Possible bipolar

[Mitch]

I was recently diagnosed bipolar, the doc has hinted he wants to pull me off trt. My testosterone prescribing doctor says there’s really no study to support being on or off trt if bipolar. Anyone have any experience?

 

[Gman86]

I was recently diagnosed bipolar, the doc has hinted he wants to pull me off trt. My testosterone prescribing doctor says there’s really no study to support being on or off trt if bipolar. Anyone have any experience?

I have no personal experience with bipolar, but it would make no sense that someone with bipolar would do better with low levels of testosterone, or have adverse reactions to optimal levels of testosterone.

I was listening to a podcast maybe a month ago, where the guy was talking to a really good psychiatrist, and he reported that he was curing his bipolar patients by optimizing thyroid function, with an 80% success rate. He reported that bipolar disease and hypothyroidism was extremely linked. So make sure you get a full thyroid panel done, if you haven’t already.

 

[madman]

I was recently diagnosed bipolar, the doc has hinted he wants to pull me off trt. My testosterone prescribing doctor says there’s really no study to support being on or off trt if bipolar. Anyone have any experience?

Psychiatric safety of testosterone replacement


A few older studies using physiologic doses of testosterone found a subjective increase in aggression, irritability, and hostility, although these changes were not observed on rating scales for mood and hostility.47, 48 Naturalistic studies following athletes who abuse steroids have shown significant increases in irritability, aggressiveness, and euphoria and manic symptoms. Steroid withdrawal also has been demonstrated to induce depressive symptoms in some users.49 There also is some evidence in the literature to suggest that steroids can lead to dependence or addiction.50, 51 In general, steroid use and certainly steroid withdrawal are believed to have the potential to produce adverse psychiatric effects, although these seem to be subtle in physiologic dosing and more prominent with markedly supraphysiologic doses.49




There are very limited data on the impact that testosterone might have on patients with bipolar disorder. One study found that patients with bipolar disorder and higher physiologic testosterone levels had an increased rate of manic episodes and suicide attempts.52 Although the risk is difficult to quantify given the paucity of data, testosterone’s antidepressant effect might produce an increased risk of mania in an analogous way to other available antidepressant treatments.



None of the testosterone-replacement studies for hypogonadism reviewed systematically evaluated for adverse psychiatric events such as irritability, aggression, paranoia, or mania. Depression rating scales such as the HAM-D, PHQ-9, and BDI do not capture these categories of symptoms despite their potential relevance. It would be useful in future testosterone-replacement studies to look systematically at these potential adverse psychiatric events.







Conclusion: clinical implications for psychiatric outpatients


It is important to keep in mind that testosterone is more likely to be a factor in depressive symptoms when the level is substantially below normal, although some men might have testosterone-responsive depression even in the borderline low range. There also is evidence that subthreshold depressive symptoms (not meeting full criteria for major depressive disorder) might be more responsive to testosterone. If testosterone is initiated, there is more evidence for the effectiveness of parenteral forms than oral forms of testosterone replacement.



We recommend that psychiatrists remain involved in the management of patients’ depressive symptoms in collaboration with a urologist or other medical provider experienced in testosterone-replacement therapies. Specifically, management of antidepressant and opioid medication might be of use to optimize the gonadal axis and to monitor for rare adverse psychiatric effects of testosterone.

 

[Mitch]

Your shrink knows less about TRT than a stranger who reads the stickies on this forum. Think about that for a second.

Lol... just getting conflicting responses from shrink and perscribing trt doc. More looking for guys with experience with my diagnosis.. there really isn’t a lot on the web about it.

 

[Mitch]

Your shrink knows less about TRT than a stranger who reads the stickies on this forum. Think about that for a second.

Assuming some sarcasm? Yes or no?

 

[Systemlord]

Assuming some sarcasm? Yes or no?

He was being serious.

 

[Gman86]

He was definitely serious. Your shrink knows literally nothing about hormones and endocrinology.

I would 100% keep testosterone levels optimized, through TRT, and look into other aspects in regards to curing your bipolar. Things such as thyroid, sleep, exercise, diet and supplementation.

THYROID - get a FULL thyroid panel done

SLEEP - make sure to get sunlight in your eyes for a few minutes as soon as you wake up. Then 4 hours prior to bed, put on a pair of specialty glasses that block green and blue light, so that your body can start making a bunch of melatonin. Also try not to expose too much of your skin to artificial light 4 hours prior to bed. And try to go to bed around 8-11pm, and try to get 7-9 hours of sleep. Improving sleep will always be the biggest factor in whatever your goal is healthwise. Curing bipolar disorder is no different.

EXERCISE - Lift weights up to 5 days per week. Throwing in some cardio here and there if you like as well.

DIET - remove all dairy, all gluten, and added sugar from your diet. Including artificial sweeteners. Only cook with solid fats, such as coconut oil and grassfed butter or ghee. Olive oil is fine to eat with, but only if you’re not cooking with it. It has a low temp at which it oxidizes and becomes a carcinogen. Rule of thumb is, if it’s solid, it has a high burn temp and you can safely cook with it. If it’s a liquid, don’t cook with it. Use it for dressings and things like that. Replace synthetic salt with good brand of sea salt.

SUPPLEMENTS - basically just supplement with certain vitamins and minerals you are deficient in. Common ones are vitamin D, b12 and magnesium. A good and easy way to get most of these vitamins and minerals is to take a desiccated grassfed beef liver supplement. This is the one I use. Most people also benefit from taking an omega 3 supplement. I use cod liver oil.
https://www.amazon.com/Ancestral-Supplements-Grass-Liver-Desiccated/dp/B01MSBZYQW

 

[James]

I'd think TRT can help a mood disorder if a hormone imbalance is making your symptoms worse, assuming the dose/scheduling is correct. But it's doubtful imo that bipolar can be treated by TRT alone and probably won't do what good mood stabilizers, like lithium can do.

You give a guy who's sensitive to E2, even a lower dose of T, and then condition him that AI's (even in micro doses) are bad, this can create another level of mood disorder.

 

[Gman86]

I'd think TRT can help a mood disorder if a hormone imbalance is making your symptoms worse, assuming the dose/scheduling is correct. But it's doubtful imo that bipolar can be treated by TRT alone and probably won't do what good mood stabilizers, like lithium can do.

You give a guy who's sensitive to E2, even a lower dose of T, and then condition him that AI's (even in micro doses) are bad, this can create another level of mood disorder.

I was listening to a podcast with a well respected psychiatrist, and he was talking about how in his practice he realized that a lot of people with bipolar, also had a thyroid imbalance. He reported on the podcast that he had an 80% success rate of either resolving their bipolar all together, or at least putting it into remission for large chunks of time, by balancing their thyroid hormones. I forget whether he was using medications in conjunction with the thyroid treatment. I want to say they were only using medication to treat their thyroid. Either way, hormones play a much bigger role in mood disorders than most people think. If correcting a thyroid imbalance can have this great of an effect with bipolar patients, I would assume correcting other hormone imbalances like testosterone and estrogen would have similar benefits. But you’re right, going on TRT and creating worse hormone imbalances than pre-TRT could potentially make a mood disorder worse, I would imagine.