I Feel Like I'm Dying After 12 Months of TRT. Something Else Isn't Right

[el_nino_malefico]

This is the worst suggestion can be given to him. Low cardio is not at all detrimental on any aspect, he don’t have to run a marathon, but can just stick to the minumal 20 minutes sessions without worrying about losing anything from it, more than ever on trt. Aerobic training has a very huge impact on health and brain chemistry and by stimulating neuroplasticity it elevate exponentially whatever form of therapy he try (self-therapy like meditation or psychotherapy).
And you practically suggested of dying in the lifting room such that this has to become a priority. No! Again, low cardio is perfectly compatible with lifting, even with heavy lifting for maximal strength, but lifting should not become an obsession just to distract himself on another objective. I explicitly say that both form of training should be kept balanced and cardio should be kept low to not interfere with whatever he choose to do in the weight room. This is just to adhere to what all researches says about mood. He need to develop healthy, balanced routines and lifestyle.

About coffee, again, his priority should be health, and high caffeine intake is not healthy and can interfere with sleep. If he needs catecholamines (and we really don’t know), he should increase them with other methods, keeping in mind that catecholamines management should be careful and can be readily traduced to tolerance, side effects and withdrawal symptoms, if not managed well.

Even if there could been some mixed results, there are extensive suggestions that testosterone generally decrease serotonin, and serotonin and testosterone has opposite effects. I always suggest to have a medical specialist for confrontation, but about drugs that affect serotonin I have a vision drastically different from usual medical practice (although in the last years, medical community is becoming more aware of his mistakes).

[el_nino_malefico]

Clearly, you are an intelligent guy that has encountered some not so intelligent specialist, but your drive to discover “what’s wrong with you” (that I appreciate very much) could have exacerbated some hypochondriac tendencies, so keep it in mind when you do your research.

I knew that having an exact diagnosis can give you mental peace, but I suggest you to continue to monitor all parameters you could do and, with the help of your doctor, try to optimize it. Yes, having a formal diagnosis will help your doctor treat the (eventual) disease, but you can only make all possible avaible tests and bring them to your doctor in order to gently give him help and suggestions on finding a possible disease. If you try to diagnose yourself (and it is a very difficult task to accomplish, even if you are a genius) you put your doctors on defensive mode, and they will automatically discard your suggestions. If he is not as intelligent to understand that patients can be intelligent people with a good understanding of themselves, you need to be clever with your approach with him.

Can we know on what other drugs and supplement you are on over than TRT? Have you tested your adrenal hormones also (ACTH, cortisol)? Have you considered of using supplements to complement TRT and manage its side effects? I also insist on manage neurosteroids also, and manage your symptoms (like insomnia) with supplement and/or drugs.

Remember that human variation is huge, and you do not need to have a medical condition like a cancer to have bad symptoms. Yes, it can be extremely peaceful to have a specific diagnosis, so your doctor will fix it, but even if you have one, for a lot of them it is very likely that your doctor will manage them by treating symptoms, as a lot of conditions could be managed with treatments more than real cures.

[ucfguy01]

I actually can relate to you……

I was tired a lot in my late twenties, early thirties. I too drank a ton of coffee and I still dip tobacco everyday for most of the day. I have a few of the lumps like you have(fatty cysts which are harmless). I too had depression and anxiety for years…not 20+ years but many years. I went to the ER on multiple occasions thinking I was having a heart attack. I’d focus on every little thing going on in my body and I too can “feel my hormones” as you put it. I’m very in touch with how I’m feeling every day. And we’re close to the same size. I’m 6’5" 225 lbs.

I personally think your dose is too low. I’ve taken 120mg a week and it’s like I’m not even on TRT. I’d still be anxious and depressed on 120mg a week. When I take 160mg - 200mg a week it’s a huge difference. I stop feeling like a shell of a person. The higher dose makes me feel like my old normal self. Testosterone is an unbelievably good antidepressant for me. Has been for years!

Also, your diet probably needs work. I don’t think the sugar is doing you any favors. I’d probably drop the processed sugar as much as possible. Try to eat real food that isn’t from a box. Also, make sure you try to prevent the low E2. Low E2 for me makes me anxious and on edge…along with achy joints and no libido.

[el_nino_malefico]

Guys I can understand you both, and I agree with on the the idea of trying to increase testosterone in order to manage SOME mood symptoms, but it must be done in a more extended big picture. TRT as a cure for depression is just silly. We know that most of the times it can mitigate some depression symptoms and that its lack can be pro-depressive, but testosterone should be treated only as a piece of the puzzle in people with evident mood disorders. Without counting that high testosterone can also aggravate symptoms in some people.

