T Nation

High T, Perfect E2 - TRT a Complete Failure (1 Year) - Help!


#1

Hi everyone. I’m here desperately looking for advice, because I’m dumbfounded by my lack of response to TRT. It has been what I consider a complete failure, even at my current dose of 200mg a week, which I have been on for a year. Now I’m stuck on it for life, and it has done absolutely nothing positive for me. I feel it was one of the worst decisions I’ve ever made, now I have to live with it.

I am the poster child for what an extremely “low T” guy would be imagined as. Problem is, I’m exactly the opposite (extremely high T). My symptoms include: brain fog/inability to focus and concentrate, extreme fatigue (always tired, I have no energy to do what I need to do after work at all), completely absent libido (despite having an attractive girlfriend whom I love), no drive/motivation/ambition, poor sleep quality, weak erections. I feel very timid and I don’t have any confidence. I still feel weak and like I am so much less masculine than 90% of guys. I can hardly think clearly. I have a very skinny build and I have put on only a few pounds of muscle mass since starting TRT nearly a year ago, despite regular weight training and an on-point diet. I’m still only 150 pounds. Maybe that’s because my workouts really suffer due to the fatigue and weakness (muscular weakness) I experience.

I get plenty of sleep (8 hours every night), I have a very healthy diet, etc. I drink only water, and lots of it. I have a low stress life. I would consider myself to be happy, but… I really feel nothing. I am always just “neutral” or “numb”, at best- but nothing is wrong with my life, at all. I would say it’s the best it has been in a decade or more. I’m not depressed.

My response to TRT has been almost literally “none”. The only factors that I can say I have noticed any mild change in would be that it has in some sense decreased my overall sense of anxiety for the unknown (“I’ll just deal with it, whatever happens, when it happens”) and my mood has gone from “up and down” (feelings of sadness/depression) to “neutral” every day-- which may be good, but in a sense, it’s just a feeling of numbness or lack of emotion. I don’t get happy or excited. I just am at baseline all of the time. None of the “testosterone” traits you’d expect have shown.

Oh, it made me much hairier than I already was. I’m now like a bear, which wasn’t exactly a good thing. Surprisingly it hasn’t given me any acne, even at 200mg a week, despite me having bad acne as a teen/ in my 20’s. I am in my late 30’s now.

Anyway, before I get to the “TLDR” point, what can explain why I feel like absolute hell? I can’t fathom how someone can be on 200mg a week of testosterone and literally feel no improvement at all. I look at the “what testosterone does” checklist, and I am like “nope, nope nope”. I would think it was a scam if it didn’t work for other people, lol. I’m still not convinced it’s not. I feel just as bad or worse with high T than I did when I was first diagnosed hypogonadal with 250 ng/dl levels. It’s not a new thing, as said, I’ve been on it about a year… and my test levels have gone from 500 ng/dl, to 750 ng/dl, to 950 ng/dl to >1500 ng/dl (and free test going up as expected with those, while maintaining ideal E2 of around 20-25 ng/dl the whole way) and they all feel the same-- like I did before I even got my first shot.

Thyroid is good, cortisol is within range. B12, iron, vitamin D are all good. Prolactin is good.

The most frustrating of these are that I still have absolutely ZERO libido. My erection ability actually got WORSE on TRT. And the brain fog and lack of energy is literally preventing me from enjoying my life at all. I sleep whenever I’m not working because I’m exhausted. But TRT didn’t “cause” any of these symptoms-- it just absolutely failed to remedy any of them, even a little bit.

This isn’t a matter of whether T is too low or too high. I have felt just as bad from 250-1500+ levels. I have stayed at each tier for months at a time to gauge how I felt on it.

I started out at 100mg per week, then went to 150mg per week, and now I am at 200mg per week, split into TWO test cyp injections per week (100mg monday, 100mg thursday). I take 2mg of Arimidex a week, split up in 0.5mg doses across the week. Please, can anyone imagine what could be the problem? I imagined TRT to be the panacea since I was diagnosed hypogonadal, but it has done nothing but cause inconvenience and disappointment.

