T Nation

No Energy on TRT? Here's Help


#1

I have done PMs with many guys here. Some get good T levels, have their estrogen controlled and lack energy, can't get things done. Apathy about many things can be a dominate issue.

Some doctors suspect a thyroid issue and prescribe, even if levels are otherwise quite decent. This can make one feel agitated but not do anything about the apathy and energy levels.

This situation can be a type of depression, characterised, no surprise, by low energy, not getting things done and apathy. In these situations there does not need to be any "profound sadness" that is typical in may depressions.

I bring this up, because I have gone through this as well as some others that I am aware of.

I think that SSRIs would be a really bad route for many. Wellbutrin can eliminate most symptoms quickly. For me, I changed profoundly and am busy doing things all day.

Sleep problems can reinforce the above type of depression. And some prescription or OTC sleep aids may create problems when these are used long term. I found trazodone to work very well, and it has some good anti-depressant effects as well... $4.00 per month at Walmart or Sam's. You sleep aids/drugs may be a major issue. I had been using a antihistamine type non-benadryl sleep aid for years. I think that that was messing things up, but one does need to sleep. The first night on traz gave me a deep sleep and I felt fantastic and energized the next day. I was stunned.

These things were transforming for me and I wanted to share my experiences in case some others might recognize some of these things in themselves.

Elevated estrogen can also be a huge factor and getting that under control may be critical in dealing with things like depression. Estrogen may strongly contribute to depression.

Sexual sides: Wellbutrin has a reputation for enhancing libido. For me, I don't see much of that. That reputation would certainly be true for those who have been chemically castrated by SSRIs. Both Wellbutrin and trazodone are known to, for some, increase erections. Trazodone has a warning about erections that will not go away, go the the hospital ASAP etc. So no sexual downsides for many.

If you have something to say about this that you are not comfortable posting here, you can PM me.

Thanks to Dr.PowerClean who helped me understand some of this and what the drug options were. Part of the problem is that one does not know that they have [this form of] depression. Dr.PowerClean helped me understand that these things happen.

It is all too theoretical, but when your life gets obviously turned around for the better in one week, this all takes on a different level of meaning. I had some good local support to help me, but I needed some context and understanding so I could be less than passive with my Doc.

Edit: minor changes


#2

Thanks, KSman, I printed this out for my files. Good information to have!


#3

Great post Ksman! You sir should be T-Nation writer of the year

I can't thank you enough, you sir are an invaluable pool of knowledge.


#4

What are you paying for wellbutrin?


#5

I take Wellbutrin. XL is pricy, generic is under $10 per month copay.

One must be very careful with Trazodone. When I first took it (by prescription for depression) back when, I passed out, I think due to low blood pressure. Once the dose was sorted out, wood was easy to get, however, it was very dehydrating, and actually I never got to a stable regimen with it, so now I take Wellbutrin.


#6

Thanks, KSman, for the compliment. As I'm sure you realize, the options in psychiatry, for almost every mental health problem, are even more complicated and hazardous than HRT.
And many of you are frustrated with anti-aging docs, try finding a good psychiatrist!

The one thing I would say that might help anyone out there, is that meds for mental illness are as much art as science. And the largest unbiased study (ECA) showed 47% of us have some degree of mental illness at some part of our lives. Of course, that landmark 1993 study had no acknowledgement of hormone deficient depressions, cognitive problems, or anxiety.

The model of achieving mental health is still largely the same as the model for achieving hormonal health, as many on T-Nation have figured out. Take responsiblity for your own health, educate yourself as much as possible, and use doctors like you would use an electrician-clearly point out the problem to them to get what you need done.

I will say, though, sometimes mental illness can rob you of the ability (energy, mental clarity, drive) to do what you need to do. That's when you really need help. I would think most of us can think of a time when we felt that way, but most of us guys just tough things out, as long as it takes.

T-Nation has given me so much in such little time, if I can help others, let me know. Doc


#7

It is for this reason that I've pretty much given up on most of this. I'll med myself, see what works and doesn't, get the blood draws and go from there. If I didn't need a doctor's order for a blood draw, I wouldn't even bother seeing a doctor at all.

