T Nation

Feel Worse with Higher T, Managed E2?

I thought I would open a new thread for this just to keep this simpler. I was wondering if anyone has had a similar experience to me as far as TRT and if anyone has found an explanation, solution, or any suggestions at all. My endocrinologist seems to be clueless as to why I still feel like junk with my current lab values…

Here’s where I’m currently sitting as far as labs:

Total T 650 ng/dL (taking 100mg/wk T cyp)
E2 22 pg/mL (taking 0.125mg/wk Anastrozole)
Cortisol 19.6 ug/dL
TSH 2.17 uIU/mL
Free T4 0.75 ng/dL (taking 50ug Levothyroxine/day)

I’ve been on TRT for 1.5 years now; original T level of 280 ng/dL. On 120mg/wk of T-cyp (split into 3 doses/wk), I felt not much better than before ever starting. I dropped on my own to 100mg/wk about 6 months ago and felt slightly better but still far from normal.

If I attempt to increase to even 110mg/wk T cyp (also increasing Anastrozole by 10%), I feel much worse: brain fog, terrible energy, low libido, depressed mood, lack of interest in things I normally enjoy, etc. 120mg/wk produces even more severe symptoms than a 110 dose, with E2 managed. Right now, I still feel pretty darn bad (all the symptoms I jsut mentioned) on 100mg/wk. I have still not come close to feeling “normal” again even after 1.5 yrs. of TRT. I really have no clue what else to try.

Has anyone had a similar experience? Is there a genetic limit for how much T the body can handle? Should I consider dropping my dose below 100? Any suggestions whatsoever?

Final None: I know the Free T4 is low. My doc has tried me at 75ug/day Levothyroxine for 8 weeks, bringing Free T4 to 1.25. However, he dropped me back to 50ug/day because on the 75/day dose, my TSH dropped to 0.09 (range 0.3-4.0 uIU/mL). For the record, I felt no different on the 75ug/day compared to the 50ug/day. On the 50ug/day, my body temp is consistently in the 98.4-98.6F range.

Thanks in advance,
npeters1989

If I was in that situation I would try some changes ( I am close - I don’t feel much different now while on TRT , and it is causing difficulties with occasional ED and libido issues - but I am loosing belly fat so I will continue for longer ) I have been on T cyp 100mg weekly for 4 months . Recently added Anastrozole liquid . THE CHANGES I WOULD TRY : I would first get an rx for anti depressants .

I would try going up to 1mg anastrozole per week , I would give each about 3 weeks to take effect . As a last resort I would taper off the T cyp over a few months and go natural for about 6 months then take a look at my situation again . I would see if dr would recommend an rx of clomid to help speed restart of natural production .

[quote]Sir toddington wrote:
I would first get an rx for anti depressants . [/quote] I didn’t mention that, but I actually have been on Zoloft 50 mg/day for 4 weeks now, as I had suspected that depression could be a cause for continued symptoms myself. After 2 weeks on zoloft, all symptoms but libido were probably 50% better. At this point (idiotically) I tried a 110mg/wk T dose again. I felt much worse again in the week after that (last week). This week I now feel basically the same as before I ever started the zoloft (pretty crappy, but better than last week after the 110 dose). Extremely complicated… Is the zoloft not actually working, or am I still reaping physiological effects from the higher T dose 2 weeks ago? I just don’t know

[quote] I would see if dr would recommend an rx of clomid to help speed restart of natural production . [/quote] The doc actually put me on 50mg/day clomid the very first 2 weeks of my TRT 1.5 yrs ago. After 2 weeks, T came up to 550ng/dL and I felt better than I ever have since then. Doc then took me down to 25mg/day, after which point my T level and symptoms crashed and never again came up again, even after months at 50mg/day again. Doc was absolutely astounded as to why this was. I have considered trying this again, but fear how bad I felt when my T crashed that low.

Ask dr if there is another rx option to jump start the natural production again - tell him you want to get off TRT gradually. Zoloft can be bumped up in dosage and I would ask DR to go higher ( I take 200mg daily for last 10 years - its been working 95% of time with a few hiccups) . It sounds like the T isn’t making it to the receptors - maybe because the receptors are occupied by E , that’s why I would go up to 1mg week anastrozole .

Btw my Total T level was 100-130 ( range 300-1200 ) tested 3x in a month before TRT. Aside from retaining more fat I was feeling great with no libido problems and no ED problems . I speculate my receptors were utilizing a good portion of this low T and not much aromitazation happening . Yep this whole hormone thing is very confusing and complex to treat for me .

