T Nation

5 Weeks In, Frequent Panic Attacks

Hello,

I initially started on 200mg test cypionate every 2 weeks. Initially, I felt INCREDIBLE: lots of confidence, lack of anxiety, positivity, all around well-being, high libido.

Then, 2 weeks later, I took my second 200mg dose of test cypionate and that’s when all the problems started.

A day after my second injection of 200mg (2 weeks after the first injection), I got like 3 major panic attacks that day. Blood pressure was at like 165/90 for almost an entire week and I felt awful: chest pains, dizziness, eye twitching, tons of anxiety. I would still feel confident and amazing intermittently throughout the week, but at least twice a day, I’d feel the panic attacks coming on. It was hard to get work done.

I continued to get panic attacks every few weeks. 3 days after I missed my next 200mg dose, I started feeling lethargic, weak, and a little anxious/depressed. HOWEVER, lots of my panic issues, blood pressure problems, etc. were beginning to subside.

Yesterday, I decided that, instead of a 200mg test cyp dose, I would do a small 40mg dose to assess tolerance (and to mitigate this tiredness and lethargy I felt for missing my dose). Within hours, I started feeling panicked again, feeling very uncomfortable and almost like I was about to get a panic attack. Last night, I only slept 1 hour because of how anxious and uncomfortable I felt.

I’ve had to start taking Xanax to ease the anxiety and prevent the panic attacks. Xanax is doing a good job at controlling that, but when the Xanax begins to wear off (after 6-7 hours or so), I begin to feel anxious and panicked again…I feel as if I will DEFINITELY get a panic attack if I go on too long without taking my Xanax now. Mind you, I don’t have a history of panic attacks or taking Xanax.

Help! I don’t know what to do. Do I continue a small dose of 40mg test cyp every week and hope that these panic attacks eventually subside as I get acclimated to it? Or do you suggest that I stop the test completely? Is TRT just not for me?

These are my labs so far:

March 4th, 2019 (3 days before staring TRT):
Testosterone, Serum: 333 ng/dL (reference is 264-916 ng/dL )
Free testosterone, Direct: 9.1 pg/mL (reference is 8.7-25.1 pg/mL)
Estradiol: 20.0 pg/mL (reference is 7.6-42.6 pg/mL )
Prolactin: 6.4 ng/mL (reference is 4.0-15.2 ng/mL )
LH: 4.7 mIU/mL (reference is 1.7-8.6 mIU/mL )
FSH: 1.6 mIU/mL 1.5-12.4 mIU/mL

March 14th, 2019 (One week after starting TRT, BEFORE the panic attacks started with the 2nd dose)
Testosterone, Serum: 575 ng/dL (reference is 264-916 ng/dL )
Estradiol: 20.0 pg/mL (reference is 7.6-42.6 pg/mL )

I am scheduled to test Testosterone, Serum and Estradiol again tomorrow. I will update you with numbers. I hope that they can steer me in the right direction. These panic attacks are pure torture and almost don’t make the amazing benefits of TRT worth it so far.

Protocol from March 7th, 2019 to March 21st 2019 has been:
Testosterone Cypionate, 200 mg injections every 2 weeks

My exploratory protocol from April 7th, 2019 has been:
Testosterone Cypionate, 40mg injections every 1 week.

Any and all guidance would be greatly appreciated. Thank you!

We see a lot of cases coming here very similar to your own, most doctors are ignorant in sex hormones therapies, if you want knowledge doctors you will have to seek private care for your TRT because few doctors are good at TRT.

These 200 mg every 2 week protocols according to a 2005 clinical study these protocols are not ideal. You can’t just go to any garden variety doctor for your TRT, those that do are in for a hormonal rollercoaster which is exactly what you’re experiencing.

You need to test SHBG and base your protocol off this value. SHBG binds testosterone and estrogen, so starting TRT without this test is a sign your doctor is clueless.

Low SHBG guys do better on multiple injections per week, higher SHBG guys can get away with once or twice weekly injections. Multiple injections regardless of SHBG is best when attempting to lower estrogen excess which sounds like your problem.

Most men need on average 100mg weekly, I’m at 96mg weekly and SHBG is low, so I inject 24mg every 2 days.

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Hey i signed up just so i could reply to you.

Your test levels dropped, get off the meds you don’t need them. You need to manage your dosage levels with more frequent injections. Same thing happened to me, i have been on trt for a long time.
I do daily 15mg test prop and 50 iu hcg daily and that’s it nothing.
my E2 runs slightly higher than what others may like arouind 35-40 but i have no symptoms.
Before all the comments come in i have been on this protocol since 2007 and i have tried every dosage and ester there is except the nebido(sp)

This is your body, pay attention to it, you said you felt great at first, well take a look at the half life of the steroid ester you are on (cyp) and look at the graph of what happend to 200mg over a 14 day period. steroidcalc.com

Day 1 of your shot you have 19mg of test hit your system on day 7 you are at 7mg at 14 days your back down to 2mg
after 5 cycles thos levels go up slightly…it’s roller coaster ride to hell.

