Panic's TRT Log

Pharma TRT
1

Unfortunately, my TRT journey is off to an extremely poor start, in spite of reading a lot here and trying to follow best practices.

Hopefully this log will be a place where I can consolidate all my health information, experiences, and receive feedback from all you knowledgeable people. I’m really down right now and hope this is the correct path for me in order to turn my health around.

I will provide all the information I can think of, but if you can think of any other information that may be necessary, please ask.

Stats: Male, 26 y/o, 5’10, 155 lbs, naturally lean/athletic build (swimmer body type)

Drug history: SSRIs (Post-SSRI Sexual Dysfunction), tricyclic antidepressants, benzodiazepines, among other psychiatric drugs…

Symptoms: Dead libido, ED, shrunken testicles, sparse pubic hair, lack of motivation/drive, low emotional tone, anhedonia, cold body temperatures (especially feet), low appetite, blunted drug reactions (little euphoria from recreational drugs), dry skin/hair, CNS dysfunction (sensitivity to stress and stimulating environments.

The symptoms essentially mirror those of Post-Finasteride Syndrome in that you can produce normal levels of androgens and estrogen yet have seemingly no response to the hormones (insensitivity).

Note: NONE of these symptoms existed prior to psychiatric drug use. I had an extremely high libido, rock-hard erections, morning wood every day – everything a health 21-year-old should have.

Brief background: Started Prozac (fluxoetine) and Klonopin (clonazepam) in early 2016 after a rough period dealing with anxiety. Prior to these drugs, my sexual function was excellent. While taking these drugs, my sexual function diminished (morning wood disappeared and libido was dampened, but I still enjoyed having sex and could get it up – I just didn’t have the same insane libido as before). Discontinued Prozac/fluoxetine in late 2016 and all hell broke loose. Turned asexual, in addition to developing all those symptoms above (although some came later with drugs that were given by the doctor to treat the existing function).

Current medications: Clonazepam (discontinued once when I attributed my symptoms to this drug. That was not the case. In fact, everything probably deteriorated further upon quitting. I ended up reinstating and will stay on it until I am in the place to start a veeery slow taper.

Currently using antihistamines as needed (started getting strong histamine responses since starting TRT).

Current Supplements: Vit. d3, k2, Mg Glycinate, NAC

Diet: Paleo-ish (paleo + rice and starches, mostly).

Exercise - lifting and some HIIT (have been fairly fatigued lately though so less exercise)

Sleep - Pretty decent most of the time. I haven’t noticed any parallel between sleep hygiene and other symptoms, however.

Blood work prior to TRT varied a lot over time. I had various “crashes” - a term commonly used in the post-drug communities to characterize a major decrease in your baseline (usually from ingesting some drug or supplement). When I had bloodwork after these crashes, my sex hormones appeared to tank. Over time I noticed -some- correlation between “good” testosterone and estrogen levels and better sexual function and mood (though still a far cry from my former self’s function).

In February 2019, I took labs when I felt my sexual function was somewhat ok for a weekend (had some degree of libido and erections were solid). These were the following numbers:

Total T - 763 ng/dl [264 - 916]
Free T - 21.7 pg/ml [9.3 - 26.5]
SHBG - 48.1 [16 - 56]
LH - 5.6
FSH - 3.2
E2 - 28 pg/ml [7.6 - 42]
Prolactin - 7 [4 - 15.2]
ACTH - 32 [7.2 - 63]
Cortisol - 12.4 [6.2 - 19.4]
IGF-1 266 [115 - 355]
DHT - 68 [30-85]
DHT, free 6.66 [.54 - 2.58] High
DHEA-S - 541 [138.5 - 475.2] High
Pregnenolone - 168 [ < 151]

After these labs were taken, I had a major crash in march – a crash from which I believe I never fully recovered (returned to my shitty baseline).

