Stopped TRT and HCG Severe Panic Attacks

Pharma / TRT Testosterone Replacement
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I have researched until I’m blue in the face and yet I’m hard pressed to find my specific circumstances. I have been on TRT for roughly a year now. My initial blood work showed low T levels that are likely due to steroid abuse when I was younger. I’m 35yrs old and I was prescribed 100mg per week and it worked perfectly. Eventually we did some labs and determined I could back off to 80mg per week which seemed to work just fine.

Over a month and a half ago my wife an I decided we wanted to start a family so I backed off my dose cold turkey. Initially didn’t seem to be a huge issue. I began .5mL HCG twice a week (this lasted for a week and a half) and had to stop because it made me feel incredibly irritated, anxious and depressed. Now I haven’t taken the HCG in over a week and yesterday took my took my first does of my regularly prescribed routine of 100mg with the hopes to get back to a normal mental state. The first day was great and I felt like myself again.

The problems began the yesterday morning. I woke up about an hour early in the morning with pretty bad anxiety. It lasted all day yesterday with a couple of full blown panic attacks while at work. I went to sleep last night and now here I am woken up out if a dead sleep with rapid heart beat, anxiety, heart palpitations, chest pains, bp spikes, dizziness/vertigo, severe GERD. Could anyone shed some light on what might be happening? Any input would be greatly appreciated. I’m planning on calling my clinic first thing when they open to go get some blood work and have a bit more ranges/labs to help.

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It’s really hard to say without blood work/labs. Your mood swings could have been from a variety of issues. It’s hard to narrow it down because you dropped your TRT cold turkey then switched to hCG. I would theorize that your T levels slowly dropped and it took a few weeks for your system to completely metabolize the lingering esters.

I personally have a strange response to hCG (only 250 IU’s EOD) and seem to get acute estrogen surges from hCG, so I only inject 250 iu’s once per week. If you’re similar, there’s a chance that the hCG in turn increased your e levels, while your T was low, which is obviously a recipe from anxiety, depression, irritability, etc. Again, this is all just speculation without your labs. I would guess that your T was low and your E was high. You said you’re feeling better now that you’re back on TRT? Do you have an AI? I get bad anxiety when my e2 gets even slightly elevated, while still “in range”.

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How many units of hCG is that? Seems like a lot judging by standard dosage per ml for hCG. That explains why you felt bad, your T has been low, hCG at high doses increases your e2 way beyond any AI can manage. High e2 has that effect on people especially when high e2 is from hCG and not a SERM. The hypothalamus is not hidden from estrogenic activity.

For fertility, you should have been on low dose hCG throughout your T replacement and when you want to impregnate your partner, you can probably stay on T and replace hCG with SERM to produce LH and FSH. You probably wouldn’t even need to in my knowledge.

Just my 2 cents.

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Your testes and fertility are mostly the same if you are on hCG or T+hCG.
So why torture yourself and crash.
When on TRT+hCG you will actually feel like having sex.

Follow these links found here: About the T Replacement Category - #2 by KSman

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

TRT:
50mg T cyp/eth injected twice a week
0.5mg anastrozole at time of injections, adjust dose to get near E2=22pg/ml
250iu hCG SC EOD

Guys are making babies doing the above.
T shuts down your LH/FSH
hCG shuts down your LH/FSH

Labs:
TT
FT
E2
CBC
hematocrit

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Wow, you fellas are tremendously helpful.

For a bit more clarification I was prescribed to inject .5ML of Chorionic Gonadotropin Lyophilized 11,000 unit twice per week intramuscularly. I also have been researching a lot and found that intramuscular injections of HCG is uncommon I wonder if that had any affect on this entire situation being that absorption from stomach fat/tissue would absorb slower into your body no?

At any rate, I had my labs done today however being a Friday I won’t receive the results until next week. I mentioned to my nurse practitioner what you all had mentioned here (which was uncomfortable explaining to a medical professional what I learned on the internet) and she offered to give me some Arimidex tomorrow morning if I can meet her at her downtown office She didn’t have any stocked at her current facility. Would this be a wise thing to take prior to getting my labs back? At this point I’m sort of willing to try anything that can improve my well being right now. I’m just under the assumption that an AI would help. Or is it too late?

On an end note I appreciate everyone’s feedback. Anxiety and depression can be a scary thing when adjusting one’s hormones. It’s helped me a lot to have members input and support. So thank you :slight_smile:

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IM hcg injection would accelerate absorption. You’re flying blind at the moment and low e2 is just as “painful” as high e2. You can make a better dosage and arimidex assessment once you have your labs.

