T Nation

Insomnia while on TRT


#1

I have been having trouble with insomnia for about 10 months and always thought that TRT was the reason behind this but didn't know why. The insomnia has been on and off during this time. I think the reason for this was because I was trying various things to cure the problem, however because I didn't keep a diary of the various changes, its taken me longer than what it should have to identify the cause of the problem and solve it.

Anyway, I am not looking for advice here, I am looking to share my findings because I know that like myself many people on this forum want to further their knowledge on the subject.

I have secondary hypogonadism, I was on test replacement for about 12 months before I switched to SERMs. I respond very well to SERMs which pushed my total test and free test into the top 1/3 of the normal range. However from my experience SERMs caused a lack of interest in sex so I switched to testosterone replacement after my wife conceived our second child. (I was not on TRT with our 1st child and had low normal sperm and LH and FSH levels.

I currently use Testosterone Undeconate, at 125mg per week. Currently Im not on an AI or HCG because I wanted to identify the insomnia problem with as little moving parts as possible, having said that I have experimented with both and respond well to Exemestane and HCG so I will decide on adding Exemestane back into my protocol after the next blood test to see where Im at. At last test, I was feeling horrible, I had an enlarged prostate (frequent urination, inflammation in the lower abdomen), and my insomnia was worst than it most recently was. I found that my oestrogen was at the rock bottom of the normal range. I was using 6.5mg exemestane per day which I stopped after getting the results. I suspect I don't need an AI because Undeconate has a very long half-life and because I inject weekly my levels should be now very stable.

Anyway, I saw a lot of stuff on this forum and others that adrenal fatigue might be the cause of the insomnia, yet I didn't find a way to cure the problem. So I went and done blood tests for free T3 and T4. Both of which came back normal, almost exactly in middle of range.

This lead me to test cortisol, however from what I read online I found that cortisol fluctuates significantly through the course of a 24 hour cycle so if I was to do a test in the morning before 10am (which its supposed to be highest), if my cortisol level was at its highest at 3-4am when I was waking up and couldn't get back to sleep, then perhaps the test would not provide the necessary clues to treat the problem.

I did the cortisol blood test on friday and over the course of the weekend that just passed, I thought I would do more online research because I was determined to find the cause and cure myself of this problem.

I found an article by chance about DHEA and how an italian study showed that it lowers cortisol levels. It referenced a study from pubmed which I read the summary on an the article went on to explain how cortisol is lowered with DHEA supplementation. The author suggested using 25mg at night before bed because DHEA has a relatively short half life and will most likely peak this way when cortisol tends to wake me up.

So I tried it last night for the 1st time and slept through the night, I wouldn't say that I had a perfect sleep, I did wake up once and go to the bathroom but I did manage to get back to sleep and felt refreshed this morning, relative to how I have been feeling in recent months

Now I did experiment with DHEA at an earlier stage of my TRT treatment and I cured this problem once before, however it was the same time that I added the exemestane at the time and I was certain in my own mind that my insomnia was due to high oestrogen (I had a blood test to back this but was on 2 sachets of testogel at the time which were probably been aromatised significantly because I was putting them on high fat areas of my skin).

So I totally overlooked the fact that I accidentally cured my problem with DHEA on the 1st count about 3 months ago and just assumed it was due to high oestrogen. Thats why I ended up driving my oestrogen level so low, in an effort to cure the insomnia, when I received the results showing that oestrogen was at the bottom of normal range I knew there was something else.

I was glad that TNation pointed me in the right direction, my cortisol level came back as expected, normal (about midrange) but as I explained this means nothing because of how much it fluctuates over a 24 hour period.

I will report back and give an update, but based on how I am feeling today (exceptionally well), I think I have cured my insomnia with 25mg of DHEA on top of my test undeconate weekly shot.

I hope this helps some people here, I will report back and advise if my sleep disorder is gone for good in the coming weeks, I suspect it is, but i guess we shall see.

Sorry for typos and grammar mistakes, I did not re-read my work due to time constraints.


#2

A few further thoughts on the topic. Although I could not sleep when I woke up at 4am, i did notice that I would get extreme tired late in the afternoon. Sometimes I would take a nap for an hour or so and other times I would force myself to stay awake in hope that I would sleep better in the evening. However weather I took the nap or not made no difference to the quality of my sleep the following night.

This can possibly be explained by the cortisol fluctuation, you need to see a 24 hour cotrisol graph to appreciate what I am saying, google and it will come up as a google image. Cortisol peaks and troughs at various points throughout the day, my late afternoon sleepiness was probably a trough occurring at the wrong time of day. Likewise, my 4am wake ups were a peak occurring at the wrong hour also.

So whilst my cortisol fluctuation may have benn somewhat normal, the times of the day over a 24 hour timeframe were occurring at the wrong hours. DHEA has possibly corrected this, interestingly enough both cortisol and DHEA are made by the adrenal glands and it sounds kind of logical that one would peak as the other made a trough and vice versa.