I simply don't trust these guys any more. When its obvious that they simply regard you as a payday, then I'm done trusting them.


#8

Headhunter, it seems we've gone around this issue a few times now, and I gotta admit, I think we've just about arrived at the same place. I couldn't get Adex from my doc down here, despite my E2 breaking 50 and no doubt going higher because the doc raised my T.

Frustrated and feeling all the shitty things you and others have felt from poor T/E ratios, I took matters into my own hands. In Costa Rica, the only thing you can get OTC to reduce E is Nolvadex (tamoxifen), which I put myself on. I'd rather be on Adex, but WTF, no options at the moment. A month of Gaspari Novadex and Reservatrol did nothing.

We'll see how this Nolvadex does for me, it's been nearly a week and nothing dramatic. A little more drive and fire maybe, and slightly more upbeat. Doc

BTW, in my career, I have met maybe SIX genuine "healers", doctors whose mission in life was to help people and cure illness, with zero secondary gain. When you meet someone like this, it is an awe-inspiring experience. Six out of thousands. I have aspired to be like these people, but I think these healers are born, not made. Oh well.

#9

I have taken KSman's advice and went on trazodone. It was a godsend. Especially since I have gotten off xanax after being on it since 9/11. To be honest, I used 9/11 to get xanax from my MD and was in a fog for 6yrs.

Having said that, I have since lost my career of 30yrs due to computer trading and am dealing with having to start over at an advanced age.

My face is BEET RED from what I assume to be xanax withdrawal and am hoping it is just a little high blood pressure that will right itself in the near future.

Yeah, I would say that I am going through a bad time, and as KSman says, a little depression and apathy. The trazodone seems to be helping aleviate the sleep issues from xanax withdrawal and I hope to get a bump in mood as well.

And I went to a shrink and after I went through my spiel, he asked, "and what do you want from me"? So I said I wanted some trazodone and he simply gave it to me. WTF, I know now to know what I want from him and just ask him as soon as I see him.
Like Headhunter says, some of these MDs are amazingly inept.


#10

This post was flagged by the community and is temporarily hidden.


#11

Buy lottery tickets. Today. You, sir, have 'The Luck'.


#12

This post was flagged by the community and is temporarily hidden.


#13

FWIW the Walgreens here carries a generic of the Wellbutrin XL 300mg.

From what the pharmicist told me, apparently there is no generic of the XL 150mg, but there is of the 300mg.

I guess that is because the 300mg is the "standard" dosage.


KSman, thanks for the post -- a ton of info here.

I'm one of those who have low energy on TRT. I never seemed to get the dosage right, etc etc.

After some PM's w KSman I researched the symptoms of depression in men -- it isn't "sadness" or whatever, it is:

-- fatigue
-- lack of focus
-- lack of drive

I asked my GP about it and started Wellbutrin about 15 days ago. Within about 5 days I had more energy and focus. I resumed a couple household projects that had been sitting for about 2 years because I was overwhelmed by them.

It will be interesting to see how it goes as apparently the full effects of the drug aren't felt for a month or two.

I can't help but wonder if having my testicles fail screws up other stuff in the body.



#14

Same here with my GP -- mid 60's, did my labs one physical, and said "You have low testosterone -- you need to get treated."

There is a specialist I see -- I met him because of a catastrophic health crisis with a rare condition. He saved my life. He is an amazing doc and human being.

My shoulder surgery guy is so knowledgeable and quick that it is kinda scary. Always insightful.

While my endo has frustrated me, I have had some really great doctors.

And in fact that endo is gone and I have a pretty damn sharp urologist who is treating me now!



#15

Depression in men includes a large constellation of symptoms, often without overt sadness. Besides fatigue and lack of focus, there is also irritabitly, sleep disturbance, decline in libido and anhedonia. "Anhedonia" means a loss of pleasure in doing things that one usually enjoys.

e-loo, I am surprised you "never" got the big bang early effect of HRT-is that right? For me, coming in with T below 200 and low thyroid, after two weeks of HRT I was ready to climb Mt. Everest (and climb every female I laid eyes on-although I didn't). 

