My Ongoing TRT Mystery

[osirisrisen]

Hi Everyone,

Looking for some insight into my seemingly complex issues. Been on TRT for 10+ years in all forms, have seen Crisler, Nichols, Defy. Have had windows of feeling great but then issues always creep in.

Background:
1. Took Propecia in college, def caused some issues here and there.
2. Have had Lymes and usually still high levels of active EBV
3. Low vit. D, but supplementing causes high calcium (even with K2) and anxiety
4. Usual issues are anxiety, depression off and on, and E.D.

Past Protocol:
T Cream, Empower 200mg and applied 2 clicks every morning to the scrotum. No hcg or anything else.

Here are my labs, drawn 5 hours after application.

Total Test 1503 (250-1100 ng/dl)
Free Test 396 (35 - 155 pg/ml)
E2 Ultra-sensitive 33

Follow Up Protocol:
50mg Test Cup Mon and Thurs, 12.5mg scrotal cream daily.

Labs:
Total T 1274 ng/dl (High) Range 250-1100
Free T 280.3 pg/nl (High) Range 35-155 pg/ml
DHT 216ng/dl (High) range 12-65
SHBG 26 nmol/l range 10-50
E2 Ultrasenstive 45 (High) range <26

Again on this for the first month or two I felt great, then air hunger, anxiety, worry, feeling overall weird and lost erections again. It is obvious I’m super sensitive to the Scrotal Cream, as my DHT and e2 would stay low even on high doses of just Test Cyp.

Like an idiot I went off everything and now feel like a basket case. I’m thinking of trying 30mg Test Cyp M and Th and 6.25mg of cream on the scrotum. Any insight would be appreciated, thanks!

 

[Simbarn]

I think you can already see your T levels are too high.
Have you tried hCG at some time?
If my T levels were that high, my penis would not work at all. My anxiety would also be elevated.

 

[Systemlord]

There is a thread specifically, how to make TRT work for those who have lymes disease. Trying to circumvent a disease that causes inflammation and going on a therapy that reduces inflammation is going to be challenging.

 

[osirisrisen]

I think you can already see your T levels are too high.
Have you tried hCG at some time?
If my T levels were that high, my penis would not work at all. My anxiety would also be elevated.

Yes, too high is definitely the case I always run into with scrotal cream solo or added. I do feel like something in it helps, but it always goes haywire with rising levels.

 

[osirisrisen]

There is a thread specifically, how to make TRT work for those who have lymes disease. Trying to circumvent a disease that causes inflammation and going on a therapy that reduces inflammation is going to be challenging.

I’ve searched the forum for this and haven’t found the exact one you speak of. I wouldn’t say that I have any hardcore Lyme’s issues, but it is hard to tell what it is or isn’t contributing to the big picture. Many of my issues existed pre Lyme’s so I’m at a loss on this aspect of things.

 

[eli]

Have you used only injections?

Maybe try 40mg twice a week now

 

[Willyt]

I’m thinking of trying 30mg Test Cyp M and Th and 6.25mg of cream on the scrotum. Any insight would be appreciated, thanks!

That sounds about right. This should bring you in physiological range again when testing on trough day.

With cream everyday, my guess is your DHT will still be high though which causes side effects for many. A little DHT goes a long way IMO.

I have read about some guys who only use cream once or twice weekly just to get small DHT bump along with their injections protocol. I don't know how long that DHT bump would last though versus everyday application.

 

[Guided_by_Voices]

30mg test cyp sounds very close to what I do and may work much better for you. Your levels sound way too high and as other threads have pointed out, many of us do best with fairly low dose levels. I would just do the cyp to start with to remove variables.

 

[Keepfit1]

Hi Everyone,

Looking for some insight into my seemingly complex issues. Been on TRT for 10+ years in all forms, have seen Crisler, Nichols, Defy. Have had windows of feeling great but then issues always creep in.