I would be interested in finding out of others using DHEA as part of there TRT protocol and what dosage they are using in combination with testosterone whilst avoiding a significant increase in oestrogen. I think 100mg a day for me caused excessive oestrogen, as I experimented with the last time I ran DHEA.

For now, I am just happy to have made this distinction and hopefully I can continue to sleep well by managing the cortisol response in the evening when I want it all the way down.


#3

Interesting. I've had issues with cortisol being very low. My DHEA has always been pretty good, but take 25mg EOD to keep just above the high end of the range. I also have terrible insomnia. I'm sleeping ok now, but I take a ton of shit. I'm going to try taking the DHEA at night. You might also try Progesterone at night. I use KAL transdermal as a part of my regimen. Also take zinc, magnesium, Z-12 and trazadone. I'd love to ditch the trazadone at a minimum.


#4

My doctor told me to take the DHEA in the morning, because it might increase energy level and interfere with sleep. He said take D3 and GABA at night because it might help with sleep.


#5

I have been using DHEA at night for the past 3 days and slept well. This is a major change for me because I would normally always wake up between 3-4am and felt wide awake with no chance of going back to sleep, this had been an ongoing problem for me which is why I thought I would share...


#6

Oh BTW, my cortisol levels came back normal when I tested. Do not believe these tests unless your doing 4-6 saliva tests overt a 24 hour period. Cortisol levels swing significantly over a 24 hour period so depending on when you test they might show low or normal.

Mine was mid range when I tested but in my mind that just meant that I caught it at a low point. I felt it was high at 3-4am because I would wake up and felt like I had just taken a stimulant.

It was easier to try DHEA 25mg at night than convince a doctor that I need to do 4-6 tests over a 24 hour period to monitor what is happening with my cortisol levels.


#7

4x saliva tests are pretty cheap. I get mine from canaryclub. Mine was verified low all throughout the day but your right, it could a have been peeking at 4am when I was waking up every night. I tested at 8am, noon 4 and before bed, so it wouldn't have caught that.


#8

Well from my experience, I only had to take a single 25mg capsule of DHEA on the very first night that I wanted to test my assumption (cortisol was spiking in the middle of the night) to confirm that my suspicion was true.

But yeah I think if you are waking up in the middle of the night it would be interesting to do a saliva test when you wake up and compare the cortisol level with your daily range.


#9

Ok, after some blissful night sleeping whilst taking 25mg DHEA every night, I have fallen back into insomnia mode as of yesterday.

However it seems different this time.

I used to wake up in the middle of the night wide away which seemed to fit in with the theory that cortisol was spiking at that time rather than at 8am, as should happen.

Now, while taking DHEA, I seem to now have difficultly falling asleep, and kind of stay that way the whole night, I sort of zone out and am in a semi light sleep mode, but I hear when ever the kids wake up, or my wife gets up to breastfeed. I was like a dead log last week, I heard nothing and was not disturbed at all in my sleep, so a major shift has all of a sudden taken place.

I don't feel like cortisol is spiking any longer because Im not getting the middle of night wide away feeling like I had just drunk a cup of coffee, which is how I used to take up. But something seems is still not be right because I can't sleep even though I am tired.

I read on another forum a few weeks ago that someone suggested cotrisol was the issue and this is how I identified DHEA as a way to neutralise it. However the guy suggested Vitamin C and Phosphatidylserine as remedies and also said they only worked for a few weeks for him before he fell back into insomnia.

The same seems to have happened to me now whilst using DHEA to blunt the cortisol response.

Any thoughts from anyone here would be helpful?

The final piece of the puzzle, I read KSman's thyroid sticky and after getting readings body temp readings or 96.8F on wakeup and 97.7F during the day, I figured I was low on iodine and wanted to correct it.

I took 32mg of potassium iodide a few days after statring DHEA and I was wide away the whole night, I figured due to iodine over stimulation of my thyroid.

So I didn't take it the next night and I slept the whole night.

The following night I took 1/2 of a tablet (16mg) and woke up at 3am, this was an improvement because the 1st night I didn't sleep at all, so I just figures the dosage was still high and I need to lower it further.

I didn't take any the next night and slept perfectly.

The following night, I took 1/4th a tablets, this was my last attempt to take iodine, I didn't sleep the whole night.

I slept the following night and decided to stop the iodine at this point because it was causing insomnia after I had just rid myself of the problem.

Since stopping iodine, now a few days ago, I have not been sleeping for 2 nights in a row.

Im only taking 125mg of testosterone once a week, but I use Undeconate which has a very long half life so I don't think my E2 is spiking. I don't have blood results ATM because I have only been on this protocol for a few months and I am due for blood testing in 2 weeks.

Thought, ideas?


#10

You should really get blood work. That could tell you a lot. I might tell you nothing. There's lot's of things you can try for insomnia.

