For Those That Get Headaches on TRT

[Jerajera]

I'm still only 8-9 weeks in but feeling wired and very sensitive to everything which I don't like

Irritability for me is a symptom of high E2.

So had a thought maybe the fast acting Ester don't agree with me as I get that strange wired feeling

Definitely possible, I feel very wired on Prop. It's the reason I stopped my Prop experiment back in the day. I'm trying again at a lower dose and subQ instead of IM, reasoning that it'll lessen the peaks and associated side effects.

Will see if I'm able to get some AI and try a tiny dose to see what happens and how I feel

I think that's a good idea, but if you buy it through a UGL you probably won't be able to get smaller than 1mg tabs (for Anastrozole), which are really hard to cut into more than 4 pieces evenly. You might need to disolve the AI in vodka and use a syringe to draw out exactly the dose you want.
There's a thread somewhere here on that specfic technique.

Thank you for your time and this detailed post. Will post more updated when I figure out next piece of the puzzle

Same, good luck to you!

 

[Fortunate]

Anyone around here that has read any of my posts knows that the biggest thing that stands between me and achieving therapeutic HRT benefit is headache. @sammmy, or anyone else that has contemplated headache, what are your thoughts on histamine as a potential cause or contributory factor?

I have systematically tried to isolate the source of the headaches. I have made a number of observations over the course of time, but won't bore you with the details. A few salient observations:

• Even tiny doses of injected esters cause headaches
  • therefore, seems unlikely that hormone levels are the culprit
• Xyosted is less likely to cause a headache (but this is not always true)
  • suggests that preservatives and/or alcohol could be a culprit or contributors to the headache pathway
• Yogurt triggers headaches (even unsweetened, plain Greek)
  • makes me wonder if I am sensitive to histamine triggering things
• Verapamil has helped control my headaches in the past
  • making it seem more likely that one pathway to headache for me is vascular
    • maybe verapamil promotes vascular relaxation or dilatation (or, instead, simply keeps vasculature stable)
• Anything with pseudoephedrine causes bad headache hours after taking it
  • Very much suspect this is due to vasoconstriction or vasospasm or vasorelaxation after a state of constriction, suggesting that I am likely sensitive to vascular events
• Triptans work well for me
  • one theory on triptans is that they may influence neurovasculature

Based on various observations, I suspect that injections trigger some kind of vascular response - either directly or via something like histamine? I have considered various possibilities (oil, preservative, excipient) and have tried to test all of them (I can provide details if interested).

I have never tried taking Benadryl along with an injection, but may consider it. On the other hand, I don't want to fall asleep every time I inject....

Any thoughts?

 

[FunkOdyssey]

Anyone around here that has read any of my posts knows that the biggest thing that stands between me and achieving therapeutic HRT benefit is headache. @sammmy, or anyone else that has contemplated headache, what are your thoughts on histamine as a potential cause or contributory factor?

I have systematically tried to isolate the source of the headaches. I have made a number of observations over the course of time, but won't bore you with the details. A few salient observations:

• Even tiny doses of injected esters cause headaches
  • therefore, seems unlikely that hormone levels are the culprit
• Xyosted is less likely to cause a headache (but this is not always true)
  • suggests that preservatives and/or alcohol could be a culprit or contributors to the headache pathway
• Yogurt triggers headaches (even unsweetened, plain Greek)
  • makes me wonder if I am sensitive to histamine triggering things
• Verapamil has helped control my headaches in the past
  • making it seem more likely that one pathway to headache for me is vascular
    • maybe verapamil promotes vascular relaxation or dilatation (or, instead, simply keeps vasculature stable)
• Anything with pseudoephedrine causes bad headache hours after taking it
  • Very much suspect this is due to vasoconstriction or vasospasm or vasorelaxation after a state of constriction, suggesting that I am likely sensitive to vascular events
• Triptans work well for me
  • one theory on triptans is that they may influence neurovasculature

Based on various observations, I suspect that injections trigger some kind of vascular response - either directly or via something like histamine? I have considered various possibilities (oil, preservative, excipient) and have tried to test all of them (I can provide details if interested).

I have never tried taking Benadryl along with an injection, but may consider it. On the other hand, I don't want to fall asleep every time I inject....

Any thoughts?

So testosterone cream does not cause you a headache? If that's correct, why wouldn't you just use cream?

I would try the antihistamine experiment, what do you have to lose?

 

[FunkOdyssey]

A couple other things: you mentioned the pseudoephedrine headache occurs hours later. That sounds like a rebound effect from the vasoconstriction. I assume you experience the same from caffeine?

Also are you a regular consumer of caffeine? It treats headaches acutely but regular use makes you more susceptible to headaches over time.