Closed this parentesis, do you monitor your allopregnanolone levels? Do you take pregnenolone to complement TRT?

[trtwuzup]

You will figure this out @oppenheimer . Keep researching and doing tests.

I would do the growth hormone suppression test.
Looks like your jaw is growing. Are your feet growing too?
If doing this test in addition to checking GH they can check insulin too to confirm diabetes.

Growth hormone suppression test. This is the definitive method for verifying acromegaly. In this test, your blood levels of GH are measured before and after you drink a preparation of sugar (glucose). Normally, glucose ingestion depresses levels of GH. If you have acromegaly, your GH level will tend to stay high.

Acromegaly - Diagnosis and treatment - Mayo Clinic

Do you have a sense of smell?

Have u ruled out Kallmann syndrome and

Klinefelter syndrome? You should be able to tell by description.

Lab test
ACTH dexamethasone suppression test
A1c
Am cortisol
Dheas
Iron panel
LH& FSH ( make sure suppressed during trt)
Fasting insulin
C peptide
Lipid panel
Free t3 and free t4
Tsh
MRI pituitary
Urinalysis - see if glucose in urine
Testicular ultrasound
If above tests indicate adrenal problem, ultrasound/MRI of adrenals

Stop guessing what you have and do these tests. I do think you have some condition from what you describe.
While you investigate, I would lower does to like 100 or 120 split in 2 injections.

[hardartery]

@el_nino_malefico

Low cardio is not at all detrimental on any aspect, he don’t have to run a marathon, but can just stick to the minumal 20 minutes sessions without worrying about losing anything from it, more than ever on trt.

I didn’t say it was detrimental, I said it won’t help. It will not help him. That doesn’t take a great analytical mind to figure out. He has a history of high aerobic activity, it did not help him. Because what it can help is in no way his problem. If you have cardiovascular health issues it’s a good idea. If you have hypogonadism and depression, it simply is not a great idea.

@el_nino_malefico

high caffeine intake is not healthy and can interfere with sleep.

And space aliens might give him a probe if he doesn’t keep his foil hat on. This is generalized WebMD crap not related to his actual condition and reactions.

@el_nino_malefico

here are extensive suggestions that testosterone generally decrease serotonin, and serotonin and testosterone has opposite effects.

I have not found a single study suggesting any such thing, only the opposite. Post some examples.

[hardartery]

@middleages

With sweets in his system, he wont get motivated to even start lifting the weights on to the bar.

Sweets at 2AM have nothing to do with motivation to lift. It’s a symptom, not a condition, and sugar is not evil. Sugar is overused and depended on by too many people, but it is not evil and shouldn’t be demonized. It’s actually a totally natural substance from plants. Notice how he mentioned that that changed when he started TRT. Because it was a symptom of a problem, not a root cause. Don’t buy into the hype about sugar.

[hardartery]

@oppenheimer

My endo is 70 and doesnt treat anything but old people with diabetes.

That’s most of them, just plug in a different age. Your best hope is you in a medical diagnosis. It doesn’t require a genius, just logic and a desire to get to the bottom of it. Doctors can be wrong, and you know you. I managed a self-diagnosis of a rare condition that required surgery, in spite of the endo’s assertions that I was wrong. I had surgery, paid for out of pocket because the endo disagreed with me. I have empirical evidence in the form of removed hyperplastic glands that I was in fact correct. The difference between me and several specialists was that I read the labs and did my research, they didn’t. I am not denigrating them, rare disorders are simply not going to get attention or be takin into serious consideration because they all get to the opinion that rare means never. It’s rare, so you don’t have it. Except that some people actually do. Ignore generalized advice on exercise and diet, it is detrimental to you. Figure out what does what to you and use that information to pursue your diagnosis. Item X having a certain effect on most of the population really is fairly irrelevant if it doesn’t have that effect on you.

[NH_Watts]

It seems that you felt better when your ratios were sub 20. I dont think that E3.5D is working for you based on your estradiol level. Its lower than before TRT and we have established low E2 is a horrible thing. When mine drops below 20 my hot flashes start. You need to switch back to weekly and use the aromatase to your benefit. Guess what women going through menopause regularly report as their estrogen crashes…insomnia.

Sleep problems during the menopausal transition: prevalence, impact, and...

