinent info and not write an intro novella.

ACUTE ISSUES/CONCERNS :
The day after my second 70mg Test E, I experienced rather severe anxiety starting early afternoon and insomnia later that night. The anxiety occurred spontaneously in a relaxing, low stress setting (boat). It was just an amped up, nervous, non-specific, anxious/exhausted energy that was not at all pleasant. I am also noticing that my penis and scrotum are, subjectively at least, cooler and ‘heavier’ than I’m used to. I don’t have a significant hx of anxiety.

Overall these last few days I have felt like total smeared dog s**t. Very discouraging and concerning. I hope I’m just experiencing some relatable bumpy start issues and not indications of a terminal, TRT-resistant flaw in my Finasteride-altered physiology.

Of note I am a former propecia user who got sides. Any people here former Propecia users and had an improvement from TRT? There’s too much noise online about it.

MOST RECENT LABS:
On NO Rx. Previous baseline labs were all similar [can post], but these were the lowest-TT. FT. Lh.
QUEST:
- TT - LC/MS - 358 - [250-110 ng/dl]
- FT - dialysis - 61 - [35-155 pg/ml]
- LH - 1.4 - [1.5-9.3 miu/ml]
- E2 - 33 - [<39] . Standard assay. Not ultrasensitive.
- SHBG in late April ranged btwn 28-33 – [10-50 nnmol/L].
Thyroid panel and Prolactin and other basic/trt labs norm.
- ? Btw What would be ideal FT range with this range/test method?

PROTOCOL:
All from Hallandale Pharmacy, FL. Known/Reliable?
- M/TH: 70mg (0.35ml) 2x/wk -Test Enanthate. Compounded with Vit D 10000IU/ml.
- 0.5mg Anast 2xWk. [1mg ttl/wk]
- 500Iu HCG 2xWk. [1000iu ttl/wk]
- At this time, I have only taken my Mon and Thur doses of 70 mg, 0.25mg of Anast x1 and 350iu of HCG x1. Pharmacy had compounding delay.
-? My Test E is compounded with Vit D – could the vitD and compounding source be a factor? Should I switch to a non-compounded formula ie: Pfizer, Sandoz etc? Test cyp?

————

I'm a 39yo physician. My HOPE is that this is transient and manageable and helps me learn more about the art of TRT so I can help myself and other similarly affected patients.

Thoughts, similar experience and /or suggestions? Please don’t hesitate to be direct.

Many thanks.
-


You just started trt, added hCG and an AI let alone your dysfunctional HPG axis has not even shut down yet!

The best piece of advice would be to start low and go slow.

Although your dose is far from absurdly high 140 mg/week split (70 mg every 3.5 days) with an SHBG 28-30 nmol/L (normal) you can rest assured that your trough TT/FT will be sky-high let alone estradiol (most likely the reason why you were started on an AI)!

Top it off that the addition of hCG will bump up your T and e2.

Unfortunately, an AI was thrown into the mix off the hop.

This could have been easily avoided by starting off on a much lower weekly dose of T let alone even with the dose you were prescribed you may have never needed it as we have no idea how you will feel even if estradiol ends up being really high.

Would have been more sensible to start on T-only protocol 100 mg/week split (50 mg every 3.5 days) to see how your body reacts to testosterone only and where such protocol will have trough TT/FT/estradiol levels let alone RBCs/hemoglobin/hematocrit.

The addition of hCG or possibly an AI (micro-doses) could be added if need be once you see how your body reacts to a T-only protocol.




post #2
 

Zibernet

Active Member
Hello. Thank you for all the work this forum does. I just started TRT for low libido and energy about 1wk ago (protocol below). I will do my best to limit this post to pertinent info and not write an intro novella.

ACUTE ISSUES/CONCERNS :
The day after my second 70mg Test E, I experienced rather severe anxiety starting early afternoon and insomnia later that night. The anxiety occurred spontaneously in a relaxing, low stress setting (boat). It was just an amped up, nervous, non-specific, anxious/exhausted energy that was not at all pleasant. I am also noticing that my penis and scrotum are, subjectively at least, cooler and ‘heavier’ than I’m used to. I don’t have a significant hx of anxiety.

Overall these last few days I have felt like total smeared dog s**t. Very discouraging and concerning. I hope I’m just experiencing some relatable bumpy start issues and not indications of a terminal, TRT-resistant flaw in my Finasteride-altered physiology.

