T Nation

On TRT 6 Months, Stopped 8 Months Ago. Constant Panic Attacks

Hey everyone,

I’m looking for some help in regards to how to proceed with my hormone issues at this point. I had my last shot of test cyp about 8 months ago and I’ve been feeling pretty terrible. Extreme anxiety and panic attacks, depression, no appetite, no energy.

I had three separate tests done before treatment and they all came back in the 250’s and 260’s. I’m 30 and my urologist said my testosterone should not be that low at my age. He tested thyroid and pituitary gland, everything came back normal. He then prescribed test. I was on test cyp for 6-7 months and felt on top of the world for the first time since I was in my early 20’s. Then the panic attacks hit. I’d inject and have panic attacks for 3 days in a row each time. He took me off and, as mentioned before, it’s been months of hell.

Here are my results since last year:

Hematocrit: Ref Range (42-52)

May 25th - 45.1%
August 25th - 47.4%
Sept 27th - 48.1%
Jan 24th - 51.2%

Sept 15th - 45%

Testosterone: Ref Range (123-814)

May 25th - 254
Jun 7th - 268
Jun 13th - 261
Aug 25th - 723
Sep 27th - 503
Jan 24th - 948

April 4th - 163

June 11th - 189

July 16th - 183

Sept 15th - 121

Free Test: Ref Range (4.5 - 17.5)

May 25th - 7.0
Jun 7th - 7.5
Jun 13th - 7.0
Jan 24th - 28.9

April 4th - 4.5

June 11th - 5.8

Sept - 3.0

PSA: Ref Range (0-2.5)

Aug 25th - .377
Sep 27th - .435
Jan 24th - .454

Estradiol: Ref Range (0-40)

Jun 13th - 29
Jan 24th - 47

Luteinizing Hormone: Ref Range (2-9)

Jun 13th - 3.5
Jan 24th - <0.1

FSH: Ref Range (1.4 - 18.1)

Jun 13th - 3.8
Jan 24th - <0.3

SHBG: Ref Range (14.6 - 94.6)

May 25th - 16.1
Jun 7th - 15.8
Jun 13th - 17.4
Jan 24th - 19.0

Sept 15th - 19

Prolactin: Ref Range (2.1 - 17.7)

Jun 13th - 7.1
Jan 24th - 10.1

TSH: Ref Range (0.47 - 4.68)

May 25th - 0.665
Jan 19th - 0.714

August 31st - 1.91

Sept 15th - 0.500

These panic attacks are ruining my life and, as you can see, my testosterone dropped another 60 points since July. Not sure what’s going on…

Describe your protocol and detail, if you were injecting less frequently than every other day that would explain your outcome.

Most endocrinologist and urologist are ignorant when it comes to TRT. An estrogen of 47 would send me into a panic attack. Low SHBG men usually need estrogen closer to 20 since free E2 is usually higher in low SHBG men.

My SHBG is the same as yours and I inject 20 mg every other day and if I inject a larger doses than this less frequently I have a problem with anxiety.

You need to find a hormone specialist that’s been doing hormones for decades, not some garden-variety endocrinologist in urologist because your results are going to be what they are now.

Thanks for responding, systemlord. My protocol was 200mg test cypionate every two weeks. I tried 100mg every week for a while but it wasn’t much better.

My urologist refuses to acknowledge that estradiol could have been the issue. I have since dropped him but now I’ve been referred to an endo at the same hospital, which doesn’t inspire much confidence.

I’ve thought about going with Defy Medical but my experience with HRT has been horrifying so far, so I’ve been hesistant start a new protocol. However, with the way I’ve been feeling lately and with my total test now being 121 I’m getting desperate.

I have your SHBG brother, even lower, latest is 15. I pin 17mg EVERY FUCKING DAY, subQ into belly for a total of 120mg cyp a week. Feels great, less filling. Good luck to you!

Thanks, Phil! I think I’m starting to get the picture, lower doses more frequently. Any recommendations for companies/doctors would be totally welcome (if that’s allowed here).

I’m in Canada brother. Few countries are worse off then mine for TRT, I had quite the struggle to get to where I’m at in proper treatment. Hopefully you are in the States, others will chyme in. :slight_smile:

I am in the US but I can see the lights of Montreal from my house lol. Thanks for the positive messages!

Defy Medical is the best option, I’m a patient with Defy. Dr Saya has been doing TRT for 20+ years, he was able to see that my insulin resistance is causing my Reverse T3 hormone to be elevated as my body slams on the brakes metabolically, a kind of protection mode against insulin resistance.

