Been Prescribed TRT, Progress Thread

Hey, some of you may recall I started a thread not long ago, and since I started a TRT protocol for nibido, 250mg every three weeks with a minor loading phase. The doc prescribed in this pattern to allow for quicker blood testing and adjustment for quicker stabilisation whilst on the super long lasting undecanoate ester.

the first shot didn’t have much of an effect, totally as expected.
3 weeks later, the second shot had a dramatic impact! the following six days after I felt like a new man, completely reinvigorated, horny, romantic with my partner, a strong desire to move and my friends and family said I was suddenly walking way faster and had more pep in general (strange what people notice!) - then it basically disappeared after those six days.
So me and my doc are considering a bi-weekly dosing scheme with subq because I’m quite comfortable self-administering.

HOWEVER, some side effects have now appeared and I really wanted to ask you guys for some advice.

I have since developed some pretty wicked insomnia, however it’s really weird and unusual - it ONLY happens during the hours 12am- 4am. If I fall asleep at 10 - I wake up bolt awake at 3am, akin to receiving a massive cortisol spike. I’ve started taking 1000mg Vit C to try and blunt this response but naturally cant see anything yet

To top this off, I have now developed unilateral breast tenderness / itching, around the general area, no nipple puffiness but an asymmetrical swelling on that side. There is NO palpable breast tissue, no golf ball, no hard pea, I’ve had a few people check and there’s nothing discernible present.
I discussed this with my doc and he said he would strongly prefer to avoid using aromatase inhibitors due to recent things he’s heard and seen.

He says they could be very bad for the heart in ways we don’t know yet, and all of his patients do fine without one on TRT, so long as they get the dosing pattern correct to minimise conversion. He said that this tissue swelling is a short-term response and that it should balance out in time, akin to teenage breast swelling during puberty.

I don’t have any typical excess eostrogen symptoms as far as I know, generally my libido has dropped but not to pre-TRT levels, it’s just a typical “not dialed in” type profile. No achy joints, no moodiness.

This leaves me feeling quite anxious naturally but I know that breast tissue doesn’t develop overnight and that I know myself, there is no signs of current tissue present other than these symptoms.
I would prefer to avoid AI use, just for simplicity’s sake, but I would consider using a SERM like tamoxifen to alleviate such symptoms if necessary.

Do you guys have any advice?

What you are probably experiencing is water weight which isn’t all to uncommon when first starting TRT, your tissues is holding onto more water and this is what you are experiencing. Your body will find a new balance, but it will take time, a long time because of the long half life ester of nebido.

It will take months to get stable levels on nebido.

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This would make sense, I think I am seeing an illusion of breast swelling - it is certainly itchy but I get itchiness on the other side too, albeit rarer and absent of any swelling.
I think this because on the side of the ‘swelling’ is also my dominant side, and my pectoral muscles are actually larger on that side, elevating the newly gained water weight into visible asymmetry.

It is unfortunate about how long the dialing in will take on nebido, but I will continue for now. I am planning on seeing a new doc soon (a well known TRT doc who is much more informed on the frontier of the field) but I can’t until after the Christmas period.

Having done some research around this topic, I see well known physicians such as Dr. Crisler (RIP) who ceased prescribing AI’s as a routine as he found Eostrogen side effects were often initial/transient complaints that resolved by themselves, prescribing tamoxifen only if the patient was distressed by the symptoms, and tapering later when the patient felt more stable.

I hope the insomnia side effects will also subside as I become more stable as it is a very stubborn insomnia. Thankfully I am pretty psychologically unaffected by insomnia, I know full well that it’s the ‘stress’ of not sleeping that actually hurts you the most when dealing with it. I just get up and brew a pot of relaxing tea now when I can’t sleep and get on with my shit. (which is surprisingly easier since starting TRT. I’m so much more ‘get on with it’ and ‘chill’ since beginning treatment. )

Some providers in the UK are importing cypionate, a lot of the doctors on the bleeding edge of TRT and dissing nebido as the worse TRT ester available considering all of the complaints.

