T Nation

Brain Fog and TRT Questions (Labs Included)

Hi All,

It has been a while since I have posted. I have a few questions for the experts regarding TRT usage. I have been having an extremely hard time dialing in E2 since I am an over responder to anastrozole. My e2 can crash and I will have joint pain/feel terrible or it will get too high if I hold off on usage for a week or so and I will get extreme brain fog, irritability, lack of concentration. I am very successful and do my best to be focused all day, but I have a general feeling of “being off” and having an inability to concentrate and feel “all there” quite often. I am in the process of eliminating sugar, gluten and dairy to see if it is an inflammatory response going to my brain. I suspect that it is something hormonal and I am desperate to get to the bottom of it as soon as possible. I gave up caffeine for a month and that didn’t help as all. I would love to hear insight on possible hormonal imbalances that can cause this. I go in and out of a fog frequently during the day. It is not a blood sugar issue.

Second question: I have the option to switch to aromasin. Should I give this a go. Are anastrozole over responders frequently aromasin over responders as well?
Additionally, I wanted to know if arimidex (anastrozole) has joint pain side effects from the medication (or is it purely from lowering e2 as I suspect). It seems even when my e2 is in the 20-30 range, for a few days after I take a pill, my elbows, knees and feet kill me.

Age: 30
Waist: 33 inches
Weight: 215 lbs
Body and Facial Hair: Lots
Where I carry fat and how it’s changed: I am very lean and carry little fat

Health Conditions/Symptoms: I used to have High BP on 200mg of cyp a week and cured that completely by lowering the dose, lowering caffeine intake.

RX and OTC Drugs: None

Diet: Extremely healthy. High Carb, Moderate Fats, High Protein: An average day would be 500-600g carbs (oats, rice, fruits), 300 protein, 100-120 fats. I juice vegetables, eat a ton of vegetables, eat lean ground turkey, ground beef, chicken, eggs as protein source. Zero artificial sweeteners anymore (trying to cure my fog).

Training: Extremely intense (4-5 day intense weights), 3-4 days cardio.

Testes Ache?: Never

Morning Wood: Never but wood and libido are always extremely strong and high. If I wake in the middle of the night I have wood but never when I wake up in the am

Symptoms: Extreme brain fog off and on. I will go from feeling clear headed to hardly being able to concentrate and feeling “in my own head” like I have a cloud around me. I don’t suffer from depression or anything so this is very frustrating.

Temp: I will do an all day test today

This is my hormone history:

Been on varying doses of TRT (test cypionate for 7 years now)

Current protocol:
170mg test cyp (2 injections per week of 85mg)
Anastrozole: .10mg 2x a week totaling 20mg
I am done having kids so I don’t use HCG anymore since it was harder to manage E2 on it anyways.

Current blood work 3 days after injection:

Vitamin D: 50 (30-100 ng/ml)
Aldosterone: 10 ng/dl
Aldo/PRA Ratio 5.3 (.9-28.9)

TOTAL TESTOSTERONE: 896 (250-1100 ng/dl)
FREE TESTOSTERONE: 173 (35-155 pg/ml)
DHT: 39 (16-79 ng/dL)
Estrodial: 34 (I recognize this isn’t an optimal number and this was after a week of not taking an AI because I had joint pain from over responding)
Progesterone .8 (.2-1.4)
TSH (1.5 (.450-4.50)

Basic Metabolic Panel:
Sodium 139 (135-146)
Potassium 4.8 (3.5-5.3)
BUN: 27 (7-25)
BUN Creatinine Ratio: 19.9 (6-22)
Creatinine: 1.36 (.60-1.35)
Calcium: 9.5 (8.6-10.3)
Cholesterol 178 (125-200)
Cortisol 13.3 (4-22)
DHEA Sulfate 187 (85-690 mcg/DL

I just requested another test when I felt at my foggiest and terrible and also requested thyroid function, mercury levels, and uric acid added to the test.

Any ideas or suggestions of what type of deficiency or imbalance can contribute to the fog?

Thank You All and I look forward to hearing some feedback.

Need to clear up a couple of items.

65mg twice weekly doesn’t equal 170mg
10mg of Adex isn’t possible


My mistake. I just corrected it to 85 mg 2x a week totaling 170mg
.10mg of Adex is possible. I get this from a compounded pharmacy.

Ok I’m confused. Wouldn’t an over responder to a drug need much less of the drug? An over metabolizer would need a much larger than normal dose. You are taking an enormous dose of Adex. That’s more than they give women with cancer. I’m obviously out of my depth on this.

.10 mg adex twice a week****. I used to try to break down the 1mg pill to quarters then divide those until I found a compounding pharmacy that would do .10

Lol. Ok now we’re on the same page.

I have not heard of joint pain associated with the use Adex. The joint pain associated with the use of Adex comes from low E2. I have no experience with aromasin, but it’s a completely different chemical compound, so in theory you shouldn’t be an over responder. If it were me, I’d give it a try. What do you have to lose?

Thanks. That is what I suspected. I definitely am an over responder. If I take .25mg adex my e2 drops to 5-13 levels. I will let you guys all know how aromasin goes.

Strange that libido is high when you’re suffering from brain fog. Makes me wonder whether the brain fog is related to the E2 levels.

I definitely feel a substantial amount more brain fog when e2 gets a little too high. Libido is honestly never affected for me unless e2 crashes below 5. I am trying to get to the bottom of whether it is an estrogen issue, thyroid issue, deficiency, or diet allergy.

1 Like

I noticed that you wrote:

“Training: Extremely intense (4-5 day intense weights), 3-4 days cardio”.

I as well train with extreme intensity throughout the week and often deal with the brain fog you speak of. It tends to dissipate if I take 2-3 days off. It’s usually associated with CNS fatigue.

Does it go away if you stop training for a few days? If so, I’d suggest looking at your training program and tweaking it to give your CNS a rest. I’ve been dealing with this conundrum for the past decade by the way, so if you figure it out, let me know as I could use some pointers.


Completely agree. It does get a bit better after taking a few days off. I almost feel like I permanently altered my neurochemistry but who knows. If I do a heavy deadlift/squat day with low reps/high intensity, I always get worse brain fog.

Light cardio seems to combat this the best. 30 minutes followed by some stretching makes me feel a lot fresher physically and mentally. I also take tyrosine and up to 1000 mg of phosphatidylserine the 6-8 hours after these sessions and it seems to help that CNS fatigued feeling

1 Like

Thanks for the info. This is a supplement I’ve heard nothing about until now. Does the “relief” carry over to the next day or is it temporary with that CNS hang over the following day?

Regarding your labs, everything looks ok except your e2 which is a bit high, but you already touched on that.

TSH is decent too. I’m curious to see your ft4, ft3 and would bet money your rt3 is high because you push yourself past exhaustion frequently.

When rt3 is high, it will give you the symptoms of hypothyroidism since rt3 will block/negate the mechanism of ft3.

Can you take & report your oral waking body temps before you eat, drink, talk and also again around 3pm away from exercise, eating, drinking? Post three days of that info.

Oh yea, PS is the best. Check out piping rock.com and buy the 300mg PS. You can take 1-2 grams a day and it is clinically proven to lower cortisol substantially. It is extremely healthy for the brain as well.

Very interesting information regarding the thyroid. Thank you for the insight.

I will take my temp as your recommended and get back to you with the results as well as my newest blood test numbers when they arrive.

Do you ever take it closer to bed time or does it inferfere with sleep as a subtle nootropic? I would think since it reduced cortisol it would help with sleep but sometimes I’ve experienced counter intuitive results.


Have you found anything else out about the brain fog?