Hi, I am looking to decide whether to get on TRT or begin using anti-depressants for low grade depression to improve motivation and excitement about things. While I don’t experience sadness, I have general apathy about life and things I should be doing.
From what I’ve been reading, it seems testosterone gives you motivation, confidence, and energy to do things by increasing dopamine and lowering prolactin (by increasing the testosterone). Wellbutrin seems to improve the functioning of dopamine system. However, because of TRT side effects I have not fully decided to go with it.
As you can see, not on the lower end, but still feel apathetic and definitely need more energy.
I’m OK with being on TRT for the rest of life as I don’t plan to have kids anymore (have 2 already). My plan is to do TRT myself as no doc would prescribe it because my levels are not that low. Already did research on HCG, AI, etc.
So, the question is: does raised Testosterone really improves your life or Wellbutrin does it better ? If you have experience with both, which would you prefer or a combo ?
I think most psychiatrists would agree that treating depression with testosterone is an ineffective route. While most questionnaires for low testosterone include mood and drive I think supplementing with exogenous testosterone is over-estimated in it’s efficacy to improve mood. Whether mood is low because of low testosterone or low sexual performance or whether it’s the cause of the low testosterone we don’t know.
We just know that it’s often associated with people with low testosterone but so is chronic and acute illness. There may be a placebo affect but I think if there is ANY other underlying cause of the depression such as mood, behavioral, or cognitive disorders, suppressed emotions or past traumas, treating with testosterone will only result in very temporary symptom relief.
Wellbutrin is a pretty safe drug to try to improve symptoms of depression but it depends on which neurotransmitters are dysfunctional for you. For me SSRIs have been absolutely horrible but I remember bupropion was something I hardly noticed.
I’m no psychiatrist but I think it’s best to think of and treat these two things separately. As for your T levels I think you may want to do what you can to increase levels without going the testosterone route first. It isn’t just testosterone your testes make but if you use testosterone you shut it all down and start needing adjunctive therapies to make up for it. It isn’t all fun and games.
Wellbutrin is a good choice as it avoids all of the negatives of SSRI’s. So you don’t need to get your brain rewired starting or ending.
However, you should be looking for a cause.
Is lower T the cause or is lower T a symptom of something else that that is also the root of your “depression”.
Example: Your lethargy can be from lower thyroid function and that can be a result as simple as an iodine deficiency caused by not using iodized salt.
Please read the stickies:
advice for new guys
things that damage your hormones
thyroid basics
The best measure of your thyroid [dis]function is checking your waking and mid afternoon body temps as per the thyroid basics sticky. You need to be using iodized salt continuously for years to have decent levels.
Please post all labs with ranges. T-tunnel vision will not solve your problems. Provide more info about you as per the advice for new guys sticky.
TRT can be a hassle. I would not open that can of worms with your levels. You should test for E2, DHEA-s and Vit D. Optimizing those can help with mood and might bump T a bit.
A good thyroid panel and 4x saliva cortisol test would be good too.
There are lots of things you can try to improve hormone levels.
I would do all of this before jumping on Wellbutrin, but not that big of a deal. Wellbutrin is generally well tolerated and easy to come off of if you choose. I would strongly suggest staying away from SSRIs or SNRIs.
I think my fatigue issues are primarily caused by weight. I’m 6’2" at 290 lbs right now, and ideal weight is 175 lb. Currently I have testosterone at 438, if I were to lose fat and get down to 175 lb, is there a way to estimate high much higher will my test level be ?
I was put on Wellbutrin for a depression cure - it didn’t really work.
Then the doctor and I decided to do TRT - but we never looked for a cause.
So I have no basis for why and would urge you to start there. I would look at Thyroid for sure - TSH levels. Read that sticky KSman has posted. Track temp.
I was told there are 3 kinds of depression - situational, hormonal, and chemical.
With your T levels (especially your good free T) I think it is very unlikely that your depression is from low T.
Raising an already fine T level by getting on TRT may cause an initial bump in mood lasting maybe 2-6 weeks but that is almost always temporary. So you end up where you started except now dependent on a drug that you may have difficulty getting off of because of the shutdown caused by TRT.
Depression can have a multitude of other causes. My total T levels were comparable to yours before starting (though unlike you I had low free T) and my case TRT certainly didn’t help my depression.
TT is mid range. Lowish for age-32. Yes FT appears OK, but remember that FT is released in pulses in ‘natural guys’ and a lab can catch a peak. Typically, TT is a better measure of T status than FT in these cases. And we also do not know how much E2 is opposing his T.
Body temperatures will easily complete the picture.
No other relevant blood test results other than
TSH 1.07 (0.40-4.50 mIU/L)
The test was requested by me, and I had to tell GP to test for testosterone levels. GP obviously hasn’t ordered E2, prolactin, etc (wish I knew about these).
Has anyone gone on Clomid to increase testosterone and experienced the same benefits similar to injecting test ? I’m considering low dose EOD Clomid + AI.
There are several studies and I’ve seen forum members post decent levels of TT from just Clomiphene. Adding an AI is most likely going to be beneficial as well. I’ve seen TT as high as mine and I’m on Tcyp 90mg/wk, 825units hCG, 0.875mg anastrozole. As long as there is no primary cause for your hypogonadism you’ll stand a very god chance of obtaining decent numbers. There is a small risk of side effects related to Clomiphene however but not everyone is affected. It will also support fertility better than say hCG+AI.
The other thing that comes to my mind is sleep apnea. Something to consider. Your T looks fine. The brain meds are a total joke. None of them have any lasting effect. Neurotransmitter levels go up, short term response, receptors desensitize and back to square one. Ketamine does work but it’s really expensive and I think questionable. I would do a sleep study first. I have two friends now with a CPAP and it was life changing.
Do you have overall fatigue? Does everything in life seem dull?
For those types whose depression includes a component of anxiety, Wellbutrin isn’t a great option. I’ve been on it and it made me jittery at effective dose. I much prefer Lexapro. I’ve tapered off lexapro while on TRT, and it wasn’t terrible (TRT seems to help depression for me a little) but I went back on Lexapro because being on both (again, for me) is much better than either alone.
That said, if I were you and TRT doesn’t resolve your depression, I’d first try Wellbutrin since it is one of the few antidepressants that is more likely to increase libido rather than decrease it. Good luck.
Wellbutrin can be a stimulant and that is good for some situations. And if you use too much, the stimulation can wear you down and that could be compounded by thyroid or adrenal issues. Also suggest using it earlier in the day to avoid any affects that might affect sleep.
For those types whose depression includes a component of anxiety, Wellbutrin isn’t a great option. [/quote]
I can confirm this. Wellbutrin is more for the type of depression where you can’t get out of bed. Give Wellbutrin to an anxious depressive and you may just have to scrape him off the ceiling.
[quote]brentf13 wrote:
Ketamine does work but it’s really expensive and I think questionable. I would do a sleep study first. I have two friends now with a CPAP and it was life changing.
Do you have overall fatigue? Does everything in life seem dull? [/quote]
I love Ketamine and its analog - Methoxetamine (MXE). NMDA antagonists are amazing for depression! However, because of MXE I’ve had full blown schizophrenia incident which led to me hearing male and female voices in my head. It is scary when that happens first time. LOL, I had almost converted to one of the mainstream religions because of that. But upon researching I’ve realized MXE caused massive dopamine increase and had triggered psychosis.
Anyway, thanks everyone for replies. At this point I’ve settled on Ephedrine (Bronkaid brand in US). It is mild but has subtle euphoric and stimulant properties, and best of all - prevents binge eating.