T Nation

Anxiety and Palpitations from TRT

Dear All,

I am 38yrs old and I used to take steroids in the past for bodybuilding and after living for these last 3 years on low test, I decided to go on TRT and something very unexpected happened. Last year I tried TRT subq 50mg twice weekly and after 3 weeks I ended up in ER with a severe panic attack, anxiety and heart pounding. I did all tests possible including my heart and thyroid and everything was fine. I stopped TRT but the symptoms never went away and I became really sensitive that if I touch a cup of coffee, I would go into panic.

After 4 months I decided to go on compound creams because my test was still very low and my symptoms got worse and had to stop again. I visited 6 doctors trying to identify my problem and no seems to understand why. The anxiety flared up my Acid Reflux which is contributing to my anxiety aswell and cortisol is high in the morning aswell.

My natural test was 350 and e2 23 and I have a low SHBG of 16. Thyroid including rt3 is fine, Iron and ferritin fine, Dhea and Dht all in range, everything looks so normal but I am really in a bad situation.

Can anyone come up with any possible solution to end this hell and increase my testosterone. P.s I used to take 500mg weekly in the past for bodybuilding without any issues.

Thanks

If your adrenals are messed up you need to fix that.

Check dhea s (good indication of adrenal function)
Acth
Am cortisol
Pm cortisol (take later on)
Even a midnight saliva cortisol test.
Prolactin

Thyroid you say is fine what is your tsh and free t3?

It’s very common to see anxiety in guys with low SHBG in men on TRT injecting large to moderate dosages, especially when pre-TRT estrogen is already at a good level and when testosterone is raised, estrogen is now very high and anxiety is experienced.

You need daily dosing, if this doesn’t work, nothing will, maybe except T scrotal cream.

We need all labs to be able to determine if there is a problem, doctors can’t agree on normal thyroid levels and is still under debate, so fine is someone else interpretation, but it might not actually be fine.

I say this because it’s common to see anxiety in those with thyroid problems which TRT can worsen because more demand is placed on the thyroid as TRT steps on the metabolic gas pedal.

The high cortisol is suspect, TRT usually lowers cortisol, but have seen a couple of cases where cortisol increases.

I have heard of men waking up with pounding heart rates and anxiety and aren’t sure why and is linked to cortisol being off balance throughout the day.

Dr. Saya of Defy Medical has treated this in other men. I get acid reflux the first couple weeks of initiating TRT, I also get urinary symptoms which only last for a few days.

I see, now since I started IM injections 50mg twice a week, I am feeling a bit better, kinda my body can tolerate the anxiety more. I am taking 20mg Nexium daily which is helping with the reflux, so hopefully will get better.

If not, I will try daily subq injections

Dhea is in range and Thyriod including free T3 and reverse T3 are all in range.

Prolactin is in range aswell and on the saliva cortisol test marked a bit higher that normal in the morning and afternoon, then in range during the evening.

Nonsense comment. If anyone believes this, again, I have a bridge to sell you.

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Cannot solve this level of anxiety with trt, you’ll need to handle the anxiety first by itself… Whether it be thru ssri or whatever, you’ll need to look into it. It could be serotonin it could be gaba, both calm the amygdala, many studies show that testosterone works in many parts of the brain including the amygdala aka the fight or flight center.

Daily low dosage injections WILL help. Youll just need to find the right dosage

The man has specified he’s taken 500mg weekly for bodybuilding without issue

I don’t understand? What’s does a bridge have to do with a lack of credibility in a comment? One can’t “sell” a bridge either… at least according to my knowledge I don’t think they can, I believe you’d have to purchase the land the bridge is already on in order to acquire said bridge… Or can one purchase a bridge? Perhaps, but I don’t think so, esp if it was on/connected to public infrastructure (roads, pathways/sidewalks etc)

T/AAS in general (to varying degrees, fluoxymesterone is a far more potent 11HSD inhibitor than test etc) inhibit the 11 HSD enzyme, this inhibits active cortisol conversion to cortisone… HOWEVER, T/AAS also blunt cortisol increase in response to stress, environmental factors etc and in general also tend to decrease cortisol. Estrogen can increase cortisol, but not to the extent that androgens decrease it… Even if circulating cortisol was for some reason increased (canceled out via 11hsd inhibition and estradiol increase) the effect of said circulating cortisol would be partially blunted… If cortisol is the issue, it is NOT induced by a physiologic, replacement dose of test

anabolic steroids can induce autonomic dysfunction in men predisposed, this is a facet often overlooked when people complain of heart palpitations on cycle or on TRT… Testosterone is the most potent inducer of this variable for me… I don’t like using doses higher than 225mg/wk (test) due to this exact reason… but I can handle nandrolone, drostanolone and even dbol without issues regarding cardiac autonomic dysfunction (however the cardiac effects of all these drugs long term can be profound, barring autonomic dysfunction… talking about morphological/structural alterations in the myocardium, atherogenesis etc)… the correlation between androgen levels and structural changes in the myocardium has been hotly debated/controversial, and differing bodies of data (in terms of real world, not rodent/in vitro) interaction exists, however I’m of the opinion that very high dosages over long periods of time (say 300-400mg+ long term) will eventually induce deleterious effects within the myocardium… tren is a different beast, I’d stipulate even 100mg would induce cardiac manifestations

Correct, but we can’t assume we will respond to androgens the same for life, our body’s change as well as our minds.

Something obviously changed during the time he spent with low-T. You want to sell me a bridge, talk about not making sense. It must be a canadian thing.

You haven’t seen the free E2 of someone with low SHBG while injecting large infrequent dosages.

I’ve also seen guys who previously where fine on steroid cycles and now have low SHBG from very high levels over longs periods of time and now have to play things differently now.

That’s not how it works, low SHBG develops acutely in response to excess androgen concentration… it isn’t a permenant manifestation

If the individual developed insulin resistance, other endocrine pathology etc then SHBG would remain low… that or genetics

Free E2 levels being high typically correlated hand in hand with high free T… thus the notion of elevated free E2 is irrelevant and inconsequential

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I haven’t seen it because we know enough about it know to not even measure it anymore.

This is the part you fail to grasp over and over and over again.

It’s an old saying. It’s a way of telling someone they are naive. So naive, in fact, that they would actually believe you had a bridge to sell, pay you for said bridge on blind faith alone, and then believe that they now own a bridge.

Capiche? :wink:

This is rubbish.

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Thanks for all your replies. Do you guys recommend me to go subq daily or eod? Shall I start like 15mg daily?

Due to the issues you are describing, start low and slow.

I’d start off with 10mg a daily. Give that 2 weeks and ensure you’re not feeling any symptoms of anxiety or panic. If so, raise to 15mg daily for another two weeks and assess. If improvement, raise again to 20mg.

If you feel good at 20mg, stay there for a good 6-8 weeks before deciding to raise again.

If you DON’T feel good at 20mg, go back to 15 and stay there for awhile. Then decide where you need to go from there.