Even though it seems I’ve had consistently low body temperatures and cold feet over the years, my thyroid bloodwork always came back normal, except once (after I started supplementing iodine. I probably was deficient given that I had been using himalayan salt for years.

July/August, before starting iodine (have symptoms of cold body temps and feet):

fT4 - 1.29 [0.82 - 1.77]
fT3 - 3.1 [2.0 - 4.4]
TSH - 1.42 [0.45 - 4.5]
rT3 - 19.1 [9.2 - 24.1]
T3 uptake - 24% [24-29%] very low end of range
Thyroxine binding globulin - 18 [13-39]

September 2020, after supplementing about 3x the 100% recommended daily value for a month or so (thought I was “replenishing” my stores after being presumably deficient for so long):

Oddly, fT3 went up yet TSH went waaaay up(??) (presumably in response to supplementing Iodine). Fatigue also hit me like a freight train. After discontinuing iodine, these symptoms subsided.

TSH - 3.6?? [0.45 - 4.5]
fT3 - 3.9 [2.0 - 4.4]
fT4 - 1.26 [0.82 - 1.77]
rT3 - 13.8 [9.2 - 24.1]
t3 uptake - 25% [25-39]
thyroxine binding globulin - 22 [13 - 39]

Most current hormone test, at the same time as the thyroid panel - September 2020 - before starting TRT:

Total Testosterone - 700 [264 - 916]
Free T - 15.7 [9.3 - 26.5]
Estradiol - 24 [7.6 - 42.6]
Prolactin - 7 [4.0 - 15.2]
SHBG - 58.1 [16.5 - 55.9] high as always
Pregnenolone - 192 [< 151] high as always (odd in spite of poor thyroid numbers)
DHEA-S - 356 [38 - 523]
ACTH - 49.3 [7.2 - 63.3]
Cortisol AM - 20.6 [6.2 - 19.4] high but was previously normal ( ~12 in Feburary 2020)

I felt like garbage with these “normal” September hormone numbers, hence my decision to bite the bullet and start TRT after 4 years of dealing with this hellish post-drug syndrome that exists even when my serum levels of everything are nearly perfect (as they were in February of 2020 - seen above).

The first couple months of TRT have not gone well. I know some people believe 6-12 weeks of a stable dose is when you see real benefits. I have not been able to be on a stable dose for such a period of time yet (I had to lower my dosage and retake bloods because my CMP showed some irregularity that could potentially be caused by high levels of androgens).

I have now been on 210 mg/wk (30mg/day IM, no AI, no HCG) again for about 3-4 weeks. I’ve maybe seen some improvement with erection quality and libido (on a few days, if I can attribute it to this), but haven’t noticed really any benefits in any other domains. My appetite is still dead, which doesn’t make sense (given the energy requirements of T, my body should be boosting my caloric requirements significantly, correct?). I’m struggling to get near 2,000 calories per day. My numbed emotions and anhedonia have been pretty constant. If there is slight improvement, it isn’t super noticeable.

Note: I’ve been having heavy (and progressively stronger) histamine reactions since starting TRT. This is prohibiting me from exercising and working out. Anything that enhances blood flow - even spicy foods - appears to be result in a massive “wave” of histamine that leaves me with a splotchy red body that burns and itches like hell. I usually have to lie down for a while + take antihistamines to resolve/prevent this. I’m looking into changing from test C to test E, as this appears to be an allergy to something in the compound and is becoming progressively worse.

Overall, my TRT experience has been pretty terrible. I’m wondering if I’m on the right road or fucking up my health more. I feel quite hopeless and directionless at the moment. I will continue for now, but given what I’ve experienced thus far, my hopes aren’t that high.

If anyone could chime in and potentially offer any advice or just motivation, that would be great.

2

Are you self prescribing trt or going through a doc / clinic? Or more to the point your test is from a pharmacy?

Switching from test-c to test-e probably won’t change much, they’re very similar, but switching to a different carrier oil might make a difference.

