Depression and anxiety on TRT week 5 after great start.

[nicknot]

I've been on TRT for almost 5 weeks (started the 5th week last monday). I didn't feel much during the first 3 weeks, but at the beginning of the 4th week I started feeling much better. Very focused and clear of mind in a way I'd never experienced before. I've had brain fog my entire life and have never been able to stop the constant chatter in my mind long enough to formulate any long term plans. Since my early 20's I haven't even felt the desire to do anything.

This all seemed to change very quickly during that 4th week. Most of my social anxiety went away and I started experiencing a calm focus that felt amazing. I even started for the first time in my life to want to actually do things, to have some thirst and enthusiasm for life, it was almost euphoric.

These positive changes however only lasted for about a week or so and 5-6 days ago I started feeling even more anxiety than I ever did before in my life. I've also started feeling desperation and sleeping 12 hours/day with no motivation or energy to do anything.

I'm with a clinic remotely and they have me on 23 mg per day (160 mg per week) of Testosterone Cypionate and nothing else. I asked for a daily protocol after doing some research.
My Estradiol is naturally very low and my SHBG extremely high (80 nmol/L out of a 20 to 55 nmol/L range).

I actually worked out 6 days/week before getting so depressed a week ago. I'm very lean and eat very healthy. No drugs/smoking/drinking, anything. All my bloods are great. Blood pressure, cholesterol, etc...

They started me on what some would consider a high dose because my SHBG is so high and they said it would take a lot to get my Free T where I would feel good.

Did this happen to anyone? Does it mean I'm taking too much? Not enough? One theory is that on my way up to higher levels of Test I passed a zone optimal for my mental well-being and have now overshot it. Another theory however is that I was getting a double dose of Test (natural production + TRT) and now that my natural production is shutting down I actually need more Test to make up for it.

I'm not taking any hCG (don't care about kids of smaller testicles) or any AI.

 

[Systemlord]

I've been on TRT for almost 5 weeks (started the 5th week last monday).

Your testosterone levels aren't stable yet and to top it off your natural production is getting shut down, so my advice is hold the course.

Note every time one changes their dosage hormone levels will be in flux and you will feel good on and off for about 6 weeks until hormone levels are stable. So if you increase your dosage right now, you will start this process all over and another 6 weeks until levels are stable.

You only have 1 week to go before hormones stabilize.

Did this happen to anyone?

Yes a very large percentage of men report similar experiences when first starting TRT and after dosing changes, however it's not nearly as bad as when first starting TRT.

One theory is that on my way up to higher levels of Test I passed a zone optimal for my mental well-being and have now overshot it. Another theory however is that I was getting a double dose of Test (natural production + TRT) and now that my natural production is shutting down I actually need more Test to make up for it.

Do yourself a favor, stop the guesswork and get labs at the appropriate time which is 6-8 weeks after dosing changes.

 

[madman]

I've been on TRT for almost 5 weeks (started the 5th week last monday). I didn't feel much during the first 3 weeks, but at the beginning of the 4th week I started feeling much better. Very focused and clear of mind in a way I'd never experienced before. I've had brain fog my entire life and have never been able to stop the constant chatter in my mind long enough to formulate any long term plans. Since my early 20's I haven't even felt the desire to do anything.

This all seemed to change very quickly during that 4th week. Most of my social anxiety went away and I started experiencing a calm focus that felt amazing. I even started for the first time in my life to want to actually do things, to have some thirst and enthusiasm for life, it was almost euphoric.

These positive changes however only lasted for about a week or so and 5-6 days ago I started feeling even more anxiety than I ever did before in my life. I've also started feeling desperation and sleeping 12 hours/day with no motivation or energy to do anything.

I'm with a clinic remotely and they have me on 23 mg per day (160 mg per week) of Testosterone Cypionate and nothing else. I asked for a daily protocol after doing some research.
My Estradiol is naturally very low and my SHBG extremely high (80 nmol/L out of a 20 to 55 nmol/L range).

I actually worked out 6 days/week before getting so depressed a week ago. I'm very lean and eat very healthy. No drugs/smoking/drinking, anything. All my bloods are great. Blood pressure, cholesterol, etc...

They started me on what some would consider a high dose because my SHBG is so high and they said it would take a lot to get my Free T where I would feel good.

Did this happen to anyone? Does it mean I'm taking too much? Not enough? One theory is that on my way up to higher levels of Test I passed a zone optimal for my mental well-being and have now overshot it. Another theory however is that I was getting a double dose of Test (natural production + TRT) and now that my natural production is shutting down I actually need more Test to make up for it.

