Looking to start TRT again, any advice?

[Dustoff32]

All,

I joined this site to learn and improve my experience on TRT. About 3 years ago I returned from Afghanistan and began having normal symptoms of low T. Im currently 38 and am about to retire from the Military. My PCM performed a sleep study, thyroid test, and a few other blood tests before testing my Testosterone levels. About 9 months after the testing began my doctor finally diagnosed me with Low T. The PCM began shots with 200 MG of test cyp, moved up to 300 mg, then 400 mg every 2 weeks. I was feeling great for a few months and the PCM was performing normal blood work. However, he didn’t have any set days of when I drew blood so the below numbers are skewed, I tried to draw blood 7 days after shot.

14 March: Free Test=66, Free Test Weekly=137, Testosterone=344
10 July: Free Test=32 pg/ml, test free + weekly bound=99 ng/dl, Sex hormone=19nmol, testosterone=179 ng/dl
10 Jul began TRT 200 mg 2 weeks

Both tests were taken at 9am and as a result my PCM started me out on a 200 Mg shot of Test Cyp every 2 weeks.

3 sep: Estroidal=48.13

5 Sep: My PCM increased me to 300 MG of Test Cyp every 2 weeks, I was still feeling tired and all other symptoms.

30 Oct: Test=632, Free dialysis=3, free=190, free+weekly bound 528, sex hormone=15.2

30 Oct I was increased to 400 MG every 2 weeks and felt great. Muscle and joint aches went away, began building muscle, more energy, wife is getting tired of sex, all I want is sex, mental cognition is great

6 Jan I began to have heart palpitations

10 Jan I experienced severe anxiety, I have never felt this before, also problems catching my breathe. I wanted to die, literally felt like I no longer wanted to live. My wife wanted to admit me to the hospital due to what she called a nervous breakdown. I don’t recall much of it except I wasn’t mentally available for a few days. I still don’t know what happened.

10 Jan my heart rate will not go below 90 bpm, and Im having really bad anxiety, im scared to be in the house alone as I feel like im going to die. This lasted until 16 March, I cry, am angry, heart hurts, feel like im having heart attacks for 3 months. Im grounded as a pilot.

16 March I ended up in the Hospital, EKG said I was having a blockage, heart cath administered and no blockage. Heart doctor said my body is very stressed and I needed to come off of the Testosterone

24 April: Test 1057 ng/dl, free dialys=2.7, free test=285, test free+weekly bound=>883, free+weekly+total=>83.5, Sex hormone=13.3

1 May: talked with Endo, reviewed my levels and says I was being overdosed but said that overdose shouldn’t have caused anxiety. She began to taper me off of the Test to see what my baseline levels are since my PCM didn’t baseline me and didn’t draw blood for levels 7 days after the shot. PSA and CBC were normal. Referred me to Psych

1 June psych places me on Zoloft “SSRI”

27 July 14“ tapered off test” Sex hor=30.7, free test=32 pg/ml, test bioval=129 ng/dl, test free dial=1.2, test total=269 ng/dl

20 October: LH and FSH were normal, Estrogen=24, prolactin=normal, testosterone=180ng/dl with a lower Free test. This new endo repeated the test and found similar results, I do not have the test results. However, the Endo tells me that my numbers are low but as long as I can get an erection during sex im fine. Also he has no idea of why I wanted my estrogen levels taken.

Currently, anxiety is gone, im still having breathing issues even though I have seen multiple pulmonologists and have taken 3 PFT’s. Been diagnosed with Vocal cord dysfunction as the breathing issue “I don’t buy it”. Liver enzymes are still high and liver biopsy came back with slightly fatty liver 5 %.

I Have severe joint pains, am tired, cannot lose weight, cannot gain muscle, mentally slow and confused, low confidence, frustrated. I want to get back on TRT but am very scared of having a repeat of the nervous breakdown. I am also scared that if I start the TRT again and have to get off of it due to anxiety that I wont fall back to the current levels I have. I do not trust my endo and being in the Military its difficult to get another Endo.

Can any of you tell me what likely happened to me around January? Any advice on any of my concerns? Is my Endo a quack?

Thanks

 

[CoastWatcher]

Welcome to Excelmale. You need to find another doctor. I'm afraid that what you were prescribed, 400mg of testosterone every two weeks is going to lead to failure. The half-life of the drug doesn't lend itself to injections every 14 days. You were on an enormous dose of testosterone - 400mg. You will see an enormous spike in your testosterone level, followed by a steady increase in your estradiol level - and you are likely to feel horrible. Typical starting dose for TRT is 100mg every week, or, as more and more well-trained doctors and knowledgeable patients are finding, 50mg every 3.5 days. At the end of a 14 day period you will start the cycle of dual spikes (testosterone and estradiol) all over again. When you began experiencing the anxiety - was your cortisol tested? Thyroid? When you were tapered off testosterone was any attention paid to your HPTA axis?

You have faced a lot, and been through a great deal.

