T Nation

Reassurance of TRT, at a Low Ebb


#1

Hello,

I'm posting this message because, as the title states, I am desperately in need of some reassurance regarding the testosterone treatment that I have now been on for nearly four weeks.

I'm a 19-year old who has, for many years now, struggled with depression. Other issues which turned out to be symptoms of low testosterone included extreme fatigue, lack of motivation, low self-esteem, irritability, difficulty retaining information, loads of fat around the belly despite eating very healthily and actually being well underweight, erectile dysfunction, insomnia etc.

As you can imagine, when I was finally diagnosed with low testosterone a few months ago, I was actually quite excited because it seemed to finally explain why I had all these symptoms, having checked out a list of symptoms for low T online.

It was decided that I would be put on a course of low T treatment, which I was told would be life changing.

Having been on Testogel (5mg per day) for almost four weeks now, I am quite distressed with how things have gone. For literally the first couple of days I was pretty encouraged as I experienced a little increase in my energy levels and seemed to feel a bit more upbeat; I thought that this would just be the start of an upward trend.

However, things soon rapidly deteriorated. The two most worrying developments have come in the form of insomnia, and a 'brain fog' that I can't seem to shake. This is particularly frustrating as I was led to believe that insomnia and poor cognitive process would be two of the major improvements to come with my treatment.

The insomnia has been much different to the type that I had pre-treatment, and also the worst bout of insomnia I have had for quite some time. Basically, rather than the issue of not being able to get to sleep, on most nights (apart from very early on in the treatment when I had this kind of 'nervous energy' which prevented me from falling asleep) I have been able to get to sleep, but have been waking up so many times in the night and have found it difficult to rest for any meaningful length of time before being woken up.

I have been waking up four or five times at least every night, and have also noticed an incredible increase in the amount of dreams that have occurred. Not only that, but the dreams have been quite 'normal', rather than the outlandish dreams we normally experience at night.

The 'brain fog' has been very disturbing. I am a University student, and since beginning my treatment I have found it more than a bit difficult to complete assignments to any kind of decent standard, because I have found it hard to process things which would normally be easy for me. To elaborate further, I'm not necessarily talking about technical subject matter related to my assignment but, for example, processing the right English to use, which is so worrying as this has always been a major strongpoint for me.

Also, I am one of those people who, if on medication, can't help but look around the internet for stories of other people's experiences when on the same or similar course of treatment. This has led me to find that many other people have had disappointing experiences while on TRT, whether they have been on gels, injections, patches etc.

One recurring theme I have noticed is that many people say that the gel has worked well for them initially, but then once the body realises that extra T is coming in, it shuts down its own production, resulting in one�?�¢??s overall level becoming just as low, if not lower, than it was pre-treatment. What's frustrating here is that the person describing this never seems to go on to say how this problem was overcome, if at all. Another recurring theme seems to revolve around TRT causing a rise in estradiol levels, which blocks the production of testosterone.

So, as a young man seriously worrying about the future, my questions are these:

  1. Does TRT (through Testogel) have a good success rate eventually in improving people's lives in areas such as mood (relieving depression and increasing happiness levels), ED, irritability etc? I know it may take a while to get dosage levels correct, and there may be some setbacks along the way, but does this generally work out as a real catalyst for life improvement?

  2. How is the problem of the body ceasing production of testosterone countered once it realises extra T is being produced? Is the idea of TRT that I will eventually receive all my T through gel (which I guess would mean a large increase in dose) thereby basically accepting that my body will no longer produce any of its own?

  3. Insomnia and brain fog seem to be incredibly rare (in fact almost undocumented) side effects of TRT. Has anyone else experienced either of these things while on the treatment, and if so, is it anything I should be worried about?

Could this waking up in the middle of the night constantly be linked in any way to 'sleep apnea?' (I doubt this is the case as I am certainly not overweight and have never woken up and struggled to breathe, but I just thought I would make sure). The only other thing I can think of is that the treatment has caused the side effect of too much red blood cell production, which I guess could well cause insomnia.

Any success stories would be ever so appreciated too, I really need some encouragement guys. Finally, I should have mentioned this earlier, but my current total T level is a mere 70 (I'm not sure of the units, but my endocrinologist said optimum levels should reside somewhere between 230-1000).

Thank you very much, I really appreciate it.


#2

1 - Read the stickies! All of your questions will be answered. Then re-read them.

Post your labs with ranges. It sounds like you are not absorbing the gel.