I'm not taking any hCG (don't care about kids of smaller testicles) or any AI.

When first starting trt it can be a bumpy ride.

You are injecting exogenous testosterone and not only will your hpta shutdown but your hormones are in FLUX during the weeks leading up until levels stabilize (6 weeks) and depending on the individual many will experience what we call the honeymoon period where you feel euphoric due to the surge in hormones/dopamine which is short-lived and temporary as the body will eventually adapt.

Others tend to experience ups/downs during the transition until levels stabilize and during this time (first 6 weeks) it would be a big mistake to gauge how you truly feel on such protocol as even once levels stabilize it will take 2-3 months for the body to adapt and this is the critical time period when one should truly gauge how they feel overall regarding relief/improvement of low-t symptoms and overall well-being.

Blood work should be done at 6 weeks to see where said protocol (dose of T/injection frequency) has your TT/FT/e2 levels along with other blood markers such as (CBC which includes RBCs/hemoglobin/hematocrit).

No point in jumping to conclusions just yet and the smartest thing to do is tough it until you have blood work done than you and your doctor can decide if any adjustments need to be made.

Odd that they would start you off using daily injections seeing as you have high SHBG let alone with a whopping dose 23 mg/day as it will most likely have your TT/FT levels very high.

Larger doses of T injected less frequently as in once weekly would have a bigger impact on driving down SHBG but even than in many cases it will not drop significantly when using trt doses.

Some men may experience a bigger drop in SHBG whereas in others it will be insignificant.

You would most likely have been better off starting on 100mg/week or slightly higher and splitting up the dose into twice-weekly injections (50 mg every 3.5 days).

More sensible to start low and go slow.

 

[nicknot]

Odd that they would start you off using daily injections seeing as you have high SHBG let alone with a whopping dose 23 mg/day as it will most likely have your TT/FT levels very high.

Larger doses of T injected less frequently as in once weekly would have a bigger impact on driving down SHBG but even than in many cases it will not drop significantly when using trt doses.

Thanks for replying. The doctor actually wanted to start me on twice/week IM but I insisted on daily Sub Q after reading that it would minimize side effects and provide the most stable levels. I have a bit of a perfectionism OCD so it felt like the optimal thing to do. In retrospect it might've been a mistake but I really thought it would be better and I wanted to avoid side effects at all costs.
He said to expect my TT to possibly go up to 15-1600 ng/dL but that it was totally fine and that men see improvements across all health markers long term up to around 2000ng/dL.
He said he wants me slightly supraphysiological in Free T because that would be high end of normal on the lab ranges of 50 years ago and where his patients typically start feeling good. Somewhere around 30-35ng/dL FT.

I'm starting to think I should've just gone with IM 2x/week...

 

[nicknot]

Your testosterone levels aren't stable yet and to top it off your natural production is getting shut down, so my advice is hold the course.

Note every time one changes their dosage hormone levels will be in flux and you will feel good on and off for about 6 weeks until hormone levels are stable. So if you increase your dosage right now, you will start this process all over and another 6 weeks until levels are stable.

You only have 1 week to go before hormones stabilize.



Yes a very large percentage of men report similar experiences when first starting TRT and after dosing changes, however it's not nearly as bad as when first starting TRT.



Do yourself a favor, stop the guesswork and get labs at the appropriate time which is 6-8 weeks after dosing changes.

Thanks. You're right, I'm so close to getting blood work done I don't want to mess with my protocol now. It's good to know that I'm not the only one feeling this way. This is very discouraging because I've spent the entire second half of my life from 20yo feeling like absolute shit, so when I started feeling the best I'd ever felt in my life a few weeks in I of course hoped it would stay that way or even get better.
So when I went from that to feeling the worst I've ever felt, it hit me really hard.

 

[madman]

Thanks for replying. The doctor actually wanted to start me on twice/week IM but I insisted on daily Sub Q after reading that it would minimize side effects and provide the most stable levels. I have a bit of a perfectionism OCD so it felt like the optimal thing to do. In retrospect it might've been a mistake but I really thought it would be better and I wanted to avoid side effects at all costs.
He said to expect my TT to possibly go up to 15-1600 ng/dL but that it was totally fine and that men see improvements across all health markers long term up to around 2000ng/dL.
He said he wants me slightly supraphysiological in Free T because that would be high end of normal on the lab ranges of 50 years ago and where his patients typically start feeling good. Somewhere around 30-35ng/dL FT.

I'm starting to think I should've just gone with IM 2x/week...

No worries just wait until you get lab work.

Keep in mind that most men on trt even with high SHBG can easily achieve a healthy FT level without hitting an absurd TT 1500+ ng/dL.