If you stick with a cyp then after your next 200mg shot then do 2 or 3x weekly from there. You can figure it out just think through the problem. Most important is you have to give changes time to work. Make a change, wait 2-3 weeks get blood work and go from there. You have to have bloodwork. If you are feeling really bad one day go get labs done that day if you can. There are online labs the let you do your own. I swear i had labs done 6 times in a 2 week period to get my protocol sorted out.

good luck and hang in there. these trt docs never cease to amaze me.

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Thank you! I ordered an LC/MS/MS Estradiol “sensitive” test today on directlabs.com and already had the labwork done. I’ll get back to you with those results (as well as the test/estradiol labtest that my doctor ordered for me…I got those labs done today, too.)

I also asked my primary care physician to order lab work for: CBC, Basic Metabolic Panel, TSH (Thyroid), Total Testosterone, Prolactin.

That’s 3 labs in two days! I’m getting to the bottom of this.

Thank you so much for your help.

At 200mg/every 2 weeks, i definitely felt the fluctuations : every high highs and very low lows.

I’m gonna try 40mg/ every 3 days and see if that helps symptoms and helps me “stabilize.”

Seems like I’m a “low SHBG guy” like Systemlord suggested.

Thanks for the encouragement. Steroicalc.com is an awesome resource…thank you!

I will definitely switch to injecting smaller doses every 2 to 3 days instead of doing the 200mg every 2 weeks. Everyone seems to agree that it’s the way to go to avoid nasty side effects.

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Since April 7th, I have been injecting 40 mg of testosterone cypionate every 3 days.

My panic attacks are gone!!! I am still taking Xanax, but I am tapering off of them slowly. Before, I was taking 1mg xanax 3x per day…now I’m down to 0.5mg xanax 3x per day and watching symptoms. I will keep you all posted.

Blood pressure problems are also completely gone. Blood pressure is often ~125/85. Not too bad. No chest pains, dizziness, or eye twitching on this current dose of test (40mg/e3d).

My confidence is through the roof. My work performance is off the charts… I’ve gotten commendations from my director and supervisors multiple times the past 3 weeks already, and I attribute it to the confidence I get from the Test. Everybody notices that I’m “better”: more social, more confident, etc. Gym performance is great!

Below are some labs I’ve completed before I started up this new routine @ 40mg/every3days. Please keep in mind that these labs were taken ~18-19 days after my last 200mg dose of test cyp…I started my current protocol (40mg/e3d) after completing these labs:

Test Serum and Estradiol (ordered by nurse practitioner)

(04/09/2019)

TESTOSTERONE, SERUM: 899 (NORMAL) {Reference Range: 264-916)

ESTRADIOL: 20.0 (NORMAL) {Reference range: 7.6-42.6 pg/mL}

Prolactin and other levels (ordered by general practitioner)

(04/10/2019)

PROLACTIN: 17.2 (HIGH) {Reference Range: 4.0-15.2 ng/mL)

Testosterone, Total, LC/MS: 818.6 (NORMAL) { 264.0-916.0 ng/dL}

Everything else (TSH, Hemoglobin, Hematocrit, etc.) came back within NORMAL range.

LC/MS/MS sensitive Estradiol test (ordered by myself online, directlabs)

(04/09/2019)

ESTRADIOL, FREE: 0.61 pg/mL (HIGH) {Reference Range: ADULTS: < OR = 0.45}

ESTRADIOL 31 pg/mL (HIGH) {Reference Range: ADULTS: < OR = 29}

Test, Estradiol, and TSH+Free T4 (ordered by Urologist)

(04/10/2019)

TESTOSTERONE, SERUM: 693 (NORMAL) {Reference Range: 264-916)

ESTRADIOL: 25.2 (NORMAL) {Reference range: 7.6-42.6 pg/mL}

TSH: 2.250normal (NORMAL) {Reference Range: 0.450-4.500 uIU/mL }

T4,Free(Direct) 1.65 (NORMAL) {Reference Range: 0.82-1.77 ng/dL}

My recent labs say that my Prolactin and Estradiol (LC/MS/MS) are higher than normal, but that was before I started 40mg/e3d.

Current symptoms: although I feel AMAZING, there are two complaints:

  1. Nipples are sensitive and irritated. Is this due to high E2/Prolactin?

  2. low libido. At first, when on 200mg/every2weeks, my libido was sky-high, but then it crashed when I stopped taking that dose. My libido on 40mg/e3d is okay at best, but not fantastic. It’s a 3 out of 10, at best. Is this due to high E2/Prolactin?

Thank you all for your help. Any and all guidance would be greatly appreciated. Thank you!

HELL yea brother good for you, good for you man!!! this makes me so happy!

oh i forgto to repsond to your toher questions,
Libido…let your body sort this out, it may take a few months but only because it’s gettign used to a steady state of test, IT WILL come back…doint change anything if you feel good. the same thing with the nipples it will sort it self out unless your in a lot of pain but your E2 is really good. Your prolactin is not high, it’s just over that range barely. Try hard to lower your bodyfat to about 12% no sugar lower carbs and eat veggies, it will help ALOT