Your urologist basically knows nothing about TRT he’s getting these 200 mg once every two weeks from what was done during the clinical trials eons ago. A modern TRT protocol is designed around your SHBG value, lower SHBG, smaller more frequent injections.

I can’t believe your urologist left you hanging all these months, these are disease state levels. When a low SHBG guy injects 100 mg once a week, he is levels will swing wildly, including estrogen which then causes anxiety and panic attacks.

50mg eod here. Feel great after messing with higher less frequent dosing.

Low E2 gives me anxiety high E2 makes me cry like a girl. To each their own. Estrogen is a powerful hormone.


What do you think qualifies for low shbg and therefore eod or Ed injections?

I’m usually 23-27 on my shbg tests.

I agree that it was probably your E2 causing your panic attacks. My last labs came back around 39 I believe, and was beginning to get really high anxiety. Was prescribed a AI and anxiety dropped a few days later. Good luck.


Alright everyone, thanks for your responses! I’ve contacted Defy and set up a consultation but everything is going to take about 2-3 weeks. Going to be a rough wait but worth it to have some answers.

Are there any questions in particular I should be asking? I ordered the full hormone panel and thyroid panel.

Under 20 so around this number I like to recommend EOD, closer to 15 like to recommend ED. As for the mid 20’s twice weekly is fine, however I’ve heard some guys in the mid 20’s say they feel better on EOD which probably has to do with estrogen being better controlled.


I was on eod for about three weeks and was feeling great mentally (except for still no libido) but got convinced to go back to weekly shots hoping to spark libido.

I should’ve run the eod longer. Mentally I felt great. It’s just more a pain in the ass w injections.

1 Like

You should’ve gone 3 weeks longer, then you might have experienced libido. My libido turns on about 5 weeks on a new protocol, this is when erections come alive.

You’ll never find your libido unless you spend months on new protocols. Libido requires a good mental state.

Thanks. I’m slowly headed back to eod or at least a MWF protocol.

Is it a stretch to say that mental clarity can be found at one protocol and libido at another? Or would both happen together at the same protocol if things are dialed in correctly?

Update: Had one month thyroid bloodwork done today. PCP only ordered TSH and Free T4. Also had consult with Defy today.

TSH: 1.11 mlU/L Ref Range .47 - 4.68mlU/L
Free T4: 1.11 ng/dl Ref Range .78 - 2.19ng/dl

TSH is up from .5 and Free T4 is down from 1.77. So things look ok thyroid-wise and hyperthyroidism is probably out as far as panic/anxiety symptoms. Defy PA I spoke with today doesn’t think test cyp is the cause of these symptoms either. It was advised that I could switch from EOD to ED for more stability. Guess I’m just waiting to see if things improve…

@systemlord I know you switched to ED shots recently. How have things been? I’m thinking I’d like to continue EOD dosing until things stabilize at 8 weeks, then maybe try other frequencies.

Estrogen management is difficult for some lower SHBG men who are sensitive to E2, when it’s out of control anxiety is the norm. Apparently anastrozole attacks my E2 within my tissues and affects my serum E2 to a lesser extend, this is a theory of Dr. Saya’s. It’s also explains why I recover so damn fast, within 2-3 days because the reservoir is full to replenish back into the tissue.

It’s the only thing that can explain low E2 symptoms (clicking joints) when serum E2 is elevated. I seem to be having an immune system response to ED dosing, DR. Saya believes it may be do to cottonseed oil because 10mg everyday is nothing compared to spending 3 months above 1000 ng/dL, could only guess where Free T was.

I get hives and rashes 7-10mg everyday, but no rashes on 20mg EOD or even 50mg twice weekly. I have some leftover ethanate I’m going to try tomorrow to see what happens.

1 Like

That all makes sense, low E2 symptoms but normal/high serum levels due to AI going after E2 within tissue. Glad you’re making some progress. Dr. Saya sounds like the man and I think I’m going to just wait to talk with him next time (no offense to the rest of Defy).

Do you get your test through empower? Mine is made with grape seed oil.

This defies everything we know about allergens. When someone is allergic to peanuts don’t matter how often they eat/ you get an allergic reaction each time.

If you were allergic to cottonseed oil you should certainly get a reaction when injecting 50mg.

Did you start a new vial when these symptoms occurred?

In regards to the AI , I feel the same thing happens to me.