I can’t argue with trying aomething, your symptoms would be very frustrating. I’ll think some.more and chime back inlater.

G’nite.

3

It’s pharm-grade test. I’m guessing the most likely explanation is the carrier oil as well. I have been on a paleo-like diet for quite some time (which avoids the inflammatory polyunsaturated fatty acids). Perhaps my body isn’t taking so kindly to injecting these agents

4

I’m guessing this is low-ish carbs? Could explain the higher SHBG. My humble opinion you could try to lower that before fully committing to TRT, esp since it isn’t going well for you so far

5

I see you tried iodine … it doesn’t work well for someone with a low performing thyroid . Supplement yes, fix no.

I really think this fatigue and etc will be much better once you start thyroid meds and fix that rt3 if it’s still high.

I cannot guarantee it, but it sounds like that’s your main issue here. Once I started thyroid my fatigue and everything else got better almost immediately.

I would stop focusing on everything else and jsut get thyroid started. Compare 1 grain of armor thyroid with just t3 and take that dose of t3 starting off.

At the least I can say confidently you will feel better and energy should return. If not, then start going down the list again. Jsut make sure you are taking a good dose and often.

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I say paleo-like because I have varied the diet to include more carbs (a fair amount of starches like rice, potatoes and sweet potatoes). I was never low-carb for an extended period. I sampled keto once or twice for a week and didn’t like it. I believe those diets raise SHBG, raise cortisol (lipolysis requires high doses of cortisol), and lower metabolic activity (thyroid output) over time.

Anyway, regarding the SHBG…

I’ve tried boron, magnesium, hell - even threw some proviron at it. Boron may have improved my symptoms a bit initially, but you can’t fight homeostatic processes.

From what I’ve seen here, chasing SHBG rarely results in good results. I know it’s always good to look for underlying pathologies, but I’ve ruled out all the basic causes of SHBG (had liver tests conducted and such). I couldn’t tell you why it’s high, but it seems common to have elevated SHBG in the post-drug communities. From what I’ve seen, usually long-term TRT brings it down, and if it doesn’t, running high doses at least gets you a decent free T level (one reason why I chose this direction).

Anyway, thanks for the reply.

7

Thanks for the reply.

I understand the hypothyroidism → hypogonadism connection. In some cases, if the thyroid is working very poorly, you can also end up with low preg, which in turn can cause a cascade of low hormones. It is also my understanding that the symptoms of hypogonadism and hypothyroidism overlap significantly (energy levels, mood, etc.)

I want to preface my reply by saying that my thyroid wasn’t always sluggish – even during the first few years of PSSD hell. My appetite was decent, losing weight was extremely easy, constipation wasn’t an issue, and I always had normal energy levels. I would say I’ve only noticed symptoms of hypothyroidism during the last 9 months, which likely developed after “crashing” on a supplement. As such, I don’t think the thyroid can explain all the sexual symptoms PSSD caused, but it certainly is adding additional unpleasant symptoms and perhaps making the sexual ones worse as well.

I agree that the thyroid situation is somewhat odd. The low body temperatures obviously indicate low metabolic activity, which usually is caused by poor thyroid function. Additionally, I’ve developed others symptoms of hypothyroidism such as low appetite, constipation, thinning on the outer eyebrows, etc.

I’ve read thyroid madness, browsed thyroid forums and groups, as well as been on the RayPeat forum, where all are pretty well-versed in thyroid and consider it the cornerstone of health. And I’d have to agree - it’s extremely important. But it’s ridiculously hard to optimize.

So, the thyroid numbers I posted above from July/August show general thyroid normality (fT3 and fT4 in the middle of the range, with TSH not far from one), in spite of being symptomatic. I discussed this with my doctor. I told her rT3 appeared high to me, and given I was still symptomatic, I wanted to try T3 to see if it could potentially counter the high-ish rT3. She said to try iodine first, but she put in a script for T3 (5mg cytomel) that I could try if I wasn’t seeing any results from the iodine.