This was taken a day or two prematurely, my trough levels are right at 1000.

Total Testosterone, Serum >1500 ng/dL(348 - 1197)
Free Testosterone, Direct 40.3 pg/mL (8.7 - 25.1)
Estradiol 20.5 pg/mL (7.6-42.6)

LH <0.2 Low mIU/mL (1.7 - 8.6)
FSH <0.2 Low mIU/mL (1.5 - 12.4)

Cortisol 19.2 ug/dL (6.2 - 19.4)

TSH 0.844 uIU/mL (0.450 - 4.500)
Triiodothyronine (T3) 93 ng/dL (71 - 180)
Free Thyroxine Index 2.4 (1.2-4.9)
T3 Uptake (32) 24-39
Thyroxine (T4) 7.5 (4.5-12.0) ug/dL

Prolactin 10.2 ng/mL (4.0 - 15.2)

Growth Hormone, Serum 11.8 ng/mL (0.0 - 10.0)
IGF-1 Insulin-Like Growth Factor I 424 ng/mL (88 - 246)

Vitamin D, 25-Hydroxy 42.1 ng/mL (30.0 - 100.0)
Vitamin B12 1157 pg/mL (211-946)
Iron, Serum 54 ug/dL (38-169)

I can post more labs if anyone requests a certain lab. I’ve been to endocrinologists and had everything checked out. No doctors can find anything “wrong” with me. My bloodwork looks ideal. Please help.


#2

IGF-1 Insulin-Like Growth Factor I 424 ng/mL (88 - 246)

Have you talked to your doc about this? My IGF-1 wasn’t much higher, and that was enough for the doc to suggest an MRI, which showed a 0.8cm pituitary adenoma. Pituitary tumors can secrete anything the pituitary produces, maybe yours is producing some other hormone besides HGH that’s causing your symptoms? My first guess would’ve been prolactin, but yours looks to be in range. Besides the MRI which showed the presence of the tumor, I also had a glucose suppression test, which IIRC showed my HGH didn’t drop after eating glucose (which it would have if it were just the pituitary working normally, and not a tumor secreting it).

FWIW, I had good results with TRT before surgery, and am still on TRT now after having the tumor removed. Supposedly excess HGH may have been messing with my cardio and causing joint pain, but it’s unclear how much that’s improved for me post-surgery. Mostly I didn’t want to risk the tumor growing and pressing on my optic chiasm, or the HGH leading to increased risk of cancer down the road. I also have some facial traits related to acromegaly, and would not want that to become severe (right now I’m just a tall guy with big nose, jaw, hands/feet, but not really funny looking).


#3

Thanks for the helpful reply, and you’ve made some great points. The endocrinologist was concerned about the growth hormone and IGF levels being out of range on the high end. I was ordered to do a brain MRI, which came back normal. They did not find any tumor. The doctor also wanted to do the exact test you mentioned, the glucose suppression test- but I have yet to do it, because I’ve felt at this point I’ve had so many tests done that have come up fine and I feel like we’re just chasing ghosts… expensive ghosts. The MRI alone was $3,000.

Would you think it is worth it? I have no signs of acromegaly. I just kind of felt like the doctor was pushing me to keep doing test after test to make money off of me.

It’s interesting that you responded to TRT, though. Despite the possibility of a tumor (which it looks like I don’t have), shouldn’t I still have responded in some way? I just can’t imagine how I could feel this bad when it seems that nothing is physically wrong with me… :confused: Thanks again for the insightful response.


#4

I’ve had 5-6 MRIs related to my pituitary tumor, and for the exact same procedure at different facilities, the cost has been quoted between $600 and $3000. There was one time when it was cheaper to pay cash out of pocket and get it done at the $600 place, rather than go to the $3k place and pay $1k myself after insurance would pay $2k.

For blood tests for TRT, I’ve been paying cash and getting them through lef.org or directlabs.com. lef.org has a glucose tolerance test for $75:
lifeextension.com/Vitamins-Supplements/itemLC090365/Glucose-Tolerance-Test-4-specimens-Blood-Test
You just buy it online, and show up at a local labcorp or quest. That’s often where people’s blood is analyzed even if it’s drawn in their doctor’s office.

