Anxiety Attacks Recently For No Apparent Reason

[medvetz63]

I have been on TRT since March of this year, 2018.
I started on 200mgs of cypionate per week but in August I reduced the dose to 100mgs per week divided into two 50mgs injections on Monday and Thursday.
The past two weeks I have been having severe anxiety attacks where I'll wake up with a rapid heart beat, anxiety, stomach cramps with intestinal gas, and slightly lightheaded. I'll have a bowel movement and the symptoms will then slowly subside and I'll go back to normal and feel fine, but while it's happening I'm about to call an ambulance since it's so damn nerve wracking. There's no chest pain or pressure, just the extremely rapid rate as if I had been running at top speed. Also, the stool looks perfectly normal, no diarrhea or blood in it, etc.
Today it happened again as I went to sleep last night and I woke up out if a dead sleep this morning with rapid heart beat, anxiety, slight dizziness/vertigo, and intestinal gas. After the bowel movement I slowly returned to normal.
It happens about three to four times a week, always the same way. Could anyone shed some light on what might be happening? Is it the TRT or something else?

 

[BigBamBoo]

Are you using an AI? Having low E2 can cause this.

I am sure others will post up some advise.

 

[Systemlord]

It hard to advise you in the absence of labs, but I suspect a abnormal morning cortisol spike, high estrogen can trigger high cortisol levels in women. You need to test estrogen (LC/MS/MS) is recommended, not the standard Roche ECLIA methodology as this test overstates estrogen in men.

If estrogen is confirmed high, it's likely you will have to lower your dosage or increase injection frequencies to lower estrogen, an EOD protocol would achieve just that while maintaining more stable testosterone.

You don't even need a doctor to order this test, I do self testing on discount labs.

 

[captain]

Sounds like sleep apnea. I don't how taking a dump would help high or low E2 but by the time he does his oxygen and pulse probably have returned to normal.

 

[madman]

I have been on TRT since March of this year, 2018.
I started on 200mgs of cypionate per week but in August I reduced the dose to 100mgs per week divided into two 50mgs injections on Monday and Thursday.
The past two weeks I have been having severe anxiety attacks where I'll wake up with a rapid heart beat, anxiety, stomach cramps with intestinal gas, and slightly lightheaded. I'll have a bowel movement and the symptoms will then slowly subside and I'll go back to normal and feel fine, but while it's happening I'm about to call an ambulance since it's so damn nerve wracking. There's no chest pain or pressure, just the extremely rapid rate as if I had been running at top speed. Also, the stool looks perfectly normal, no diarrhea or blood in it, etc.
Today it happened again as I went to sleep last night and I woke up out if a dead sleep this morning with rapid heart beat, anxiety, slight dizziness/vertigo, and intestinal gas. After the bowel movement I slowly returned to normal.
It happens about three to four times a week, always the same way. Could anyone shed some light on what might be happening? Is it the TRT or something else?

Has anything changed in your diet lately?

I know when I was eating a lot of red meat or chicken daily as in 2.2lbs/day spread out with each meal along with a large volume of complex carbs and vegetables.

There were periods were I would wake up in the middle of the night feeling anxious/sweaty with stomach discomfort (cramps/gas/feeling bloated) and light headed and felt terrible.....got wound up until I realized I had to punish the throne.

Turns out from the large volume of food I was eating daily had me waking up in the middle of the night with an extreme urge to go causing many of the symptoms you mention.

Every time I went to the washroom all the symptoms resided fairly quickly and back to bed I went.

I have since cut back on the volume of whole food I was eating to attain my 4000 cal/day diet.

Have not had an issue since!

 

[medvetz63]

Are you using an AI? Having low E2 can cause this.

I am sure others will post up some advise.

I was using an AI (Arimidex, .25mgs 2x per week) when my dose was 200mgs of Cypionate per week, but since reducing my dose to 100 per week divided into two shots I have not used one.
Maybe I need to. My E2 was within normal limits on a non-sensitive test when I checked it last month.

 

[medvetz63]

Has anything changed in your diet lately?

I know when I was eating a lot of red meat or chicken daily as in 2.2lbs/day spread out with each meal along with a large volume of complex carbs and vegetables.

There were periods were I would wake up in the middle of the night feeling anxious/sweaty with stomach discomfort (cramps/gas/feeling bloated) and light headed and felt terrible.....got wound up until I realized I had to punish the throne.