 

[Dustoff32]

When I began to have anxiety I did not have any labs, I wish I did. Also, when the endo began to ween me off she didn't order any labs. Unfortunately, Im in central Louisiana and TRT doctors are slim pickings here. There are TRT clinics about an hour and 1/2 away but they charge an arm and leg and won't allow me to pin myself. Im fighting the Army to see a local Urologist who has been recommended as being TRT knowledgable, however that will take a few months.

Is it possible to dial in TRT and never have anxiety again?
If I get back on TRT and have a negative reaction what are the possibilities that my Test levels will diminish further?
Is severe joint pain common with low T? Im talking pretty severe, very achy.

Thanks

 

[Vitamin_C]

When I began to have anxiety I did not have any labs, I wish I did. Also, when the endo began to ween me off she didn't order any labs. Unfortunately, Im in central Louisiana and TRT doctors are slim pickings here. There are TRT clinics about an hour and 1/2 away but they charge an arm and leg and won't allow me to pin myself. Im fighting the Army to see a local Urologist who has been recommended as being TRT knowledgable, however that will take a few months.

The anxiety was probably caused by a big spike in estrogen. You need to clean up that liver as well, need to do a liver detox. Don't drink alcohol, drink a gallon of water per day. The military is so stone age with their TRT guys, they are still doing 200mg Q2W. 400mg every 2 weeks is ridiculous, a huge spike in Testosterone and then back down to nothing. Your SHBG is rather low, I think you would do real well off 50mg bi weekly.





Is it possible to dial in TRT and never have anxiety again?
If I get back on TRT and have a negative reaction what are the possibilities that my Test levels will diminish further?
Is severe joint pain common with low T? Im talking pretty severe, very achy.

Thanks

The anxiety was probably caused by a big spike in estrogen. You need to clean up that liver as well, need to do a liver detox. Don't drink alcohol, drink a gallon of water per day. The military is so stone age with their TRT guys, they are still doing 200mg Q2W. 400mg every 2 weeks is ridiculous, a huge spike in Testosterone and then back down to nothing. Your SHBG is rather low, I think you would do real well off 50mg bi weekly.

Your test levels most likely won't diminish further if you have to get off again, but you will have to really make some serious life style changes if you want to get your testosterone higher naturally.

 

[CoastWatcher]

Consider consulting Defy Medical. They have a unique tele-medicine model that permits them to treat men anywhere in the United States. Many of Excelmale's members are patients. No hard sell, all questioned answered up front. Check their website and/or call them. I have no relationship with them but know of their excellent services. You

 

[Dustoff32]

Update!

As recommended I Consulted Defy Medical and have been a patient for about 12 weeks. Dr. Crisler completely analyzed my case and agreed that my anxiety was likely caused by spikes in estrogen due to high testosterone shots spaced out EOW.

Dr. Crisler suggested we start slowly with Clomiphene (Clomid) 50mg M, W, and Friday. I was very skeptical but am pleased with the results so far. After 5 weeks of the clomid protocol Most of my symptoms have gone away and I have been anxiety free, actually feeling good again. Not feeling great... but good is better than where I was 12 weeks ago.

Jan 21 2016

LH...7.6 mis/ml (1.2-7.8)
Testosterone...568 ng/dl (300-1080)
Sex Hor Bind Glob...29 nmol/L (16.5-55.9)
Free test...13.1 (4.8-25.7)
Estroidal ultrasens...30.4 (10-42)

Associated Regional UniversityPathology, Salt lake City


During the follow up call I voiced my concern to optimize my levels. We agreed to give the climid another month to see if the levels would improve further.

I have a followup question for the forum, I feel its very likely that my test levels may go up 50-100 (total 650-700) points but nowhere near the 1080 Optimized levels. Im sure he will have a plan but would this request be ethical? I would like to supplement and add a small dose of test E3.5Days to raise me into the optimized range.

Any other suggestions to reach these higher levels?

 

[ERO]

Do not supplement Clomid with Test. Clomid is stimulating your natural T production, where external T stops your natural production. You will end up at a far LOWER level than where you are now.

Wait 4 weeks, do blood work, and if you Total T is only up to 600, ask to stop Clomid and just go with T injections every 3.5 days. Most of us here have Total T around 1000 plus or minus, which is higher than you will ever be with Clomid.

 

[CoastWatcher]

Clomid and testosterone supplementation, at the same time, is a ticket to lower testosterone values. That isn't an option.

 

[Dustoff32]

So my only option to increase my total levels is to get back on the testosterone injections?

If I go back on testosterone and begin having anxiety again (as previous), quit the testosterone and begin clomid again, will my levels return to where they are now or will they permanently decrease?

Or, If I stay on the Clomid and drop all of this weight I acquired (25% BF) (after having <200 Test levels for about 10 months), will my body natural Testosterone also increase while on the Clomid or has the clomid already maxed out my bodys total potential of test production?

