TRT in Russia, Advice Needed

Pharma / TRT Testosterone Replacement
16

Hello again. I returned with a big report.

First of all, I did a thyroid test:

TSH:      1.67
Total T3: 92.6
Total T4: 6.5
Free T3:  3.4
Free T4:  12.5
Anti-TPO: 10.0
Anti-Tg:  5.4

Looks good.

Then, I found a doc who at least can hear me, discuss things, agrees to try different strategies, tune them in an effort to achieve some results. For the start we agreed to try the most easy way - using Androgel, with ability to switch to injections, add hCG, use clomiphene, tamoxifen, anastrozole, if needed.

Here is the chronology of the glorious crusade.

From 2019-03-27, lasting about 2 weeks - same duration almost every antidepressant has, kind of “adaptation period”.

  1. I can hold water, at last. Before I was a peeing machine peeing every 2 hours, including sleep - so, after 2 hours after falling asleep I had to wake up, and then could not fall asleep again, suffering from insomnia. And now I actually can drink water as much as I want anytime. Before I drank very little. After some googling I found that that’s because testosterone converts to estradiol, which allows a body to retain water.

  2. Sleep quality improved. Falling asleep way more quickly and sleeping without interruptions.

  3. Mood immensely brightened (in a wrong way). Really crooked for first two weeks, then some sanity started to appear. Right after first dose I completely abolished learning new things for web dev. Instead started gaming with much more interest than before. Stopped giving a fuck to anything. Lack of work? - IDGAF. Little money income? - IDGAF. Talking with friends? - nope, IDGAF. Cleaning, dusting, bathing, eating - meh, IDGAF. That’s like: mood significantly brightened, but motivation, interests, cognition - crashed. On that side TRT reminds me of SSRI on steroids. Like people very often complain that antidepressants improve their mood, but makes them apathetic.

  4. Mood started to swing wild swings. Happiness, deep dread, irritability, apathy, complete apathy, tiredness, feeling miserable, no libido, explosive libido etc.

  5. My morning and evening activity levels flipped. Previously I was more apathetic/sleepy/calm, stable at mornings, and more active, angry, feeling unhealthy at evenings. Now I easily awake at ~05:00, drop asleep at 13:00 - and then can’t open my eyes until 19:30, and even then I remain very sleepy.

  6. Hair became more oily, I need to wash them more often.

  7. Eye strain greatly reduced. I can look into PC monitor without feeling pain and fatigue.

From 2019-04-12 (16 days in)
“Broken happiness” disappeared, started again to think about work, life problems and such. But heavy sleepiness creeped in. I started to sleep nearly 3/4 of a day - day, evening, night. Only mornings remained active.

Also, that day I did a blood test. Here are compilation of previous results and current one:

TSH:        1.67          -> 3.24
Cortisol:   298, 433, 640 -> 83.7
Prolactine: 152           -> 114
LH:         1.52          -> 2.0
FSH:        4.15          -> 3.25
TT:         296.64        -> 380.16
E2:         20.0          -> 38.1

Cortisol tests are from previous year.

Things I noticed:

  1. TT is increased by ~30%, but E2 by ~100%
  2. Huge drop of cortisol, below acceptable minimum of 101. Like 4-8 times.

The doc agreed to try to add anastrozole - to lower E2 to <25 levels, prevent testosterone aromatising, thus rising it’s level.

Then I felt like I see some new tendency in my condition, some improvement of the mood, I thought I might had stabilized and decided to not to start anastrozole immediately, but to wait for a while to be completely sure.

I dragged my mountain bike out - and all of a sudden discovered that my endurance improved like 5-10 times. I rode much longer, much faster, quite enjoyed the ride, and returned home feeling completely OK, not dead tired like previous years. I jumped into TRT train primarily for chronic fatigue, mental exhaustion, and completely forgot that people often use it for performance. And that huge boost of physical abilities is a pleasant surprise. Now I can say that will alone is not enough to do any kind of physical activity: if you have puny amount of testosterone, no matter how hard you try, all you’ll get is exhaustion, headache, and suffering.

