Testosterone replacement therapy (TRT) not working anymore need help please!

[steele-44]

TRT not working anymore need help please!

Hello, I'm new to this forum and I'm beginning to feel extremely desperate and I'm looking for some help. I have suspected of having low T for awhile I went to a Endocrinologist about 6 months ago who misdiagnosed me with cushings disease then came back and said it was low T. My T was 320 and I'm 20 years old. My estrogen was a 90. My endo then put me on 50mg of Cypionate once a week. I decided to go to my brother in laws doc who specializes in Hormone therapy. He immediately put me on an estrogen blocker. HCG and .75mg of cypionate once a week. I felt good fr the first two months or so and in the last 3 weeks I've been declining to where I don't feel its working anymore. I never was able to fully get out of depression and it has taken a dive lately and I'm extremely depressed and feel like if this doesn't work I'm not sure what' next. In addition, my joints have started hurting again like it did before I started TRT. I called my doc and he told me to wait 3-4 days from last day of taking medicine and go get blood draw to check T, Estrogen, and thyroid. Why do you think it isn't working anymore? What should I do?

 

[3J]

well.. whats the estrogen blocker he has you on?

and he has you on 75mg of test a week?

 

[bigben34]

.double post

 

[bigben34]

Your joints hurting could definitely be a symptom of your E2 being too low, along with being depressed. You're taking a pretty low dose of test, so you may not even need the Aromatase inhibitor (AI). Everyone is different, I take 150mg a week and don't need the Aromatase inhibitor (AI). I think you should do the lab tests asap and go from there. Don't make any changes until you see the bloodwork. Make sure the E2 test is the sensitive assay.

I second that...what Aromatase inhibitor (AI) and how much per week?

 

[steele-44]

I'm taking an Anastrosle Estrogen Blocker of .5mg twice per week, and .75 mg of testosterone cypionate once per week. Thank you for the quick response I appreciate it I don't like anti-depressants and I've never had a problem with depression or anxiety until the low testosterone stuff started happening and I don't want to talk to a counselor if there's a correlation with TRT. Sorry if I double posted

 

[steele-44]

Sorry Anastrosle is .5mg twice weekly Cypionate is .75ML once weekly and HCG is .1ML twice weekly

 

[jomamma007]

That's wayyyyyyyyyyyyy too much.
You probably don't even need it
STOP THE Aromatase inhibitor (AI) UNTIL YOUR NEXT BLOOD WORK. IT'S BETTER TO HAVE HIGH ESTROGEN THEN LOW ESTROGEN AS YOU ARE NOW FINDING OUT. I'd say 10% of people would need an Aromatase inhibitor (AI) at that dose so drop it brotha!

Edit theres a big difference between 75mg and .75ml...
.75ml = 150mgs generally

Have you had any blood work so far on testosterone replacement therapy (TRT)? If not we can't help much. Joint pain usually indicates low estrogen, but if you're getting blood work soon I would just lower your adex to .25mg twice a week.

Make sure you get at least
Total Test
Free Test
Estradiol sensitive(make sure you ask for this, the standard estradiol test is designed for females)
SHBG

150mgs is a high starting point for trt. You'll see guys on here on 300mgs per week but I don't think that's right unless they need it to get their levels up.

For most 100mgs will put guys at 800-1000 which is the top of the ranges.
We need blood work...

 

[steele-44]

So I'm confused what is causing the depression and joint pains? I'm just confused and I'm not sure why I'm feeling the way I am or why it's s difficult to gain muescle or why my testosterone is so low to begin with?

 

[bigben34]

So I'm confused what is causing the depression and joint pains? I'm just confused and I'm not sure why I'm feeling the way I am or why it's s difficult to gain muescle or why my testosterone is so low to begin with?

No one can tell you for sure without labs but if I was a betting man, which I am, I would put a lot of money on your E2 being too low from too much Aromatase inhibitor (AI). You might even need a higher dose of test as well. I went too low on my e2 once and it was miserable.. I was anxious, agitated, and couldn't keep it hard to save my life... Get those labs done ASAP. Also, you need estrogen to build muscle.. So that would make sense as well.

 

[Megatron28]

So I'm confused what is causing the depression and joint pains? I'm just confused and I'm not sure why I'm feeling the way I am or why it's s difficult to gain muescle or why my testosterone is so low to begin with?

Hormone imbalances can cause depression. Sometimes it is hard to tell the difference between Low T symptoms and depression. Are you sure you are depressed or just too fatigued to want to do anything?

A sign of low Estradiol is joint pain.

It is difficult to put on muscle when you don't have enough testosterone.

Why is it so low? Could be many reasons.

Testicles not working properly
Pituitary not working properly
Hyper or Hypo Thyroidism
Sleep Apnea
Mumps
Diet
Stress
Pituitary tumor
Etc

Were you diagnosed with primary or secondary hypogonadism? Do you have your lab work from when you were being diagnosed? And any relevant medical history?