Also based on a few googles on low E2:

Symptoms of low estrogen in men include:

• Fatigue
• Anxiety
• Irritability
• Depression
• Forgetfulness
• Oversleeping or sleeping too often
• Sexual dysfunction
• Water retention
• Bone loss
• Fat accumulation

Fix that E2 and you may very well feel a ton better and in turn fix your sleep and a lot of the mental aspects could get better then. Also, have your magnesium checked. I used to have a lot of negative ruminations before I got onto a mag glycinate supplement schedule.

[oppenheimer]

I very much appreciate everyone’s well thought out and supportive responses. I do not mean to come across as defensive or combative, but something the past month has just snapped (probably from horrible sleep) and dealing with doctors that don’t care or understand. I’ve dealt with this my entire life and it has stolen my life from me. Yes, my ACTH is elevated but not over range, and cortisol is normal. But of course in science, there’s cases of cyclical Cushing’s, pseudo-Cushings, and Cushings with normal cortisol. I do have very large stretch marks on stomach, groin, arm pits/arms. You can see one set in the first album I posted.

I agree a glucose oral tollerance test would be useful, I asked for one.

I do not have Kallmann syndrome because I have a sense of smell, but I was “diagnosed” of having the other kind, normosmic congenital hypogonadotropic hypogonadism. But, I don’t agree with that. My doctor just called it idiopathic hypo hypo. I reached out myself to the leading research group at MGH in Boston that studies this disease, filled out their questionaire, and got accepted. I am donating my blood/genome sequence to them, so I get it sequenced for free, but I don’t get results for a year.

The reason I don’t think I have true ncHH is because my genitals developed normally. I just had highly suppressed HPTA, and with excessive sweating and low SHBG and insulin resistance…that points to acromegaly, hypothyroid, or pheochromocytoma. Fun fun! Yes I do try to eat healthy I swear. There’s just some nights I was binging on sugar because my body craved it. Normally I make smoothies with fruit, vegetables, protein powder. I have 30 pre-made keto meals that are great. I don’t eat junk 24/7. I have friends who are heroin addicts/alcoholic who eat trash and still are in better shape than me, with facial and body hair, etc. I’ve felt under-developed, inflamed, and sick my entire life. I know I’m writing astory, but I look like my grandfather, and he died young due to symptoms I was having, rapid abdominal weight gain from being skinny, low self esteem, blood in stool, heart failure. I’m following in his footsteps and that scares me.

I saw a recent paper that stated that ACTH/Cortisol ratio >2.5 was an 86% accurate diagnosis for Cushing’s in a sample of like 300 patients. And, my ratio is >5

But of course if it’s in range it’s in range according to doctors.

[middleages]

You certainly do have a lot going on. You’re not being combative, and def not the snarky type which Ive seen here before. Spread out your shots to EOD and it should help lower your E and stabilize your T. Once that is set, gotta get a new doc, and he has to be a TRT doc that can help with all aspects of male health. Lowering tour dose is an option, but if you simply spread things to EOD or daily this part of the puzzle could be solved.

[hardartery]

@middleages

Spread out your shots to EOD and it should help lower your E and stabilize your T.

He already has low E, and more frequent already didn’t go well for him.

[oppenheimer]

When I was 26 and originally went on TRT for a year, the only time I felt most “alive” and actually wanting to “hump” things was on 150mg/week while drinking alcohol. That had my TT trough at ~550 ng/dL.

Since being sober, and more healthy, 140mg/week puts my trough in the 700’s, but I have no desire to fuck or even jerk off really. So, alcohol may have increased liver clearance, or aromatization, not sure. Doc never tested E2 back in the day. All I know is that alcohol obviously helped lower stress or increase dopamine, which lead to me for the first time in my life, feeling this primal ungodly urge to want to mount and fuck things. It’s weird to say, but that was the first time I understood and felt that primal sex drive. Men mount shit, women lordosis. Sexual behavior.

This is one of the mental mind-fucks of hypogonadism. I spoke to some other patients from the rare disease group I got invited to and guys said the same thing, “I didn’t have sex for 17 years, or 15 years” etc. I’m in the same boat. Low testosterone during puberty doesn’t just give you lack of secondary sexual characteristics and health problems, and low self esteem. It legit takes away your male reproductive drive to want to fuck. It’s nature’s way of saying, you got a shit hand of genes, and you don’t get to pass them on.

Going to 70mg every 3.5 days the idea was to lower the peak, raise the trough, and lower E2. All that actually was reflected in the bloodwork, but I physically felt worse. Acne increased, feeling of psychosis increased, and my dick stopped working. I was even taking cialis my endo gave me, and couldn’t maintain an erection.

I have been messing with my dose too frequently as of late, which I have no doubt is influencing my mood swings.