Of note I am a former propecia user who got sides. Any people here former Propecia users and had an improvement from TRT? There’s too much noise online about it.

MOST RECENT LABS:
On NO Rx. Previous baseline labs were all similar [can post], but these were the lowest-TT. FT. Lh.
QUEST:
- TT - LC/MS - 358 - [250-110 ng/dl]
- FT - dialysis - 61 - [35-155 pg/ml]
- LH - 1.4 - [1.5-9.3 miu/ml]
- E2 - 33 - [<39] . Standard assay. Not ultrasensitive.
- SHBG in late April ranged btwn 28-33 – [10-50 nnmol/L].
Thyroid panel and Prolactin and other basic/trt labs norm.
- ? Btw What would be ideal FT range with this range/test method?

PROTOCOL:
All from Hallandale Pharmacy, FL. Known/Reliable?
- M/TH: 70mg (0.35ml) 2x/wk -Test Enanthate. Compounded with Vit D 10000IU/ml.
- 0.5mg Anast 2xWk. [1mg ttl/wk]
- 500Iu HCG 2xWk. [1000iu ttl/wk]
- At this time, I have only taken my Mon and Thur doses of 70 mg, 0.25mg of Anast x1 and 350iu of HCG x1. Pharmacy had compounding delay.
-? My Test E is compounded with Vit D – could the vitD and compounding source be a factor? Should I switch to a non-compounded formula ie: Pfizer, Sandoz etc? Test cyp?

————

I'm a 39yo physician. My HOPE is that this is transient and manageable and helps me learn more about the art of TRT so I can help myself and other similarly affected patients.

Thoughts, similar experience and /or suggestions? Please don’t hesitate to be direct.

Many thanks.
-

The anxiety is from the vitamin D.
Get some testosterone that is not compounded with vitamin D.
 

Systemlord

Member
Any people here former Propecia users and had an improvement from TRT?
Some recover on TRT, some do not, but based on your symptoms early on in treatment I would say your response is perfectly normal. PFS men typically don't feel anything from TRT, benefits or sides.


Btw What would be ideal FT range with this range/test method?
When symptoms are all gone because there's no one size fits all approach to TRT. I believe your protocol to be a bit aggressive for someone just starting TRT, best to gradually increase your dosage than to start out on the higher end.

The goal should be the minimum effective dose that relieves all symptoms of low T. AI should only be prescribed in the presence of symptoms and most of the time increasing the injection frequency and lowering the dosage will eliminate the need for the AI which can throw off your lipids.

There are some men running absurdly high T and Free T levels that seem to have the libido and erectile issues.
 
Last edited:

BUD987

New Member
I truly appreciate the insight guys. Everything you’re saying makes sense both from a rational and a scientific/physiological POV. I’ve discussed with my doc, he personally had similar sx on the same dosage and went down. Why they started me so high I’m not sure. His rationale was that the vast majority of men feel better on the higher dosage. Granted the majority of patients in my area are older than I am.

He suggested dropping from 140 to 100 split 50mg twice a week. I asked about more frequent shots and he suggested 30mg EOD. Hcg 250iu 2xWk. No AI. Retesting labs in 4-6wk. No more changes unless severe sx develop.

Thoughts?

Also, your comment, systemlord, about PFS in my context was very helpful (…comforting).

Thank you all. I will continue to share and learn as the process continues.

Somewhat off topic: Are the works of the late Dr Crisler still felt to be current ?
 
Last edited:

Fortunate

Active Member
This seems like a very common protocol. If you still have issues, you might consider dropping hCG, unless fertility and endogenous production is a big deal, which it is to many. On the other hand, many feel great on hCG. I am currently undecided despite the fact that I’ve been on it for several years.
 

Zibernet

Active Member
I truly appreciate the insight guys. Everything you’re saying makes sense both from a rational and a scientific/physiological POV. I’ve discussed with my doc, he personally had similar sx on the same dosage and went down. Why they started me so high I’m not sure. His rationale was that the vast majority of men feel better on the higher dosage. Granted the majority of patients in my area are older than I am.

He suggested dropping from 140 to 100 split 50mg twice a week. I asked about more frequent shots and he suggested 30mg EOD. Hcg 250iu 2xWk. No AI. Retesting labs in 4-6wk. No more changes unless severe sx develop.