ZMA
Z12
Melatonin - I like the lef.org time release. Start with a very small dose and increase if needed.
Progesterone - I like the KAL brand transdermal.

There's a ton of other supplements you can try. I used quite a few. For me, everything works ok for awhile and then doesn't. Insomnia seems to come and go as well. It's controllable for a few months then it's not for 6. I'm currently taking two prescriptions plus z12, magnesium, zinc and progesterone. I getting ok sleep. Ok sleep for me is probably shit sleep for most.

I'd like to try DHEA at night, but mines already pretty high. I really can't take even 25mg every day without being well over range. This might not be an issue, but I'm trying to get off my AI and don't want to do anything that will make managing E2 more difficult.


#11

What would you suggest I get blood work on?

I want to see someone who specialises in insomnia with men on TRT but I have no idea where to find such a doctor. From my experience they want to give you a pill and move on to the new patient.

If you know of a specific field in medicine that specialises in such problems, I would love to hear about it.


#12

Testosterone can cause insomnia as a side effect. It is one of the side effects listed in the FDA pamphlet. Since testosterone affects lots of neurotransmitters and may act as a stimulant, this is not surprising. It could be that your T level is too high. I guess you will find out if that is the case once you get your test results.

There is no specialist that would specialize in insomnia in men on TRT.


#13

+1 for Malatonin

I used to take 1mg before going to sleep and it was great, it wasn't that I slept a lot but the sleep was more restful/helpful. Later I bought another bottle that was 3mg and it was way too much and I woke up feeling like going back to sleep so I empty the capsules about 2/3rds and that's my magic number/amount.

Are you lifting/exercising late in the day?


#14

I started TRT 3 weeks ago and noted I was sleeping better at first.

My Iodoral came in the mail 3 days ago and I started taking it. I have hardly slept at all in the past 2 nights. I've taken the Iodoral in the morning and I'm awake until 3 -4 AM. Luckily I have a flexible schedule and have been able to sleep until 10 to 11 AM. But then I wake up and take my dosages of meds and supplements and then back in the same boat again the next night. I'm going to have to try to figure this out over the weekend.


#15

I would check E2 at a minimum.

Insomnia's a bitch. Doctors don't really try and figure it out. Just give you a pill. I've spent a grand with a sleep specialist so far and ended up with another prescription and a CPAP. This is ridiculous because I have insomnia, not apnea. They just treat everyone the same and collect $ from insurance companies. Most doctors are fucking idiots and only really care about billing your insurance company. The biggest problem with the stupid third party payer system we have in the country.


#16

True, but to be fair many of the causes of insomnia are not known, so expecting a doctor to figure it out is like expecting them to be clairvoyant. I would bet that in most cases insomnia is really largely due to psychological factors, not hormones and such.

For example, people tend to become anxious about not being able to sleep, which then prevents them from sleeping in turn, and this builds up in a vicious cycle. Cures do exist: for example, cognitive behavioral approaches can be helpful in many cases of insomnia, but are unpopular with patients who want a quick fix, and with insurance companies who don't want to pay for the required therapy.


#17

They don't even try and figure it out. When someone as fucked up as me comes in (insomnia, low T, adrenal issues, hashimotos, etc) they start writing scripts. Nutritional deficiencies, gut issues, immune system issues, naw just need to try some pharmaceuticals.

I'd shit my pants if a doctor ever recommended actually testing for nuerotranmitters before prescribing an anti depressant. Why something like spectracell nutrient testing isn't common practice is beyond me. Actually it's not beyond me. The medical establishment has no interest in fixing deficiencies or imbalances. They are interested in office visits and writing prescriptions.


#18

This is from one of my posts last year...

Melatonin is natures anti stress hormone because it counters the effects of high cortisol. Scientists consider it to be the best antioxidant known, it's a very powerful scavenger of oxygen free radicals.

( according to book The Anti-Aging Solution - the most yellow pen highlighted book in my collection ) http://www.amazon.com/...g/dp/0471479322

http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_gear/injections_and_sleep_issues?pageNo=0


#19

Because those neurotransmitter tests are just a way of separating hypochondriacs from their money. Serum or urine neurotransmitter tests don't have any correlation with CNS neurotransmitter levels, which would require a spinal puncture to access. But even spinal fluid neurotransmitter tests have been known since at least the 80s to have no correlation at all with mental illnesses such as depression.


#20

You could say the same of most blood and saliva testing. It only tests for substances in serum or saliva, not in the tissue that the substances acts on. It's a diagnostic tool that can help piece together potential issues.

The point is there is very little diagnostic work done by most doctors. If they can't solve the problem with their favorite scripts, they quickly lose interest. Their time is better spent moving more patients in and out with a script in hand.

As an example. Any doctor that prescribes something like effexor with a "give it shot and see if it works" attitude isn't worth a shit. Effexor in particular is toxic shit that is incredibly hard to come off of.