Do you have a free T # ?
This is a guess (from your story and TSH) as I don’t see your free T #, but I bet you have very low SHBG, and as a result very high Free T. If I am correct, your free T will be 2-3x above the high limit.

I am 44 and have SHBG of 12. It allows me to use just 87mg of Test per week which
puts my total T around 600, but keeps my Free T near the top of the range (160-180).
If I use more test and AI I feel like crap.

I also use T prop, not T cyp…but that’s another story.

[quote]PKNY wrote:
Do you have a free T # ?
This is a guess (from your story and TSH) as I don’t see your free T #, but I bet you have very low SHBG, and as a result very high Free T. If I am correct, your free T will be 2-3x above the high limit.

I am 44 and have SHBG of 12. It allows me to use just 87mg of Test per week which
puts my total T around 600, but keeps my Free T near the top of the range (160-180).
If I use more test and AI I feel like crap.

I also use T prop, not T cyp…but that’s another story.
[/quote]
Very interesting. I actually did get a free T done the last time I had labs, but the doc’s office never sent me the results. I will have to check into that. Out of curiosity, what about my TSH makes you suspect that free T would be high? Muscle-wise, I am definitely not that strong for my age (23). I am pretty much plateaued out at 215 max bench with comparable amounts on other exercises, which would lead me to think free T is really not that high. Guess there is only one way to find out…

More AI also makes me feel like crap, second that. On 1mg Anastrozole per week, I felt absolutely terrible and had to cut all the way down to 1/8 mg/wk to get my E2 up into the 20s.

The million dollar question: What on earth makes some people feel worse with a higher T dose if E2 is held constant? Many report the exact opposite! What is going on here???

Your story is similar to mine.
Hard gainer, TSH @2
CYP barely works for me, higher doses make me feel worse
even with e2 in check.

All the above typify low SHBG.
You can google “low shbg and trt,” and it’ll bring up a lot of threads about the subject.
See if any of it rings true for you.

Here is a thread on T-Nation where the subject is being discussed too.

[quote]PKNY wrote:
Your story is similar to mine.
Hard gainer, TSH @2
CYP barely works for me, higher doses make me feel worse
even with e2 in check.

All the above typify low SHBG.
You can google “low shbg and trt,” and it’ll bring up a lot of threads about the subject.
See if any of it rings true for you.

Here is a thread on T-Nation where the subject is being discussed too.

[/quote]
Thanks for the link. I have been researching all this now for nearly 4 hours, what a mess. I suspect I had low SHBG. The last time I had that tested was the first couple weeks I was on CLomid; I had Total T at that time of 306ng/dL with a relatively higher Free T of 9.6ng/dL.

Did you have brain fog, depressive mood, low energy, etc while you were on T-cyp 100mg/wk?

Did you yourself find any answers as to why a higher free T would cause a WORSENING of symptoms with E2 kept in check?

Thanks again,
npeters1289

Cyp was basically worthless to me.
If it wasn’t for the fact that I was using Watson brand that I was RX’d at Walgreens,
I would’ve thought it was fake. Basically felt no better on it than off. Although with high doses (400mg /wk)
I made big gains in the gym, I just felt like shit the whole time wrt libido, mood, erection strength.

I’ve been researching why higher free T causes worsening of symptoms with e2 in check (with ow SHBG),
but I’ve found no definitive answer. My GUESS is that some men have genetically low SHBG.
I believe a few things come with this: 1) Higher TSH, lower T4 and T3, and higher glucose (88-96 range).
Attempts to raise SHBG (t3/t4 and iodine supplementation, tried separately) make me feel like crap as well.
Many in this cohort are also over responders to Adex (looks like you are) Aromasin is way better IMO.

As you probably read in the other thread, the only thing I found to work HRT wise is Test Prop.
My theory is that men with low SHBG rid themselves of test so fast that the test they use must deliver its
expression fast. It’s the reason low SHBG men do somewhat better on gels (the T in them is unestered).
Cyp and Enth esters are longer and they deliver slower so you never get the amount you need to feel
the positive effects of the T.

If you continue with cyp, I’d encourage small daily IM (will deliver faster than subq) injections 12mg /day,
and trying out aromasin. If you can get your doc to RX Test Prop that would be even better.