Fast forward a couple months - the iodine whacked out my thyroid numbers. I can’t begin to understand the results as they seem completely paradoxical. The iodine apparently raised TSH while raising fT3 (these two should be inversely related, normally). Secondly, rt3 went down. Yay. Good fT3 and low rT3 should have me feeling better. The TSH must be some anomalous “blip” in time, since TSH is probably somewhat pulsatile, I thought. Nope. I was fatigued as all hellllll during this time (sleeping up to 16 hours a day and struggling to get anything done). Never in my life - not any time during these last 4 years - would I say I have suffered from major fatigue. It almost seems like my body is not responding to t3 at the cellular level. If t3 is higher and rt3 is low, the t3 should shut off the hypothalamus’s signal to produce TSH, no?

Anyway, I thought it was probable that the iodine inclusion mapped on to the start of the fatigue, so I dropped it and just started using iodized salt in place. I did this for a couple weeks and started feeling more energetic (although body temps were still poor). I then tried straight the T3 (cytomel) in 5 and 10 mg doses for a few days and the fatigue came rushing back. I had to stop, as I had heavy school work I had to tend to.

I just don’t understand. How could T3 alone cause fatigue, unless my natural T4 is suddenly converting at a higher rate to rT3 to fight off the new changes to the system? I guess this is the conclusion I came to and I stopped all thyroid medication. I decided to just keep running TRT, get on a stable dose for 8-12 weeks (have run into far more roadblocks than expected, so haven’t really “stabilized” yet), and then test/mess with thyroid. Otherwise, I could be playing with too many variables.

Maybe you can interpret some of this and help me understand what’s happening under the hood. I certainly cannot. The only thing I haven’t checked is antibodies. I doubt that’s playing a role here, but I’m surprised the doctor didn’t order it to rule it how.

Thanks, and sorry for the long response. Just trying to provide as much info as possible. All the help is greatly appreciated.

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I think you will help yourself allot by not over thinking this. Thyroid is not hard to optimize at all. Your doctor is just underusing the shit out of you and it sounds like you didnt really take a good dose to alleviate symptoms properly. 10mcg is not much thats half a grain and I rarely see someone on half a grain of armor thyroid. its usually 1 grain or more twice a day.

My wife was taking t3 cytomel and her doc was very ignorant and gave her 5mcg once a day. I told him three times a day and 15mcg and he would only give 10 twice a day.

After 3 months she switched to my doctor and started armor thyroid 2 grains am and pm. Guess what… she never felt better. its was a night and day difference. She actually tried my armor thyroid tablets and thats when she realized the difference.

If you are going to take t3 you have to take there right dose and realize that the half life of t3 is quick. You need to take it 3 times a day or at least twice a day 4-6 hours apart.

My good friends wife also had the same doctor and same protocol… she stared armour thyroid and said “im so glad It works, because the cytomel barely put a dent in my fatigue”.

Thyroid is a simple thing to optimize. If rt3 is high, you simply take t3 but make sure the dose equates to at least 1 grain of t4/t3 desiccated. Freet3 should be top of range not middle. T4 can rest in the middle. RT3 as close to 0 as possible. Some folks dont feel well on thyroid until they reach the very upper limits of the ft3 range. For example it might be 5.5 at the top range and they feel fatigued at 4.5. the get up to 5+ and symptoms are gone. This was me.

I also tried synthetic and I spent a month feeling like death until they put me back on armor thyroid. desiccated thyroid is just better.

For rt3, anything above 5 (around there) is getting high. The more t4 you take, the more Rt3 will go up. Something endo’s and non thyroid specialists wont ever realize.

Thyroid Conversion Guide | Get Real Thyroid shows that 1 grain of armor thyroid is equal to 25mcg of t3. 2 grains is 50. meaning I would need to take 50mcg twice a day since im on 2grains x 2. if I took t3 instead of armor thyroid, I would see how I feel in the evening. I might add more (3rd dose) to the evening if I feel like hell, but not necessarily. At the very least I would take it twice a day and pick the right dose.

