T Nation

Feeling Awful on Testosterone Injections and Not Responding

Hi everyone, first time user here. I’ve read all of the stickies in the T replacement category.

I am currently on 250mg of Testosterone Enanthate per week split into two injections of 125mg on Monday and Thursday. I self-administer IM in my quads. I realize this is not a TRT dose yet am not looking to go higher.

It’s been 10 weeks on this protocol now and I have noticed no change in symptoms. Prior to the Testosterone injections I had low testosterone and was diagnosed with hypogonadism due to dieting and weight loss. I am 21 and do not wish to discuss my reasoning for using Testosterone at this age. I have my reasons and they’re very good ones and I don’t need or require judgement from anyone. To cut a long story short, I grew sick and tired of dealing with ED and low libido for 2+ years straight.

So what’s happened since I started on the injections is that I’ve actually experienced significantly weaker erections. I have no libido, energy is poor, concentration is terrible, and I’m very moody and distressed. It’s been 10 weeks and I have noticed NOTHING. No change. It’s actually worse now as I can barely get erections. When I wake up in the morning, no matter if I get 9 or 10 hours of sleep, I have heavy, dark bags under my eyes and they feel very groggy.

I believe the issue is due to Estradiol. It was at 327 pmol/ L (89pg/ml) at week 6 and I have since lowered it using Arimidex to 122 pmol/ L (33pg/ml). However, since doing so, I have noticed no change. My libido is terrible, energy is terrible, and I feel awful in general. I am currently on 4.5mg of Arimidex per week to get my E2 in the low 20’s or slightly lower. I realize this is a very high dose. I definitely convert a lot.

Lately my appetite has been in the gutter.

Here are some details of mine:

  • 21
  • 6’1
  • 34’’ waist
  • 100kg
  • About 13-14% bodyfat as a rough estimate
  • No serious health conditions or diseases that I’m aware of
  • On no drugs other than Test E and Arimidex. I used Roaccutane at age 16 for 7 months which screwed me up, was never the same since but gradually got much better.
  • I lift weights 4-5 days per week and do cardio on my off days.
  • Currently experiencing weak to no morning wood, rare and weak nocturnal erections.
  • I eat a balanced diet of atleast 3000 cals a day. Though lots of potatoes, tuna, fruit, greek yoghurt, vegetables and beef.

Here is my blood test from Monday 1/05/2017 for Testosterone, Thyroid and Oestradiol:

Testosterone 58.1nmol/L (6.0- 28.0)
Free Testosterone 2364 pmol/L (200-600)
SHBG 26 nmol/ L (15-50)

Oestradiol E2 122 pmol/ L (<150) = 33 pg/ml

TSH 6.23 mIU/ L (0.5 - 5.00)
Free T4 14.1 pmol/ L (9.0 - 25.0)
Free T3 6 pmol/ L (3.5 - 6.5)

My morning temperature averages using an oral thermometer have been 97.0 - 97.2 degrees.

I’m very dumbfounded why I still feel awful on Testosterone and have noticed no change. Do I need to reduce E2 further? I also am aware my TSH is ridiculously high and I have subclinical hypothyroidism. Could that be a reason? If so how do I treat my high TSH. Free T3 and Free T4 numbers are good.

I’m very worried and concerned. I just want to feel better. I have done everything right so far and it’s not working in the slightest. I plan on doing this for life but despite high T levels and lowering my E2 I am not feeling the Testosterone at all.

Thanks for the help anyone has to offer.

You have hypothyroidism. Please read the thyroid basics sticky from end to end.

Please explain your history of using iodized salt.

Where are you located?

You do nothing other than inject T and take anastrozole?
How much have testes become smaller?

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

Are you on pharmaceutical testosterone or underground?

More: Guys on a good and balanced TRT can have most of the symptoms of low-T if thyroid function is low, because most of the symptoms are the same.

Hopefully your TSH is high from an iodine deficiency as that can be fixed.

You may also have noticed that you feel cold easier and your outer eyebrows may be sparse. Thyroid may be enlarged, asymmetrical or lumpy.

There is no useful amounts of iodine in sea salt, the iodine gets lost in the process of crystallization.

Different countries provide iodine in different manners. Iodized salt, iodine in commercially baked bread or in dairy products. Dietary restrictions can be a factor. Restaurants typically do not use iodized salt and prepared foods typically do not.

Hi Jasmincar,

I am on underground Testosterone Enanthate as no doctor would prescribe me T even though I scored as low as 12 nmol/ L and had every symptom of low Test. I have verified the Testosterone multiple times through blood tests and have never scored below 50 nmol/ L for Testosterone blood levels in the past 10 weeks of use. My balls have shrunk too a little bit so it’s legitimate.