Here is some good reading for you.

https://aace.com/files/hypo-gonadism.pdf

 

[SolomonGrundy]

yup too much Aromatase inhibitor (AI) , lower your dose .. shit at .75 a week you dont need one unless the blood work say so

 

[jomamma007]

thats 150mgs,,, a lot of guys need an Aromatase inhibitor (AI) at that dose

 

[steele-44]

Hormone imbalances can cause depression. Sometimes it is hard to tell the difference between Low T symptoms and depression. Are you sure you are depressed or just too fatigued to want to do anything?

A sign of low Estradiol is joint pain.

It is difficult to put on muscle when you don't have enough testosterone.

Why is it so low? Could be many reasons.

Testicles not working properly
Pituitary not working properly
Hyper or Hypo Thyroidism
Sleep Apnea
Mumps
Diet
Stress
Pituitary tumor
Etc

Were you diagnosed with primary or secondary hypogonadism? Do you have your lab work from when you were being diagnosed? And any relevant medical history?

Here is some good reading for you.

https://aace.com/files/hypo-gonadism.pdf

Megatron28,
I think it's both I'm very much too tired to do anything and I feel like I'm depressed and just irritable and critical of everyone and everything. On a side note I read that PDF link you attached and it was very helpful what would cause little volume of ejaculate I'm experiencing that as well. I'm not sure which type of Hypogonadism I was diagnosed with they just told me hypogonadism. Below were my labs from before I started TRT...

Globulin Total 1.9
T4= .83
TSH 1.2
Cortisol 0.8
Estrogen 90
LH 10.2
FSH 3.7
prolactin 8.2
Sex Hormone Binding globuline, serum 19.9
Testosterone 320
Free 9.1
DHEA Sulfate 481

 

[SilverBackGorilla]

Steele, they're gonna need the ranges for those tests you had.

 

[Megatron28]

Megatron28,
I think it's both I'm very much too tired to do anything and I feel like I'm depressed and just irritable and critical of everyone and everything. On a side note I read that PDF link you attached and it was very helpful what would cause little volume of ejaculate I'm experiencing that as well. I'm not sure which type of Hypogonadism I was diagnosed with they just told me hypogonadism. Below were my labs from before I started TRT...

Globulin Total 1.9
T4= .83
TSH 1.2
Cortisol 0.8
Estrogen 90
LH 10.2
FSH 3.7
prolactin 8.2
Sex Hormone Binding globuline, serum 19.9
Testosterone 320
Free 9.1
DHEA Sulfate 481

You didn't include reference ranges. But your LH looks like it was on the high side. That usually indicates primary hypogonadism. Do anything to harm your testicles? Have you consulted with a urologist?

Estrogen isn't very useful. Always measure estradiol instead. Get yours checked out now to see where you are at.

 

[steele-44]

You didn't include reference ranges. But your LH looks like it was on the high side. That usually indicates primary hypogonadism. Do anything to harm your testicles? Have you consulted with a urologist?

Estrogen isn't very useful. Always measure estradiol instead. Get yours checked out now to see where you are at.

Globulin Total 1.9 range= 1.5-4.5 g/dL
T4= .83 range= .82-1.77 ng/dL
TSH 1.2 range= .45-4.5
Cortisol 0.8 range= 6.2-19.4 ug/dL
Estrogen 90 range= 40-115pg/mL
LH 10.2 range 1.7-8.6 mIU/mL
FSH 3.7 range= 1.5-12.4 mIU/mL
prolactin 8.2 range= 4.0-15.2 ng/mL
Sex Hormone Binding globuline, serum 19.9 range= 16.5-55.9 nmoI/L
Testosterone 320 range= 348-1197ng/dL
Free 9.1 range=9.3-26.5 pg/mL
DHEA Sulfate 481 range 211-492 ug/dL

 

[bigben34]

Globulin Total 1.9 range= 1.5-4.5 g/dL
T4= .83 range= .82-1.77 ng/dL
TSH 1.2 range= .45-4.5
Cortisol 0.8 range= 6.2-19.4 ug/dL
Estrogen 90 range= 40-115pg/mL
LH 10.2 range 1.7-8.6 mIU/mL
FSH 3.7 range= 1.5-12.4 mIU/mL
prolactin 8.2 range= 4.0-15.2 ng/mL
Sex Hormone Binding globuline, serum 19.9 range= 16.5-55.9 nmoI/L
Testosterone 320 range= 348-1197ng/dL
Free 9.1 range=9.3-26.5 pg/mL
DHEA Sulfate 481 range 211-492 ug/dL

As Megatron said, the fact that your LH is looking good, indicated that your balls aren't working so well. Thats one concern, but the fact that your cortisol is almost non-exisistent is a pretty big red flag. Thats typical of Addison's disease...Or it could be that your pituitary isn't producing enough ACTH. Since your pituitary is producing LH, FSH, and Prolactin normally, I would probably lean towards a problem with your adrenal glands. Your T4 is also borderline.