I’m still slightly unclear what you’re doing now with trt and hcg? You could follow ksman and take 0.5 mg of adex/50 mg test, injecting test and ingesting adex twice per week.

Again though, you’re so close to having a blood work snapshot which will shed more light on if its even e2.

It takes weeks to get stable blood serum levels but I can “feel” each adex dose almost exactly two hours after ingestion. Everyone has the potential to be different of course.

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To clear up Hostile’s inquiry about what I’m doing now, is I’m just trying to return to stability so I may address a more appropriate way to incorporate the HCG in a month. However to be honest I need to practice self care and ensure I’m at 100% mentally and physically prior to even considering putting HCG back in my body due to my last experience.

I received my blood work results last night. The only thing to consider is they were drawn less then 48 hours after injecting 1ML of my T (after being off T for close to a month and attempting intramuscular injections of HCG solo without T). Therefore I’m lead to assume the numbers may read high given my previous account written above based on whats happened.

ENDOCRINE EVALUATION ////////// RANGE

ESTRADIOL (E2) 37.3 ////////////// 7.6-42.6
TESTOSTERONE, TOTAL 1045 ////////////// 280-1100
SEX HORMONE BIND GLOBULIN 32 ////////////// 10-80
TESTOSTERONE FREE 24.01 ////////////// 1.9-27

COMPLETE BLOOD COUNT/////////////RANGES

WHITE BLOOD CELL 8.3 ///////////// 3.9 -11.1
RED BLOOD CELL 5.78 //////////// 4.2 - 6.0
HEMOGLOBIN 17.8 ////////////// 13.2 - 18.0
HEMATOCRIT 54 ////////////// 38.5 - 54.4
MCV 94 ///////////////// 80.0 - 100.0
MCH 30.7 ////////////// 26.0 - 34.0
MCHC 32.9 ////////////// 31.0 - 37.0
RDW 13.1 ///////////// 11.0 - 15.5
PLATELET COUNT 248 ////////////// 140 - 400
MPV 10.8 ////////////// 7.5 - 11.6

GENERAL CHEMISTRY ////////////////////////////////// RANGES

GLUCOSE 63 (LOW) ///////////////// 65 - 100
BUN 16 ///////////////////////////// 6 - 20
CREATINE, SERUM 1.0 ///////////////////////////// .5 - 1.2
SODIUM 143 /////////////////////////// 133 - 145
POTASSIUM 4.5 /////////////////////////// 3.3 - 5.1
CHLORIDE 102 /////////////////////////// 96 - 108
C02 25 /////////////////////////// 22 - 32
CALCIUM 10.1 ////////////////////////// 8.5 - 10.5
TOTAL PROTIEN 7.3 /////////////////////////// 6.4 - 8.3
ALBUMIN 4.8 /////////////////////////// 3.2 - 4.8
GLOBULIN 2.5 /////////////////////////// 2.1 - 3.6
BILIRUBIN, TOTAL .9 //////////////////////////// 0.0 - 1.0
ALKALINE PHOSPHATASE 58 /////////////////////////// 35 - 129
ALT 23 /////////////////////////// <42
AST 21 /////////////////////////// <39
ALBURNIN/GLOBULIN RATIO 1.9 ///////////////////////// 0.8 - 3.0
BUN/CREAT RATIO 1.9 /////////////////////////// 7.3 - 21.7
GFR, ESTIMATE 90

My nurse practitioner gave me 2 x 1mg tablets of Arimidex advising me to take on half every week for 4 weeks. I was hesitant to take it due to the fact that Low AI and be just as rough as High AI. She said with this low of a does it wouldn’t necessarily matter all that much and I should be fine. I’m just paranoid right now because I don’t want to make matters worse.

I did my second weekly injection this morning of .5mL and I can feel the benefit already. I’m just hung up on whether or not to take the small does of Arimidex. But based on the opinion and direction I have gotten here I am leaning towards taking one half this afternoon. Unless some of you veterans have some better advise. Lately it seems that I’m getting more knowledgeable feedback from this post then when I’m at the clinic (which is upsetting)…so FIRE AWAY GENTLEMEN

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Can you indicate your T dose in mg’s please? Most doses are 200 mg’s/ml, some are 100 mg’s/ml. I would tend to agree with you to stabilize with minimal variables before introducing new variables ie hCG.

Your e2 is high. Not extremely high and some feel ok with that e2, but I do not and many don’t either. When I get into the mid 30’s I start to feel bad (emotional/weepy, difficulty sleeping, aggression). When I get into the low teens, I start to feel bad as well (lethargy, sleepy, depressed, lose my vascularity and erection issues. Many get achy joints, but I never experience that myself).

