T Nation

On TRT 3 Yrs, Suddenly Anxiety/Depression

51 years old.
Starting levels 3 years ago were
TT 175
E2 19
Shbg 13

I went on pellets and the first year was spectacular. No ai and no hcg. Had energy and cared about things again. Got off the couch and finally was successful working out regularly. Lost 55 lbs and looked better than when I was 20. Got off all meds (cholesterol, reflux, etc.). Cut cholesterol in half, blood pressure of an 18 year old, etc.

I have never had a problem with sex drive but wifey tells me I was noticeably harder. She is on trt also and running high t so suddenly we were like rabbits. Sometimes 2-3 times a day. I thought I had hit the mother load.

Year 2 was not as great but still good. Would get 6-8 pellets every 3-4 months. When tt started dropping and reached 500-600 I would reload so we were overlapping. Unfortunately didn’t check e2 after the initial test. The week after I got reloaded I felt great then would have a kind of blah week thn slowly would build back to feeling really good.

But I seemed to not be quite as good as early and one time I reloaded too much (tt700 and got 8 pellets). About a month later I went through a couple months of super high emotions. Felt terrible so I started running lower doses after that but then never felt great like the first year. Also put about 15 lbs back on. Sticking to a diet just seems harder.

4 weeks ago got a little higher dose to see if I could get feeling more passion for life, etc. the day I got it I had a huge anxiety attack. Valium, etc finally got it under control but it was awful. Over the next few weeks I struggled with anxiety every day. Not over anything significant. Just sitting with the family watching tv and I get an adrenalin rush and fear that the attack is coming again. Got on an airplane and got right back off, cancelled the trip. Got a test and e2 check and it was

TT 936
E2 36
Had complete physical from gp and everything was fine.

Then the anxiety let up but then I struggled w what I am guessing is depression. If you haven’t felt this you don’t know what it is. You imagine anxiety being like when you are anxious about something or depression being sad. The anxiety I had felt chemical and horrible and there is nothing to reason with.

The depression is like the blah, don’t care feeling you get when your t is off but turned WAY up. Can’t see anything enjoyable in my future. Imagine 30-40 more years of feeling like this with nothing to do but try to get out of bed and struggle all day not to have anxiety.

Then after 4 weeks (and some serious prayer) it started to break. About the time it was getting better I did another bw and it was
TT 683
E2 31

This was only 2 weeks later. Seems weird that I was 900at week 2 and 680 week 4. I would typically be 600-700 at week 9-10.

Anyway. Talked to doc. He is very sharp reproductive endo and he suggested a new oral hcg he is starting to use with patients. He wants to get me on hcg and lower my pellet dose to augment what I can make. Discuses ai and he was cautious about that and cited the recent study from finklestein on t and e. My concern with that study is that they gave the ai group 1mg a day so low and behold they tanked their estrogen and didn’t feel good.

Any thoughts? Could e of 36 really be an issue?

So if I understand correctly you started doing worse the first time you started increasing the dose, and then decided to increase the dose even more and felt even worse? I am not sure why this should be surprising. The obvious first thing to try would be to lower the dose again.

I’m no expert, and I didn’t sleep at a Holiday Inn Express last night either. But my guess is your E is high for you. Some people feel fine with E in the 30’s, and for others 20’s is best.

Seekonk- grossly oversimplified IMO. I was on a routine of getting down to 500-600 then getting 7-8 pellets. I felt a gradual decline in benefits. One time I was at 700 and got 8 which is higher than I was used to and a month later got emotional.

I suspected it might be related so I started getting less than I used to for a year or more but finally decided that I would try a little higher because I felt like I was getting little benefit so I got 7 when I was at 500. I have gotten that much many times in the past. This was a COMPLETELY different experience. I wasn’t emotional. I was emotionally drained and panicked.

Gossamer - thanks for the input. I have a new standing bloodwork order for every other week and I am hoping that I start feeling good again so I can draw a sample during a time I feel positive benefits of trt. Maybe I will learn something.

I wonder if much is understood about the connection between sex hormones and serotonin. My symptoms sounded like the exact kind of thing that people use ssri’s for. Fortunately I feel a little better as time is passing. I am kind of back to feeling the tired, lack of interest in life I had before trt which rocks after the last few weeks.