The substance in fermented foods like yogurt that is most likely causing your headache is tyramine, not histamine, although they are often found together so practically speaking it doesn't matter too much. Basically you want to look at the tyramine-containing food list that people on MAO inhibitors avoid because they'll trigger a hypertensive crisis, and avoid them yourself. They're known migraine triggers.

That also reminds me to ask: Do you monitor your BP during these headaches to make sure they aren't a symptom of a BP spike?

Have you experimented with your diet at all to see how that influences the headaches? What have you tried and what happened? Besides the possibility of foods containing headache triggers, your microbiome is also producing histamine, tyramine, and other noxious headache inducing chemicals as it ferments food in your gut. Have you ever tried starving them with a low fermentable material diet, like low carb, low FODMAP, keto, carnivore, etc? Ketogenic diets are also known to reduce headaches via independent mechanisms involving ketones and the shift away from glucose as fuel source.

 

[Fortunate]

So testosterone cream does not cause you a headache? If that's correct, why wouldn't you just use cream?

I would try the antihistamine experiment, what do you have to lose?

It's mostly correct.

In theory, I am fine using cream. But, it has been a bit of a difficult pony to tame. Results have been really inconsistent. At times I feel supraphysiologic. But, more bothersome than that has been recurrent severe fatigue.

I think I posted about the fatigue elsewhere. I seem to have decent energy every day until about noon, at which time I get crushing fatigue. It's been going on for about 4-5 months. Around the time I started having it, I had just started an SSRI and cream simultaneously. Blaming cream and whatever comes with it seems far fetched, and it has been at the bottom of my list. But, I have been off SSRI's for a while and still get the fatigue. It's not mild. It's severe and pretty unusual for me.

For a while, I have planned on pulling labs to see what's up. The only reason I haven't is because I have varied location, timing, dose too much to get into a homestasis. But, I finally said "screw it" and decided to get labs just see if there are any hormone issues that stand out. They are actually scheduled for later today.

Long story, short: At times, cream is great, but it has also been inconsistent for me.

 

[Fortunate]

So testosterone cream does not cause you a headache? If that's correct, why wouldn't you just use cream?

I would try the antihistamine experiment, what do you have to lose?

I agree. I may try it in the next few days. Trying to decide if I should take Benadryl right away or wait an hour or two. Either way, I will probably give it a try.

 

[FunkOdyssey]

It's mostly correct.

In theory, I am fine using cream. But, it has been a bit of a difficult pony to tame. Results have been really inconsistent. At times I feel supraphysiologic. But, more bothersome than that has been recurrent severe fatigue.

I think I posted about the fatigue elsewhere. I seem to have decent energy every day until about noon, at which time I get crushing fatigue. It's been going on for about 4-5 months. Around the time I started having it, I had just started an SSRI and cream simultaneously. Blaming cream and whatever comes with it seems far fetched, and it has been at the bottom of my list. But, I have been off SSRI's for a while and still get the fatigue. It's not mild. It's severe and pretty unusual for me.

For a while, I have planned on pulling labs to see what's up. The only reason I haven't is because I have varied location, timing, dose too much to get into a homestasis. But, I finally said "screw it" and decided to get labs just see if there are any hormone issues that stand out. They are actually scheduled for later today.

Long story, short: At times, cream is great, but it has also been inconsistent for me.

If you're anything like me, your values on cream might be alot higher than you're used to on injections, because the creams are absorbed well, the high levels from cream are somehow easier to tolerate and you don't realize it. I could see fatigue being caused either directly by levels that are too high, or indirectly by draining your iron levels down into the deficiency zone, as Systemlord likes to remind people about.

 

[Fortunate]

A couple other things: you mentioned the pseudoephedrine headache occurs hours later. That sounds like a rebound effect from the vasoconstriction. I assume you experience the same from caffeine?

Also are you a regular consumer of caffeine? It treats headaches acutely but regular use makes you more susceptible to headaches over time.

The substance in fermented foods like yogurt that is most likely causing your headache is tyramine, not histamine, although they are often found together so practically speaking it doesn't matter too much. Basically you want to look at the tyramine-containing food list that people on MAO inhibitors avoid because they'll trigger a hypertensive crisis, and avoid them yourself. They're known migraine triggers.

That also reminds me to ask: Do you monitor your BP during these headaches to make sure they aren't a symptom of a BP spike?

Have you experimented with your diet at all to see how that influences the headaches? What have you tried and what happened? Besides the possibility of foods containing headache triggers, your microbiome is also producing histamine, tyramine, and other noxious headache inducing chemicals as it ferments food in your gut. Have you ever tried starving them with a low fermentable material diet, like low carb, low FODMAP, keto, carnivore, etc? Ketogenic diets are also known to reduce headaches via independent mechanisms involving ketones and the shift away from glucose as fuel source.

These are all excellent points.

Agree on tyramine - likely the issue rather than histamine (alcohol jacks me up, too).