 

[CoastWatcher]

You wrote that you were feeling good, yet here you are anxiously asking about options. Your care is being directed by a capable physician, one of the most knowledgeable in the country on matters of androgen replacement, it has only been 12 weeks of treatment...you still need to give it time. Getting everything right, dialing it in, isn't necessarily a quick process; but, you have made progress. Raise your questions in your next consultation.

 

[GA8314]

All,

I joined this site to learn and improve my experience on TRT. About 3 years ago I returned from Afghanistan and began having normal symptoms of low T. Im currently 38 and am about to retire from the Military. My PCM performed a sleep study, thyroid test, and a few other blood tests before testing my Testosterone levels. About 9 months after the testing began my doctor finally diagnosed me with Low T. The PCM began shots with 200 MG of test cyp, moved up to 300 mg, then 400 mg every 2 weeks. I was feeling great for a few months and the PCM was performing normal blood work. However, he didn't have any set days of when I drew blood so the below numbers are skewed, I tried to draw blood 7 days after shot.

14 March: Free Test=66, Free Test Weekly=137, Testosterone=344
10 July: Free Test=32 pg/ml, test free + weekly bound=99 ng/dl, Sex hormone=19nmol, testosterone=179 ng/dl
10 Jul began TRT 200 mg 2 weeks

Both tests were taken at 9am and as a result my PCM started me out on a 200 Mg shot of Test Cyp every 2 weeks.

3 sep: Estroidal=48.13

5 Sep: My PCM increased me to 300 MG of Test Cyp every 2 weeks, I was still feeling tired and all other symptoms.

30 Oct: Test=632, Free dialysis=3, free=190, free+weekly bound 528, sex hormone=15.2

30 Oct I was increased to 400 MG every 2 weeks and felt great. Muscle and joint aches went away, began building muscle, more energy, wife is getting tired of sex, all I want is sex, mental cognition is great

6 Jan I began to have heart palpitations

10 Jan I experienced severe anxiety, I have never felt this before, also problems catching my breathe. I wanted to die, literally felt like I no longer wanted to live. My wife wanted to admit me to the hospital due to what she called a nervous breakdown. I don't recall much of it except I wasn't mentally available for a few days. I still don't know what happened.

10 Jan my heart rate will not go below 90 bpm, and Im having really bad anxiety, im scared to be in the house alone as I feel like im going to die. This lasted until 16 March, I cry, am angry, heart hurts, feel like im having heart attacks for 3 months. Im grounded as a pilot.

16 March I ended up in the Hospital, EKG said I was having a blockage, heart cath administered and no blockage. Heart doctor said my body is very stressed and I needed to come off of the Testosterone

24 April: Test 1057 ng/dl, free dialys=2.7, free test=285, test free+weekly bound=>883, free+weekly+total=>83.5, Sex hormone=13.3

1 May: talked with Endo, reviewed my levels and says I was being overdosed but said that overdose shouldn't have caused anxiety. She began to taper me off of the Test to see what my baseline levels are since my PCM didn't baseline me and didn't draw blood for levels 7 days after the shot. PSA and CBC were normal. Referred me to Psych

1 June psych places me on Zoloft “SSRI”

27 July 14“ tapered off test” Sex hor=30.7, free test=32 pg/ml, test bioval=129 ng/dl, test free dial=1.2, test total=269 ng/dl

20 October: LH and FSH were normal, Estrogen=24, prolactin=normal, testosterone=180ng/dl with a lower Free test. This new endo repeated the test and found similar results, I do not have the test results. However, the Endo tells me that my numbers are low but as long as I can get an erection during sex im fine. Also he has no idea of why I wanted my estrogen levels taken.

Currently, anxiety is gone, im still having breathing issues even though I have seen multiple pulmonologists and have taken 3 PFT's. Been diagnosed with Vocal cord dysfunction as the breathing issue “I don't buy it”. Liver enzymes are still high and liver biopsy came back with slightly fatty liver 5 %.

I Have severe joint pains, am tired, cannot lose weight, cannot gain muscle, mentally slow and confused, low confidence, frustrated. I want to get back on TRT but am very scared of having a repeat of the nervous breakdown. I am also scared that if I start the TRT again and have to get off of it due to anxiety that I wont fall back to the current levels I have. I do not trust my endo and being in the Military its difficult to get another Endo.

Can any of you tell me what likely happened to me around January? Any advice on any of my concerns? Is my Endo a quack?

Thanks

Hey buddy.

Did they say anything about Takatsubo's Cardiomyopathy? It's also known as "stress induced cardiomyopathy". Look it up. Often it presents as an MI (Myocardial Infarction/Heart attack) but catheterization is clean. That being said, they should also see some other "classic" sign's on cath (left ventriculogram) with Takatsubo's.

I highly doubt this is in any way related to Testosterone. I think you need to get your anxiety under control. You could consider talking to your physician about a Beta Blocker, which protects the heart from "sympathetic discharge"/adrenalin which stems from a hyperactive adrenal gland, anxiety, PTSD?????

Just a few thoughts.