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My wife takes 1/2 grain of armour thyroid which is 30mg and she has optimized her thyroid. She was borderline hypo but her tsh went down under 1 and get free t 3 just over 3.

It is possible to supplement your natural production with less treatment.

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Everyone is different. The point is to not stop just because the first couple of tries didn’t work. Especially when it comes to thyroid.

1/2 a grain of armor thyroid is 12.5 mcg of cytomel. Atleast the table I saw says so.

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It appears I’m allergic to something in the compound. It’s pharma-grade test Cyp, which contains cottonseed oil, the test salt, and BA. My histamine reactions have seemingly become more severe over time, which is quite concerning.

I asked my doctor if I could switch to enanthate (approx. same pharmacokinetics, so easy switch), and she suggested that I discontinue test altogether for a month+ to “let my immune system settle down.”

We have only exchanged short email messages, but I believe her logic is that my body could potentially respond the same way if I start introducing the next ester while I still have this allergic reaction going in my body for quite some time (cyp has a half life of ~ 8 days, so I’m guessing it takes about 48 days to fully clear). Not sure.

@highpull could you offer any wisdom on this? Is the above scenario likely? Is switching esters in the current state risky?

Given that my endogenous production is shut down, I think abruptly quitting is not the most prudent of choices. I have clomid and tamoxifen on hand, but I tried them before starting T and felt horrid. I’m currently in graduate school and have many demands resting on my shoulders. I can’t afford to try a risky restart at this time. In general, a restart seems like a really bad idea, as I’ve experienced permanent “crashes” (significant worsening of sexual function) as a result of large hormonal swings in the past.

What a nightmare. I was starting to see some sexual benefits before these allergic reactions got out of hand.

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Not likely, but possible, if you mean possible to be allergic to something in the mix.

I don’t see how, unless you are allergic to both esters. I’ve seen guys who were allergic to the cypionate and switching to enanthate did the trick. I’ve also seen some allergic to the carrier oil, usually cottonseed or sesame seed, and switching to grape seed was the solution. Don’t think I’ve seen anyone allergic to the grape seed. Interestingly, both esters were dissolved in peanut oil at one time.

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13

You can test for cottonseed allergy. Probably one for grapeseed too.

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Update - 2/24/21

@dextermorgan @highpull @dbossa @ncsugrad2002

I’m going to tag a few guys who seems knowledgeable and post here frequently. I would really appreciate if you guys could read my update and provide me with any advice. I’m at a loss for what to do as of now.

I know I’m a medical oddity (I’m here with these “hormone problems” because of previous psychiatric drug use), so perhaps my TRT response is going to be atypical as well, as is sometimes the case with the Post-Finasteride-Syndrome guys and others such cases.

Anyway, I’ve been on a relatively stable dose of 200mg/wk for 6 weeks now. I’ve kept a detailed log of sexual function, mood, diet, sleep, etc.

A couple quick updates:

Histamine reaction:

Two weeks ago, I reported symptoms consistent with an allergic reaction. I changed esters from Cypionate to enanthate. The enanthate preparation does not share ANY of the same ingredients as the cypionate suspension; however, in spite of that, I am still getting histamine reactions. More details below.

Thyroid:

I’ve been monitoring my temperatures near daily for the last month. After introducing 2 drops of iodine per day (100% of the recommended daily amount), my temperatures have seemed to normalize somewhat. Most days, I wake in the mid 97s and reach low to mid 98s at the height of the day. Highs are usually 98.0-98.2, but I’ve been at 98.6 a handful of times. Overall, it appears my thyroid isn’t extremely problematic, if temperature is the best judge. I’ve also noticed that there is no correlation between my cold feet and my internal temperatures; I can be at 98.6 and my feet can still feel icy.