I assume that testosterone boost might be boosting dopamine. On the “bicycle day” I was feeling signs of dopamine enhance: I was in good mood; concentration was also nice; I had will to excercise - it’s well-known that dopamine increases locomotor activity; I was enjoying the ride - dopamine also enhances ability to feel things around, to feel emotions, to have insight, to feel connected to reality.

Unfortunately, after a few days most signs of improvements vanished.

2019-04-22 (26 days in)
Next week was increased sleepiness, tiredness, and irritability. I was feeling like I was withdrawing from something, like antidepressants, - that’s shitty feeling of fever, chills, malaise, anxiety, irritability. At the friday (26th) my boobs started to hurt. Saturday (27th) was a second “bicycle day” - which I forced to have - because actually I was very tired and in poor mood. The results was also poor: like previous years, I barely managed to ride ~2 kms, returned home feeling exhausted, dead tired, covered in sweat, with headache and nausea, and that’s it.

At sunday I got another blood test results - from 2019-04-26 (30 days in).

Cortisol:   760
Prolactine: 169
LH:  1.29
FSH: 3.13
TT:  250
E2:  52.9

Welp… cortisol is completely opposite to previous 83.7, and it seems that it’s irrelevant to my condition: I don’t feel any differences having it tiny or huge amount. Prolactine is roughly the same over years. Absolutely every drop of testosterone was hunted down by aromatase and converted to flood of estrogen. No wonders I had bad results with bicycle.

2019-04-29 (32 days in)
Started taking small amount of anastrozole - 0.125 EOD.
For several days I had darkened mood, quite depressive dreams, was feeling grumpy and moody.

2019-05-01 (34 days in)
Morning was a clone of the first “bicycle day”: nice mood, will to move, riding, enjoying, not feeling tired.

Also that week I had a few days of pretty good working capacity and odd eloquence, constructing fierce sentences from weird combinations of words.

2019-05-06 (39 days in)
Started to have increasing insomnia, that led to sleep being possible only daytime. Note: daytime is the time I have the least anxiety, while night is having the most. So that condition could indicate boosting of noradrenaline. Also mood was cold and depressive, interests was lowered, concentration was poor, as well as locomotor activity, social activity. Started to watch much of TV shows. Overall speculation: high noradrenaline, low dopamine.

2019-05-13 (46 days in)
This week’s second name is “Shitty week”. Had another blood test at 2019-05-15. Results are:

LH:  1.33
FSH: 3.04
TT:  284
E2:  64.4

0.125 of anastrozole EOD ultimately failed to give any benefit. My aromatase is completely mad, E2 rose even more. Increased anastrozole 4x - to 0.25 mg every day (1.75 per week).

Results came in a matter of days. Very bad mood, feeling of fear, dread, anxiety, somewhat increased peeing, eye strain, feeling like losing my mind at evenings, extreme sleepiness and tiredness at evenings, feeling stupid. Only time I have acceptable condition is mornings. Every other time of day is sleeping, a disaster and sheer madness.

After some googling I found that depression and feeling like shit is not uncommon adverse effect of anastrozole, letrozole, etc.

Not going to continue this anymore, this is madness. Going to take another blood test to see what adequate dose of anastrozole is capable in terms of numbers, then going to the doc to discuss other options. Unfortunately he is unavailable until monday.

Final results of using Androgel and anastrozole.

  1. My aromatase - specifically that that works outside of testes and hunts the testosterone from the gel - is absolutely crazy, able to eat everything you throw at it.