#3

You might have other (non-T-related) stuff going on. I'm definitely interested in seeing your labs. What's your diet like?


#4

Sorry to say that I don't have any lab results unfortunately, I'm from the UK and my endo didn't provide me with a copy of my results after the tests which showed that I had low T. I realise this makes it harder for anyone to help me, but I would still really appreciate it if some of my questions could be answered.

I have looked at the stickies, but can't find anything about increased brain fog WHILE ON the testosterone, and all the insomnia stuff seems to be related to the possibility of sleep apnea, which I am pretty sure that I don't have.

Wish I could be of more help.

My diet is very healthy overall, admittedly I probably don't take in a huge amount of calories (around 1800 a day) but I'm certainly not an under eater by any means.

I feel I am absorbing the gel in the sense that big changes have occurred since I have been on it, but that just makes the fact that my energy levels haven't increased at all all the more confusing.


#5

You pretty much summed everything up right here...

You have been on for 4 weeks...if your dose is not high enough, you will begin to crash as your levels drop off due to shutdown of your own production. Though your own production was very low (maybe lowest I've ever seen?) so its hard to imagine this is the only cause...my guess is that it is also causing a rise in E2 (estradiol)...

You have been on 4 weeks, is your doctor planning follow up bloodwork to see where the current dosage brought you? If not, prode him to and if he refuses, find a new endo that will properly manage your care...you need follow up bloodwork!!!

If your levels aren't good, then suggest to your doctor to up the dose. I'm not familiar with the product you are on in particular, but androgel can be dosed between 5-10 g per day, and if this is analagous product you are at the lower end and have room to work with.

You also need to test thyroid and cortisol...the increase in metabolic rate from the extra testosterone may be straining either of those systems (or both) if they are low and causing the brain fog...

My guess for the dreams and waking up is increase in neurotransmitter levels...I know when I increase my prengenolone dosage to 100 mg a day or so, I wake up frequently during the night and have very vivid dreams...it should level off if so...it really is just an indication that your brain is functioning properly again (which you arent used to) and should help with depression...


#6

oh and to answer one of your other questions, yes you can expect TRT to shut down your own production...that is, if the TRT is effective...that is the whole point...

You can't "supplement" your T with TRT

Your doctor should have informed you of this before beginning your treatment IMO....


#7

Hey, I am very impressed with your writing skills at age 19. There are not a lot of people that can express themselves so eloquently especially given your age. I'm in college (age 25) and I am astounded at the level of grammar the "kids" around have obtained. I got into a argument with a fellow student that didn't think "fatal deaths" was redundant.

ANYWAY, I cannot answer your questions as I have not tried gels but I am on my first week of testosterone injections. I too, have noticed some sleeping issues. I can't speak for you obviously, but I believe it's not the testosterone directly. I think my mind is so caught up with quick gratification that I have been extremely apprehensive causing sleep disturbances. I wonder if the same thing is happening with you. I am not noticing any improvement in my symptoms and I feel as if my apprehension is growing each day, again, wanting to feel something. In my case, I can pretty much fall asleep with no problems but noticed I am easily awakened.

Do not worry about shutting down your own natural productions. It's hard to gauge a person's tone in forums but I say this in a humorous way: Your natural production sucks! It doesn't matter if you shut it down. Also, I don't believe that is the problem. Even with the best protocols, shutdown is expected. I believe the problem is that you are not absorbing it. This seems to be a common problem with gels and creams and could possibly stem from the fact that a person has hypothyroidism. Have you looked into checking your thyroid panels?

Hang in there man. Sometimes it isn't always a smooth transition and bumps in the road are expected.


#8

Thanks for all of your help so far guys.

I am scheduled for a blood test in the week prior to when I go and see my endocronologist again (I have an appointment with him on April 14th). I gather then that the key tests that need to be ran concern estradiol, thyroid and cortisol. My question then is whether I need to specifically order any of these to be tested for (as I previously mentioned, however, I'm not sure if UK patients can achieve much in this regard) or are these all accounted for by a normal blood test?

'B WS6', I can certainly see where you're coming from when you mention that apprehension may well be playing its part in sleep deprivation, as this trait has undoubtedly exacerbated my sleep issues in the past, but, personally speaking, I don't believe this is the case at the current time. This is for two reasons:

A: Quite a while ago now, I stopped worrying so much about not being able to sleep, as I felt totally powerless over it, and, having lived with the stress of sleep deprivation for such a long time, had reached a stage of near acceptance.