T peaks on average 3 days after IM injection, so I’m not surprised by your total T, even if only 100 mg injection. Your free T is good.

You can reduce T spikes and consequently T → E conversion by injecting smaller doses more frequently. If I were you, I would personally inject twice per week (Mon & Thurs) and start with only 0.25 mg of adex twice per week the night of the injection. I like to inject in the morning and take my adex before bed personally. Get a pill splitter and cut the adex pills into quarters. Doses smaller than that will require that you dissolve your adex into a vodka solution which allows for micro dosing (typically only needed for adex over responders).

Your HCT (hematocrit) is high and frankly much higher would be getting dangerous. You may want to consider a double red blood cell donation to reduce your hematocrit. When HCT gets high it makes our blood thick and viscous which increases the chance of stroke and blood clot. In turn it can make us feel dizzy and disoriented. I’m surprised your Dr didn’t make mention of it actually.

As far as hCG goes; I respond differently than most people and with low doses of only 250 IU’s EOD, I start to get high estrogen side effects. I typically inject 250 iu’s only once per week to keep my testes in the game.

Anxiety issues and low T can often stem from thyroid issues, being the root cause. You didn’t happen to get a thyroid panel did you?

A good diagnostic test if you did not, would be to take an oral temp upon waking, before you get out of bed. Don’t drink anything, talk or move around prior. If you’re less then 97.4, that indicates a potential thyroid problem. Take your temperature again around 3pm (avoid taking it around drinking, eating, working out, a shower etc). You should be able to get very close to 98.6. Less indicates a potential problem. Do this for 5 days in a row and report back with that info as well.

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Also do not know how many iu’s of hCG you are injecting.

Product instructions for hCG are IM because for inducing female ovulation for IVF, the doses are extremely high.

Suggest:
50mg T injected twice a week - use #29 0.5ml [50iu] 1/2" insulin syringes
0.5mg anastrozole at time of injection
250iu hCG SC EOD with above syringes or #31 0.5ml 5/16"

Labs need to posted with lab ranges. You can edit your posts.

With TRT, gene expression changes, cells change, bulk tissue changes, metal patterns change. Do not be to hasty to reject things.

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My dosage is 200mg/ml…Unfortunately I didn’t get a thyroid panel. I will mention that when I speak with the clinic again. I will begin to monitor my temps per your advise, that seems like the logical next step.

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I updated the ranges above for you…unfortunately I am unsure of the dosage I was taking of the HCG as well. I just followed the directions I posted. I stopped taking it after the third time over a week ago. When I speak with the clinic I will clarify the dosage.

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Testosterone
The concentration is 200mg/ml.
Your dose is 0.5ml X 200mg/ml = 100mg

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Roger that. I made a mistake above. When injecting the T (that week on 4/14), I took 1mL. When I took the HCG (on I took .5mL ) my concern is that the initial HCG dose is ridiculously high! I researched it and you were spot on (not a big surprise).

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SO I feel like I am back at square one. After getting those labs back and listening to everyone’s advice I backed off taking my T for a little over 2 weeks and felt great for about 3 days towards the end. So after that last day of feeling great I had a stressful weekend and thought to myself that it was time to take my dose. So I took 40mg IM and here I am 2-3 days later feeling the way I felt at the beginning of this thread!? I just wonder why on earth I am so sensitive to TRT this time around?

I emailed my clinic and am requesting labs plus a thyroid and adrenal workup. Is there anything else I should ask for?

I’m by no means an expert or even close to being as well versed as the majority of you. I’m just trying to post or document as much of my struggles as possible so someone else researching and learning might possibly find some answers for themselves in this thread.

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Well i had another issue which was not before i m on hcg/hmg treatment i was doing 500iu eod than i lowered to 250iu eod took aromasin caused problems lowered dose very much but was having joint pains and panic attacks so i skipped ai and just lowered hcg dosage but worked fine if i feel like i simetime increase the dose but all was fine but since last two weeks i had 3 episodes i woke up middle of night with 110 heart rate shakiness etc i went to hospital they said ur ecg is normal and so is bp gave me omeprazole and xanax after few days i had similar episode but was for little time and heart went up to 85 than came down in gew mins i again went to sleep yesterday same small episode wtf first i thwat my low estrogen is causing this now what i have no high or low estrogen thyroid is also fine now what i also have tingling all over my body esp feet and hands and yesterday a bit stiff jaw