One thing I’ve noticed is that if I go a few days past when my next injection is due, my erections return and I feel less “wired”. Given my low SHBG, I don’t think high doses work well with me because I have so much Free T and Free E floating around, which leads to spaghetti dick.

So far I see doing something like returning to 100mg/week for 6 weeks and returning to a fundamentally low baseline starting level, getting bloods in December, and adjusting from there.

[roscoe88]

@oppenheimer

Have you ever tried any dopamine or serotonin agonists/antagonists?

I had some success with libido with buspar. Wellbutrin didn’t do much. Selegiline nothing and dostinex nothing.

Just wondering what you’ve tried, if any.

Also, any diagnosible mental disorders besides depression? Personality disorders? I’m trying to understand your brain chemistry.

I too am searching for libido. I know how you’re feeling. It’s horrible. The more you discuss, the better.

[oppenheimer]

I have 0 doubt there is an issue with dopamine/serotonin, but what if that’s induced by low testosterone or excess stress? Intense sweating/hyperhidrosis in children is usually associated with neurological disorder or endocrinopathies, or tumors. Symptoms built through childhood, I wet the bed for 10 years until like 13 (vasopressin issues), and then initially told my PCP at 13 something isn’t right, and listed all the symptoms, hot flashes, sweating, no libido, tired and depressed all the time, left sided gyno/breast lump.

They gave me Paxil and something else at THIRTEEN for depression. I stopped after I think 1-3 months because I remember it made me feel numb, and I felt literally nothing, not good, not bad, it was like emotions ceased to be a thing.

I’ve not tried anything since that, because those drugs scared the shit out of me.

I think testosterone during that honeymoon phase feel so good because your dopamine goes up before your receptors down/up-regulate.

One complete character change is that I went from mega-impulsive (buying $4,000 of scratch tickets, drinking to excess, porn to excess, video games to excess, buying things to excess) to 0 impulsivity on testosterone.

It was like night and day. I no longer felt the need to seek constant “highs” to boost my dopamine.

So yeah…dopamine I’m sure is an issue. I did 23andme and while it’s not 100% diagnostic at all, there are mutations in the MAOA gene which control how quickly dopamine and other neurotransmitters get degraded.

I asked my PCP about adderall or ritalin for ADHD (which is comorbid with hypogonadotropic hypogonadism) but she said all she could do is offer Wellbutrin.

I also think TRT helped lower inflamatory cytokines or regulate serotonin because, my gut motility increased and I now have normal bowel movements, with 0 blood in them, and don’t “feel sick” every-time I eat food, which may have been dumping syndrome. Didn’t realize the gut has serotonin receptors in it, wild.

Grandfather displayed all my same issues, impulsivity, blood in stool, heart attacks, needed alcohol to calm down, rapid abdominal weight gain, little body/facial hair. Mother also gained weight rapidly, diagnosed hypothyroid, then hyperparathyroid, and bipolar. The males in my family are all tall/skinny/secondary sexual hair. The females are all hypothyroid/anxious/depressed. Aunt tried to kill herself, other has chronic candicidas and the other has chronic hives/skin outbreaks. Medicine is wild.

Diagnosis only seem to come when they’re easy, and something is SO far out of whack it cannot be ignored. Being symptomatic and having blood levels in the 99% of the BellCruve seems to not be enough, which is odd. I don’t know how they come up with blood ranges but, they have changed dramatically even over the past 5 years I’ve been doing them to push the ranges further and further out to not cover treatment.

Total testosterone went from 350-1,400 to now just, >280 ng/dL.

[hardartery]

Your E2 is too low. The alcohol increases aromatization, especially beer. When you go past your injection day your T falls off in relation to your E2, which is better because your ratio is too low. I think you actually have your E2 too low, and need a beer or something here and there to bump it up, and probably less frequent injections.

[roscoe88]

Have you ever seen a psychiatrist?

These issues seems related to neurotransmitters. A good psychiatrist should be able to prescribe an dopamine agonist.

What the root of the issue is though, i’m not sure.

There also comes a time in life where we just brutally accept who we are. Warts and all. And make peace with it.

But for now, keep searching.

[NH_Watts]

Just for clarity, how soon after you quit drinking did your bloody stool subside? I hate to paint with a broad brush here but could alcohol abuse be the constant in you and all of these family members? I’m not saying there isn’t more going on.

I seriously think you just keep your dose where it is and go to weekly injections again for a full 8 weeks without any other changes and see where you are.

[middleages]

I dont know why I saw test results and thought E was high. I mustve mixed up threads. Thanks for clarifying.

[hardartery]

We all do it sometimes, no worries.