Hi KSman,

So it is clear I have hypothyroidism. I never would have expected that this would completely negate the effects of the exogenous Testosterone!

I am located in Australia. My history of using iodized salt is limited - it is possible I could be deficient in iodine, however I have always eaten a lot of dairy? I eat 500g of greek yoghurt a day and used to always eat two pieces of bread a day as toast with 5-6 eggs.

I have read all stickies including the Thyroid basics sticky. I do have a question - can this be resolved through Iodine supplementation or should I use synthetic T4 (Thyroxine) which I have a prescription for?

Before I went on Testosterone, a doctor diagnosed me as hypothyroid and prescribed me T4 and said to take 50mcg a day. I didn’t because I didn’t trust him the same way I don’t trust all doctors when it comes to hormones. Before TRT my TSH was 4.3 mIU/L. It has increased from Testosterone injections. It is apparent I may need the Thyroxine after all, unless you believe iodine is the best option. (or both?)

I am also confused as although I have ‘hypothyroidism’ my free T3 and T4 numbers look good?

Oral body temperature this morning was 96.8 degrees. Rechecked a few times and it didn’t rise above 97.2 degrees.

Other than hypothyroidism, is there any other possibilities as to why I have not felt the Testosterone? I am still a bit dumbfounded as to how hypothyroidism can cause me to feel so terrible even with such high Testosterone levels.

I am still working towards E2= 22 pg/ml. Getting another blood test tomorrow (Monday) and will report back what my E2 is.

That is correct also KSman - I just inject T and take anastrozole. I sure need a lot of it. My testicles have decreased in size a little bit but is only really noticeable when it’s cold. When it is warm they look normal. Testicles never ache.

Other details:

  • Good amount of facial hair, have to shave every day
  • I do get some small pimples on my face from the Testosterone and DHT, almost daily
  • Lots of body hair, hair on chest (moderate)
  • I carry fat on my lower abs, has changed since pre-TRT where it would go to glutes and hips more.
  • I take a week off training every 3-4 months. Train push/ pull/ off/ legs/ off/ repeat

All Australian bread (with the exception of organic) is required to be baked with iodised salt. Dairy contains some iodine too.

There are a few doctors in Australia who are open to TRT. @flash74 and I are seeing Dr Zentner, who is probably the best one to speak to Down Under.

Lastly, depression has similar symptoms to hypogonadism, and might explain why you’re not responding to a high dose of testosterone. Get yourself checked out for that too.

You may also have noticed that you feel cold easier and your outer eyebrows may be sparse. Thyroid may be enlarged, asymmetrical or lumpy.


"Iodine intake in Australia has dropped

In the past, low dietary levels of iodine were thought to be a problem only in developing countries. However, some researchers suspect that iodine intake levels in Australia have dropped considerably, perhaps by as much as half, over the past few decades. Ongoing research is looking at the problem and what might be done about it.

Some reasons for low iodine intake may include:

consuming most of our salt in processed foods, as manufacturers do not use iodised salt in processed foods (except recently, in bread)
less iodine in milk because of changes in treatment methods
a possible reduction of iodine levels in Australian soils
a reduction in the use of salt in cooking and table salt (particularly iodised salt)."

AM oral body temps are your low, mid-afternoon would be peak. Need both.

Others in a household can be iodine deficient, please check body temperatures.

TSH should be closer to 1.0
fT3 and fT4 should be mid-range or a bit high.
The lab ranges are rather useless.

Your fT3 above mid-range and low body temperatures suggest that elevated rT3 may be blocking fT3 at T3 receptors. This can be part of adrenal fatigue and the conversation then needs to address: stress, major stress events, accidents, surgeries, chronic inflammation/infection. See those terms in the sticky. Starvation diets can raise rT3 and SHBG.

Please get iodized salt and discard non=iodized salt. You need to have selenium in your diet as a selenium deficiency and time+TSH can create thyroid inflammation and tissue damage that can lead to an auto-immune thyroid disease. There are labs for that.

When rT3 is elevated, the problem is that T4–>rT3 is too high. Taking a T4 medication can then lead to more T4–>rT3 and the problem gets worse. To treat this condition, T3 only meds are used to drive down TSH and thus T4 so less T4 means less T4–>T3. Not many doctors here [USA] understand these issues. We can also get a T3 time release here from compounding pharmacies. Fast acting T3 is not ideal. While desiccated thyroid has T4+T3, that does not lower T4.

Hi KSman.

I don’t actually feel cold easier and my outer eyebrows are most definitely okay! Thyroid feels fine.

Ok - well morning temperatures have been 97.0F and below consistently. I will start taking my afternoon temperature over the next few days. (been difficult due to being in the city all the time)

So it seems I am very likely iodine deficient. I have read your full sticky on the Thyroid.