Who analyzed your MRI? If it was a GP or endocrinologist, maybe have a neurosurgeon look at it and see if they spot something the other doctor didn’t? Aside from that, maybe go to an endocrinologist and see what else might cause the high IGF1, or if there’s anything else related to pituitary issues that other blood tests might reveal? Fatigue and weakness definitely can be signs of high growth hormone (http://www.md-health.com/Growth-Hormone-Side-Effects.html)

Are you eating enough, and how is your appetite? I don’t know what 150lbs is like for you, but for me I’d have to be literally starving to get below 200lbs (I’m 6’4" with a big frame and perhaps dense bones from acromegaly). I usually eat low-carb, with tons of fat and protein from meat. Not trying to start a debate or cause offense, but I’d expect a lot of symptoms similar to low-T if I were to switch to a vegan diet, avoid dietary fat, or had an eating disorder, which is what some people consider a “clean” diet. With high testosterone from TRT and still slightly elevated IGF1 (around 235, vs 500 pre-surgery), I got as high as 250lbs when I was stuffing myself and lifting weights heavy, at 15-20% body fat. I haven’t lifted weights as much recently and hence stopped force-feeding myself, and I’m around 225lbs at about 15% body fat. I’m 37, and it honestly feels like I’m cheating, how much muscle I can put on easily without gaining fat. I thought that was due to high T and high HGH/IGF1, so I’d expect you to have the same benefits, and it surprises me that you don’t.

Sorry I couldn’t be more help! It’s got to be frustrating to still have low-T symptoms even while on TRT. I had a lot of those same symptoms before TRT and it sucked :(. I also have had symptoms similar to a mild form of bipolar disorder for a lot of my life, and apparently some of that may have been related to elevated HGH. Being irritable and easily frustrated, with long periods of mild depression punctuated by brief mania. Those symptoms have improved over time even before surgery, due to some combination of eating less carbs (carbs definitely make my mood erratic!), just getting older, and/or learning how to avoid triggering depression and manic episodes (regular sleep and exercise).


#5

Thyroid does not seem right. T3 is well below midrange, T4 a bit too. Low ferritin can interfere with T4–>T3 conversion. fT3 is the active hormone. Labs should have been TSH, fT3, fT4 and skip the uptake and index labs which are obsolete now that we have fT3 fT4 labs available.

Eval your overall thyroid function via last paragraph in this post.

Have you always used iodized salt? - needed to make thyroid hormones

What time of day was Cortisol=19.2 done?
Is there a lot of stress in your life? Illneses/inflammation chonic or acute, accidents?
Are your limbs thin? Body not?

IGF-1 is a better indicator of GH status than GH itself.
Level very high for your age and very high for those who need to inject GH.

Labs, please show:
RBC
MVC
hemoglobin
HTC hematocrit
AST/ALT
ferritin
serum iron = 54 38-169

Iron seems low.
Do you have digestive/GI problems or food sensitivities?
Heart burn?
Use heart burn medications? PPI’s?

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

  • advice for new guys
  • 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.


#6

Thank you for responding, KSman.

Interesting that you say that about my thyroid. I have been seeing an endocrinologist for about a year and he checks my thyroid every time I get bloodwork done. He has never thought twice about any of the results; neither did my GP. Not that they always know what they’re doing… Endo freaked out about the IGF-1 and GH readings, and I ended up getting an MRI, etc. All tests came back fine.

My build is very thin, I am 150 pounds right now (5’10"). Most people call me “really skinny”. I have very thin, long bones which makes me look even skinnier. It is easy for me to put on weight, but only fat weight in the midsection. Arms are legs are like twigs. Weight going mainly to the gut is due to high cortisol, as it would seem. That reading was done early in the morning, around 8-9am.

Higher cortisol is likely the result of me being on high dose benzodiazepines for 15 years. I tapered off of them 2 years ago and that was a MAJOR ordeal for me. I can presume higher cortisol is a result of no longer having that GABA “suppression” on my sympathetic nervous system.