TRT can worsen or cause sleep apnea.

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Going to try and get a better ester soon. Just need to wait until after Christmas

Thanks again Systemlord, you’re always the first to reply and offer help.

Appreciated.

@systemlord what do you mean by TRT can cause sleep apnea?

Theres no other way to put it, TRT can cause or worsen existing sleep apnea. I wasn’t given a choice by my provider, the sleep study was mandatory or I would have lost my TRT prescription.

It is new information for me that TRT can cause sleep apnea. I know it can worse an existing one. Can you provide some credible literature about it?

Obstructive Sleep Apnea and Testosterone Deficiency

@systemlord I read the article, and unless I missed something it does not explain how you will develop sleep apnea from TRT if you didn’t already have one

I’ve never been able to find a suitable explanation for TRT causing apnea.

Sleep apnea is often believed to be caused by a combination of factors such as neck and body size combined with hypotonicity of the muscles in the nasopharyngeal area.

I’ve read theories that the increase in red blood cell production triggered by TRT goes on to cause shortness of breath, which then causes deeper apnea, which then in itself causes an increase in red blood cell production, leading to polycythemia.

But this is all muddied by the fact that nearly all of the associations found are general remarks that the incidence of apnea is much higher in TRT populations. Which IS NOT helpful, as hypogonadism/low T is often secondary to preexisting sleep apneas.

I’m not really well informed on the matter, but I’m sure there are some individuals who will be able to elucidate on the topic.

I have been told I’ve been snoring more since starting but not sure I’d call that sleep apnea. But I was told that completely without asking or bringing it up so I don’t doubt it’s true in my case

I have conducted sleep study and they said I do not have apnea.
However my sleep is far from perfect since a bit mentally traumatic events 7 years ago. I suspect its from issues of cortisol and some of the nervous systems.

I have planned on starting TRT next month and really hope it improves my sleep or at least not worsens it

So far I’ve had one report of snoring since starting TRT from my partner. However my insomnia does not appear or feel related to apnea at all.

I’m certainly not overweight and I’ve never had issues which suggest apnea before.

The ‘flavour’ of insomnia I’m getting, if you will, is more like restless legs syndrome. As it gets closer to bedtime, I experience increasing energy levels, after going to bed and falling asleep (around an hour later) I wake up with ‘energy’ in my legs. I find I cannot stop moving my legs and shifting around in bed.

Getting out of bed alleviates this issue, but it returns quickly if I try to sleep again. The problem subsides after about 5am, at which point I can resume normal sleep.

I suspect this is coming from low ferritin levels. My last ferritin level was really quite low (48) <50
but that was quite a while ago. Low ferritin has an association with RLS and insomnia. TRT drives up red blood cell production, so it could hypothetically exhaust ferritin.

I will be getting my bloods tested very shortly and should know the answer by the end of the week.

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Definitely start with a low dose such as 100mg per week and divide it by two… You and me have very similar problems regarding adrenals/cortisol and sleep.
When i was on 100mg per week my sleep wasn’t affected… Since i started 150mg per week i am having terrible issues with sleep. I was planning to increase my dosage to 170mg to reach optimal FT but with this sleep issue , it seems not possible. Now I want to go back to 100mg per week despite having much lower FT with that protocol…

@kemosi Two times per week is horrible in my opinion. I will inject ED for sure. I want absolutely stable levels, no peaks and troughs.

As per the dosage doctor will say but I think I need at least 140mg per week, because my total test is 500 and seems with this high SHBG i will need to put it at least 900-1000 to start feeling better.

@kemosi Maybe its because you need to inject more frequently to cause less hormone fluctuations?

I really hope TRT to improve my sleep

How did it go with you about asking on the Facebook group about your cortisol test?

If I remember correctly, you had a mix of too high and too low through out the day right?

YOu ask me?

My cortisol is an interesting mess and I cannot say whether it is high or low, it is just messy

Do you have any thyroid and saliva cortisol tests to show us?