Testosterone replacement therapy (TRT) Issues

[willnorthwest]

TRT Issues

Hey guys. I have been on testosterone replacement therapy (TRT) for almost 3 months now. Before I started testosterone replacement therapy (TRT), I was very tired all the time, I had anxiety issues, and libido was almost non-existent with troublesome ED problems that were only alleviated by the use of Viagra. At first, the testosterone replacement therapy (TRT) pretty much changed all that. After 2 or 3 weeks, I had incredible energy, no anxiety, and my libido soared. I was hitting the weights at the gym and making great gains. About two weeks ago, however, I started to notice that my pre-TRT symptoms were slowly coming back. I have been tired throughout the day, anxiety is starting to creep up on me again, and my libido and erection quality has plummeted. I also have not been sleeping good at night, unlike the first few weeks on TRT. I have read through multitudes of posts that this reversal happens quite often, but I was hoping that it wouldnt happen to me, and that I would continue to reap the benefits of my new found youthfullness. Until then, I had been injecting 100mg cyp every 5 days, with a 500iu shot of hcG the day before my cyp shot. I did not use an Aromatase inhibitor (AI) because my original pre-trt Estradiol Sensitive score was only 9. Well, 2 weeks ago, after i began to notice my decline, I decided to go to the lab and get some blood work done the day of my next scheduled injection(prior to actual injection, of course). My total test was good at 696, but my Estradiol Sensitive score was flagged abnormal at 47. The CBC that was done all came back normal, with normal RBC, WBC, Hemaglobin etc.... The only things I did not get tested for that maybe I should have was Sex Hormone Binding Globulin (SHBG), Prolactin, and Prostate Specific Antigens (PSA).
After getting my results back, my testosterone replacement therapy (TRT) advisor recommended that I start using Anastrazole to help counter the heightened Estradiol score. I have now included .50mgs of Anastrazole the day after my cyp shot (so basically .50mgs every 5 days) with the hopes of lowering my Estrogen into the 20-something range.
I guess what Im looking for at this point, is maybe some guidance, as well as some re-assurance that testosterone replacement therapy (TRT) is a good, lasting way to feel and look better, rather than something that works for a month or two and then dissipates. I would like to hear from some long time testosterone replacement therapy (TRT) users with their input as to what maybe is going on with me, and what I need to do to get back to those weeks when I was feeling like a champ. Should i go back to the lab in a week or so to re-check those Estradiol levels and see if the Anastrazole is helping? Should I increase my cyp dosage? Help me figure out a plan to optimize my testosterone replacement therapy (TRT) so that I can feel great again. Thank You very much for taking the time to read this, and all input is greatly appreciated.

 

[halfwit]

3 and a half years on testosterone replacement therapy (TRT) myself and I will NEVER look back! The problem as you noticed is that your E2 climbed to a point that made you feel like crap and the Aromatase inhibitor (AI) should help sort this out. Do you pin yourself? If so, you can try injecting every 3.5 days to help smooth out the spikes that are inherent with such a long frequency in between injects as you're currently doing. If you do switch to that, be sure to lower your Aromatase inhibitor (AI) accordingly and take it in the same manner.

TRT is definitely a learning process as it takes time to figure out exactly where to go and what doses/scheduling works best for you. It took me the better part of a year to get mine sorted out and I can say with total honesty that it was COMPLETELY worth it in the end. You will feel better, you just need to give it time my friend.

My .02c

 

[willnorthwest]

halfwitt....thank you for helping. Do you think if my estrogen was lowered, then I would begin to feel better again? how long does it take for the Anastrazole to take effect usually? I have been taking it for about 10 days now, so hopefully it will start to kick in about now. I guess maybe i should go on the third week to have it re-tested? Also, do you think there are any other things i should check? How important is SHBG and prolactin? Could this be an issue for me as to why I have started to feel a decline?

 

[Mprtz]

I'm right at the same point, 10 weeks or so in and on a very similar program. I do think there is a psychological component once the initial euphoria wears off... What 200mg a week did for me in the first 6 weeks was amazing, now I won't say that I'm getting worse, but my strength gains and body composition changes have leveled off. I do think libido was highest in the first few weeks, perhaps because my meager endogenous production was not supressed yet.
I just changed to 100mg every 3.5 days and an additional .5mg Anastrazole per week because like you, my E2 was kind of high on recheck. I'm kind of surprised they did not recheck your PSA. It was a great relief to me when mine went from 0.9 to 0.8 (rather than somewhere higher). I'll be following your progress with interest and hope you figure out how to get that champ feeling back soon.

