T Nation

Dizzy, Wild Dreams, Insomnia, Feeling Crappy on TRT

I have been on trt cream (I tried to get injectable but doctor says I will have to visit his office for that weekly since he can’t prescribe it for self use). We started on 5mg daily almost 4 months ago.

At first felt slightly better but then began to feel dizzy, burned out in afternoons, weak, etc…bloodwork showed my TT had dropped to below the range, but saliva showed an increase in FT coupled with an increase in E2…doctor increased my dose to 15mg ED with Chrysin compounded in to fight the E2 (again he feels it is effective and no need for arimidex). And he also told me to supplement with dhea and pregnolenone daily 25mg each.

Felt much better for about 2 weeks and now I am battling nightsweats, waking up nightly, dizziness during the day, increased anxiety, poor exercise tolerance, no libido etc. Can E2 be a culprit? Can the dhea and pregnolenone be? Other ideas or specifics needed?

Also, assuming only 10 to 15% absorption from creams would a dose of 15 mg daily provide any benefits or could it be causing harm by shutting down my own production and not giving anything to replace?

As a side note, my cortisol levels were previously messed up but with some supplements recent salivary testing shows I am in the normal range throughout the day. My thyroid panels have also been good.

Updates with info and lab results
Answers to KSMans basics
38-age
5’10"-height
34"-waist
175-weight
Can grow a full beard quickly. Not to heavy on the chest hair, sparse back hair.
-mainly carry my fat on the love handles and back
-high lipids, past thyroid nodule but no current issues
-xanax 0.25 to 0.5mg daily for anxiety
-lab results with ranges (see below)
-tend to try and eat plenty of healthy fats and protein and stay away from refined carbs since they seem to make my triglycerides and cholesterol skyrocket
-I don’t overtrain. One good day in the gym seems to knock me on my ass for a week
-have maybe 2 episodes a year where testes hurt like hell
-haven’t had morning or nocturnal erections as long as I can remember unless I have some cialis in my system.

LABS

January 30, 2012 (serum)

Cholesterol 249
Triglycerides 397
Clucose 105
TSH 1.50 (0.4 to 4.5)
Free T4 1.2 (.8 to 1.8)
FSH 2.1 (1.6 to 8)
LH 1.1 (1.5 to 9.3) low
E2 16 (<39 pg/ml)
TT 419 (250 to 1100 ng/ml)
FT 69.6 (35 to 155)

February 22, 2012 (salivary results in pg/ml)

Cortisol (summary it showed afternoon tanked and then shot way up before bed)
E2 0.6 (1.0 to 3.0 males)
Progesterone 2357 (5 to 100 males) (was applying my girlfriends cream and didn’t realize the effect it would have!!!)
Melatonin 12.4 (12 to 23)
Bio Testosterone 81.3 (40 to 130 in morning)

At this point Doctor started me on 5mg/ml daily compounded testosterone cream, plus l-arginine to try and get me some energy, libido, erections, mood, etc. Also some adrenal supplements to try and correct cortisol.

June 29, 2012 (salivary)

Cortisol - levels corrected to normal
Cortisol/Dhea-S Ratio 6.4 (5.0 to 6.0 normal) High -
E2 2.2 (1.0 to 3.0) (increased since last visit)
Melatonin 8 (12 to 23) LOW - decreased since last visit
Bio Testosterone 98.7 (40 to 130) showed increase

July 7, 2012 (Serum Results) (went to Patient First because I felt like my body was going to shut down)

CBC - all good except my MCH is always slightly high
TT - 303 (348 to 1197)
TSH - 1.94 (0.450 to 4.5)
Vitamin D - 40.6 (30 to 100) seems low considering getting summer sun and supplementing 5,000 IU daily

After this visit and showing my TRT doc the Patient First Results coupled with the misery I was in, he upped my T dose to 15 mg/day with the Chrysin compounded in. He also started me on pregnolenone and DHEA oral tablets to see if they helped. They worked for about a week and now I feel like hell as stated above.

Please let me know if there is anything else I can provide and Thanks.