B: Secondly, in regards to my TRT treatment, I understood that it would take some time before I started to feel better, and was prepared to be patient given that this course of action would supposedly reap huge benefits in the long term.

The strange thing is how this symptom, along with the mental fogginess, has become even more pronounced since starting TRT, but there have been a couple of explanations in this thread that have calmed me somewhat.

Thanks for the compliments on my writing style by the way, I try my best!

I will bump this thread as soon as I learn more (I am just about to email my endocronologist with some questions). In the meantime, any more input from anybody would be fantastic (particularly an answer to my question regarding whether I need to specifically order those E2, thyroid tests).

EDIT: I also forgot to mention that my brain fog is making it near enough impossible to complete University tasks, which is really getting me down. Do you think Universities will make allowances for my condition (I am a UK student, and in my first year, which may be a blessing as the first year results don't go towards my overall grade, it's simply pass or fail). Hopefully the University will consider my condition should I fail some units and maybe let me back into the second year regardless. I can only hope....


#9

Our problems seem so alike. Again, I am only on my first 10 days of TRT and noticed some trouble sleeping. At first, I thought it was apprehensive anxiety like I explained previously but now I am thinking it is a case of misdiagnosed sleep apnea that's worsening on TRT. As you may or may not know, TRT has been shown to worsen sleep apnea if untreated.

In my case, I notice that I "hum" during my sleep that is waking me up and during the day I feel tired. Not fatigue-kind-of tired but "burning eyes" tired. In your case, the symptoms might be mental fog. Maybe you have sleep apnea unbeknownst to you and you are confusing it with insomnia maybe?

I would really push for taking a sleep study. Even if you don't suspect you have sleep apnea, it wouldn't hurt to check it out because it may be what's causing you to feel like this.


#10

I have certainly considered the possibility that sleep apnea could be at work here. I suppose I only disregarded that thought initially because I felt that if I did have it then I would certainly know about it, given the extreme breathing difficulties upon awakening that accompany it, but it is possible that we have a milder form of the disorder...

Just an update on my situation:

I emailed my endo with my concerns, and he told me to have my testosterone levels measured along with my TFT's. Would these tests also give me my estradiol and cortisol levels, or would I need to try and get this pushed through by special request?

Thanks everyone. I look forward to keeping in touch with you B WS6 about how our situations progress by the way. Good luck!


#11

Most people that have sleep apnea never know about it until they get a sleep study. It is rarely obvious and in most cases of sleep apnea, there is no "extreme" breathing difficulty. In fact, the disease itself is often quite mild which is why so many cases go untreated.


#12

I would urge you to consider switching to injections. The topical gels/creams/patches are kind of a crapshoot. Their absorbent efficiency is at best 10%, and that depends on many individual skin factors. Thus you have to apply 10x the desired dose (and even then you may be getting less than intended). Yes, they work for many people, but the fact remains that injections are cheaper AND you are getting a known dose...you know exactly how much is being injected, it has nowhere to go but your bloodstream, and the absorption rate of each ester is fairly predictable in order to keep your levels reasonably constant. Some people also develop skin problems from the creams/gels/patches because they contain various adjuncts to increase absorption.

I have recently started TRT as well and I have not yet experienced any negative symptoms. My mood, energy and outlook are definitely improved. Nothing has changed for the worse. As far as your sleep goes, have you tried the traditional remedies? Try the following and I can guarantee you'll see some improvement:

1) Follow an intensive exercise program. This is the big one.
2) No caffeine after 10AM
3) No bright lights, TV or computer use 2 hours before bed
4) Read a book for 30 minutes-1 hr before bed
5) Alcohol disrupts the quality of your sleep, even in small amounts. Limit or eliminate it.


#13

Thanks for the advice reidnez, I am certainly looking to switch to injections now. The only problem, as I mentioned before, is that I'm 99% sure that UK patients cannot self-administer their own shots, so I would have to visit the hospital once or twice a week, which I'm not really sure is realistic (particularly if twice a week shots are needed).

Speaking of which, although I clearly understand that TRT cannot be effective if you only have the shots done at 2 or 3 week intervals, what is the consensus regarding the effectiveness of having one shot a week done? Getting to the hospital twice a week will be extremely difficult, but once a week might just about be manageable. I have heard that once a week works well for a lot of people, but also concurrent suggestions that you still get the peaks and troughs this way.

