T Nation

Insanely Fatigued


Hello all,

When I first started TRT I felt incredibly good: I managed to get on a regular exercise program, eating well, regaining long-lost muscle, and was beginning to enjoy life. About 6 weeks ago I started feeling really fatigued again, like I was before starting TRT. The doc upped my dose from 75mg 2x week to 100mg 2 x a week. I still am tired all the time.

2 weeks ago I got an E2 test, which came back at 31pg/mL (range <39pg/mL), and even though my doctor didn't think that was too high to worry about I insisted on starting anastrozole, which began five days ago. Needless to say, I haven't noticed any major changes.

I was wondering if anyone has any idea what could be causing my fatigue. Below are my most recent labs.

E2 31pg/mL (<39pg/mL) Test taken day 4 after injection (I do shots on Mon/Thurs)
Total T 936ng/dL (250-1100)
Free T 262.8ph/mL(35.0-155.0)
T4 Free 1.0ng/dL (0.5-1.6)
TSH 1.94uIU/mL (.34-3.50)
Total T3 157 (87-178)
T3-Free 3.7 (2.5-3.9)
Vitamin D 41 (and rising. Up from 17)
Cortisol AM 14.2ug/dL (5.0-25.0)

I have follow-up tests on E2, Free and Total T, and Free T3 to be taken on Monday 4/16. Any ideas on what else should be tested or things that could be wrong would be greatly appreciated. My primary doc it testing me for sleep apnea tonight even though I don't have a history of snoring.



What time do you go to bed and what time do you get up? Does it very each day or are you on a steady pattern? What do you mean by fatigue? Is your performance in the gym gone down, meaning a physical drop off or do you just not feel like going to the gym, mental?


The time I go to sleep and the time I wake up varies from day to day. I usually go to sleep between 11pm and 1am and wake up anywhere from 8am to 11:30am.

By fatigue I mean that I don't feel like moving. Just running errands makes me want to go home and lie down. I haven't been to the gym in weeks. I have basically been attached to the house. I yawn a lot, too.


Nothing in your bloodwork give me cause for alarm mate. Perhaps the sleep apnea test will do good for you. I feel a ton better since I got mine under control using a CPAP (plus my girlfriend is happy that I no longer snore and she can sleep in the same room as me!).

Second thought, your Vit D is still low. What dose are you taking to increase it? Need to get that into the 70+ range.

Keep us posted.


Thanks man. My Vitamin D is likely higher than 41, that test was about 1 month ago. I take a 50k D2 once a week and 5k D3 the other 6 days. I haven't had it retested because it went from 17 to 41 in a little less than a month, so I figured I was on the right track.

I hope that it is sleep apnea, just so I have something to go on. I don't see how it could explain how I had a few good weeks of high energy and then go back to the slums. I've heard that TRT can exacerbate sleep apnea, so I suppose that could be a factor.

I have a machine that I get to stick to my forehead and tubes to shove in my nose while I sleep tonight. It will tell the doctor whether I need to have an in-house test. I guess it'll give pretty instant results when I bring it in tomorrow. My girlfriend says I snore on rare occasion, and it is mild at worst.

I don't really care what is wrong as long as I fix it soon.

Is it hard to sleep with the CPAP machine? I move around a lot when I sleep, so it seems like it would bug the shit out of me. My doctor told me that if it isn't severe I can get by with just wearing a mouth guard at night, which seems just as irritating.


CPAP is pretty annoying at first but you get used to it...truthfully though, i dont even bother with it when my girl is out of town or when I am on travel. A mouthguard would be much more convenient, im going to investigate that in the future.

Why do you take D2? I have never even heard of that being a supplement, and not aware D2 does anything. D3 is wehre its at.


D2 is ergocalciferol and D3 is cholecalciferol. Basically the D2 supplement is what my insurance would pay for, and the D3 is OTC. There's debate as to whether D2 is as effective as D3, but I get it free, so why not?


T challenges usage of cortisol and thyroid. I would get the reverse T3 done, b12, and iron profile and make sure you are off of iron for five days prior to test if you are taking it now. Also, get a ZRT 24hour saliva cortisol test and review stopthethyroidmadness web site to get yourself familiar. I agree with VT that your D is way too low


Cortisol looks a little low and if you are dealing with a low grade infection for what ever kind this may not be enough for your daily functions as well to fight what kind of inflammation which is going on inside you. Ferritin levels also should be check optimal is 120-200 on should be shooting . D2 is sythetic d3 is natural there is a huge difference.

I would not want to take a chance on d2 not converting into d3. D3 is not going to break the bank at $15-20 for a 4-6 month supply. D2 may act differently in people not giving the possible full benefits of d3. SHBG was also no available which if <20 then your e2 could be in the high side. Do remember these levels are at the trough not at the peak. One does not know how high e2 could spike at peak .


I can feel the difference the next day if I forget to use my sleep apnea machine even once. It used to be that I didnt dream at all without it, but now I dream with or without it. The problem is my oxygen gets to the mid 80's without it--yeah damage to organs and very likely why I've had so many issues. Who knows how long I had it. I can remember snoring to back into my teens... explains a lot though. Snoring is obstruction, thats why theres a fucking sound! LOL regardless of the degree.