Most men on trt are injecting 100-150mg/week and in most cases can hit a high-end TT/FT level.

Many do well with FT in the 30 ng/dL or slightly higher whereas others feel better running lower levels.

Sure some may need higher doses 150-200 mg/week but most would never need the high-end dose 200 mg/week to achieve a healthy FT level.

As far as one needs to hit a TT 1600-2000 ng/dL to benefit from trt is hogwash!

Forget this 50 years ago bulls**t.

I can pull up studies for you from the 70s and you would be shocked at the average levels of men back then.

He said to expect my TT to possibly go up to 15-1600 ng/dL but that it was totally fine and that men see improvements across all health markers long term up to around 2000ng/dL.

If we were talking peak levels on once-weekly injections this would be expected but for a trough level when injecting more frequently twice weekly (every 3.5 days), M/W/F, EOD, or daily (peak-trough minimal) that would be absurd.

Even then such levels will not only have your FT through the roof but your RBCs/hemoglobin/hematocrit would be driven up!

Regarding your FT make sure you get the correct testing method which would be the most accurate assay the gold standard Equilibrium Dialysis or Ultrafiltration (next best) if you truly want to know where your FT level sits.

Forget the direct immunoassay which will most likely be the one your doctor recommends.

 

[nicknot]

No worries just wait until you get lab work.

Keep in mind that most men on trt even with high SHBG can easily achieve a healthy FT level without hitting an absurd TT 1500+ ng/dL.

Most men on trt are injecting 100-150mg/week and in most cases can hit a high-end TT/FT level.

Many do well with FT in the 30 ng/dL or slightly higher whereas others feel better running lower levels.

Sure some may need higher doses 150-200 mg/week but most would never need the high-end dose 200 mg/week to achieve a healthy FT level.

As far as one needs to hit a TT 1600-2000 ng/dL to benefit from trt is hogwash!

Forget this 50 years ago bulls**t.

I can pull up studies for you from the 70s and you would be shocked at the average levels of men back then.

He said to expect my TT to possibly go up to 15-1600 ng/dL but that it was totally fine and that men see improvements across all health markers long term up to around 2000ng/dL.

If we were talking peak levels on once-weekly injections this would be expected but for a trough level when injecting more frequently twice weekly (every 3.5 days), M/W/F, EOD, or daily (peak-trough minimal) that would be absurd.

Even then such levels will not only have your FT through the roof but your RBCs/hemoglobin/hematocrit would be driven up!

Regarding your FT make sure you get the correct testing method which would be the most accurate assay the gold standard Equilibrium Dialysis or Ultrafiltration (next best) if you truly want to know where your FT level sits.

Forget the direct immunoassay which will most likely be the one your doctor recommends.

Thanks for the detailed reply. I'm going to take your advice and ride it out while I wait for the blood test results. One good thing about this doc is that he's into monitoring pretty much everything when it comes to blood work and he's on TRT himself, which to me is a good sign (put your money where your mouth is kind of thing, even though of course it doesn't guarantee anything, doctors make mistakes all the time).

He's a bit aggressive with TRT for my taste, but I'd rather have him be this way and then take less than what he recommends, than have to fight a doctor who will never give me more than 100mg/week or allow me to stay above 700ng/dL or something like that.

 

[tropicaldaze1950]

Thanks for the detailed reply. I'm going to take your advice and ride it out while I wait for the blood test results. One good thing about this doc is that he's into monitoring pretty much everything when it comes to blood work and he's on TRT himself, which to me is a good sign (put your money where your mouth is kind of thing, even though of course it doesn't guarantee anything, doctors make mistakes all the time).

He's a bit aggressive with TRT for my taste, but I'd rather have him be this way and then take less than what he recommends, than have to fight a doctor who will never give me more than 100mg/week or allow me to stay above 700ng/dL or something like that.

I'd rather have a doctor such as yours as opposed to someone who barely has any understanding or is a 'lab' doctor who never strays outside the AUA or Endocrine Society guidelines.

My urologist, practicing for several decades, continually reads books on endocrinology, written by other doctors, attends seminars and knows some of the top doctors in trt/bhrt/hormone optimization. He likes sharing what he's learned and also respects a patient who is knowledgeable. Doctors who are also 'teachers', regardless of their specialty, are the best doctors. They're passionate about medicine and their particular specialty.

I always say that there are so many doctors but few good ones. Some of that is the fault of the practitioner, who has no desire to broaden his or her knowledge, but also, IMO, how medical students/doctors are taught, and that includes those that come out of the top medical schools in this country. And we're left to endlessly seek someone who actually knows something and can help.