T Nation

Newbie on TRT, Feeling Lightheaded and Foggy After Injection


Most guys will get to high normal testosterone on 50mg twice weekly unless you hyper metabolize your testosterone. Guys who insist on 1200+ run into problems as controlling estrogen becomes a challenge.

I believe with your current dosage that’s where you’ll end up.


Just picked up the lab results from last Wednesday (5/16/18). These results were after the 1st T injection on 5/10/18 where I injected IM 150 mg Test Cyp 200 mg/mL. Here are the results - please let me know if anything looks out of whack:

The response I described last week after the first injection slowly got better over the course of last week. I still have felt light-headed with shortness of breath at times…even yesterday. I would describe it as the same feeling if you’re trying to blow up lots of balloons. I was talking to a lady at the pool yesterday and it was hard to talk and breath at the same time. I wonder if most of last week, my body/brain were reacting to this shock to the system with 150mg of test cyp for the first time and then by day 9 or 10, my body was withdrawing from it?

I did inject my 2nd T shot (50 mg of Test Cyp 200 mg/ml) in my stomach with #31g .5mL syringe (thanks KSman for tip on that…I didn’t feel a thing). I feel much better today - don’t feel anxiety as I was feeling.

Based on lots of reading, I would think we need to closely monitor my E2 levels and get on AI if E2 levels get out of bounds as well as get on HCG so that my nads don’t turn into nothing. I’m 49 and don’t want more children but I do want to keep my nads at normal size. Would you recommend I go ahead and get on HCG now?

KSman, I owe you the temp readings and will buy a oral therm today unless you think it’s unnecessary to do this.

I did add Vit D3 (5000 IU) and Kelp with Iodine to my other supplements (Multi Vit with no iron due to my hemocromatosis, Fish Oil/Omega3, Magnesium).




One thing to add to my post this morning : my Lipid Panel numbers from last Sept were not ideal, especially my triglyceride count. Here they are:

LDL 89 mg/dL
HDL 63 mg/dL
Triglyceride 194 mg/dL
Cholesterol 191 mg/dL
Total Chol/HDL Ratio 3.0 Ratio

My diet is good…could be better. Don’t eat fast food but could be more disciplined. Starting to eat egg whites/oatmeal in the morning. Usually have a high protein smoothie with fruit (strawberries, blueberries, banana, raspberries, chia seeds) each day. Usually have a salad with grilled chicken, lean meat or tuna for lunch. I want to kick my diet into high gear as I’m getting back in the gym (just started OrangeTheory twice a week as well).


Your doctor is not only missing important tests, he’s order the wrong E2 labs designed for premenopausal women and children. You need the LS/MS/MS method designed for males. No Free T3 which is the only active thyroid hormone, this is where the rubber meets the road and all other hormones can appear good while Free T3 is low. It’s like not testing free T together with Total T.

This doctor needs to evolve or he will remain ignorant, doctors are like computers, they need to get updated from time to time to remain relevant.


Systemlord : I’m fairly sure we ran the right E2 test because I took notes from this site and then handed them to him. We ran the Estradiol sensitive. What tells you that this test was for women and children? Happy to go back and ensure we’ve run the right test.

Did you see these numbers from results I posted above:

TSH 1.610 (.450-4.5)
T4 7.3 (4.5-12.0)
T3 Uptake 30 % (24-39)
Free Thyroxine Index 2.2 (1.2-4.9)
T3 116 (71-180)

I took a printout of everything I was asked to get done - as you can imagine, it’s a little frustrating to go through this exercise and then have you respond with “not only missing important tests, he’s order the wrong E2 labs”.


Negative, the Roche ECLIA methodology test is for females. The LC/MS/MS and Ultrasensitive was designed for males. T3 Uptake, Free Thyroxine Index, sorry man your doctors a little behind the times. An experience doctor runs Free T3, Free T4, Reverse T3 and antibodies.

He tested only bound hormones (T4/T3), not free hormones. The downstream Free T3 is at the end of the line which acts upon your T3 receptors in the same way free T acts upon androgen receptors. Most doctors fail at thyroid and TRT, their understanding is surprisingly limited.

This estradiol assay is designed for the investigation of fertility of women of reproductive age and for the support of in vitro fertilization.


@jtb0968, 100% not the right E2 test. They performed Roche ECLIA method for sure. Trust me. I read through your entire thread here and one thing I want to say is this… the way you feel is based on hormonal swings. I know them well. I’ve completely crashed my E2 numerous times and whether I was on my way down or up I felt this way. I felt it when I started trt as well. Took me 3 weeks to level out. I guarantee that’s what it’s from. Your score of 20 on eclia may indicate your estrogen is low at the time of this test. That’s the worst feeling in the world. Well maybe water boarding is worse idk but hormonally speaking it really sucks. It’s worse than high E2 by far and way worse for your overall health.


Thanks Alldayeveryday and Systemlord - I greatly appreciate your help/input.

Sounds like I need to get the right test( LC-MS/MS). I took my 2nd injection around 8am today subq of 50mg - should i wait a day or two to get this test run?