What supplement do you suggest for an Australian to consume to acquire optimal levels of Iodine? Iodoral? (I can order this from eBay and acquire Selenium elsewhere).

To better phrase this - what do you suggest I do going forward? I think my free T3 and 4 numbers are good.

It seems T4 is not the answer. Iodine supplementation seems the logical step to support the thyroid. I cannot envision any other approach to getting TSH closer to 1.0 other than Iodine or T3 (or a combo of T3 and T4). How important is this? I imagine TSH is similar to LH on TRT - not all that meaningful in the context that it does not necessarily need to be changed. Correct me if I’m wrong!

rT3 worries me. I do not believe I have high levels of rt3 but guess there is no way of knowing. I have not suffered any major stresses or issues that I can think of. I did diet for a year and a half over 2015-2016 but always felt better when I came out of the diet. Unfortunately it lead me to a permanent hypogonadal state.

In other news, I have lowered my Estrogen to E2= 22.8 pg/ml. I am on 4.5mg Arimidex a week to keep it here. I found out on Monday and have only just lowered it. Maintaining it here indefinitely and hopefully will see some drastic improvements over the next few weeks. I can confirm that at E2= 33pg/ml I feel terrible.

Testosterone 58.1nmol/L (6.0- 28.0)
Free Testosterone 2364 pmol/L (200-600)
SHBG 26 nmol/ L (15-50)

I am on 4.5mg Arimidex a week

I am currently on 250mg of Testosterone Enanthate per week split into two injections

TT is twice upper range.
FT is ~4x upper range.

FT is driving FT–>E2

We you playing with a higher dose of T before these labs? Numbers seem too high for 250mg/week. Your anastrozole dose is way way higher than ever seen here before.

Did you have an injection hit a vein, would have made your lungs tickle and cause coughing? That would spike T levels.

Can you get iodized salt there? That and iodine+selenium in a vitamin should cover your maintenance needs.

TSH is probably elevated because hypothalamus has rT3 blocking fT3 there as well.

Both Coles and Woolworths (the big Australian supermarket chains) sell iodised salt.

Thankyou. I will buy and start using iodized salt and will start supplementing Iodine through an Iodine supplement. I will also try to acquire a selenium supplement. Furthermore, I will continue to eat Greek yoghurt and drink milk as part of my dairy consumption of iodine. That should support the thyroid. Good to know it is sold at the local supermarket too.

As far as depression goes I am definitely fine there. The E2 has caused extreme mood swings though. I am never, ever getting high Estrogen again. It is a nightmare in terms of what it does to your mood and well-being.

Mmm, I am in agreement. I have never used Testosterone or anabolics before in my life!

250mg originally put me at 48.1nmol but I had high Estrogen too. As my Test E is underground made, it could be slightly overdosed.

Since lowering the Estrogen, it increased to 58.1nmol. I have a doc I talk to on the phone about my blood tests and he is also on 250mg - but every 10 days. He’s around 48nmol for Testosterone.

Going forward please see my reply to the other gentleman. I will start using Iodized salt and an Iodine and selenium supplement. I will not take T4.

Additionally, I have taken a week off the gym and cardio and am doing my best to destress to avoid adrenal fatigue from rT3. I do not know of any other strategy to combat high rT3 blocking free T3. If it really is as bad as you say - that is overwhelming.

In the meantime, I am still injecting 125mg’s Monday and Thursday. Estrogen last Monday came back as E2 = 22.8 pg/ml.

I am getting another blood test on Monday to check Estrogen again. 4.5mg of Anastrozole is indeed a lot. Confused as to why this is but I have stuck to this protocol of Test for 10 weeks. Levels have been stable.

I was thinking, in future, to switch to EOD injections of 62.5mg. This would theoretically result in more stable levels and less conversion to E2 if I’m not mistaken? Is this worth implementing if it means I can use less A.I? It makes sense from my point of view. Smaller peaks/troughs. I use 25g needles.

How does all this sound?

Physically I have not been as tired this week, though the dark bags under my eyes and moodiness has been a prevalent issue, along with weaker erections and generally poor libido.

Does it take time for you body to adjust to the changed E2 levels?


It reduces fT3 effectiveness, not a total blocking. See references to stress, adrenal fatigue and Wilson’s book in the thyroid basics sticky to understand more if you have not already.

You might find smaller needles more comfortable and less cost. A factor when increasing injection frequency. subq is smoother than IM.

When a guy has E2>30-35 with no AI, an AI dose that gets lower 20’s will typically have a strong effect on energy, mood, sexual function and libido in 5-7 days. More happens as brain patterns adjust and everything that can be felt is over in 4-5 weeks. Fat pattern changes have their own time table and belly fat problem areas with thin out.