  2. Androgel is comfortable to use. No need to poke with needles. Short half-life makes it easy to jump on, quickly get stable concentration, quickly jump off if needed - not like Nebido, which is 2 months obligation, whether you like it or not. Somewhat pricey, judging by reviews aromatizes more than testosterone from injections. According to FDA, T levels are pretty stable with Androgel: https://www.accessdata.fda.gov/drugsatfda_docs/label/2004/21015s012lbl.pdf And I think, that users can even split daily dose into 2 applications. In overall I see Androgel as a nice option for OTHER people, they can give it a try. But In my case it was completely useless.

  3. Anastrozole makes me ill, crazy, stupid and depressed.

  4. Effects that was relatively stable and persisted through entire period of treatment: ability to retain water; to sleep through nights without eternal peeing; reduced eyes strain; improved sleep; aggravated sleepiness, tiredness, fatigue; improved endurance; mood, libido, erections, POMS - not sure what to say, it’s kind of same shit but of another flavor; face and neck acne; fluffy belly - thin light hairs all over the stomach, where I apply Androgel.

  5. Few days ago I had ultrasound scan of the balls to see if there an atrophy. And no - they was the same size as before Androgel. This is interesting, because I read that any TRT quickly leads to shrinkage, and personally I noticed for sure that the ball sack became smaller.

  6. Periodically I had mild pain in testes.

Things to consider:

  1. Looks like I never was a testosterone guy. Skinny, not much body hair, mediocre endurance. But that’s what was making me myself. Thus targeting high levels of testosterone is kind of wrong. I more likely want just enough of testosterone. What is “enough” is another question.
  2. I definitely should keep estradiol above 20. Otherwise I have eye strain, no water retention, pee like damned, and thus I’m dehydrated.

Options I see:

  1. Decrease Androgel dosage to only keep estradiol levels above 20. But while it will help with eye strain and water retention, I doubt it’ll help with mood, energy, and endurance.

  2. Use tiny amount of Sustanone instead of Androgel and see what will happen. Considering injections are thrice more effective than gels, it is 10-20 ml twice a week. Probably it won’t aromatize that strong and some testoserone increase is possible. And if entirely converted to estradiol - it will be useful anyway, by preventing overpeeing and eye strain. And it’ll cost 3-5 times less than Androgel. haha.

  3. Use larger amounts of Sustanone if #2 will not show overaromatizing. Then I can expect normal levels of both testosterone and estradiol.

  4. Try to cheat aromatase and switch from Androgel to hCG alone, 2-3 times per week. Might be that testosterone-to-estradiol conversion inside the testes not going to be THAT crazy like outside of them. As a bonus, it will provide not only good levels of testosterone, but pregnenolone and DHEA as well, while making balls big and beautiful, oh yeah.

  5. Jump off from Androgel to clomiphene or tamoxifen. These drugs don’t shut down testes, they actually asks them to work harder and produce more T, pregnenolone, DHEA. Sounds good. Costs less. But data is too controversial. On one side, I didn’t read any positive reviews from users or docs. Clomiphene isn’t approved for hypogonadism by FDA also. On other side bodybuilders often use it for PCT to restart HPTA. And then there is tamoxifen, that sounds like “clomiphene but good”.
    HPTA Restart: Clomid 25 mg EOD - one of the topics about TRT, clomid, tamoxifen, KSman.

Some another article about tamoxifen, popped out from google.
Testosterone +50%, estradiol +341%, increasing SHBG, possible liver damage, blood clots, eyes damage.
With my natural testosterone levels of 230-290, +50% will lead to 346-432, that means it will fluctuate between “not enough” and “just enough”.
Sounds discouraging.

Tamoxifen-associated eye disease. A review - PubMed - tamoxifen and eyes.

Worst expectations: drowning in estradiol, eyes falling out, awful condition.
Best expectations: good levels of T, pregnenolone, DHEA, cortisol, no testicular atrophy, comfortable price, easy administration; everything working more naturally.

Among the listed options I mostly prefer 2, 3, 4.
1 as a temporary solution.
5 as a last resort.