I had something similar happen to me. Good period lasted about 5 days… then dropped. I figured it was E2 to blame, doc didn’t have me on an AI, so I got some Chrysin and used it when I felt like crap.

After a while, I realized that I would crater on the days I used some Chrysin to ‘make sure I got off to a good start’ and it just got worse when I tried to ‘treat’ it.

Stopped the Chrysin and I balanced out pretty well.

Since then, I’ve switched from cream to T-cyp… but the effect made me think that I was driving E2 too low and that was the problem. Seems to have been the case.

" nightsweats, waking up nightly, poor exercise tolerance, no libido" < These can be E2 issues. Post your labs as soon as you can so we have some numbers with which to work.

In the meantime, why did your doctor say, “[You] will have to visit his office for [injections] weekly since he can’t prescribe it for self use”? I have never heard of a doctor who can’t prescribe testosterone for home injections, especially when he can prescribe the gel for home use. I know doctors who won’t, but not doctors who can’t. Maybe it’s an issue where you will have to either push him to do it, or you’ll have to find another doctor. I’m guessing that you’re in America or some other English-as-a-primary language? No English speaking country has laws against home use of liquid testosterone if you have a prescription, at least not that I know of.

In my experience, I’ve found that doctors who won’t prescribe home injections often won’t even test E2 (which I know isn’t the case with your doctor), let alone prescribe anastrozole (as is the case), and getting hCG is completely out of the question. Taking hCG will keep your natural production of pregnenolone running, so you wouldn’t need to supplement with it. Injections are far cheaper than the gel ($80 for a 10 week supply of Test-C, vs over $250 for 1 month of gel), and even if your insurance covers both, you’re saving your insurance company money which in the long run is a good thing.

“Also, assuming only 10 to 15% absorption from creams would a dose of 15 mg daily provide any benefits or could it be causing harm by shutting down my own production and not giving anything to replace?”

Any time you’re adding exogenous testosterone (or any hormone for that matter) into your system your body will shut down its own production. The average male produces somewhere between 7mg and 15mg of testosterone a day naturally. At the high end of 15%, you would be getting 2.25mg a day. The standard starting dose of Androgel 1.62% is 2 pumps (though I’m guessing you’re on 1%?), which is 40.5mg of testosterone, so unless I am misunderstanding what you wrote, you’re taking less than half the standard starting dose of the gel. So to answer your question: Yes, you are shutting down your own production, and yes, you aren’t replacing it with an amount that will raise your testosterone levels to anything worthwhile. Even if you had 75% absorption, at the dose you’re on you’d still be on the low end (though within “normal” if that matters). Compare that to injections: at 50mg twice a week, and only a 30% waste rate, you’d be getting 70mg a week, or an average of 10mg a day (some days higher, some lower, but this is averaged out). And that is at the standard starting dose too, so you’ll have a lot of room for expansion if necessary.

So, get us the labs, with ranges, when you get a chance. Also, you may want to discuss strategy with us to help you get on the injections. Let us know if you have any other questions in the meantime!

Updated original post with lab results and some more info

[quote]ctastrophe wrote:
" nightsweats, waking up nightly, poor exercise tolerance, no libido" < These can be E2 issues. Post your labs as soon as you can so we have some numbers with which to work.

In the meantime, why did your doctor say, “[You] will have to visit his office for [injections] weekly since he can’t prescribe it for self use”? I have never heard of a doctor who can’t prescribe testosterone for home injections, especially when he can prescribe the gel for home use. I know doctors who won’t, but not doctors who can’t. Maybe it’s an issue where you will have to either push him to do it, or you’ll have to find another doctor. I’m guessing that you’re in America or some other English-as-a-primary language? No English speaking country has laws against home use of liquid testosterone if you have a prescription, at least not that I know of.

In my experience, I’ve found that doctors who won’t prescribe home injections often won’t even test E2 (which I know isn’t the case with your doctor), let alone prescribe anastrozole (as is the case), and getting hCG is completely out of the question. Taking hCG will keep your natural production of pregnenolone running, so you wouldn’t need to supplement with it. Injections are far cheaper than the gel ($80 for a 10 week supply of Test-C, vs over $250 for 1 month of gel), and even if your insurance covers both, you’re saving your insurance company money which in the long run is a good thing.

