First Week on TRT - Not Going Well

After a few years of going to various doctors and having numerous tests run for lethargy, depression, low sex drive, brain fog, etc, my new endocrinologist came back with a TT of 208. That would be low for an old man but I’m 27 so there’s definitely an issue. Long story short, more tests revealed that my pituitary wasn’t sending out any more signals to ramp up test so he started me on Axiron 2 Pumps (60mg) daily. I can’t begin to describe how good I felt after the first application! I had tons of energy but more than anything, I was very relaxed. That being said, I had terrible insomnia (slept ok before) and after a couple of hours of sleep, I would toss and turn all night. I would wake up in the morning with a little bit of soreness under my nipples and they were a bit puffier than normal but still I felt great during the days. On day 6, the soreness/puffiness of my nips decreased but a couple of hours after application, my heartbeat felt much stronger than usual and remained so for 8 or so hours and the great sense of well-being from before had flipped on its head. I contacted my doctor and he said to reduce my dose by half so I did. I’ve been on the new dose for 2 days and feel no different than I did before I started trt. Any ideas on what’s going on?

My Stats:
Age: 27
Height: 5’10
Waist: 33 1/4
Weight: 172
Body: ~10-12% BF, Very Hairy, chest, back, arms, legs, face, slowly thinning on top
Carrying more fat in love handle area, retaining water and getting flush in the evenings. My chief complaint leading up to these tests where (still is) brain fog and cold hands/feet often throughout the day. Waking body-temp is 97.2, max is 97.7
Diagnosed with Microscopic Colitis 2 years ago (definitely auto-immune).
I once took finasteride for a couple of weeks (at least 6 years ago)
No Dairy, No whole wheat - they aggravate my colitis. Oats will full on make me dizzy and make my insides explode. (not celiac)
Typical day: Breakfast - egg sandwich, pre-lunch snack - massive scoop of peanut butter, Lunch - 6 inch sub (turkey, peppers, cucumbers, mayo) cookie, pre-dinner: other half of sub, dinner: whatever wife cooks
Training: 3x week split with intervals following workout, Sunday 2-3 mile run

I do get morning wood but it’s this weak half-mast crap for the last couple of years

I had the numbers faxed from the Dr’s office today.

Tests done on 5/2:
T3, Free - 3.5 (2.3-4.2pg/mL)
Thyroxine Free - 1.11 (0.65-1.52ng/dl)
TSH - 1.056 (.55-4.78uIU/mL)
Testosterone Total - 213 (250-1100ng/dL)
CBC was mostly normal except WBC Count 3.5 (4.8-10.8 K/uL)
Methylmalonic Acid - 74 (87 - 318)

Follow-up tests done on 5/23:
LH - 1.69 (1.24-8.62MIU/ML)
FSH - 4.8 (1.4-18.1mIU/mL)
Prolactin - 6.7 (2.1-17.1ng/mL)
IGF-1 - 316 (88-374ng/mL)

Full disclosure, I hadn’t been sleeping much at all before my first visit and in between visits, I discovered that 2000mg of glutamine in the morning on an empty stomach both reduces the inflammation in my colitis and makes me sleep like a baby so I was sleeping quite well before my follow-up tests. I wish he had run testosterone again on the 2nd visit since I’m confident the sleep would have boosted it.

Hopefully I’ve over-compensated for my previous lack of info!

You need to immediately have your Estradiol (E2) tested; sore/puffy nipples are warning signs of gyno. Once it forms, gyno generally does not go away without surgery…demand that your E2 be tested and that if it’s higher than 30 (low-mid 20’s are ideal) to be put on an aromatase inhibitor. If your doc won’t go for it, find a new one. I honestly would not continue treatment without putting E2 in check. Nobody wants man boobs.

I, too, felt amazing when I started TRT; that soon dropped off when the estrogen caught up with me. Estrogen dominance will ruin your TRT and potentially put you in a worse place than when you started–estrogen is a way more powerful hormone than T, and a little bit of it will wipe out all the great effects of T you’re looking for (read the sticky.) Adding Anastrozole has made a world of difference for me.

It’s odd you mention insomnia, my sleep actually improved greatly after starting TRT. I wonder how common that is.

As reidnez says, if you are experiencing gyno symptoms, you need to clear that up–it doesn’t go away.

You say your FT was 208, but you didn’t bother to give us a range or even units, so its impossible to really make heads or tails of that. In the US, on most labs, an FT of 208 is pretty freaking good.

Your doc said your pituitary wasn’t sending signals, so I assume they tested your LH/FSH?

You need to post all your labwork to give us more to go on.

I would suspect cortisol and thyroid interactions from the meds…your metabolism may be trying to speed up with the added T, but these two can’t keep up so you may need to prop them up as well, at least for a while.

I should have mentioned that when things went bad with the TRT, I also had this feeling like there was something stuck in my throat near my thyroid. It isn’t the first time I’ve had this feeling and almost always, it’s been associated with a feeling of hyper-ness. I’ve read about Hashimotos and the symptoms sound similar to what I’ve experienced several times but the tests always come back normal. Should I ask for the anti-body test?

doesn’t hurt to rule hashi out.