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.