Thoughts?

Also, your comment, systemlord, about PFS in my context was very helpful (…comforting).

Thank you all. I will continue to share and learn as the process continues.

Somewhat off topic: Are the works of the late Dr Crisler still felt to be current ?

Supplement with Pregnenolone.
 

BUD987

New Member
Pretty much guarantee I am over analyzing this.

Is there anyone on 40mg twice a week sc, with similar “normal” range e2 and shbg that it works for?

I am a fan of keeping things low and slow and simple. If it would work.

I have not yet committed to a protocol and want to in the next 2-3 days.

Any and all advice is appreciated. In the context of over stimulation or anxiety with a dose of 70 mg.
Examples I’ve seen on the site. Any thoughts on a protocol that would keep stable levels, limit overstimulation while still providing sufficient dosage?

50mg 2x/Wk —100/wk
40mg 2x/wk —80/wk
25mg eod— 100/7d right? (25 on M,W,F,SU for eg).
20eod— 80/7d.
Etc.

I honestly don’t know where I fall on the higher frequency dosing benefit spectrum. With my Shbg within normal range as above, theoretically 2xWk should be adequate? Or could there be a benefit for me with more frequent dosing. I have no prob with keeping up with the schedule.

I know, it’s all personal and fine tuning.
 
Last edited:

BUD987

New Member
This seems like a very common protocol. If you still have issues, you might consider dropping hCG, unless fertility and endogenous production is a big deal, which it is to many. On the other hand, many feel great on hCG. I am currently undecided despite the fact that I’ve been on it for several years.

I’m still in my baby making years and so is my SO. So if at all possible I’d like to preserve fertility. And ball size.
 

Zibernet

Active Member
I’m still in my baby making years and so is my SO. So if at all possible I’d like to preserve fertility. And ball size.

Pregnenolone does preserve fertility:


You ARE over-analizing this. Just inject ED or EOD.
 

eli

Active Member
Dose is high, 50mg twice a week is good. Also, Normal to feel like shit for 5-6 weeks til levels balance out
 

BUD987

New Member
Dose is high, 50mg twice a week is good. Also, Normal to feel like shit for 5-6 weeks til levels balance out
Good to hear, about feeling shitty for 6wk or so when starting. Things shutting down and building up Im assuming. When you say 'dose is high' you're talking about my initial 140mg right?

I have been reading the studies and posts here about IM in VG or shallow IM in delt vs SC. What is your method and preference?

I'm going to go with the 50mg 2xwk as you, others and doc rec'd. THOUGH the studies posted here about the xyosted Test E SC autoinjection posits that 75mg Test E as SC inj gives similar levels as Test C IM. There was an interesting discussion on that post.
Preserving fertility on TRT may come at a cost side effects wise, adding HCG and FSH to your TRT protocol should work.
Can you clarify? Sides from HCG countering positive benefits from T?

My Initial prescribed protocol was for hcg 500iu 2x wk. Ive read post and some of the linked studies here.

What is your preferred dose to minimize sides and still have a chance to maintain fertility? 250iu 2x wk? 3x/wk?
 

BUD987

New Member
Pregnenolone does preserve fertility:


You ARE over-analizing this. Just inject ED or EOD.
Agree on the over-analysis. Regarding that interesting post-link. At at 12:1 ratio of Preg to T -- 100mg TE a week would require 1200mg preg. How much preg and T are you on if you dont mind me asking?
 

Systemlord

Member
Can you clarify? Sides from HCG countering positive benefits from T?
It's well known HCG causes side effects, water retention, moodiness, anxiety, low libido, erectile issues and just feeling unwell.

It's not the case with everyone, some do benefit and absolutely need it to make TRT work.

My Initial prescribed protocol was for hcg 500iu 2x wk. Ive read post and some of the linked studies here.

This is a good protocol, you can break it up more often if you do get sides, but a lot of guys feel terrible at any dosage.
 

Zibernet

Active Member
Agree on the over-analysis. Regarding that interesting post-link. At at 12:1 ratio of Preg to T -- 100mg TE a week would require 1200mg preg. How much preg and T are you on if you dont mind me asking?

6 clicks / day of 20% testosterone cream on the scrotum.
100mg of pregnenolone / day.
 

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