Big update - My endocronologist adviced me to get my T levels and Thyroid Function Levels checked, but I managed to push him into also doing my estradiol and cortisol levels at the same time. With much assistance from my Dad, we even managed to move the tests forward, so much so that I am just about to leave my University halls to get them done!

2 VERY IMPORTANT QUESTIONS THAT I HOPE SOMEONE CAN HELP ME WITH:

  1. To control my estradiol levels, what dosage of arimidex would you recommend that I take, also bearing in mind that I'm very conscious of pushing my levels too low?

  2. HCG in the UK doesn't come in shot form, but in the form of tablets or drops that you place under your tongue. Will this method be just as effective, and how would I calculate the correct dosage in this case? (Just as a hypothetical, let's say I order 50 tablets, 1mg of HCG), and the recommended protocol is a 0.5mg INJECTION every three days. In this case, would it simply mean cutting a tablet in half to digest every three days (basically I'm clueless as to whether the dosages for tablets are equivalent or not).

The above questions are so important in helping me progress with my treatment, so if anyone could shed any light on either then I would be enormously grateful.

Thanks guys,
James.


#14

The recommended dosage to start with for Armidex is 1mg/wk per 100mg Testosterone, in divided doses of course.

The only oral hCG I've heard of is the homeopathic shit that they are pushing with the hCG-diet fad. From what I have gathered, it is so diluted that it isn't effective. I know that doesn't help you much, but it's all I've got.


#15

Sorry, I'm an absolute idiot when it comes to understanding dosages (as I'm sure you can tell). If I bought 30 1mg tablets then, to get a consistent dosage would I divide one tablet into seven and swallow one of those segments every day, or divide into approximately three and just take a segment every couple of days etc? Thank you.

Any more info on HCG from anyone (it is really urgent that I get a definitive answer on this one). Should I go for the HCG in the pill/drop form or is it only worth it if I can get it injected?

If there is no way of getting the injection of HCG, what an earth should I do? If anyone has any helpful UK contacts who can help me with this that would be fantastic.


#16

Sounds like your brain fog could be from high levels of E2 or at least high relative to T. This is not uncommon with transdermals. Your T dose may simply be shutting you down [always expected] and not really increasing T while E2 goes up. Sometimes T does not go up or may go down.

Transdermals simply do not work for everyone.

Inability to absorb T transdermals is a symptom of hypothyroidism.

Get those old labs - most needed. There should have been testing for LH and FSH, which will help determine if you have primary or secondary hypogonadism. At you age, the reasons need to be known as this can lead to root causes of your problems that need to be addressed and perhaps fixed. If low T is secondary to some other cause, TRT is then treating a symptom and not the underlying condition.

Read the advice for new guys sticky and please come back with more info in the context of that.

Sublingual or oral hCG is a scam. None shows up in serum or urine; from solid research. Ditto for hGH. Do not waste your time or money. What next? Oral insulin?

Dose of anastrozole is quite predicable for injections. With transdermals, serum T levels are predicable. Anastrozole dose needs to match ones free or bio-available T levels. In both cases, lab work for E2 guides dose refinements.

Can't inject your own T in the UK. Why? Diabetics self inject, so cannot be a safety issue. Actually, insulin dose errors can be fatal.


#17

Thanks for the info KSman. I am going to ask my endo for my original labs when I see him on Monday, as well as obviously getting my T level, thyroid function, cortisol and estradiol results from the tests I had done yesterday.

Monday is the most crucial day of my treatment so far, as I will be pleading with the endo to get me heading down the right path by prescribing Arimidex and the HCG injections. In order to try and sway him, I am planning to bring printed internet information with me to substantiate my claims. Obviously this is an incredible website that contains a wealth of riveting detail on all things TRT related, but he will surely be looking for proof in the form of studies, expert advice from medical practitioners etc.

With this in mind, what internet sites/particular pages would you recommend I refer to in my argument? It's very important that I pick carefully; with the right source material on hand he will surely struggle to simply wave away my claims.

Many thanks, as always.