I forgot to mention: my SHBG was 21 (range 11-80). What do you recommend for my Amiridex regimen? I took .5mg EOD for the first three doses and now am taking .25mg EOD. I know the sticky says 1mg a week, but I was wondering if there is a "loading phase". My doctor wasn't too familiar with it (though luckily he didn't mind prescribing it). He called a pharmacist who said the standard dosing was 1mg a day, and thankfully I knew that this was a standard dose for a woman who was trying to get her estrogen levels to 0.


If the script is written for 1 mgs a day and insurance covers it TAKE IT ...One can never have too much
1 mgs is over kill unless doing 200 mgs per week. I prefer aromasin as its less rebound then adex. for adex if <50 e2 then probably .25 every 3 days then after 3 weeks get retested to see where you are then adjust



If the script is written for 1 mgs a day and insurance covers it TAKE IT ...One can never have too much
1 mgs is over kill unless doing 200 mgs per week. I prefer aromasin as its less rebound then adex. for adex if <50 e2 then probably .25 every 3 days then after 3 weeks get retested to see where you are then adjust

Thanks. Does it matter that I'm on 200mg a week of Test? I don't quite understand what you said above about the 200mgs a week. I realized I was stupid moments after telling my doctor not to write the scrip for 1mg a day. It dawned on me that I screwed myself out of having a hefty supply on hand.


He meant take the script and fill it. Do NOT however take 1mg of dex a day, thats insane. Follow the general guidelines of 1mg spread through a week


The only thing one can do is find the dosage which works for you. If you are in any pain or anything you will eat testosterone like its going out of style. I do not know the full history of the person so it will be hard to any decision on what to do next. Getting the e2 in check will adding little AI would be the best place to start. With guys with issues around 30 e2 who need a little drop, I tend to look for OTC things because ADEX may be too strong in these cases making matters worse.


OP, do us all a favor and start with the guideline. Anyone who suggests experimenting with such a high dose is an idiot. Start with what is in sticky and modify as needed. This is TRT we are talking about not a 700+ mgs/week cycle.


When did anyone say anything about a 700mg/week cycle? I am on 200mg a week which isn't uncommon among TRT patients. Please explain what is going through your head.

By the way, I have read through the guidelines, several times, to the point where I almost have everything in the stickies memorized. Perhaps you either didn't read what any of us wrote, or are gravely misunderstanding what we're saying.


We cant fix stupid, and you obviously arent following the past 4-5 posts despite your claims. If you choose to take 1mg/day, thats your choice--albeit an absolutely fucktarded one that you will regret. You are not the only one on 200mg/day. I am as well and so are others. You claim youve read the sticky, but 1mg/day states otherwise. My advice to you was to follow the sticky, which states 1mg/week per 100mg as a general guideline that appears to be too much in some cases. So thats 2mgs a week for 200 just in case you cant do math. Whatever the case its your body and we cant fix stupid. Dont post for advice if your going to be a derp.


You're right: You can't fix stupid.

The sticky doesn't say 1mg per 100mg of Testosterone, it just suggests 1mg a week as a standard dose for someone on 100mg/week, without instruction on how to change the dose based on how much T you're injecting. I wasn't sure how to scale it, so I was asking. I don't take 1mg a day. If you read what I wrote I said that my doctor's pharmacists said that was standard, but I corrected him as that would be a dose for estrogen producing cancer, and that 1mg a week is more the standard for people on TRT. I am not on 200mg a day of Testosterone. Learn to read. W-E-E-K spells "week", which is a period of 7 days (just in case you don't know how a calendar works). In that 7 days I take 2 (two) 100 (one-hundred) milligram shots. That is a total of 200mg a week in case you can't do math.

"You are not the only one on 200mg/day. I am as well and so are others."

I am not on 200mg a day, and I don't know of any people who are on 200mg a day as part of TRT. And if this is what you are doing I hope you aren't doing it long term and I hope you don't actually advise people to do so. 200mg a day isn't REPLACEMENT, it's performance enhancement.

Thanks for all the juvenile name-calling! I hope that attitude works out for you. I would suggest you pay closer attention before you do though. It doesn't make sense to insult someone for something they didn't say.

And not that it matters, but I'll break it down for you: I was asking Hardasnails and others if there is a "loading phase" with anastrozole for people who start taking it months after starting TRT, a topic that is not covered in the sticky. I currently take 1mg a W-E-E-K and am on 200mg a W-E-E-K of Testosterone. I had an E2 test on Monday and will get the results on Thursday. If my E2 is still high I will increase the dose.

Now, feel free to take something I said out of context and say childish things about me. I look forward to your mundane insults.


200/week--a typo. Im quite aware of what was said. You left the impression of going ahead with the dosage, thats why i quoted the other guy and said it is not a good idea in my post to be sure--his post made it sound like it was ok to experiment at that dosage. You for some reason took offense to that. Whatever, i dont give a shit about your take on that as ive shown thats irrelevant anyways. Dont take the fucking 1mg/day, just fill the fucking script so that you have it. Follow the guideline in the sticky. The sticky has more than just one fucking post in it. Had you read the thread in its entirety, you would have seen how to break up the dosage. Read it ALL.