SSRIs such as Zoloft cause sexual side effects including loss of libido in up to 60-70% of patients depending on source. This is rather common knowledge, so I am surprised that you are expecting an SSRI to solve your issue rather than make it worse.

[quote]seekonk wrote:
SSRIs such as Zoloft cause sexual side effects including loss of libido in up to 60-70% of patients depending on source. This is rather common knowledge, so I am surprised that you are expecting an SSRI to solve your issue rather than make it worse. [/quote]
For me, libido was big time secondary compared to mood and energy level, but I’ve just now quite the Zoloft and am honestly feeling better now energy-wise than I was on it. After all the research I did plus thinking critically about the cycling of my symptoms, the whole thing is revolving around the T injections 100%. Why that is, I’m still trying to figure out.

[quote]PKNY wrote:
As you probably read in the other thread, the only thing I found to work HRT wise is Test Prop.
My theory is that men with low SHBG rid themselves of test so fast that the test they use must deliver its
expression fast. It’s the reason low SHBG men do somewhat better on gels (the T in them is unestered).
Cyp and Enth esters are longer and they deliver slower so you never get the amount you need to feel
the positive effects of the T.

[/quote]
That’s interesting as I had been leaning toward the opposite conclusion after reading all the posts on that other thread you linked to… They were speculating that the very problem with low SHBG is the resulting spike in free T that occurs due to decreased buffering from SHBG, which makes sense to me. If you have a huge dump of free T and it gets metabolized to other by-products before it can be used, perhaps it could be doing more harm than good.

I know that I personally did not respond any better to daily administration of Androgel.

Have you seen anything about Clomid on this subject? I know one guy on the other thread said he had success with it when other things had failed. I know that the only 2 weeks of the past 5 years I have felt normal were the first 2 weeks I was on Clomid 50mg/day, though the whole thing crashed after my doc dropped the dose. Considering how I felt completely normal again those 2 weeks on the 50mg Clomid, I’m seriously thinking about trying a restart on it after doing some more research.

It doesn’t seem like T-prop is much of a viable option unless you’re willing to go underground.

That’s interesting as I had been leaning toward the opposite conclusion after reading all the posts on that other thread you linked to… They were speculating that the very problem with low SHBG is the resulting spike in free T that occurs due to decreased buffering from SHBG, which makes sense to me. If you have a huge dump of free T and it gets metabolized to other by-products before it can be used, perhaps it could be doing more harm than good.

~That is why you take small daily doses (of prop) vs one or two 50-100mg doses of cyp per week. The prop delivers fast so you get its effect before your body eliminates it, but you keep the dose low enough to keep it from dumping to e2, or raising your free t to a level that causes side effects. By controlling the dose, which is small and daily, you control your free t, and e2 to a certain extent.

I know that I personally did not respond any better to daily administration of Androgel.

~This doesn’t surprise me. Its well know that thyroid issues have an effect on absorption of transderamal gels. I did ok on androgel, but after a while the effect dwindled down to just about nothing.

Have you seen anything about Clomid on this subject?

~I have read some threads where it seemed to work for a short while, but became problematic after a few weeks. I personally tried clomid before I used HCG for testicular ache. It spiked my e2 and I was done with that.

It doesn’t seem like T-prop is much of a viable option unless you’re willing to go underground.

~Yes and No.
It’s the route I went for mine, but I’ve spoken to a few guys that get it RX’d.

TRT is really individualistic, what works for me or you will probably need to be tweaked for the next guy, every case is a little different. In the end, it depends on how bad you feel at present and how far you will go to feel better.

1 Like

Why do you want to take higher doses of T in the first place? The average T levels of healthy young men depends on the study, but one study I read recently found an average of 550 ng/dl. You don’t need to chase higher numbers.

It is not uncommon for guys to feel worse on higher doses of T. I have seen various threads on various forums about that.

The most obvious solution would be to decrease your dose. A perk of decreasing your dose could be reduction or elimination of the need for arimidex. Arimidex itself can cause many or all of the problems you complain about for some people, independent of what it does to their E2 levels.

[quote]
~That is why you take small daily doses (of prop) vs one or two 50-100mg doses of cyp per week. The prop delivers fast so you get its effect before your body eliminates it, but you keep the dose low enough to keep it from dumping to e2, or raising your free t to a level that causes side effects. By controlling the dose, which is small and daily, you control your free t, and e2 to a certain extent. [/quote]

Interesting. I see how that could potentially work. I’m glad that it works for you at any rate. I that is a viable option for me at some point I may have to consider it. I appreciate your input on this PKNY, was definitely helpful!

