Do Psychiatric Meds and TRT Mix?

Pharma TRT
61

I guess I worded that improperly. I meant to ask if it’s like medications where if you get off of it things go back to baseline.

100% couldn’t agree more. I’m just iffy on my endocrinologist since he treats a lot of diabetes & thyroid patients, but I’m not sure about his expertise in TRT.

I did my research after seeing him and ordering the labs (which were ordered in October and that I hadn’t done until April… which tells you how much I’ve been procrastinating), and only recently have been doing a ton of research into TRT. Most of the reading I do that I’m frustrated I can’t fully comprehend is testosterone-related.

Finally found a doctor (urologist) that has a lot of TRT patients, top 5% in treating patients where I live, and he didn’t have appointments available until June.

So I’m thinking keep an appointment with him for June, but start in the very near future whenever I can get an appointment with him.

Here’s some info on him: http://urocellz.com/wp-content/uploads/2016/02/KarpmanCV.pdf

Edit: What blood labs do / should most doctors usually check with low-T patients? Here’s a picture of the labs my endo ordered for my low T initially (labwork done 4/6)… almost a 6 month gap between being given labs and completing them…:

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Granted, I didn’t do it between 7-9 AM, it was done at 1 PM. Let me know what you think.

62

I don’t know about testerone but am happy you’re going to a dr. Luckily, where I live there are drs galore. How are you feeling?

63

No SHBG, estrogen or reverse T3 labs, kind of pointless to not have those tests. SHBG is the gold standard for evaluating hormones in men, whoever ordered those labs doesn’t have a clue. You can have a total T of 800 ng/dL, but if SHBG is high enough it would mean free T is bound up and unavailable. You would then need TRT.

64

That’s literally the gut feeling I got from him. He was nice but in my opinion greatly uninformed about TRT. Thanks since that helps me feel a little bit better about my ability to weed out docs.

My total T on April 6 was 224 ng/dL (ref range 250-827), posted labs higher up in the thread. Free T as you can see from the labs wasn’t even checked that time, which makes me wary of the doctor like you suggested. The last time it was checked it was in December 2016 where it was 65.1 (ref range 35-155; total T was also 350 ng/dL at the time – ref range 250-1100), and before that in Sept 2015 where free was 57.3 and total 341.

If you were in my shoes and had to either wait until June for a really good doctor (have to wait so long even jusr for a consult due to office protocol / I’d technically be a new patient; had I not been I would’ve been seen stat) to manage your TRT or could start pretty soon (within the next week or two), which would you choose?

I also don’t want to wait since my insurance runs out in the middle of June.

65

fT3 is well above mid-range and I did not see that you posted oral body temperatures as was suggested. Low thyroid function = low energy and mood problems.

67

Sorry my sleep schedule’s been messed up and I keep forgetting. Need to put reminders in my phone. When I checked it after waking up / before eating a few days ago it was at 97.6.

Today, at 4:30 PM my time post-meal, it was 97.8. But also woke up around 1:30. So not sure how much of an impact that had. Trying to fix sleep schedule, figure that would help me out regardless. Could easily fall asleep right now if I wanted to, but forcing myself to the gym.

Taking even a low dose of Adderall just to stay awake is a problem, so I definitely feel like I have a problem with that as well. I.e. 2.5mg at midnight when I should be sleeping. Brain is in a major fog and feel like I’m walking against wind when I walk. Def need to re-establish good REM.

But FT3 seems to be high for sure. Could be another reason why I’m so tired as well, I think someone on here mentioned sub-clinical hypothyroidism.

Will definitely check temps regularly for a few days starting tomorrow.

68

Yeah, same here. Think that’s the case pretty much anywhere when you’re near major cities in the states.

Feeling ok. Kinda shorter temper like I said and lower energy, but still forcing myself to the gym pretty much every day.

Disappointed at the daily tasks I can’t get done, but taking solace in the little things

69

At least you’re fighting it cuz I know it can be a bitch. I’m glad I got a good night sleep and a nap yesterday afternoon. I fell asleep in middle of hockey game. Frustrating but happy I got some much needed rest. Especially if we’re having poker night this weekend.

70

Hey KSman, so I checked my oral temps today and it was 97.4 degrees F upon waking (at 3 PM) and 97.9 before bed at 97.9 degrees F.

This could be indicative of hypothyroidism, right?

71

Definitely can be a huge bitch. Hope you’re having a good week!

72

Actually I’m a little frustrated. I try to “give back too much”. Not with you but some…it’s frustrating cuz I honestly am trying to help but feel as if I’m not being taken seriously. Edit I just realized it’s their loss not mine. Why should I care?

73

fT3 was above mid-range and oral body temperatures are low. TSH is elevated. This suggests adrenal fatigue, see the sticky for related info.

When adrenals are involved, we should also look at DHEA-S and AM cortisol. AM cortisol should be done at 8AM or 1 hour after waking up.

Low T, low cortisol and low thyroid function drain your energy and lower mood, strongly contributing to depression. Doctors often prescribe AD meds for these hormone imbalances because they do not know better. So you may be able to improve your mental health to some extent by investigating and resolving these hormone issues.

1 Like
74

Will do, thanks. I actually had some issues with my workout on Saturday and was completely exhausted, and somehow came across the issue of adrenal fatigue before even reading this. I’m usually one to push myself to my limit, but just found myself incredibly exhausted, like I literally couldn’t go anymore. All I wanted to do was sleep and waste away.