Turns out from the large volume of food I was eating daily had me waking up in the middle of the night with an extreme urge to go causing many of the symptoms you mention.

Every time I went to the washroom all the symptoms resided fairly quickly and back to bed I went.

I have since cut back on the volume of whole food I was eating to attain my 4000 cal/day diet.

Have not had an issue since!

My diet has been the same and I eat very healthy. I eat red meat from time to time, but mostly fish (tuna & salmon) as well as chicken. I eat a lot of fruit and vegetables, lentils, whole grain rice, beets (juiced and steamed), broccoli, etc.
My one vice is that I drink a lot of espresso coffee and I read last night that caffeine can release cortisol.

This morning, thank God, I awoke normally without the panic attack. They're not an every day ocurrence, but definitely weekly for the last two weeks and they're bad enough to have me dreading to go to sleep. For peace of mind I have an appointment with a cardiologist for January 9th. I haven't had a stress test done since 2003 when I turned 40, so it wouldn't hurt to have one done. I've had echocardiograms done two years ago and they were all normal.

 

[madman]

I was using an AI (Arimidex, .25mgs 2x per week) when my dose was 200mgs of Cypionate per week, but since reducing my dose to 100 per week divided into two shots I have not used one.
Maybe I need to. My E2 was within normal limits on a non-sensitive test when I checked it last month.

Where do your TT/FT levels sit on 100 mg/week (50 mg twice weekly) as you dropped your T dose significantly from 200-----> 100 mg/week?

If your e2 was within range using the regular estradiol test which tends to overestimate.....most likely your e2 is even lower if you use the correct estradiol sensitive (LC/MS-MS).

What is your SHBG levels?

 

[madman]

My diet has been the same and I eat very healthy. I eat red meat from time to time, but mostly fish (tuna & salmon) as well as chicken. I eat a lot of fruit and vegetables, lentils, whole grain rice, beets (juiced and steamed), broccoli, etc.
My one vice is that I drink a lot of espresso coffee and I read last night that caffeine can release cortisol.

This morning, thank God, I awoke normally without the panic attack. They're not an every day ocurrence, but definitely weekly for the last two weeks and they're bad enough to have me dreading to go to sleep. For peace of mind I have an appointment with a cardiologist for January 9th. I haven't had a stress test done since 2003 when I turned 40, so it wouldn't hurt to have one done. I've had echocardiograms done two years ago and they were all normal.

Excess caffeine (stimulant) can stimulate the nervous system causing anxiety/rapid heart beat/palpitations/stomach discomfort in sensitive individuals but if it is a regular habit for you than doubtful it would cause issues as your body would be used to it but if you are drinking more than normal lately it could effect you negatively.

Not only caffeine but any stimulant in excess can stress out the adrenal glands and cause numerous issues.

 

[medvetz63]

Does anyone agree with this:

Sometimes I think that TRT can be a source of anxiety in and of itself. Although the articles on this forum debunk A LOT of the negative crap that's written by the media about TRT there's always that little thought in the back of your mind where you wonder if you'll have a heart attack or get prostate cancer, etc.
When these symptoms happened the very first thing I thought of as a cause was the TRT, yet it's quite possible the TRT has nothing at all to do with it, but it's the first thing that comes to mind from all the negative publicity it gets..

 

[madman]

Does anyone agree with this:

Sometimes I think that TRT can be a source of anxiety in and of itself. Although the articles on this forum debunk A LOT of the negative crap that's written by the media about TRT there's always that little thought in the back of your mind where you wonder if you'll have a heart attack or get prostate cancer, etc.
When these symptoms happened the very first thing I thought of as a cause was the TRT, yet it's quite possible the TRT has nothing at all to do with it, but it's the first thing that comes to mind from all the negative publicity it gets..

Would come down to the individual as there are many men with borderline ocd or the ones who tend to overthink and worry about every little thing!

 

[medvetz63]

Where do your TT/FT levels sit on 100 mg/week (50 mg twice weekly) as you dropped your T dose significantly from 200-----> 100 mg/week?

If your e2 was within range using the regular estradiol test which tends to overestimate.....most likely your e2 is even lower if you use the correct estradiol sensitive (LC/MS-MS).

What is your SHBG levels?

My Total Testosterone was 1268 ng/dl with a reference range of 380 to 1100
My estradiol was 58.44 pg/ml with a reference range saying it should be less than 62.
My SHGB was 35.80 nmol/L with a reference range of 10 to 57 nmol/L
These were done on December 20th 2018.