I've now lost that great feeling, and have energy problems now too, but I am working on getting my E down. I'l be really bummed if I get my T and E at good, balanced numbers and I still feel I need 3 Red Bulls a day plus coffee.                   

BTW-I don't think I'm depressed, I know what that feels like, had it after my accident, and tried many drugs including Wellbutrin. I was one of the 2-3 out of 10 that couldn't tolerate it. SSRI's neither. Getting my dopamine up helped me through that time.                          Doc

#16

Actually I had the big bang TWICE --

When I first started androgel. . .

Then my testicles shut down and the gel was not working. Switched to Striant and test level went to 150. Unable to reach my endo for about a month or so.

Then I started injections and BANG again . . . like primitive man on the hunt. WOW. It would be soooo great if our libidos could always be like that. Or maybe not :wink:


It is just since then that I never seemed to be able to get it right. Gains in gym, gains in libido, better in many areas but still fatigue, still lack of focus, and so on. Interestingly I have two old friends I only see/talk to about every two years. We have known each other for 40 years. After catching up,they said, "Your test levels are fine --you are DEPRESSED." I told them, "NO WAY, I am not sad at all, I am HAPPY w everything except how crappy I feel!"

This may not be an issue for everybody, I was surprised that it was an issue for me.

At any rate, I have started to feel more like my pre-"dead testicle" self. After two years of struggling. Am interested to see how it goes. . .


#17

I seem to have the same problem some of you are mentioning. I am not really sad or in bed in a fetal position but I know I don't do the things I use to do.

My wife and I rarely go out to dinner and our day trips on the weekend ended 4 or 5 years ago. And I never spend time with friends.

I'm finding out that stress really is the silent killer.


#18

I hope y'all aren't missing the good news here.

PROBLEMS CAN BE FIXED!

I'm the only guy in my circle of similarly aged friends that is DOING something to mitigate age related problems. It's sad. They think my vigor and virility (and 20 yrs younger girlfriend) are due to "luck" no matter how often I tell them luck has nothing to do with it.

I don't see how it could be any other way. If we've learned anything from our discussions as a group, it's that the body is a SYSTEM and you can't change one thing without affecting others. It all works together.

Worry is part of human nature but don't lose sight of the good news. You know for a FACT how it is possible to feel when things are right AND you have a team of experienced guys helping you get there! We're not talking from theory here; we've walked the walk, unlike the vast majority of doctors working with TRT patients.

I'd amend that to say cortisole is the silent killer and it might be worth experimenting with cortisole reducers like Relora and Seriphos along with stress reduction techniques.

We all like to moan a bit about problems and I'm no exception, but the point is that all of us here have decided to do more than moan and take charge of our own well being.

As a group, you couldn't be in better company!


#19

I did a quick glance at Relora and will look into it more. I did see where stress elevate cortisol and reduced DHEA. Eight months ago my DHEA was very low and my pregnenolone was close to zero. So Happydog, you have opend my eyes to something I have read before, but didn't follow up. I have to have my cortisol checked and up my DHEA sups as I stopped taking them. Thanks

My biggest problem is starting and stopping too many things at one time and never knowing what effects what.

One day, but I doubt in this lifetime, I'll get it.


#20

Just my personal experience here, but I went on a five year holistic medicine exploration in my early forties and tried many things for various reasons. I don't sleep well and have tried dozens of things for this, as well as for general stress relief. I tried Relora, felt nothing. But I feel nothing from Melatonin, 5HTP, valerian, and many other herbals/OTC's that others swear by.

The one herbal that I TRULY benefitted from was high quality Kava Kava. For me, it was almost as calming as taking a Xanax, with no downside. In the early part of this decade, they took it off the shelves because some stupid teenagers were OD'íng on it, and I gave up on it. But I just googled, and it never got totally banned, just "warnings" slapped on it.