I am not stressed at all, and I am happy with my place in life. No stressors (finances are great, relationship is great, work generally doesn’t stress me). I don’t know how I could possibly lower cortisol since my stress levels are nearly non-existent.

No allergies, never get heartburn, no digestion problems that I am aware of. I do take Hyperbiotics probiotic, but not because I “need” to. No illness that I know of. Only major health crisis was months of benzodiazepine withdrawal as mentioned, but that was 2 years ago and I have been long off of them at this point. I don’t take any other medications besides Test and Arimidex. Doctor said my iron was good. Blood cell counts came back fine. I don’t have my labs on me right now but all you asked for was in range. I will post those when I can.

I am almost feeling like my issues are neurological/neurotransmitter related, as my dopaminergic system is likely shot from a past history of drug abuse. But I have been clean and living super clean and healthy for years now. Diet is totally clean, exercise regularly, sleep 8 hours a night, don’t drink or smoke- I don’t even drink caffeine anymore. I live like a monk these days. Very disciplined and healthy.

Though I’m not depressed, so “depression” doesn’t seem fitting. I’m actually pretty happy. I just don’t feel “well” often, and I feel like TRT has only made me feel about 10% better after 1 year.

But… I’m doing the best I can. Still find it crazy that I have an insane hard time adding ANY muscle, even doing heavy weights 3x a week, eating absolutely clean (but high calorie- 3,000 calories a day)… with my test levels so high as well as my GH/IGF-1. I train hard, eat immaculately (oatmeal, sweet potatoes, veggies, brown rice, baked chicken, salmon, eggs, cottage cheese, etc). I eat super healthy but eat a lot of it. But the problem is, while I am gaining about half a pound a week, it seems to be going only to my belly. I can tell when I add weight to my stomach because I am so thin, it’s very noticeable when I put on belly fat. At only 0.5lbs gain a week, 3x a week hard workout and test levels over 1,000… why is this going to the belly and not creating muscle? Makes no sense to me. Genetic?

Not sure what’s going on. But maybe this is how I’m meant to be. I’ll just keep trucking and trying to get better. Maybe one day I’ll be better.

And that ^ is one example of the positive thought change on TRT. A year ago I would have a defeatist attitude. “Nothing ever works for me, I should just quit.”

These days, it’s “nothing works for me, but I’ll be damned if I’m gonna give up…” Lol. I’ll count my blessings, even if they’re few!

Btw, just for reference- my current dose is 160mg a week, split into 80mg mon+thurs. Arimidex 0.5mg, 12 hours after injections and on Sunday (total of 1.5mg a week). E2 readings generally come up 21-23, but it still frequently gets out of whack, despite a clockwork injection/adex routine. No idea why. And I look fit-skinny. Still have a hard, HARD time putting on any muscle. But fat comes easy, haha…


#7

Skinny limbs and an apple shaped body is a result of high cortisol, perhaps a greater extreme. Same can happen from high doses of corticosteroids, prednisolone etc. These are catabolic, tear down proteins, muscle wasting and connective tissue becomes weak. Non athletes had had Achilles tendons snap.

E2 level changes may be affected by uneven anastrozole delivery. You can dissolve anastrozole 1mg/ml in vodka and dispense by volume and get free of 0.5mg doses. Try anastrozole at time of injections, or day after.


#8

Interesting note about tendons. I forgot to mention that I do have big problems with connective tissue all the time. I figured it was because my joints and bones are so small. But I constantly get injured lifting weights because my tendons/ligaments can’t keep up with the weight. I constantly get tendon inflammation and injury, and it’s not because of improper form.

This also seems to have gotten worse after TRT. I constantly have problems with ligaments/tendons being weak and inflamed. Just this week the connective tendons/ligaments in my knee have been acting up. It feels like they’re weak and not supporting my joints properly. Even without stress in them. I just put it up to getting older (I’m 36.) What does this about my connective tissue tell you? I heard that TRT can weaken tendons. Why might my tendons always be inflaming and so easily injured?