A long time ago, I did an elimination diet (not specifically low tyramine), but don't recall what I learned. For the last number of years, I have been fairly low carb, specifically to treat the headaches. I have noted better energy and reduction in headaches.

Agree on rebound-related headache after pseduoephedrine (vascular lability, I think). I do drink coffee, but alway the exact same amount every day. Could be an issue.

I watch BP, and periodically check it specifically when I get headaches. Sometimes elevated, sometimes not. Then, it becomes a chicken and egg question - is headache causing spike or vice versa. That said, I don't think I have a strong correlation between BP and headache.

 

[Fortunate]

If you're anything like me, your values on cream might be alot higher than you're used to on injections, because the creams are absorbed well, the high levels from cream are somehow easier to tolerate and you don't realize it. I could see fatigue being caused either directly by levels that are too high, or indirectly by draining your iron levels down into the deficiency zone, as Systemlord likes to remind people about.

Yep. My two theories: Fatigue is from ultra high levels at their peak (T, DHT or E2). Or, it could be the opposite, which is such a mindF**K. It could be the drop in levels after the peak.

Interesting thought on iron. I never really give it much thought (at least not as much as our good friend, @Systemlord).

 

[Fortunate]

I actually have a bit of a blind spot when it comes to the relationship between iron and TRT (besides knowing that TRT stimulates erythropoiesis).

@Systemlord and @FunkOdyssey, can you guys gimme a place to start reading? Cliff Notes version? I have pulled a few articles, but they are pretty esoteric.

@Systemlord, I know you have posted a crap ton on this, so I can dig through your posts, but I am looking for a summary of widely accepted concepts as it relates to ferritin and iron.

Don't worry about it if you don't have what I am asking for.

 

[Systemlord]

Yep. My two theories: Fatigue is from ultra high levels at their peak (T, DHT or E2). Or, it could be the opposite, which is such a mindF**K. It could be the drop in levels after the peak.

Interesting thought on iron. I never really give it much thought (at least not as much as our good friend, @Systemlord).

Taking too much iron, can make you feel tired, sleepy and irritability. If I upped my Jatenzo dosage, I would absolutely have to increase my iron dosage as well.

Testosterone and iron, have a very close relationship to one another.

If you're on TRT, and you can't maintain normal ferritin, it’s because TRT increases EPO which equals increased erythroferrone, lowering hepcidin and ferroportin lets iron release from hepatocytes and ferritin doesn't rise.

 

[sammmy]

I get headaches after meals. In my case it is an immune activation related to abnormal digestion or bacteria releasing toxins. Digestive enzymes suppressed it in the past but recently they occur briefly even with prescription digestive enzymes Creon.

You can try anti-histamine to see if yours are histamine mediated.

If it doesn't work, try non-typical anti-inflammatories: for me 5g L-Glutamine in a cup of water or 50mg vit B2 (riboflavin) work really well in that role. L-Glutamine is a digestive and systemic anti-inflammatory and is used in sickle cell disease attacks. Vitamin B2 is an anti-inflammatory that has shown effective in suppressing some migraines - I found the effect by accident when I was taking Citrucel which is full of it. Side effects: L-Glutamine might wake up herpes viruses if you are prone to cold sores.

Another anti-inflammatory effective for headaches is Ginger powder but it may irritate stomach. It is tasty and spicy though.

The best is to address the root problem that triggers the headaches but with contemporary medicine that is rarely achieved. Yogurt causing headaches is suggesting something in the digestive tract - reaction either to the acidity or to the bacteria in yogurt. Digestive problems can manifest as headaches.

 

[Fortunate]

I get headaches after meals. In my case it is an immune activation related to abnormal digestion or bacteria releasing toxins. Digestive enzymes suppressed it in the past but recently they occur briefly even with prescription digestive enzymes Creon.

You can try anti-histamine to see if yours are histamine mediated.

If it doesn't work, try non-typical anti-inflammatories: for me 5g L-Glutamine in a cup of water or 50mg vit B2 (riboflavin) work really well in that role. L-Glutamine is a digestive and systemic anti-inflammatory and is used in sickle cell disease attacks. Vitamin B2 is an anti-inflammatory that has shown effective in suppressing some migraines - I found the effect by accident when I was taking Citrucel which is full of it. Side effects: L-Glutamine might wake up herpes viruses if you are prone to cold sores.

Another anti-inflammatory effective for headaches is Ginger powder but it may irritate stomach. It is tasty and spicy though.

The best is to address the root problem that triggers the headaches but with contemporary medicine that is rarely achieved. Yogurt causing headaches is suggesting something in the digestive tract - reaction either to the acidity or to the bacteria in yogurt. Digestive problems can manifest as headaches.

Interesting. I’m sorry to hear it, man. I feel you.