Alright, I will do everything I can to minimise the adrenal fatigue. I don’t believe that is the problem, however!

I actually got my E2 to 22.8 last Monday, and it has been a week and I actually feel worse. Extremely moody and have noticed some knee pain and lower back pain that has worsened significantly. I’ve been speaking to Jay Campbell of TRT Revolution and he believes that this number is way too low and that he feels best when E2 is between 45-65pg/ml. He did a webinar with Nelson Vergel of Excel Male and it turns out that the 20-30 ‘sweet spot’ originates from a study done on low test males with an average level of 320ng/DL TT. May have to do some experimenting. Overall I’m extremely disappointed in the lack of any changes in my symptoms.

He advised me to take just 0.5mg a week and give it 3-4 weeks and assured me I’ll feel much better at that point. Hopefully this will help.

E2=22.8 pg/ml also comes from lef.com

Many here are pursuing that target. For most, seems optimal for mood, energy, libido, sexual function and fat levels as well as patterns. Suggest that you try it, then cut AI dose in half and see how things are in 5-6 weeks.

E2 = 22.8 pg/ml: What was your E2 dosing then and how long had you been on that. Did you stay on that does after the lab work? And now?

Maybe Jay feels ok with “E2 is between 45-65pg/ml”. Most would feel horrible. We have a small number of guys here who need higher E2 levels. So there are some with genetic or epigenetic differences and one should not get confused by trying to find “one truth”. Perhaps you are on a quest that will land you into another group.

Here we have Jay thinking that everyone fits his mold? “He advised me to take just 0.5mg a week and give it 3-4 weeks” You can try this and it might work if you have such differences.


Apologies for the delay in my response. I have been trying to wrap my head around this. I am utterly confused as to what to do. I’ve got you and many others (along with strong evidence I have read, + numerous anecdotal reports) that suggest being in the 20-30 range (particularly, low 20’s pg/ml) to be optimal on TRT and testosterone dosages.

Jay Campbell said I need to trust him on this and to let my E2 climb a lot higher and thought “22.8 is far too low.” I didn’t feel like I was too low at all. I stayed at that level for about 4-5 days. Noticed some moodiness on day 3, but the day after I completely changed. My mood was significantly better. I should have stayed there longer. I stopped the Arimidex on day 4 or 5 after the lab reading of 22.8 pg/ml.

Believe it or not, I was on 4.5mg of Arimidex PER WEEK to get my E2 to 22.8. This is on 250mg Test E per week. I will switch to Aromasin because 25mg Aromasin ED puts my E2 in the same range. Note that I am quite lean too - 13-14% bodyfat as an estimate. I have veins all over my shoulders, arms, and only hold fat on my lower abs. I have noticed though that since the E2 has climbed I am looking fatter, but also fuller in the muscles.

Now I am currently on no A.I letting my E2 rise. I am getting significantly bloated throughout the day, my face is puffier and rounder, and I noticed I had less energy in the gym yesterday. My libido has slightly improved, but I’ve spent the past 2 days with my girl, and I always get horny as sin no matter what. My erectile strength, however, suffers greatly. I can’t get 100% erections. Currently experiencing weak erections and morning erections too.

I have really appreciated your advice so far. I am going to buy Kelp over the next few days which has 250mcg of Iodine in it for my Thyroid. Additionally, I am considering getting my E2 back in the lower 20’s.

Edit: now using 250mcg of Iodine a day. (In the form of Kelp) Taking 25mg of Aromasin ED with 260mg Test E per week, injected M W F. (87.5mg x 3) Implementing this today. Will get E2 in the mid-low 20’s and stay there 5-6 weeks as you have suggested.

When I first started lifting and exercising I used test and arimidex and had the same problem. I quit taking the anit estrogen and I felt awesome and got boners like I was an adolescent boy again. It’s the arimidex. You don’t need it anyways with 250mg of test.

You and your lab rat have a lot of experimenting to do. I am starting to see things going wrong with higher E2. It takes around 5 weeks for things to settle one way or another as your brain patterns adjust for better or worse. Your body is showing its opinions faster than that.

I agree with you. I’ve taken your advice and am getting E2 in the lower 20’s on Aromasin, taking 25mg per day. Today I felt great! Boners all over the place with the girl. Mood was fantastic. I think I feel better on Aromasin though it could be placebo. Wish I could see what my E2 was. Energy has been better since being back on an A.I again. I feel like shit and bloat heavily as soon as I come off. It is a nightmare. I am very estrogen prone.

Would you suggest splitting the Aromasin dose into 12.5mg twice a day instead of 25mg at once? Its half life is 9 hours in men and peaks at 12 for maximum Estrogen suppression.