Cortisol is doing this? Given what I said about super LOW stress levels that I have, the big question is: how could I possibly lower cortisol any more if I’m never stressed? Am I just doomed? Are there drugs/medications to help?


#9

I have a friend that doesn’t respond to TRT. It’s a bad deal too. I am new to this forum, but not to TRT. In your first note you said you felt numb and feel nothing. This can be quite telling. I too was numb for 35+ years and to me, it was just normal. No matter how good life was, it wasn’t good. Being numb comes from our brain as a way to protect ourselves from trauma. And you learn it at a very young age if necessary. Namely from abuse. Being numb to the world, is a stress, but it may not seem like it. Mine all led to a Stroke 7 years ago. I’m thankful I have great doctors. My GP sent me to a psychiatrist and a therapist ASP and healing finally began. A psychiatrist is a medical doctor and the first thing they do is to check all your body systems to make sure everything is good and not causing the problem. They can find things that other doctors can’t. I don’t know if you have been through some trauma in your past, but that my be another avenue to explore. Everybody needs to get over the stigmatism of psychiatrist. They are doctors like all the rest, they just happen to be doctors of the brain. I wish you the best.


#10

TRT changes one from catabolic to anabolic. Muscles increase in size and strength. Connective tissue is not vascular, think of changes that take a year or two VS months. With increased muscle strength, forces increase but connective tissue lags behind. With younger guys on TRT, they can get carried away and break things. Same for body builders on gear that make fast muscle gains.

In your case, you seem to have some inflammatory processes and some other unique issues.

You should try fish oil to get more EFA’s

You have not responded to my concern re low iron. Either you are not getting enough iron in your food or not absorbing iron in your gut. Gut absorption is involves adequate stomach acid, you are not using any heart burn meds, so that is not a factor. But GI blood loss is possible, even though you report no digestive issues. You can ask for an occult blood test to rule that in or out. It detects blood in your poop which is not visible aka occult or hidden.

I asked for some CBC lab results to help clarify the GI blood loss concern.

Please review other points in my posts. Many pick up on a fraction of the issues - cherry picking.

Body temps?
Yes, doctors think that almost all of the cased that I get concerned about are perfectly normal. That is exactly the problem. Your thyroid is not good. Body temps are something that you can do yourself.


#11

Sorry for a bit off topic, but is this the same whether its TRT or Clomid/nolva monotherapy?


#12

Re your E2 feels like it changes because you feel that way and you are altering the dose.

When you change the dose, it takes around 5 days for half-life to take your serum anastrozole levels to the changed state, and your brain has a time delay on top of that. You can’t make day to day changes. And if you are doing labs, you need to have been on a steady dose so the labs relate to something known and not transient.

Get the lab order setup and you have 6 months before it expires and all you do is go to the blood draw station whenever you want.

Are you doing things that might upset the liver’s E2 clearance rates?


#13

The comment would apply to any given achieved serum T level, obtained by TRT or Clomid/Nolvadex. However, if the SERM does creates high E2 levels, that will interfere with anabolic response. SERM does not protect all tissue and receptors from effects of estrogens.


#14

I think this is good advice. I need to stop trying to add/subtract Arimidex every time I feel things are off. I’m probably doing more harm than good by throwing my body out of homeostasis.

I am going to continue taking what I have been for a long time- a steady 1.5mg Arimidex a week (0.5mg Tues/Fri/Sun) and just stick with it, regardless of how I may feel for a couple of weeks. This is the dose that I originally got from reading your posts (thank you, 1mg per 100mg of test is indeed a good guideline). With this, E2 was consistently at 21-23 ng/dl on my labs for months.

This proved true at both 150mg test/1.5mg Arimidex and 200mg test/2mg Arimidex a week- it kept my E2 at ideal levels, so thanks again for that sound advice.


#15

Once you have a steady T dose and steady anastrozole dose, get labs and then calculate a new anastrozole dose:

ie:
If E2=28 and goal is 22pg/ml
new dose = old dose X 28/22