About two years ago I was in a bipolar depression and I started injecting testosterone in the thought that go on TRT would help me out in life. This was made without a doctor and there is no trt doctors.
Since then I have been trough several depressions and time with better mood, but I have never really managed to balanced my test and e2 levels to an good level and I did not introduce Hcg since recently and my suspicion is that my testicles are now permanently broken. Which i highly regret today.
The dosage of testosterone have ranged from 250mg/week to what it is today at 175mg/week and the arimidex was at 1mg/day. I have never been able to dial in the estrogen level correctly and have always missed the sweet spot.
I now seek some advice to dial in estrogen and hopefully restore fertilty.
Here is some stats:
25 years old
About 20% bodyfat
The protocol today is 25mg/day injecting IM with no arimidex after now have crashed my estrogen the last few week.
Wow! 1mg arimidex per day is a great way to make yourself suicidal. Just reading that makes me cringe. I took 1mg on my first day of trt and that first week was absolute hell. I can’t even imagine what it would be like to feel that way constantly. If you just stopped taking that (completely stop as in 0mg/day) you will feel much better than you do. Not sure it’ll be your saving grace but at least you’ll get the positive effects of trt.
I did something similar. I had zero energy, drive, libido and depression. I got on TRT with a total T of close to 600 (under supervision of a doc albeit not a lot of supervision). It was rough getting dialed in because of all the misinformation out there on what to do. Eventually I learned how to get past the BS and feel a lot better. It’s one of the best decisions I ever made and there were many people who tried to talk me out of it since I had decent T levels already. I have more energy, drive, libido and I look so much better it’s not even funny. You’d be surprised what looking good will do for depression. I still have shit going on like thyroid that I’ll eventually deal with but I feel good.
I started at 220mg/week with 1mg/week arimidex.
I feel best at 185mg/week doing daily sub-q injections with no arimidex. 250 is most likely going to be too much. For me I couldn’t sleep and had high blood pressure.
(edit: just noticed you said you are now doing daily with no AI. You’re on the right track. Give it time. It took me 2-3 months to start feeling decent)
Add hCG when actively trying to conceive.
TSH is too high indicating thyroid problems, TSH 2.5> usually means problems, therefore TRT will not work and you can forget about being able to dial in your TRT protocol, you’ll never find any balance and will always struggle.
These TSH reference ranges (.4-4.0) are not collected from healthy people, they are collected from people seeking treatment and are not well. The healthy population (95%) has a TSH <1.5.
TSH isn’t a thyroid hormone, I’m not seeing any actual thyroid hormones in your testing.
SHBG is an unknown therefore you cannot choose an appropriate TRT protocol. SHBG levels should dictate injection frequencies, low values will see higher free hormones in relation to hormones bound to SHBG.
Without SHBG and estrogen testing you are a man without a plan. Your daily protocol is more than likely excessive, I would decrease it to 12-14mg daily until you get more complete testing.
If you want to restore fertility stop TRT, inject HCG and FSH or restart using clomid.
I have been on 250iu e2d for months now and nothing have gotten better.
I have currently no numbers for other thyroid hormones, but SHBG is at 30 nmol/L as of today with probably crashed estrogen and with a TT level at 1300 ng/dl.
I have tested estrogen sensitive last week and are still awaiting the results which can take several weeks but i assume it is because of my low e2 syptoms with low penile sensitivity and cracking joints.
Sysytemlord, do I understand you correctly when you say that your assumption is that I possibly have a thyroid medical condition?
I have a bipolar disorder and have had constant problems for 10 years and what you now are telling me about the thyroid numbers give me some concern since I know that the two have a very close connection.
Here are some more bloodwork from over the last years.
Glad to hear things worked out for you!
Reference ranges for TSH and thyroid hormones
Though TSH remains the most commonly used endocrine test in clinical practice, the issue of an appropriate TSH, and to a lesser extent, free T4 and free T3 reference ranges is still under debate. First of all the distribution of TSH reference range is not normal, with median values (also depending on population iodine intake) usually between 1-1.5 mU/L.
There is also an argument that significant number of patients (up to 30%) with TSH above 3.0 mU/L have an occult autoimmune thyroid disease.
The evidence for a narrower thyrotropin reference range
It has become clear that previously accepted reference ranges are no longer valid as a result of both the development of more highly sensitive TSH assays and the appreciation that reference populations previously considered normal were contaminated with individuals with various degrees of thyroid dysfunction that served to increase mean TSH levels for the group.
Recent laboratory guidelines from the National Academy of Clinical Biochemistry indicate that more than 95% of normal individuals have TSH levels below 2.5 mU/liter. The remainder with higher values are outliers, most of whom are likely to have underlying Hashimoto thyroiditis or other causes of elevated TSH.
Google “Optimal VS Normal Thyroid Levels for all Lab Tests & Ages”.
Thyroid Functions and Bipolar Affective Disorder
Accumulating evidence suggests that hypothalamo-pituitary-thyroid (HPT) axis dysfunction is relevant to the pathophysiology and clinical course of bipolar affective disorder. Hypothyroidism, either overt or more commonly subclinical, appears to the commonest abnormality found in bipolar disorder.
Thanks for all the info, i have looked into it a bit but i Wonder if these (TSH) numbers could be influenced by high or low estrogen or testosterone levels?
Uh no, that’s a negative. People have full blown hypothyroidism and perfect testosterone panels and vice versa. I have low testosterone (119 ng/dL or 4 nmol/L) and estrogen in the single digits and very low TSH, 0.6 in fact and Free T3 slightly above mid-range.
Ok, I have ordered new thyroid test to get a closer look.
I take lithium as well so it could also affect it i have heard.
But if I understand you correctly this is something I would have to check with a doctor right?
Do you know why HCG have not worked for me?
It appears that i have used the right doseage but nothing have happened.
This drug can significantly reduce testosterone levels and impair nitric oxide mediated control of male erectile tissue and impair pituitary-gonadal axis.
This lithium has degraded your health and is causing damage to your bodies natural process.
It is probably because your pituitary-gonadal axis is under assault by lithium which has direct effects on your leydig cells inside the testicles.
Lithium: evidence for reduction in circulating testosterone levels in mice following chronic administration.
It is, therefore, suggested that lithium exerts its effect directly at the level of the Leydig cells rather than through the pituitary-gonadal axis. Since the noted lithium-induced reduction of testosterone was manifested when the plasma lithium levels were within (or around) the therapeutic range, these results may have important clinical implications.
I just made a new thyroid test, what would you make of it?
TSH 3.0 mlE/L reference 0,4-4,0 mlE/L
Free T4 18 pmol/L reference 10-22 pmol/L
Free T3 6.2 pmol/L reference 3,3-6,0 pmol/L
TSH receptor antibodies (S-TRAK) <1.0 IE/L reference 0-1,8 IE/L
Tyreoideaperoxidas antibodies( P-TPO-ak) 34kIE/L reference < 60 kIE/L
How should lithium-induced thyroid dysfunction be managed in patients with bipolar disorder?
Lithium inhibits thyroid function at various points in the thyroid axis. A large number of studies have shown that anywhere from 0; to 47% of patients on long-term lithium treatment will develop clinical hypothyroidism.
Lithium is inducing thyroid dysfunction, elevated TSH and abnormally high levels of Free T3.
Lithium is going to lead to endocrine damage and eventually damage endocrine glands as well, you have to get off it.