#18

Time for an update. Got my test results today as well as the original labs prior to beginning TRT. Here we are then:

Original Labs:

Urea - 4.6 mmol/L (2.9 - 7.1)
Sodium - 139 mmol/L (135 to 146)
Potassium - 4.4 mmol/L (3.5 - 5)
Creatinine - 61 umol/l (60 to 110)
LH - 0.8 iu/L
FSH - 3.4 iu/L
Prolactin - 88 miu/L
Testosterone - 4.0 nmol/L
Sex Hormone-BG - 59nmol/L
Free-T4 - 9.6 pmol/L (7.0 - 20.0)
TSH - 1.94 mU/1 (0.35 - 5)
Estimated GFR >90 ml/1
Derived Free Testosterone - 71 pmol/L (230 - 1000)
Free Androgen Index 6.8 (30 to 120)

Latest:

Urea - 4.7
Sodium - 140
Potassium - 4
Creatinine - 56
17-Beta estradiol - <50
Testosterone - 10.2
Sex Hormone-BG - 50
Free-T4 - 11
TSH - 1.56
Estimated GFR - >90
Derived Free Testosterone - * (apparently it'll take a few weeks more to obtain a reading).
Cortisol - 409 (although my tests were done at midday, which could nullify the meaning of this score).

I'm very disappointed after speaking with my endo today. The really rotten news is that Aridimex and HCG just aren't prescribed on the NHS, so to obtain either one would basically take a lot of dodgy dealing.

My estradiol levels are supposedly absolutely fine, though I'm a bit suspicious on this one. As you can see, the result is listed as simply <50; now my knowledge of the subject is limited of course, but surely that kind of reading is just a bit vague?

I brought up the possibility of switching to injections, and he indicated that this would be perhaps be the best course of action. However, I would only be able to get the shots at a maximum of once every three weeks. Upon raising my concerns about starting off on a great high before slowly deteriorating throughout the three week gap, he claimed that to do injections as frequently as I wished for would cause major peaks and valleys in my mood and overall well-being.

He summarised that because my testosterone levels were so very low originally, that the severe side effects (insomnia, brain fog) have most likely been as a result of my body simply not being used to housing all this T. I have been told to cut my dose in half for a week or so to see what changes occur.

As you can imagine, I am feeling low right now. Any feedback on my test results would be greatly appreciated, as well as advice on where to go from here. I take it no one has any UK contacts then?

Thank you,
Regards,
James.


#19

can you edit your post and add ranges?

I read about story after story of the horrors of NHS in the UK. It's a huge fight here in the US with doctors and insurance, but at least we have options, and lucky ones can find a doctor who will work with them. in the UK, you are basically screwed if you need HRT at least from what I have heard.

his arguement about more freq shots leading to mood swings is just idiotic. and I have no idea how you can argue with such an idiotic starting statement. I mean the medical lit from the shot manufacturer even shows the drop in T-levels over the course of two weeks.

the only thing you can do is research research and research some more. Find some good points with backup and then ask him to try it ON A TRIAL BASIS and if it doesn't work, you will stop. Some docs will go for that (well at least they will sometimes in the US).

E2 < 50 is meaningless. He ran the wrong test more than likely.

the side effects you are seeing are probably due to too low T and too high E2.... with possible disruptions of your cortisol and/or Thyroid functions.... also taking external T will usually suppresses your Pregnenolone production which can contribute to major brain fog.

what are your body temps? at waking, 9am, 1pm, and 5pm? are they the same day in and day out?

as a side note you can get Pregnenolone OTC - Lipid Matrix Micronized can be helpful for some. Cortisol is also available via Isocort OTC.


#20

Hey PureChance,

I have added the available ranges now (these are the complete set of ranges stated on the results sheet).

One thing that raises my suspicions regarding the validity of my results is the fact that no estradiol test was conducted initially (before I began TRT), despite the fact that my endo was clearly aware that raised estradiol on TRT is a common occurence. <50 is just ridiculously vague really; hypothetically my estradiol level could have been, say, 5, before starting treatment and is now 49.

I'd like to have my estradiol checked again in a far more precise manner, but now I am 2.5mg per day rather than 5mg I suppose that my estradiol will fall off again anyway (of course that doesn't cure my problems in the least, it's pretty much back to square one).

Unfortunately obtaining HCG or Aridimex is just a non-starter over here, but I will research into the viability of Pregnenolone OTC. Thanks for that. On a related note, I have read that zinc can in fact work as an effective anti-estrogen; might this be worth a shot, if nothing better is available?

Finally, I have emailed Dr. John Crisler for help. Fingers crossed that he can assist non-US residents. Does this forum generally advocate his methods? Everything I have read about the man seems to indicate that he is the person to see about testosterone deficiency.

Thanks guys.