 

[halfwit]

You should start to notice a change pretty soon as arimidex usually takes about a week to effectively reduce E2. Keep in mind, that you still have to excrete the extra estradiol, so I'd make sure to drink some extra water and get to sweating! SHBG can be important as it is what affects your levels of free testosterone, but if free test levels are fine - I wouldn't stress about it. Prolactin should be checked as this bugger of a hormone is responsible for all sort of problems like sex drive/ED/and even gynecomastia. Odds are it's not super high, but if you have elevated E2, prolactin can follow suit, making things messy.

I'm pretty sure it's just E2 getting out of whack. I remember a period of time where I would fall asleep every day at noon regardless of where I was. I found out that my E2 had climbed into the 200's(!) as my adex was apparently garbage at that time. I'm very happy I didn't sprout C-cups from that, or I would have been pretty upset.

 

[willnorthwest]

Also.....Although my estrogen score is elevated at 47, i have seen some posts where people's estrogen have been much much higher, sometimes over 100. Could my estrogen levels be the root cause here? or am i missing something else here?

 

[willnorthwest]

Thanks guys.... I will call my doctor tommorow and see if I can get a much more comprehensive test done. I usually circumvent them and use private md labs because I can test for what I want, when I want. Usually the doctors will feel compelled to tell you what tests need to be done and which ones dont. I have never had a PSA test done!

 

[willnorthwest]

Also, how often do you guys go for bloodwork? I use Private MD labs and it can be pretty costly.

 

[halfwit]

Also.....Although my estrogen score is elevated at 47, i have seen some posts where people's estrogen have been much much higher, sometimes over 100. Could my estrogen levels be the root cause here? or am i missing something else here?

You have to remember, everyone has a different tolerance to estrogen. I do know guys that have felt "fine" and popped over 400mg/dl on their tests, while others have felt deathly ill and been at about where you are. Did you get a lot of acne as a teen? I'm kind of working on a theory that those with acne issues in their adolescence might be more sensitive to estradiol than others and therefore would have a harder time with testosterone replacement therapy (TRT) and E2 balancing.

I do think it's a great place to start as the side effects of high estradiol are VERY similar to those of low testosterone. Sluggishness/being tired/brain fog/irritability/moody/etc. If your levels have declined and you're still not feeling well, then it might be time to look at other possible culprits, but you want to tackle one possibility at a time.

Also, how often do you guys go for bloodwork? I use Private MD labs and it can be pretty costly.

Yes, but I use the "female hormone panel" since it's 50 bucks. You miss a few goodies on it, but I have insurance to cover those with my doc if need be. I test roughly every 3 months or so.

 

[riprockwell]

As being a testosterone replacement therapy (TRT) patient myself, it looks like you are having some estrogen issues. Remember, everyone is different with estrogen. I know some guys who can have their estrogen at 50-60 and be completely fine. Me for example, I can't have my estrogen below 20 or above 30. I have to be in that range. If my estrogen gets below 20, then I have some of the issues you describe. If my estrogen is above 30, I also get the same issues including excess water retention/bloat, etc. testosterone replacement therapy (TRT) takes a while to dial in and you will have to see what your body prefers. Took me a good year to get dialed in. I would also get on a plan to donate blood every 3 months as well to keep your RBC/Hemo in check. EDIT: I just noticed your RBC/Hemo is normal but just keep an eye on it because testosterone replacement therapy (TRT) will generally elevated it over time for most guys. You might also want to check your thyroid as well just to make sure everything is good there.

 

[Mprtz]

Thanks guys.... I will call my doctor tommorow and see if I can get a much more comprehensive test done. I usually circumvent them and use private md labs because I can test for what I want, when I want. Usually the doctors will feel compelled to tell you what tests need to be done and which ones dont. I have never had a PSA test done!

I don't remember if you mentioned how old you are, but checking PSA prior to starting testosterone replacement therapy (TRT) is pretty standard, as the medical perception is that T will fuel the growth of prostate cancer (though there seems to be increasing controversy about this).
I'm almost 50 and my father developed PC so it's always a concern for me.

 

[willnorthwest]

wow this very informative. thank you all. yes i had horrible acne as a teen. i had to get on prescription medicine to help with my acne. to this day, i get back acne quite often.