“Also, assuming only 10 to 15% absorption from creams would a dose of 15 mg daily provide any benefits or could it be causing harm by shutting down my own production and not giving anything to replace?”

Any time you’re adding exogenous testosterone (or any hormone for that matter) into your system your body will shut down its own production. The average male produces somewhere between 7mg and 15mg of testosterone a day naturally. At the high end of 15%, you would be getting 2.25mg a day. The standard starting dose of Androgel 1.62% is 2 pumps (though I’m guessing you’re on 1%?), which is 40.5mg of testosterone, so unless I am misunderstanding what you wrote, you’re taking less than half the standard starting dose of the gel. So to answer your question: Yes, you are shutting down your own production, and yes, you aren’t replacing it with an amount that will raise your testosterone levels to anything worthwhile. Even if you had 75% absorption, at the dose you’re on you’d still be on the low end (though within “normal” if that matters). Compare that to injections: at 50mg twice a week, and only a 30% waste rate, you’d be getting 70mg a week, or an average of 10mg a day (some days higher, some lower, but this is averaged out). And that is at the standard starting dose too, so you’ll have a lot of room for expansion if necessary.

So, get us the labs, with ranges, when you get a chance. Also, you may want to discuss strategy with us to help you get on the injections. Let us know if you have any other questions in the meantime![/quote]

The doctor seems to be under the assumption that Testosterone injections are a scheduled substance that can’t be injected by users. He doesn’t charge extra for the service so I think he is just misinformed which is odd considering HRT is a specialty of his.

If you are in the US he can subscribe it. He just doesn’t want to for some reason.

Perhaps some good news on my doc switching to injections. My doc just responded via email - I agree with your assessment that what we are doing now is just not quite enough (or not the right thing). I am currently reviewing the steroidogenic pathways with all of the enzyme pathways. I will also review the HCG protocol. I am certainly willing to change your treatment plan to the injectable testosterone along with HCG and Arimidex. Doing it that way is not an uncommon approach.

But in looking at my labs, is there anything else that stands out that I should address or make sure that I look into before going further?

[quote]cirerecrem wrote:

[quote]ctastrophe wrote:
" nightsweats, waking up nightly, poor exercise tolerance, no libido" < These can be E2 issues. Post your labs as soon as you can so we have some numbers with which to work.

In the meantime, why did your doctor say, “[You] will have to visit his office for [injections] weekly since he can’t prescribe it for self use”? I have never heard of a doctor who can’t prescribe testosterone for home injections, especially when he can prescribe the gel for home use. I know doctors who won’t, but not doctors who can’t. Maybe it’s an issue where you will have to either push him to do it, or you’ll have to find another doctor. I’m guessing that you’re in America or some other English-as-a-primary language? No English speaking country has laws against home use of liquid testosterone if you have a prescription, at least not that I know of.

In my experience, I’ve found that doctors who won’t prescribe home injections often won’t even test E2 (which I know isn’t the case with your doctor), let alone prescribe anastrozole (as is the case), and getting hCG is completely out of the question. Taking hCG will keep your natural production of pregnenolone running, so you wouldn’t need to supplement with it. Injections are far cheaper than the gel ($80 for a 10 week supply of Test-C, vs over $250 for 1 month of gel), and even if your insurance covers both, you’re saving your insurance company money which in the long run is a good thing.

“Also, assuming only 10 to 15% absorption from creams would a dose of 15 mg daily provide any benefits or could it be causing harm by shutting down my own production and not giving anything to replace?”

