Fatigue, Drowsiness after Starting TRT Injections

Pharma / TRT Testosterone Replacement
1

Background:
Both (subclinical) Hypothyroidism (TSH: 5.75) and Hypogonadism (140.4 ng/dl Total T)
Lab tests etc are in this thread:

Medication:
Hypothyroidism - (self medicating): 125mcg Levothyroxine daily, AM, empty stomach. For past 2 months or so.

TRT:
Just with Thyroid med alone, my T levels increased to 400s ng/dl. (Good news!)

To this, I added Cernos 1% gel 2 weeks ago. Got tested after 2 weeks of using this gel, and T levels moved up to 736 ng/dl and E2 was 35.

But I didn’t feel any different or any better energy or anything. I read in the forums that injections are much better.

So, went back to the doctor and requested injections instead of gel. He prescribed me Sustanon 250mg every 3 weeks.
(I know it’s not recommended protocol but bear with me).
Note: this doctor did not prescribe me anything for Thyroid. I am self medicating with LevoThyroxine - he thought I was only slightly outside normal range so I didn’t need to take anything for Thyroid. But this same doctor did prescribe me Testosterone.

Took the first shot 2 days ago and since then I’ve been feeling fatigued all day When I wake up, I feel kinda drowsy. As if you woke-up before the effects of a flu medication like Nyquill wear-off.

When I first started taking Levothyroxine 125mcg couple of months ago, I noticed immediate improvement in mood, energy, mental clarity. I was under the impression that Testosterone will improve my mood, energy, libido further. But instead I feel worse than even before I had started Thyroid med couple of months ago.

Should I stop taking T injections and go back to gel? Or is there something I need to investigate?

Now that I’ve taken one injection, I’d much rather take injections because gel is sticky and needs to be put on daily and it is lot more expensive than injection. I rather get to once or twice a week injection protocol, if at all possible.

2

It’s going to take some time for blood testosterone levels to reach a stable state, these are hormones and it’s not like the instant relief you get from taking medication. I know test cypionate it takes 6 weeks to reach a stable state, do not know how long it takes on Sustanon. If you dosage is too high you won’t feel well and I doubt your doctor even knows what he’s doing.

TRT is more than just about injecting testosterone, 250mg every 3 weeks isn’t ideal. SHBG will determine injection frequency and dosing. Injections provide more muscle gain compared to gels. You need to remain consistent and frequently switching protocols with end in you giving up on TRT.

A lot of guys have unrealistic expectations, they expect to feel good immediately and that’s NOT how TRT works. Gene expression must occur over time, tissue regeneration must happen first. It took me about a month and a half to two months to really “start” feeling better, not 100 percent. That happens after several months and continues for years.

Once you know your SHBG, then you can have a plan of action, your doctors doesn’t know how the TRT game is played and until you do find a hormone expert little will change. In the US we must go private to get proper care, there are no insurance based doctors who specialize in hormones which is why the majority fail at anything hormone related.

You need to keep levels stable and that isn’t going to happen injecting once every 3 weeks.

3

Thyroid (Thyroxine):
I’ve reduced dosage to 100mcg.

@systemlord with regards to Dosage Frequency for T injections, you asked about SHBG:

SHBG is actually quite low (13.5) for me. Perhaps I need to increase it?
With such low SHBG, is it ok if I dose once a week?
Well, for now, I’m taking Sustanon 250 so I guess I could dose that every 2 weeks. But once I return to the US, I’ll switch to Test Cyp or Test E and then I probably need to dose only once a week?

E2:
It has climbed. So, I just took a 0.5mg of Arimidex. I’ll try to see if I can find Aromasin though.

Fatigue/Drowsiness:
Symptoms persist. I’m not sure what’s wrong with me since I took T shot, feels like I’ve a lot less energy and I wake up feeling drowsy. Eventhough my T levels have increased significantly. It’s at 892 now with 3 days after Sustanon 250mg shot.