One fun side effect of riboflavin is atomic yellow pee. It’s always fun to see!

 

[RobRoy]

I'm dead serious! I also feel a profound difference between cypionate and ethanate. I over-respond to most medicines, caffeine and alcohol.

Call me Mr. sensitive.

It's not that fast. It's not that fast at all. Whatever happened to you wasn't from the cream and peaking within seconds. Wherever you got your cream from wasn't any good and that's always a major problem with many compounding pharmacies. You weren't feeling a decrease in three hours you were feeling the peak. That's when it peaks in 2 to 3 hours and you're not an N of 1. This is the problem with forums is that the main people that are responding are those that have the most trouble or have had the most trouble because they have pre-existing comorbid conditions both physical and psychological. They are not representative of normal, fairly healthy men that take testosterone so these normal fairly healthy men that come to form to seek advice, get advice from men that are not fairly normal and healthy, and have issues with testosterone.

 

[Jerajera]

so these normal fairly healthy men that come to form to seek advice, get advice from men that are not fairly normal and healthy, and have issues with testosterone.

I agree. Those men also sometimes get advice from doctors who are ridiculously biased and dogmatic, and completely unscientific in their approach to HRT while hiding behind research papers they misinterpret because of said biases.

 

[Systemlord]

It's not that fast. It's not that fast at all. Whatever happened to you wasn't from the cream and peaking within seconds. Wherever you got your cream from wasn't any good and that's always a major problem with many compounding pharmacies. You weren't feeling a decrease in three hours you were feeling the peak. That's when it peaks in 2 to 3 hours and you're not an N of 1. This is the problem with forums is that the main people that are responding are those that have the most trouble or have had the most trouble because they have pre-existing comorbid conditions both physical and psychological. They are not representative of normal, fairly healthy men that take testosterone so these normal fairly healthy men that come to form to seek advice, get advice from men that are not fairly normal and healthy, and have issues with testosterone.

This happened because my ferritin was 24 and iron saturation 12%. That's what was causing the sides.

At the time I was unaware of had iron deficiency.

I'll feel the same on Jatenzo if I forget to take my iron supplements without my Jatenzo.

 

[RobRoy]

I agree. Those men also sometimes get advice from doctors who are ridiculously biased and dogmatic, and completely unscientific in their approach to HRT while hiding behind research papers they misinterpret because of said biases.

If a doctor practice is purely evidence based medicine and only medicine based on the medical literature that is a purely scientific practice. It is those that make recommendations that aren't evidence-based that don't have any medical literature to support why they do what they do that are unscientific. The automatic use of aromatase inhibitors for instance has no basis in the medical literature. The diagnosis of testosterone deficiency based on a specific number also has no true basis in the medical literature. And what is most concerning is that treating to a specific physiologic number such as the mid normal range believe it or not has no basis in the medical literature. It's just something everyone was taught to do without the medical literature to support that it was the right way to do it or the most beneficial way to do it.

 

[sammmy]

If you are waiting on the "medical literature" to support a treatment, most of the patients will remain with no treatment at all.

Currently, medicine is not at the level of true science and demanding a true scientific rigor from its treatments will leave you empty handed in most cases. It often fails to diagnose a disease or treat a chronic disease.

I've been for years outside the medical science and the only thing you can do in such position is empirical treatments i.e. trying stuff, guided by basic fundamental medical logic.

 

[RobRoy]

If you are waiting on the "medical literature" to support a treatment, most of the patients will remain with no treatment at all.

Currently, medicine is not at the level of true science and demanding a true scientific rigor from its treatments will leave you empty handed in most cases. It often fails to diagnose a disease or treat a chronic disease.

I've been for years outside the medical science and the only thing you can do in such position is empirical treatments i.e. trying stuff, guided by basic fundamental medical logic.

No that's not necessarily true. The literature is there the problem is people don't know where to look or how to look. Most just don't take the time to look. It takes a lot of time and dedication. It just can't be done via Google or worse... abstract surfing. People have to look outside the boundaries of their own field because many times literature is there but it's from another specialty. It's consolidating all of the various research from multiple different fields and developing an understanding of how to piece of together. Too many men and medical providers just want that one study or one chapter in a book that tells them everything and it doesn't work that way. I will agree with you on that.

 

[sammmy]

Apparently, you haven't experienced yet a degenerative condition associated with aging, that contemporary medicine has no clue how to cure, it just "treats" it. When that happens, you belief in the "medical literature" will quickly evaporate.

So not to derail that thread, please tell us, what is "out there" that we can't find with Google, which explains the OP headaches. Find the root cause according to the "research" and save us the neurology hand-waving nonsense that his "nerve endings are just too sensitive", clearly tied to migraine drugs that just cover up the symptoms, not identifying the true cause and clearly not curing or understanding anything.