Background:
1. Took Propecia in college, def caused some issues here and there.
2. Have had Lymes and usually still high levels of active EBV
3. Low vit. D, but supplementing causes high calcium (even with K2) and anxiety
4. Usual issues are anxiety, depression off and on, and E.D.

Past Protocol:
T Cream, Empower 200mg and applied 2 clicks every morning to the scrotum. No hcg or anything else.

Here are my labs, drawn 5 hours after application.

Total Test 1503 (250-1100 ng/dl)
Free Test 396 (35 - 155 pg/ml)
E2 Ultra-sensitive 33

Follow Up Protocol:
50mg Test Cup Mon and Thurs, 12.5mg scrotal cream daily.

Labs:
Total T 1274 ng/dl (High) Range 250-1100
Free T 280.3 pg/nl (High) Range 35-155 pg/ml
DHT 216ng/dl (High) range 12-65
SHBG 26 nmol/l range 10-50
E2 Ultrasenstive 45 (High) range <26

Again on this for the first month or two I felt great, then air hunger, anxiety, worry, feeling overall weird and lost erections again. It is obvious I’m super sensitive to the Scrotal Cream, as my DHT and e2 would stay low even on high doses of just Test Cyp.

Like an idiot I went off everything and now feel like a basket case. I’m thinking of trying 30mg Test Cyp M and Th and 6.25mg of cream on the scrotum. Any insight would be appreciated, thanks!

my only comment is with that sort of DHT watch out for your hair and prostate, high DHT blew mine a bit

 

[osirisrisen]

Thanks everyone, I’m going to try for 30mg M/Th and no cream. The cream’s initial benefits seem to always turn into the issue later on. I have done just Test Cyp in the past and have been ok. I think my chasing of “perfection” lead me to introduce other variables that simply caused more issues.

 

[osirisrisen]

Since I’m seeing my Dr in a week, I have the following questions on what options would be viable for me.

What I know:
1. Clomid did not result in better T, LH and FH did increase, test did not.
2. Cream on body does not absorb, cream on scrotum absorbs too much and DHT goes far to high, also feel too amped up on it.
3. HCG causes anxiety and other complications
4. E2 pre trt is low, like 10 or 11 on sensitive test
5. Shots sometimes work

Untested options:
1. Xyosted
2. Nasal Gel

Would either of the two above be worth a try vs the 30-40mg Cyp IM 2x a week?

 

[Systemlord]

Untested options:
1. Xyosted
2. Nasal Gel

Would either of the two above be worth a try vs the 30-40mg Cyp IM 2x a week?

If your current treatment is ineffective, any action that leads to you getting better on a consistent basis is preferred. There’s little reason to continue doing something that isn’t showing good results.

 

[Fortunate]

Since I’m seeing my Dr in a week, I have the following questions on what options would be viable for me.

What I know:
1. Clomid did not result in better T, LH and FH did increase, test did not.
2. Cream on body does not absorb, cream on scrotum absorbs too much and DHT goes far to high, also feel too amped up on it.
3. HCG causes anxiety and other complications
4. E2 pre trt is low, like 10 or 11 on sensitive test
5. Shots sometimes work

Untested options:
1. Xyosted
2. Nasal Gel

Would either of the two above be worth a try vs the 30-40mg Cyp IM 2x a week?

Yes. Try Natesto. Minimal side effects.

 

[osirisrisen]

Yes. Try Natesto. Minimal side effects.

This is interesting, did you have good results on it? The wife and I are also looking to have kids soon, I’m 40 and I’d like the fertility without the hCG side effects I’ve had in the past.

 

[tropicaldaze1950]

Since I’m seeing my Dr in a week, I have the following questions on what options would be viable for me.

What I know:
1. Clomid did not result in better T, LH and FH did increase, test did not.
2. Cream on body does not absorb, cream on scrotum absorbs too much and DHT goes far to high, also feel too amped up on it.
3. HCG causes anxiety and other complications
4. E2 pre trt is low, like 10 or 11 on sensitive test
5. Shots sometimes work

Untested options:
1. Xyosted
2. Nasal Gel

Would either of the two above be worth a try vs the 30-40mg Cyp IM 2x a week?

