MAOA Enzyme and TRT

I was listening to one of Jay Campbell’s podcasts with Dr Rob Kominiarek recently (I think it was this one - The Jay Campbell Podcast: Ask Jay and Jim: Why People Battling Anxiety & Depression Need to Have Their Hormones Checked w/Dr. Rob Kominiarek). Dr Rob mentioned that some men don’t tolerate test injections due to MAOA deficiencies and slow clearance of catecholamines. He describes patients who have horrible anxiety/panic attacks from TRT.

Does anyone have any more knowledge on this subject? I’m considering TRT but I’m worried I’ll be one of the minority that has this issue. I have problems with anxiety (ongoing) and had panic attacks in the past (very rarely though). My questions -

Has anyone heard about this issue?

Would genetic testing be a good idea before starting TRT?

I’m currently on an SSRI, would this mitigate the effect if I did have the genetic issue he mentioned?

I really don’t want to go through panic attacks by going on test, so any help would be appreciated.

I think I may have this problem. I have the COMT mutation perhaps MAO too so am inefficient at clearing catecholamines. I can’t handle big doses of testosterone. I started on large weekly doses (175mg) due to high SHBG and it really fucked me up. Heart palpitations, chest pain, dizzyness, weakness - I nearly collapsed at one point.

Dropped it to 100mg once a week and it was much better although still a lot of heart issues. Now on 25mg EOD and most of the really bad symptoms have gone but I still feel pretty shit most of the time. i.e fatigue, brain fog. On the positive side I’ve had glimpses of feeling pretty good and my body composition is improving. So I feel like the T is working but something else is getting in the way. Perhaps too much adrenaline causing problems.

I didn’t hear them mention it in that podcast, was it in another episode?

I wouldn’t worry about something you don’t know whether you have though. As far as genetic testing goes, if you want to know there’s no harm in getting a kit. I’m on the fence about its usefullness. It may give you useful infomation about your health but it could also lead you down a rabbit hole of endless hours reading websites & studies about your genes that doesn’t actually get you anywhere.

Sorry, it was in this podcast, at 22:46 - The Jay Campbell Podcast: The Strategic Use of Pregnenolone, Aromatase Inhibitors & Tesamorelin with Testosterone w/Dr. Rob Kominiarek

Thanks for the reply. I’m on the fence about the value of the genetic test too. Is there anything actionable you can do if you do have it?

I’ve seen quite a few people mention anxiety attacks on test, so it sounds like it may not be as rare as Dr. Rob thinks. I do feel a lot better when I get the testosterone boost from working out, so it seems like there would be some benefit from it, I’m just afraid of making my anxiety worse instead of better.


I’m not sure, trying to figure that out myself. I think there are certain B vitamins and minerals that help.

Dr Rob has also mentioned men see magnesium and pregnenolone decline right after starting TRT, if any of those are deficient those would cause anxiety.

Also if your thyroid can’t keep up with what testosterone is trying to do, your thyroid will struggle and that can cause anxiety as well.

Yeah, magnesium is a must for anxiety. Oddly enough, I started taking pregnenolone this week and saw some immediate benefit. Could have been placebo, but I felt a little more focused and mentally present. I may stick with it for a while.

My thyroid levels are normal -
TSH 0.91 0.40-4.50 mIU/L UL
T4 (THYROXINE), TOTAL 7.4 4.5-12.0 mcg/dL UL
FREE T4 INDEX (T7) 2.3 1.4-3.8
T4, FREE 1.5 0.8-1.8 ng/dL UL
T3, FREE 3.2 2.3-4.2 pg/mL UL
T3, TOTAL 88 76-181 ng/dL UL
T3 UPTAKE 31 22-35 % UL
T3 REVERSE, LC/MS/MS 17 8-25 ng/dL EZ
Do any of those numbers look like they may be an issue? I thought reverse t3 was a little high. Thanks for your help!

I don’t see anything that stands out as a problem. You want free T3 mid-range or better, it is mid-range.