Any time you’re adding exogenous testosterone (or any hormone for that matter) into your system your body will shut down its own production. The average male produces somewhere between 7mg and 15mg of testosterone a day naturally. At the high end of 15%, you would be getting 2.25mg a day. The standard starting dose of Androgel 1.62% is 2 pumps (though I’m guessing you’re on 1%?), which is 40.5mg of testosterone, so unless I am misunderstanding what you wrote, you’re taking less than half the standard starting dose of the gel. So to answer your question: Yes, you are shutting down your own production, and yes, you aren’t replacing it with an amount that will raise your testosterone levels to anything worthwhile. Even if you had 75% absorption, at the dose you’re on you’d still be on the low end (though within “normal” if that matters). Compare that to injections: at 50mg twice a week, and only a 30% waste rate, you’d be getting 70mg a week, or an average of 10mg a day (some days higher, some lower, but this is averaged out). And that is at the standard starting dose too, so you’ll have a lot of room for expansion if necessary.

So, get us the labs, with ranges, when you get a chance. Also, you may want to discuss strategy with us to help you get on the injections. Let us know if you have any other questions in the meantime![/quote]

The doctor seems to be under the assumption that Testosterone injections are a scheduled substance that can’t be injected by users. He doesn’t charge extra for the service so I think he is just misinformed which is odd considering HRT is a specialty of his.[/quote]

So this begs the question that since your doctor is either:

a. completely ignorant of TRT protocols and their prescriptions or
b. completely dishonest and morally bankrupt

(and don’t kid yourself, he is either one or the other)

Why have you not fired his sorry ass?

Regarding your actual questions, first of all saliva tests do not have a good track record in the TRT community. I do not put much stock in them at all.

You appeared to be secondary hypogonodal from your first set of blood work (what time of the day were they taken?) with the low LH/FSH. Your T results also were not HORRIBLE. They lay in a tricky area (no man’s land). But I would have recommended a SERM Challenge/restart in that case.

[quote]VTBalla34 wrote:
Regarding your actual questions, first of all saliva tests do not have a good track record in the TRT community. I do not put much stock in them at all.

You appeared to be secondary hypogonodal from your first set of blood work (what time of the day were they taken?) with the low LH/FSH. Your T results also were not HORRIBLE. They lay in a tricky area (no man’s land). But I would have recommended a SERM Challenge/restart in that case.

[/quote]

I know my values aren’t horrible but my symptoms sure are! I haven’t started the new injections (still on the low dose cream), so I assume a SERM challenge/restart is not out of the question? Although I cannot find the lab results, over a decade ago I had LH and FSH values that were even lower with TT at about 400. At that time I knew even less than I do now and was told all was fine by that doctor.

I have been trying to read every post on the SERM challenge and haven’t found one that spells it out but essentially what I gather is that I try a low dose of Clomid (12.5mg ED) or Nolvadex (10mg ED) and evaluate labs after a month. I have read conflicting posts on the use of an AI during this time though? If LH, FSH and T increase, continue for another month and then taper off as I have ‘confirmed’ my secondary status and can see if I can maintain production. If my body doesn’t maintain it’s own production after the restart, then first try HCG monotheraphy or second try the standard TRT injection protocol. Sound right?

Thanks

I guess at that point it wouldn’t hurt to figure out if any of the concussions I had as a kid damaged the pituitary… Thanks!

[quote]VTBalla34 wrote:
Regarding your actual questions, first of all saliva tests do not have a good track record in the TRT community. I do not put much stock in them at all.

You appeared to be secondary hypogonodal from your first set of blood work (what time of the day were they taken?) with the low LH/FSH. Your T results also were not HORRIBLE. They lay in a tricky area (no man’s land). But I would have recommended a SERM Challenge/restart in that case.

[/quote]

Labs were taken in the morning. I’m also not sure about saliva results, but my doctor swears by them saying that based on his experience and research they represent bioavailable levels much more accurately than serum and reflect changes due to treatment much better. He has said he will do serum if I want though so i will request that. As far as firing him, he is the first doctor I have found in my area that is willing to treat symptoms above lab values and is extremely open to knowledgeable suggestions regarding treatment. My symptoms have been disregarded more times than I can count by other doctors.

I don;t remember the protocol for a SERM restart, but it is similar to a the Post Cycle Therapy (PCT) of a steroid user. You can find info about PCT in the steroid forum. I think doses you listed are on the low end. But I really don’t know.