Erectile Dysfunction ED:
Still present. Took 20mg cialis and still didn’t get hard enough wood. Until a year and a half ago, I could take 10mg (half dose) of Cialis and be hard for the whole weekend. I had hoped that with Thyroid med, increased Testosterone, ED will go away.
Here is a summary of all the lab results I’ve. You’d notice in June 2013, I had no Erectile Dysfunction. My Testosterone was 358 and my E2 was 15 in June 2013 when I had no problems.

4

Thyroid medicine will increase SHBG, working out may help to elevate it. You need to inject test every day with your low SHBG since your losing most of what’s being injected within a day or two. Large infrequent injections is why your estrogen is so high.

5

Thanks. But I’m confused - low SHBG is a bad thing? I was under the impression that SHBG binds to Testosterone. So, lower SHBG is a good thing and would require less-frequent Testosterone injection as less will get bound to SHBG and more T will remain bioavailable.

If I’ve to inject everyday, then isn’t it better that I return to using T gel? I can get higher potency T gel say 5% or even 20% so that I don’t have to slather up 15ML of gel on my body. It’s easy to slather up 1-2ML after shower in the morning as such.

Also, I don’t know what my SHBG was in June 2013 but at that time I had no Erectile Dysfunction.

6

Your estrogen in June was 15 pg/mL, now it’s 47 pg/mL. High estrogen will cause ED and lower libido. Low SHBG is associated with obesity and insulin resistance and is not healthy. SHBG midrange is best.

7

OK. I’m not obese or even fat. I’m 5’10 (178 cms) and 70kg/154 lbs. Age 35. I also do not have any diabetes or insulin issues per my test results. All in normal range.

So, I’m confused. I suppose Estrogen will come back in range with the help of Arimidex/Aromasin. But as you are saying it is good to have a mid-range SHBG, I’m not sure how to do that. It seems like I’ve always had lower-SHBG. June 2017 and July 2018 both times it seems to be low.

Also, I’m unclear on increasing dosage frequency. I thought the main reason to do T injections instead of gel was to reduce dosage frequency to once or twice a week. But if low SHBG means I’ve to inject everyday, then perhaps, I could go back to using gel but get it compounded to a much higher potency (from 1% to 5 to 20% potency so I only have to apply 1-2 ML daily)

8

I have low SHBG (16-18 nmol/L) and unless I inject EOD I have no erections, no libido and soft muscles. I use 1/2" insulin syringes and inject in shoulders and outer quads. Injections is better than transdermals. I suggest you inject 6-8mg ED.

Intramuscular TRT is more effective than transdermal formulations at increasing LBM and improving muscle strength in middle-aged and older men, particularly in the lower extremities.

9

I think this is what Systemlord was getting at: Low SHBG means more bioavailability of test. It also means more of it can aromatise. That’s probably why your e2 is on the high side.

10

Thanks @systemlord @iron_yuppie but if I took Aromasin/Arimidex + long ester T (like testosterone undecanoate), then shouldn’t that take care of the problem?
→ Inject say 200mg of testosterone undecanoate every 10 days + 25mg of Aromasin E3D or something ?

If not. And if low SHBG necessitates frequent injection, then why not simply use a high potency gel like 10% potency everyday in the morning? That would be simpler than injecting.

11

Aromasin is a suicide inhibitor, irreversible type. Nebido is no good, we don’t recommended it.

12

Thanks!

I’m thinking of this TRT + Thyroid protocol:

Thyroid:
Continue Thyroxine 100mcg ED morning
→ This seems to keep my TSH at about 1.0. At 125mcg, my TSH was <. 01 which I figured is too low.

TRT:
Low SHBG makes it necessary to dose T more frequently, so following TRT protocol is what I’m thinking:

1 ml of T-Gel (compounded at 15%) ED morning transdermal application on shoulders, neck, arms, upper back. So, about 10-15mg should get absorbed.
+
HCG 500 IU twice a week injection (if I miss some shots because of travel, no big deal)
+
AI Arimidex .25 mg EOD or Aromasin 25mg E3D

May have to adjust dosage/frequency of AI based on lab results and symptoms. But this seems to me like a good guesstimate to start with.

What do you all think?