I’ve never felt like this - it’s like i’m anxious but have no clue what I’m anxious about. Definitely shortness of breath (but not too bad…definitely enough to notice :wink: Just feels like i have a lot on my chest.


One thing that is confusing: How could i crash my E2 with my first injection (150mg test cyp)? I thought E2 increases as T increases? NOT arguing with you but just trying to understand. I definitely feel like hormones are all over the place thus making me feel sub par. But i would think the first injection would have increased my E2. Something is definitely off.


Your hormones will swing wildly for the next 6 weeks finally reaching a stable state, then slowly you will start to feel better, how long depend in your biology. Men who rely on ECLIA E2 labs base their AI dosage on E2 labs designed for female often overstating your E2 levels which ends in you crashing your estrogen into the single digits, it can weeks or months to recover.

It you decide to make a change in dosage 3 weeks in, you reset the whole process and must wait another 6 weeks where your levels are in flux and feeling bad. Some who have no patience set upon a course that’s a never ending adjustment period and finally quit TRT.


@jtb0968, you did not crash your e2 with your first shot. You are correct in your thought process. Your first shot would increase your e2. This tells me your e2 was crashed before you took your first shot and may still be low. Stick to the 50 mg twice a week and wait 6 weeks from now before doing more blood work. Your e2 will rise. Look into chemical half life and steady state. This will take 6 weeks today achieve with cypionate. If you have a 7 day half life then after seven days you have 50% of the original right? Well then you dose again so now you have 50% + what you just injected so over time these compounding shots eventually create a steady state. You will have no idea what your treatment or well being will look like until you get to that point. I know how you feel. I was certainly calling my doctors office the first 3 weeks but it all started leveling off after 3 weeks. I’ve been on for 6 months now and its dramatically increased my quality of life. I’ve never been stronger. My joints feel better than they have in many years. Stick with it brother


I will stay the course on this initial protocol of 50 mg 2x per week. I just need to get an accurate snapshot of my levels…especially my E2. Will also try to run: Free T3, Free T4, Reverse T3 and antibodies. I plan to find an excellent endo in the North Atlanta area.


VERY encouraging and I will stick to this protocol for as long as needed. Wouldn’t it make sense to at least get the right E2 test (LC-MS/MS) as well as other numbers Systemlord mentioned: Free T3, Free T4, Reverse T3 and antibodies? I just want to make sure I don’t have some massive bill :slight_smile: I know we’ve met our deductible but just want to make sure I don’t get some crazy bill.


One way to check thyroid status is by checking body temperatures using a glass thermometer upon waking and 2pm. These temperatures directly reflect Free T3 levels. If slightly low it might just be iodine deficiency and if a little more than low hypothyroidism.


Systemlord: How were my other numbers such as SHBG? My LH was low, FSH lowish but other numbers seem to look better such as my T numbers. Do you think it’s OK for me to do the 2x/week 50mg subq injections (I did one today and had no issues with it).

@KSman - I’d love your insight on all of this when you get a chance. Your advice/expertise is greatly appreciated!


SHBG is the perfect ideal level, not too high and not too low. LH should be zero while on TRT, FSH is usually low as well and is related to sperm production. HCG can help out with fertility. 50mg twice weekly is a perfect starting point for those just beginning TRT, you can always increase/decrease later once you have your 6 weeks lab follow up.


Big thanks Systemlord!


If I were you I wouldn’t worry about E2 at all at this point. Where it is now doesn’t mean anything. Where it is when you reach steady state does. The reason the eclia method is considered inaccurate is due to the fact it can’t differentiate between e2 and C Reactive Proteins (CRP). CRP has to do with inflammation in the body. Your level is at 20 now. Could be accurate and if it is it’s perfect. If it’s over stated due to CRP your low and that might also be a good thing because once you reach steady state it will probably be perfect. No reason to test.


@alldayeveryday - good insight/advice. I was leaning towards this. I’ll plan to be religious about my SubQ 50mg test cyp shots every 3.5 days (Monday morning and Thursday evening). That should keep my T levels consistent/level. Appreciate all your help!


Wanted to send update: feeling much better than the “hell” I felt last week. Sounds like my initial injection of 150mg “shocked” my system/brain and it took over a week to get over it. Had my 2nd injection of 50mg yesterday and have felt fine. I think my mind/body are adjusting and as I’ve read, “Rome wasn’t built in a day” and I will have good days/bad days but hopefully in 6-8 weeks (maybe sooner), I’m stabilized. I am getting the correct E2 test tomorrow and will post my numbers once I have them (will also try to get Free T3, Free T4, Reverse T3 and antibodies).

My plan is to stay on this 50mg every 3.5 days for 6-8 weeks, see how I’m feeling, and then get lab work done. I’m phasing out my old business of over 20 years, building a franchise that should open by Labor Day this year (will be working 80+ hour weeks), getting my 5 year old son through chemo treatments, getting my 18 year old stepson off to college. I need to be in peak form by August timeframe ideally.