[quote]seekonk wrote:
Why do you want to take higher doses of T in the first place? The average T levels of healthy young men depends on the study, but one study I read recently found an average of 550 ng/dl. You don’t need to chase higher numbers.

It is not uncommon for guys to feel worse on higher doses of T. I have seen various threads on various forums about that.

The most obvious solution would be to decrease your dose. A perk of decreasing your dose could be reduction or elimination of the need for arimidex. Arimidex itself can cause many or all of the problems you complain about for some people, independent of what it does to their E2 levels.

[/quote]
Could certainly be true. I will probably give Clomid a try again. If that doesn’t work, I’m probably going to go with exactly the plan you just described. I think it ultimately comes down to a perception of manliness thing if most of us are honest. Everyone want to have the higher numbers, but looks like that may not work out well in many cases. After all, there’s a lot more to life than a man’s total T # on a lab sheet. High T, low T, in 80 years it will matter nada. However, it would sure be nice to feel at least again decent though in the mean time!

Try replacing the SSRI with Wellbutrin, no SSRI symptoms.

Are you sleeping OK? If not, Trazodone may be helpful and supports mood.

You may have low levels of dopamine. If so, .5 mg cabergoline can be helpful as well as low dose Selegiline. Lots of reading required. Some do need chemical assistance.

Thyroid meds will depress TSH and getting TSH near zero is not really problem.

If you study STTM, you will see that some do not convert fT4–>fT3 effectively in peripheral tissues and they can have ideal fT4 levels and have low fT3 and be very symptomatic. You need fT3 labs! Note that when T4 reduces TSH, there is not going to be much fT4–>fT3 in your thyroid. So T4 meds effectively create low fT3 for some patients. And note that fT3 is really the only thing that gets the job done, so you cannot ignore that. Thyroid hormones regulate Mitochondrial function and that is the foundation for the energy of everything in your body. That is why body temperatures can be low. Body temperatures are a very important indicator, if body temps are low, low fT3 is probably the cause.

So you might need T3 meds or a combo T4+T3 med, a trial might be useful and diagnostic. Do not let induced low TSH be so influential.

It can be difficult when playing with T, E2 and thyroid issues if neural transmitters are holding you down. Some experimentation is needed to see what is going on. If a brain med makes you feel better, that is a important diagnostic result. If you do these things, only introduce one med at a time so you can make associations of benefits or side effects to a specific drug. Note that some of these things can be stimulating and after some time might make you feel worn out. So there are some issues that take time to be recognized. SSRI’s are really horrible in many situations and are really a poor choice for mood support.

[quote]KSman wrote:
Try replacing the SSRI with Wellbutrin, no SSRI symptoms.

Are you sleeping OK? If not, Trazodone may be helpful and supports mood.

You may have low levels of dopamine. If so, .5 mg cabergoline can be helpful as well as low dose Selegiline. Lots of reading required. Some do need chemical assistance.

Thyroid meds will depress TSH and getting TSH near zero is not really problem.

If you study STTM, you will see that some do not convert fT4–>fT3 effectively in peripheral tissues and they can have ideal fT4 levels and have low fT3 and be very symptomatic. You need fT3 labs! Note that when T4 reduces TSH, there is not going to be much fT4–>fT3 in your thyroid. So T4 meds effectively create low fT3 for some patients. And note that fT3 is really the only thing that gets the job done, so you cannot ignore that. Thyroid hormones regulate Mitochondrial function and that is the foundation for the energy of everything in your body. That is why body temperatures can be low. Body temperatures are a very important indicator, if body temps are low, low fT3 is probably the cause.

So you might need T3 meds or a combo T4+T3 med, a trial might be useful and diagnostic. Do not let induced low TSH be so influential.

It can be difficult when playing with T, E2 and thyroid issues if neural transmitters are holding you down. Some experimentation is needed to see what is going on. If a brain med makes you feel better, that is a important diagnostic result. If you do these things, only introduce one med at a time so you can make associations of benefits or side effects to a specific drug. Note that some of these things can be stimulating and after some time might make you feel worn out. So there are some issues that take time to be recognized. SSRI’s are really horrible in many situations and are really a poor choice for mood support.[/quote]

Thanks for your response! I have actually gotten off the SSRI now as all it did was make me feel more tired. I need feel better than I did on it. I will have to get a free T3 test next time I get bloodwork to see what is going on here. Thanks again