Did your doc address any of these other issues?? As far as I know, your testosterone replacement therapy (TRT) isn't going to be very effective for you if you have prior adrenal and/or thyroid issues. Those things need to be taken care of as well. If your doc didn't address those issues with you, especially the cortisol level, then you need to find a new doc IMO.

I just saw that your endo had originally diagnosed you with Cushing's...Cushing's is prolonged levels of high cortisol...Addison's is low cortisol...your cortisol is 0.8...wtf am i missing here??

 

[juced_porkchop]

Hello, I'm new to this forum and I'm beginning to feel extremely desperate and I'm looking for some help. I have suspected of having low T for awhile I went to a Endocrinologist about 6 months ago who misdiagnosed me with cushings disease then came back and said it was low T. My T was 320 and I'm 20 years old. My estrogen was a 90. My endo then put me on 50mg of Cypionate once a week. I decided to go to my brother in laws doc who specializes in Hormone therapy. He immediately put me on an estrogen blocker. Human Chorionic Gonadotropin (HCG) and .75mg of cypionate once a week. I felt good fr the first two months or so and in the last 3 weeks I've been declining to where I don't feel its working anymore. I never was able to fully get out of depression and it has taken a dive lately and I'm extremely depressed and feel like if this doesn't work I'm not sure what' next. In addition, my joints have started hurting again like it did before I started TRT. I called my doc and he told me to wait 3-4 days from last day of taking medicine and go get blood draw to check T, Estrogen, and thyroid. Why do you think it isn't working anymore? What should I do?

just because you are on test doesnt mean you will not feel depressed. sure having natural or even high test levels may help, but there are many with high test levels and are still depressed. i would look into cognitive therapy.

the forst few weeks may have been placebo effect.. its not going to stop working. go for blood work if estrogen is normal and test is good then is is your thought patter/ internal dialog that needs to change, therapy is good for that.

good luck man.

 

[juced_porkchop]

As Megatron said, the fact that your LH is looking good, indicated that your balls aren't working so well. Thats one concern, but the fact that your cortisol is almost non-exisistent is a pretty big red flag. Thats typical of Addison's disease...Or it could be that your pituitary isn't producing enough ACTH. Since your pituitary is producing LH, FSH, and Prolactin normally, I would probably lean towards a problem with your adrenal glands. Your T4 is also borderline.

Did your doc address any of these other issues?? As far as I know, your testosterone replacement therapy (TRT) isn't going to be very effective for you if you have prior adrenal and/or thyroid issues. Those things need to be taken care of as well. If your doc didn't address those issues with you, especially the cortisol level, then you need to find a new doc IMO.

I just saw that your endo had originally diagnosed you with Cushing's...Cushing's is prolonged levels of high cortisol...Addison's is low cortisol...your cortisol is 0.8...wtf am i missing here??

look into the above mate--^

 

[steele-44]

As Megatron said, the fact that your LH is looking good, indicated that your balls aren't working so well. Thats one concern, but the fact that your cortisol is almost non-exisistent is a pretty big red flag. Thats typical of Addison's disease...Or it could be that your pituitary isn't producing enough ACTH. Since your pituitary is producing LH, FSH, and Prolactin normally, I would probably lean towards a problem with your adrenal glands. Your T4 is also borderline.

Did your doc address any of these other issues?? As far as I know, your testosterone replacement therapy (TRT) isn't going to be very effective for you if you have prior adrenal and/or thyroid issues. Those things need to be taken care of as well. If your doc didn't address those issues with you, especially the cortisol level, then you need to find a new doc IMO.

I just saw that your endo had originally diagnosed you with Cushing's...Cushing's is prolonged levels of high cortisol...Addison's is low cortisol...your cortisol is 0.8...wtf am i missing here??

Big Ben and Megatron 28,
The first time they drew my blood all the numbers were the same except my Cortisol was a 19.8 with the range 6.4-19.4 then the most recent was the numbers here with the cortisol basically non-existent. The doctor didn't address any of the other numbers just said it was probably a result of low T. and he was an endo at the mayo clinic in AZ. After that doctor I left and went to a hormone specialist who put me on an Aromatase inhibitor (AI), HCG, and T. He then wanted to see what that did and go from there 2 months later. I went to get my labs this morning and I'm supposed to go see him next Wednesday. The thing is I can't ever remember taking any blows to the testicles growing up but it is possible. I played lacrosse and football all through high school then served in the army after. So it is possible I took trauma to the testicles.