Just an opinion based on work by Dr. Eugene Shippen. As reported by Dr. Shippen's patient on another forum several years ago, no erections despite good lab numbers from subq T. Dr. Shippen tried prescribed an add on topical with 5% T cream/25 mg DHEA per click. Application to scrotum, then penile shaft/head caused a substantial rise in DHT, which brought about prostate issues and feeling hyper. He then directed the patient to apply one click to the inner thigh twice a month; the 1st and 14th day. Erections restored and no sides. Apparently, the topical preparation on the thigh slowly released over 2 weeks.

 

[Fortunate]

This is interesting, did you have good results on it? The wife and I are also looking to have kids soon, I’m 40 and I’d like the fertility without the hCG side effects I’ve had in the past.

Short answer: yes, decent results. Longer answer: results may depend somewhat on the level of your own endogenous production. If it’s really low, it still may work well, but may take patience as Natesto addresses symptoms while your body starts to produce its own testosterone. The in-between phase may not be great.

Overall, I definitely think it’s worth trying.

 

[osirisrisen]

Some things to note (So i have my plan documented for my own sake):
1. Genetic testing shows low SERT, Slow COMT (T/T), and low MAOA-A activity - all of these lead to anxiety states, which is my primary issue

2. Taking propecia 20 years ago MAY have lead to decreased allopreg, which is also the start of my panic attacks - I don’t think I’m a full on PFS guy

These two issues seem to point to a strong response (anxiety wise) to androgens. This would also explain why I’ve had feeling moments of great success on TRT when taking either Zoloft or Prozac. Erections returned, joy for live increased, rumination stopped.

Updated Plan (in order):
1. Trial Progesterone 20mg at night to see effects on mood, anxiety, etc.

2. If ineffective, return to low dose SSRI (Lexapro 2.5mg, or Sertraline 12.5mg, or Prozac 5mg) - These have to be sorted out based on conflicts between SERT, COMT, and MAOA-A issues

3. Once feeling stable, initiative moderate dose of TRT via either Nasal Gel or Xyosted 75mg SQ weekly

4. If all is going well and libido/erection issues persist, trial cream on thigh days 1 and 14

Thanks for the help everyone.

 

[Fortunate]

Some things to note (So i have my plan documented for my own sake):
1. Genetic testing shows low SERT, Slow COMT (T/T), and low MAOA-A activity - all of these lead to anxiety states, which is my primary issue

2. Taking propecia 20 years ago MAY have lead to decreased allopreg, which is also the start of my panic attacks - I don’t think I’m a full on PFS guy

These two issues seem to point to a strong response (anxiety wise) to androgens. This would also explain why I’ve had feeling moments of great success on TRT when taking either Zoloft or Prozac. Erections returned, joy for live increased, rumination stopped.

Updated Plan (in order):
1. Trial Progesterone 20mg at night to see effects on mood, anxiety, etc.

2. If ineffective, return to low dose SSRI (Lexapro 2.5mg, or Sertraline 12.5mg, or Prozac 5mg) - These have to be sorted out based on conflicts between SERT, COMT, and MAOA-A issues

3. Once feeling stable, initiative moderate dose of TRT via either Nasal Gel or Xyosted 75mg SQ weekly

4. If all is going well and libido/erection issues persist, trial cream on thigh days 1 and 14

Thanks for the help everyone.

Per Dr. Saya, Wellbutrin has a positive effect on TRT, but I can’t say I know anything about this. If anyone else knows, please chime in.

 

[Charliebizz]

Any updates ?

 

[osirisrisen]

Any updates ?

Not yet, been reading a lot of genetic stuff, did my nutrahacker report, and seeing Dr. Rob in a few weeks.

I won the genetic lottery, slow COMT, low MAO-a, low GAD which can mean low gaba/high glutamate, and MTHFR!