The following are my observations across the last 6 weeks at 200mg T/wk:

TRT positives:

  • Increased nocturnal erections and morning erections (hardly ever occurred prior to starting T – a clear sign of androgen issues in spite of my normal serum levels)
  • Increased body hair
  • General increase in erection strength (trending but not consistent)
  • A handful of days where I felt like I had SOME semblance of libido (porn actually was desirable to look at; it no longer looked like pixels moving). Again, this is not consistent at all, however.
  • Increased vascularity and “pumped” look after working out.

TRT negatives

  • Complete loss of thirst. This is the most concerning, and I have absolutely no idea what the cause is. Adipsia - Wikipedia. Wikipedia makes it sound like it’s related to hypothalamic dysfunction. How would starting TRT relate to this? I had a completely normal thirst response prior to starting TRT.
  • Low (and sometimes non-existent) appetite. I’m not sure if I can attribute this 100% to the TRT, but generally my appetite has seemed much lower since starting treatment. Antihistamines – especially those that antagonize 5ht2c, like cyproheptadine – appear to recover my appetite but not thirst.
  • Continued histamine reactions (in spite of changing both ester and carrier oil). These histamine reactions seem to be induced by an increase in body temperature, which is probably a proxy for increased blood flow.
  • Increased anxiety (before starting TRT, I felt nearly zero anxiety. My emotions are still quite numbed, but this one has returned to a degree. I feel more adrenaline and my heart rate has increased.
  • I’ve experienced my hands and feet “falling asleep” more regularly. I.e., I get that “needly/tingly” feeling where I have to shake my extremities for a while to get blood flow back into them.

I know many of you claim it can take a while to reap all the benefits of TRT, and I’m only at 6 weeks on a stable dose. That is true; however, some of these negative effects are quite frightening. I did quite a bit of reading on these boards, and I have never seen mention of some of the side effects I appear to be experiencing (namely, loss of thirst, reduced appetite, tingly extremities, histamine reactions).

Loss of thirst and hunger is a symptom sometimes described in PFS and PSSD. I didn’t have this symptom before, so I’m quite concerned that the use of exogenous hormones is causing more damage to my hypothalamus. BUT, I’ve experienced better erection quality, an increased frequency of morning wood, and a couple days of some libido (whereas it was completely flatlined before).

I’m really at a loss for what to do. I haven’t obtained any bloodwork yet (thought I’d wait 8-10 weeks to let myself fully stabilize before doing so).

Any recommendations? Please and thank you.

  • A very desperate young man.
15

You have a lot going on. Given what you are reporting, I’d get labs now.

16

@highpull Thanks for the feedback. I’ll try to get them as soon as possible then.

I plan to do the following. Let me know if there are any additional ones you think should be run. I’m hoping to get a full picture of the interrelated systems.

CBC
CPM
Lipids
PSA
Estradiol, ultrasensitive
T and Free T
Prolactin
Thyroid markers (ft3, ft4, and TSH at minimum)

Adrenal markers - not sure. Maybe progesterone, since it is cheaper than pregneolone and may indicate whether preg production has halted due to shutdown. If it’s bottomed out, I may test pregnenolone (and possibly even DHEA) directly.

17

Welcome future man. Any inside info you can give us? Stock picks?

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If you get dhea get the DHEA-S test. That also can measure adrenal function as that is produced by adrenals along with cortisol.

Maybe add ferritin. Not sure if you pay for labs but if you don’t do a iron panel as well.

19

Ahhh yes - We will soon have an additional 1400 stimulus check coming to cover my labs (RIP grad student medicaid)

The Chiefs are also going to win the Super Bowl.

Man, and I’ve been getting /2021 right this year too!

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Thanks for the suggestions, man. I’m paying out of pocket, so I’m trying to keep the scope wide enough but costs low enough. Seems Private MD labs has some pretty well-priced bundled labs that can be done through quest.