 

[willnorthwest]

mprtz....im 34 years old. i will get my prostate checked soon, thanks

 

[drewsicle3210]

Can I jump on this thread with a couple questions?
I just started testosterone replacement therapy (TRT) about 7 days ago, with 100mg IM. The doc states I will get an injection every 2 weeks. This seems extremly low and infrequent. SHould I ask her to do it once a week? Or just wait and see what her plans are.

30 years old, Total test- 246, free test 65.

Thanks.

 

[willnorthwest]

drewsicles.....i would definitely pin at least once a week. 100mg per week is a good starting point in my opinion.

 

[willnorthwest]

can testosterone injections have a negative effect of sleep quality? im aware that testosterone replacement therapy (TRT) can exacerbate sleep apnea issues, but im wondering if testosterone replacement therapy (TRT) can disrupt sleep in other ways. i have noticed that for a few days or so after my injection, that i do not feel rested in the mornings, and that i wake up a few times during the night. wanted to know your thoughts

 

[Mprtz]

Can I jump on this thread with a couple questions?
I just started testosterone replacement therapy (TRT) about 7 days ago, with 100mg IM. The doc states I will get an injection every 2 weeks. This seems extremly low and infrequent. SHould I ask her to do it once a week? Or just wait and see what her plans are.

30 years old, Total test- 246, free test 65.

Thanks.

That's certainly a very conservative dosing schedule. You can ask her to increase it, but she might resent you second guessing her approach. Don't even mention the internet. Does she seem reluctant to provide you with testosterone replacement therapy (TRT) from the start?

It seems to me there are two fundamentally different ways to approach this. If you go to your primary doctor, he/she will quite possibly take a dim view of testosterone replacement therapy (TRT) and take an approach to prescribe the minimum to address your symptoms. He or she may also not be up on all the latest techniques in testosterone replacement therapy (TRT), or disapprove of them, like using Human Chorionic Gonadotropin (HCG) or AIs.

If you go the other route and seek out an anti-aging, men's health or online clinic type provider, they are far more likely to be more generous and provide the most that they can medically justify, i.e. getting you up into the upper end of the physiologically "normal". They know why you are there and why you came to them. BUT: if things go sour, i.e. your PSA goes up, lipids or other problems they may "dump" you and send you to an urologist, etc. They're just not likely to have the same sense of responsibility for you.

 

[halfwit]

wow this very informative. thank you all. yes i had horrible acne as a teen. i had to get on prescription medicine to help with my acne. to this day, i get back acne quite often.

Yep, that's what I thought. I have a feeling that there are folks predisposed to estrogen sensitivity which could explain why some of us can go way out of range while others have to tread very carefully or they feel like crap.

can testosterone injections have a negative effect of sleep quality? im aware that testosterone replacement therapy (TRT) can exacerbate sleep apnea issues, but im wondering if testosterone replacement therapy (TRT) can disrupt sleep in other ways. i have noticed that for a few days or so after my injection, that i do not feel rested in the mornings, and that i wake up a few times during the night. wanted to know your thoughts

There are a TON of variables at play here. I do suffer from non-obstructive sleep apnea which was diagnosed after I started testosterone replacement therapy (TRT), but I am 99% sure I had it before I started therapy. I do know that if you've been suffering with low-t for an extended period of time, you will likely start to build muscle mass, which could affect your sleeping patterns. There's also water retention from elevated estradiol playing games with your cardiovascular system, which can do this as well. I'm not a doctor by any means, but I can see testosterone replacement therapy (TRT) introducing or magnifying already existing conditions that may not have been noticed previously.

Go get a sleep study done. They're over in one night and if you get put on a CPAP, it can be a life-changer.

 

[Ocdude]

Will thanks for asking these questions! I'm about a month and a half in, now. Have a follow up with the doc tomorrow to see where my levels ended up on 100mg cyp a week. After reading your experience I'll definitely be checking my E2 out soon!
I did notice that things were great the first couple weeks, and then libido leveled off and tapered a bit following. I can only assume this is because of the shutdown of natty test. Not sure where he'll want to get me numbers wise, but I'm curious to see where 100mg actually put me. Its unfortunate that science hasn't come up with a study on average blood levels for a specific constant dose (100/week, 150/week, 200/week). Maybe I'll suggest it to him hahaha

 

[willnorthwest]

I guess I just might be very sensitive to Estrogen. Prior to starting testosterone replacement therapy (TRT), my Estrogen was only 9, so I guess im naturally inclined to have lower E scores. I guess this elevated E, even though it isn't "through the roof" must be considered pretty high for someone like me.