T Nation

On TRT - Anxiety w/ Lab Results

Hello everyone, this is my first post but I’ve been a long time lurker on the forums.

I’m a 36 year old male, 6’4", 215lbs, probably around 15% bf currently

In short, 5 years ago I took finasteride for a few months and it gave me horrible anxiety and daily panic attacks. I didn’t realize it was from the finasteride until I ran out and immediately the panic attacks stopped. Needless to say I stopped taking it and generally returned more or less to normal with anxiety and panic much improved. Unfortunately I never had blood work done during this time.

About a year and a half ago I was starting to notice signs of low T and, sure enough, several blood tests showed results in the 300 range. I was initially given clomid which worked but then I had to come off of it and my levels crashed even lower into the 200s.

For the last 4 months I have been on testosterone replacement, being dosed 100 mg/mL per week which I split into two doses, and hcg 250 mcg twice a week.

About two months into treatment I got bloodwork done, I was dealing with a lot of anxiety and increased heart rate. My lab results at that time looked pretty good with the exception of very low estrogen.

Test 1 (2 months ago)
Test - 925 ng/dl
Free Test 23.3 pg/mL
DHT 63 ng/dL
Estradiol <5.0 pg/mL

I was taking .5mg anastrozole twice a week during that time and after I stopped my heart rate issues improved. However, my anxiety would still come and go. Sometimes I’d feel good, no anxiety, and then a day later I couldn’t get out of bed, heart racing, palms sweating, lump in the throat, pure panic. Just as a side note I’ve had two EKGs and both were fine.

After asking my doctor I lowered my test to 80 per week with eod shots of hcg. This seemed to work really well for a week or two and then, bam, another series of panic days.

I had my most recent labs done a week ago and this is how things looked leading up to the labs:

The day before the labs I took 20 mg/mL testosterone (I was taking my shots more frequently to see if that might help with the anxiety)
The day before that I took 250 mcg HCG

Testosterone, Total, LC/MS 438.7 ng/dL 264.0 - 916.0
Free Testosterone(Direct) 11.0 pg/mL 8.7 - 25.1
Pregnenolone, MS 47 ng/dL <150
Dihydrotestosterone 43 ng/dL 30 - 85
DHEA-Sulfate 413.6 ug/dL 102.6 - 416.3
TSH 3.120 uIU/mL 0.450 - 4.500
FSH <0.2 Low mIU/mL 1.5 - 12.4
Estradiol 14.5 pg/mL 7.6 - 42.6
Insulin-Like Growth Factor I 325 High ng/mL 88 - 246
Vitamin D, 25-Hydroxy 47.6 ng/mL 30.0 - 100.0
Progesterone 0.2 ng/mL 0.0 - 0.5
Sex Horm Binding Glob, Serum 32.0 nmol/L 16.5 - 55.9

I actually felt decent during the day of the bloodwork, not ideal, but not horribly anxious.

I wish that I had bloodwork from the time I took the finasteride to compare.

My thoughts were that I need to get my vitamin D levels up, maybe start taking some iodine for the TSH, go back to my normal dosing schedule of test (what I was doing during the first blood test, minus the anastrozole), and very look at using a cream to bring up my pregnenolone. I’ve read that lowered pregnenolone can lead to lower GABA levels and increased anxiety (https://neuro.psychiatryonline.org/doi/pdf/10.1176/jnp.13.3.396), and when I have taken Ativan (which works on GABA receptors) that I feel “normal”. I should also note that I did a 4 panel cortisol test a few months back and the results showed me as high in the morning and at night, and I know there can be some interaction between pregnenolone and cortisol. Those are just the ideas I’m throwing around, but I’d love everyone’s take…especially KSman! :slight_smile:

Your Vit D is in the tank. I think you may have lowered your test doseage too much as well. Are you still taking any AI?

A lot of people have a horrible time trying to dial in a protocol while taking two or three different compounds at the same time. My advice to you, drop the HCG and AI, and dial in just the test for at least 6 weeks. When you have that pretty stable, and are feeling pretty decent, then start adding in the HCG and dialing that in.

Too many moving parts to try and figure it all out together until you know how your other hormone levels are going to react to each compound.

You, me, everyone has to go through 6 weeks of fluctuations until testosterone and estrogen stabilize when either starting TRT or changing the dosage, usually the first two weeks is smooth, then week 3 the body is forced to adapt to the new dosage.

You’re just going to have to ride it out just like everyone else. I’m about to start my 6th week on a new protocol and I have notice weeks 2-4 I had experience good days and bad ones, where now in week 5 it’s good hours and bad hours, as I get closer to 6 weeks, I start to feel the same all of the time.

HCG increases estrogen and may prove difficult to control while on TRT, AI’s aren’t prefered if simply lowering the dose achieves the desired results. When I was only 7-10mg daily injections, estrogen had never been lower. AI’s can cause anxiety independant of your estrogen levels.

TSH is terrible and I don’t care if your doctor said it’s within ranges, the ranges are a problem because they are known to be wrong according to the experts and the newer studies. TSH isn’t thyroid hormones, so you need Free T4, Free T3 and Reverse T3 tested to see why TSH is elevated.

Free T3 is the only active thyroid hormone, it soaks into your cells and speeds them up therefore increasing metabolic rates. Any doctor not testing Free T3, Reverse T3 and antibodies when TSH is elevated is way behind the times and has stopped learning decades ago.

Google - Optimal VS Normal Thyroid Levels for all Lab Tests & Ages

I second this statement, too many moving parts to analyze. Start TRT in isolation and dial in and later add one thing at a time. If you add HCG later and you feel off, you know for a fact it’s not your TRT dosage.

I like where your head is at. I’ve been having a hard time trying to figure out what’s working and what’s not. My problem is that I’ll try just t not feel well and jump back into what I was doing.

I appreciate the thoughts on vitamin d as well. I don’t know much about so I thought it was a bit low. I take 2000 vitamin d but I’m going to bump that up and take it with magnesium. I’m pale and I’m not too surprised it’s low.

my Doctor did actually mention my tsh as being something he wants to address. My moms side of the family does have a history with hypothyroidism so very possible I may have a touch as well. I have iodine and was thinking about that, but I was waiting to hear what he had to say. You raise a great point though, I’m “in range” on a lot of this stuff, but am I optimal? I’m guessing not for the tsh, vitamin d, and Pregnenolone?

Surprisingly my estrogen is pretty low currently, I thought with all of the hcg and test that it might be elevated. I am not taking an ai anymore, and haven’t for about two months, but when I did I think I may have been a super responder. I started with .5 twice a week and dropped to .25 twice and week and it tanked my levels. In the past on clomid my estrogen got to 43, just slightly high.