 

[Vince Carter]

Does anyone agree with this:

Sometimes I think that TRT can be a source of anxiety in and of itself. Although the articles on this forum debunk A LOT of the negative crap that's written by the media about TRT there's always that little thought in the back of your mind where you wonder if you'll have a heart attack or get prostate cancer, etc.
When these symptoms happened the very first thing I thought of as a cause was the TRT, yet it's quite possible the TRT has nothing at all to do with it, but it's the first thing that comes to mind from all the negative publicity it gets..

Most of you guys suffer through some level of anxiety, whether you admit it or not, diagnosed or not, TRT just becomes the thing that you fixate upon for your problems and there's no way that this forum can deal with your anxiety issues as they're so omnipresent that you'll continue posting, making threads, and just not listening because it's the thing that has taken over. Not to beat you up over it but it's on this forum almost every day.

 

[Nelson Vergel]

I agree with Vince Carter. I think a lot of men are not even aware of their mental health status and tend to brush off anxiety. If you do not sleep well, are an over thinker that has not learned how to disconnect (not easy to do), have a lot of stressors in your life (family, work) and have no outlet, you will be prone to anxiety. TRT usually decreases anxiety is most men since we tend to cope better, but I have seen many posts here in the past few years from men who report more anxiety with TRT.

I know it sounds like a new age copout, but learning how to take deep breaths while you review in your mind what is good in your life helps. It has taken me years to do so even in the worst situations.

Mindfulness may reduce doctor visits

Stress and testosterone issues

Ways to Deal with Depression and Anxiety

This is also something that I experienced in the past (went away on its own)

Tachycardia for short minutes: PAC or PVC?

 

[Scully]

You might want to explore whether you have vagally mediated tachycardia. Something as innocuous as a small hiatal hernia that many people have can irritate the vagus nerve and cause episodes of rapid heartbeat along with blood pressure imbalances. I had this condition which was made worse after heavy meals, by caffeine and by lower than normal levels of magnesium. The episodes in my case lasted an hour typically. Quickest relief is ativan or alternatively ibuprofen to calm things down. Long term an ablation may be necessary but can provide complete relief.

 

[medvetz63]

You might want to explore whether you have vagally mediated tachycardia. Something as innocuous as a small hiatal hernia that many people have can irritate the vagus nerve and cause episodes of rapid heartbeat along with blood pressure imbalances. I had this condition which was made worse after heavy meals, by caffeine and by lower than normal levels of magnesium. The episodes in my case lasted an hour typically. Quickest relief is ativan or alternatively ibuprofen to calm things down. Long term an ablation may be necessary but can provide complete relief.

Thanks for the information, I will ask about that. I saw a cardiologist on Monday and he put me on an Event Monitor that I will wear for 15 days. Then he said he'll do a Echocardiogram and a Stress Test. I was told some years ago by a gastroenterologist that I do have a hiatal hernia after he performed an upper endoscopy, so that could be the cause.

 

[Starplex]

When I changed my protocol, which made my levels swing I had a few anxiety attacks. Haven't had an issue since I went back to my previous protocol and stayed there.

 

[Dansk]

I would ask, what time is your last meal of day? How long prior to bedtime is it?

There was a time this was happening to me, I would wake up in a major panic, it was odd because my sleep has always been great, and this was now happening maybe 1x-2x a week.
Then I though It might be a blood sugar thing but I ruled this out. (just didn't make sense)

Lastly I realized what it was. I was eating my dinner and my chronic nightly routine after dinner would be on the floor stretching my body, I would do a lower back stretch by bringing my knees up to my chest and holding. Well that combined with the food in me, and then going to bed was causing SILENT REFLUX, I say silent because I wasn't getting any burning sensation, or typical reflux symptoms. I stopped stretching after eating, always complete my last meal no later than 3 hours before bed, and I elevated my head 30 degrees using a pillow designed for that and I have never had the problem again, and my sleep was even improved some. I do travel for work and use extra pillows to try to keep me elevated. I also saw a tv program of an MD who had this issue and she too was being woken up with major panic at night, and she realized it was reflux.

So to summarize: Stretching with food in my belly, going to bed lying flat was causing me to wake up in a severe panic.


Your HX of hiatel hernia this just may be the causing you to reflux at night. I would try elevating your body for a few weeks and see how it goes.