My urologist laid out the protocol of 50mg of Clomid every day for 60 days and then taper down to 25mg for an additional 30 days as his SERM restart protocol. That much clomid gave me quite a few unpleasant sides so i’m now at 25 mg EOD. I hit labcorp this morning and will post my results on this dose of clomid in the original thread i created after i see the doc next week.

[quote]wmk33 wrote:
My urologist laid out the protocol of 50mg of Clomid every day for 60 days and then taper down to 25mg for an additional 30 days as his SERM restart protocol. That much clomid gave me quite a few unpleasant sides so i’m now at 25 mg EOD. I hit labcorp this morning and will post my results on this dose of clomid in the original thread i created after i see the doc next week.[/quote]

Great. I will keep an eye on it. Thanks

[quote]cirerecrem wrote:

[quote]wmk33 wrote:
My urologist laid out the protocol of 50mg of Clomid every day for 60 days and then taper down to 25mg for an additional 30 days as his SERM restart protocol. That much clomid gave me quite a few unpleasant sides so i’m now at 25 mg EOD. I hit labcorp this morning and will post my results on this dose of clomid in the original thread i created after i see the doc next week.[/quote]

Great. I will keep an eye on it. Thanks[/quote]

I do know that most PCT regimens are only 4 weeks long with the first two weeks being higher doses than the second two weeks (cut in about half dosage wise)…

[quote]VTBalla34 wrote:

[quote]cirerecrem wrote:

[quote]wmk33 wrote:
My urologist laid out the protocol of 50mg of Clomid every day for 60 days and then taper down to 25mg for an additional 30 days as his SERM restart protocol. That much clomid gave me quite a few unpleasant sides so i’m now at 25 mg EOD. I hit labcorp this morning and will post my results on this dose of clomid in the original thread i created after i see the doc next week.[/quote]

Great. I will keep an eye on it. Thanks[/quote]

I do know that most PCT regimens are only 4 weeks long with the first two weeks being higher doses than the second two weeks (cut in about half dosage wise)…[/quote]

Thanks VT. Still waiting to hear back from doctor but will keep posted on plan and results as they come in.

New bloodwork results from serum testing on 8/14/2012 (while on 15 mg test cream per day). Contains some ranges and calculations I am not familiar with.

TT - 335 ng/dl (160-726)
Testosterone Free, calculated - 92.2 pg/ml (21-135)
Testosterone, % Free - 2.8% (1.5-3.2)
T, Bioavailable, Calculated - 216 ng/dl (48-317)
T % Bioavailable - 64.5%
SHBG - 17nmol/L (9-54)
FSH - 2.6 mIU/ml (1.4-18.1)
LH - 3.8 mIU/ml (1.5-9.3)
E2 - <18pg/ml (<53)
Progesterone - 1.17 ng/ml (0.28-1.22)
Prolactin - 10.4 ng/ml (2.1-17.7)
DHEA-S 657 (80-560)
DHT - 24 ng/dl (16-79)
Pregnenolone - 45 ng/dl (<151)

So…My total Test is still on the low side, but Bio and Free T appear ok. Doesn’t appear that low doses of the cream have shut down by LH and FSH production. Actually, they are both higher than when I was on T cream?

Any thoughts on why I still have all those symptoms?
Could my E2 be too low?
Should I try and get my TT higher despite normal FT levels? (as a side note, I have been dosing slightly more cream the past few days and have felt more like my old self, laughing, less irritable, less fog, etc.)

You are not taking adex correct?

[quote]VTBalla34 wrote:
You are not taking adex correct?[/quote]

Correct. However he put Chrysin in the compounded cream as an AI. Also, just received DHEA-S results, which are high. I put them in the results post. Thanks.

Weird that your E2 is so low then.

I would not put much stock in that Free T calculation. I have not seen someone with TT levels that low actually have Free T levels in the upper half of the range. Doesn’t make sense to me.

Your LH/FSh esponse is unusual, indicatin you would probably be ok with more T. That is the path I would take (increased dose). Tlak to your doctor.