I have labs tomorrow morning at 8:15 AM, so I definitely am hoping to get some good sleep tonight. Thanks KSman.

75

Ah, jeez :frowning: well hope you’re feeling better!

76

Pretty much better but hubby woke me up and can’t fall back asleep.

77

Hi all,

Reading through this, and the advice is impeccable. I actually had one more round of labs done, and here are the results:

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Ever since stopping the Prozac in March, my mental health has dramatically declined. I still take the Adderall 20mg PRN, but am almost required to take it daily if I want to be barely functional. If anything, I realized that I may not even be ADHD since the Adderall agitates me way too much but fear stopping because of the withdrawal.

I’ve gone from a mild depression with fatiguability where my social life was still intact and I was able to enjoy things, where although things weren’t perfect I still managed with a positive attitude, to a chronically severe one where I’m miserable and hopeless. I feel angry far more often than I used to, and my ability to remain calm and reasonable mentally almost fleeting.

I had the energy to cook meals, go to the gym, and take care of other ADL’s. It’s really making me question whether or not I did the right thing getting off, and I know that it takes 2 weeks-3 months for antidepressants to gain effect if I was to get back on.

Now I’m forcing myself to do moderately helpful cardio most of the time since my lifting is terrible, my sex drive is even more nonexistent.

I did have two and maybe three concussions in the past, with the last one in November 2016 being the most severe and causing a lot of physical and mental fatigue. My QOL overall is extremely poor, and it seems like there’s a mental wall between taking action and feeling good, because anytime I do take action now feel physically and mentally drained very quickly. On top of that, whereas I used to enjoy eating on a regular schedule, I don’t really have the energy to eat. I feel empty inside and it’s tearing me apart, sounding whiny is also very unlike me but it makes me feel so overwhelmed and powerless at the same time.

I had an appointment with another doctor yesterday, an endocrinologist I have seen before, who gave me Clomid at the drop of a hat just from me mentioning it, but I’m not even sure if I want to take it. He didn’t really seem to know what he was doing.

In terms of testosterone, I have an appointment scheduled in about a month with someone who seems like a TRT specialist, Dr. Robert Karpman, located in Mountain View, California.

My major fear is that if I was to get on antidepressants, I’d be unable to reap the full benefits of testosterone therapy and even notice if it is the testosterone that’s improving my symptoms in the first place.

TL;DR, how much does testosterone therapy generally help with someone who is depressed? I know my depression is partially because of the consistent low energy / fatigue which is a clinical symptom of low testosterone

78

Taking Clomid while going through withdrawal is not such a good idea knowing what Clomid does to the majority of guys. It could sabotase your withdrawal effects and force you back on Prozac.

I really like your thyroid numbers which is nice to see for a change, but total estrogens is useless as a diagnostic tool, no action can be taken from the results. The body has three different estrogens, speaking of estrogen sensitive I don’t like it given your lower Total T score which makes you estrogen dominant.

Pituitary gland is strong, testicles aren’t. You’re looking to have primary hypogonadism, LH is near the top of the ranges and testosterone is low, Free T is also lower, testicles are responding poorly. SHBG is low enough to where injections EOD will be crucial to successful TRT.

My SHBG fluctuates between 16-18 while on TRT and I only respond well on 15-20mg EOD. I’m recommending anyone below 20 SHBG be injecting on an EOD protocol, there’s just no reason not to since SHBG can fluctuate.

Free T with Albumin accounted for is 9.47 ng/dL = 2.5 % which is where you want to be within the 2-3 percent, if your Free T3 thyroid hormones were low, which they aren’t, I wouldn’t like these numbers so much. I would have liked to see Reverse T3, reason is I have a TSH of .91 and good free thyroid hormones all around much like yours with the exception of high normal Reverse T3.

Reverse T3 competes for the same receptor as Free T3 and effectively slams on the brakes metabolically, if Reverse T3 is elevated which I suspect it is do to this Prozac withdraw your going through.

79

Thanks a lot, this definitely helped me. Reading on FSH and LH right now. I was looking at 2015 numbers, when I was on a lot of psych meds, and my numbers were: FSH (4.5 mIU/mL) and LH (4.8 mIU/mL). Total T3 was also 143 ng/dL which I’m guessing is kind of high.

The Prozac withdrawals have been over for a while now, since I haven’t taken it since March, but the depression is unbearable. My mood has been awful, as has been motivation, drive, and just my ability to feel in control of my life.

So lower FSH and LH indicate a pituitary problem?

Just checked on Quest Labs website, Reverse T3 has been submitted and is at 16 ng/dL with a range of 8-25

I’m not sure what this means?

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Let me also add that I smoked marijuana two nights before these tests were conducted, and was actually able to get a full night’s sleep and get myself to the lab on time which is generally a rarity… things like that only happen a couple of times a year for me, so whatever these numbers are, are presumably as good as they’ll get without some sort of treatment

80

Unless I am missing something, your FSH and LH are not lower, but yes, lower would point towards pituitary shutdown.

With a free T3 level of 3.5, reverse T3 of 16 is not a problem.

81

Correct, lower LH would indicate a weak pituitary gland. Reverse T3 is perfectly fine, you want it under 15 ng/dL and 1 point is inconsequential and you could choke it up to lab ± deviation.