T Nation

Restarting Natural T After 3 Years of TRT + Long Term SSRI Use

Hi there, lonnnng post here,

Age: 41

Height: 5’10

Weight: 180 pounds

Waist: tape measure around navel: 36.25 inches

Describe body and facial hair: I’m a pretty hairy guy, always have been from puberty which started very early at 11 years old, voice broke at 12 years old.

Very hairy legs, hairy abdomen & chest, forearms, some upper arm & some hair on my back & shoulders.

Facial hair: I have a full beard that grew quite well pre TRT, and better since TRT.

-describe where you carry fat and how changed: I carry it everywhere but with a slight emphasis on hips & stomach. Not a female body shape, but I’m surprised I carry this fat at all, given how much exercise I do.

No changes to fat deposition.

-health conditions, symptoms: Since TRT in Dec 2014 & stopping tobacco in 2015, not many. Shrunken testes definitely. They are 2/3 pre TRT size & I thought they were small pre TRT since using antidepressants.

Also sex function is much better since TRT but is still strongly affected by antidepressants, particularly venlafaxine. If I have a 2 day break from venlafaxine my erections are 7/10. With venlafaxine they are 5/10. Pre TRT they were 2/10 - I needed Viagra for all sex.

Libido is good on TRT - I want sex at least 4 times a week, including jerking off (haha) but again blunted by venlafaxine. A brief 2 day break from that drug & I want sex 3 days in a row.

I’ve been on TRT using Testogel 50mg once per day, for 3 years now.

I’m 41 years old & my blood work in Dec 2014 was as follows:

Serum free testosterone: 213 pmol/L (range 243 - 571 pmol/L )

Serum testosterone: 14 nmol/L (range 11.4 - 27.9 nmol/L )

Serum SHBG: 47 nmol/L ( range 18 - 54 nmol/L )

Serum albumin: 50g/L ( range 35 - 52 g/L )

History wise:

From symptoms, I believe I’ve had low testosterone for a long time - since 2000 - and my belief is that comes from using antidepressants of the SSRI class since 2000 - they really lowered my libido & sex function very quickly.

To the point where within 2 months of using antidepressants I had no confidence at all in getting or keeping an erection. Things worked well before that.

I was prescribed antidepressants from 2000 - 2003. And I’ve continually taken antidepressants since 2007.

I had a very strong libido since puberty at 11 years old until 18, when clinical depression started. I’m confident I had good testosterone levels as a young adult.

I did have testosterone blood tests done in 1996 due to a depression diagnosis & my testosterone levels were good - about the same as my current Testogel levels, from memory. That was after a year of the usual student heavy alcohol use, as well.

In 2007 I had my testosterone checked again & it was low then - I’ll see if I can get details of that test from my doctor.

Since 2007 I’ve used the following antidepressants:

2007 - 2012: fluoxetine.
2012 for 4 weeks only: sertraline (it gave me horrible anxiety)
2013 - present: I use 2 antidepressants - venlafaxine 150mg & Mirtazapine 30mg

These antidepressants work great :slight_smile:

Since starting Testogel 50mg in Dec 2014, and exfoliating the application area in the shower, I’ve had consistently good blood test results & subjectively I feel great too - good energy, improved mood & sense of well being.

The only side effect I’ve had is shrunken balls :smiley: 18 months into Testogel I went through a brief period where my testicles ached, but that went away.

My semen volume & how healthy it looks (lol) is much better than what it was pre Testogel.

Here’s a typical blood result from the Testogel:

Serum free testosterone: 461 pmol/L (range 243 - 571 pmol/L )

Serum testosterone: 22.6 nmol/L (range 11.4 - 27.9 nmol/L )

Serum SHBG: 32 nmol/L ( range 18 - 54 nmol/L )

Serum albumin: 50g/L ( range 35 - 52 g/L )

The last bit of my history/life style - I live a very clean lifestyle - I don’t use alcohol or other drugs & I don’t smoke anymore. I smoked from 2011 - 2016 - it was dabbling with cigars that got me.

I’m fit from regular weight training, hiking & generally move a lot & don’t sit down much.

I’d like to try restarting my own testosterone production simply because I don’t want to be so heavily dependent on daily medication & would like to be as naturally healthy as possible.

Part of this natural wellbeing is certainly attempting to taper off antidepressants as well - although I have always had a depressive mind - and really I should’ve been on antidepressants since about 12 years old - I felt terrible since 12 years old until I consistently took antidepressants from 2007. Therefore I don’t know how realistic being off psychiatric medication actually is.

I would like to ask a few things:

  1. Are antidepressants of the SSRI/ SNRI classes & ones like Mirtazapine known to suppress natural testosterone production?

  2. Generally, how likely is a successful restart of my natural testosterone production after 3 years on TRT (with no HCG).

  3. How would I go about attempting a restart given the complications of using 2 antidepressants as well.

Phew, long post! Thanks for reading & any & all help

A restart is extremely unlikely at your age, forget it. If you were 30 you would have less than 20 percent at restoring natural T production by dieting and exercise. Even if you tried a restart it would fail because the medications you are taking would work against your restart attempt. These medications will also work against TRT.

A couple years ago my doctor instructed my to start tapering off Klonopin which I had taken for 30 years, the withdraw caused my natural T product to fall rapidly and is the reason I’m on TRT in the first place. So I know first hand how the drugs can mess with your mind and body. I’m going on 46 in a few months so a restart for me was out of the question, the withdraw process damaged my pituitary gland.

Hi Systemlord, thanks for your reply.

What do you mean by my psychiatric medication is working against my current TRT? Thanks :slight_smile:

Here is more data from blood tests. Pre 2015 is before TRT.

Also, while I’ve not smoked tobacco in 2 years, I did smoke from 2012 until November 2015.

My cholesterol, triglycerides etc improved a great deal & rapidly once I stopped smoking.

Here’s blood test data after being on Testogel 50mg for 2 years 8 months

Antidepressants are notorious for screwing up a guys hormones, mostly of a sexual nature. Over time they will lower your T levels over the years, remember you are shoving synthetic chemicals into your body and overtime will cause other health problems and I’m your example as my pituitary is damaged from long term Klonopin usage.

I’ve been on just about all SSRI’s (antidepressants) and typically lower libido and soft lifeless erections. TRT has done more for me than all medications combined and with zero side effects.

Your doctor missed fT3 the most important thyroid hormone, fT3 is what FT is to testosterone, the active bioavailable hormone. Think about it for a minute, doctors pump you full of drugs and don’t bother checking your hormone levels after prescribing SSRI’s, but when you are on TRT only then do they start checking your hormones on a regular basis.

That’s why TRT can become so much more effective treatment option considering low T can cause depression and anxiety. These medications raise/lower SHBG, prolactin and a host of other important hormones thrown out of whack by these unnatural chemicals.

You can’t live a healthy lifestyle and proper dieting and then throw these unnatural chemicals into your body, some medications prevents you from getting proper nutrients absorbed into your gut causing nutritional deficiencies.

Testosterone is a natural hormone your body evolved to handle, it works for you not against you. I understand your main issue is the shrunken testes, HCG will fix it and if your doctor say no get anew doctor.

Thanks SystemLord,

Yes the only side effect I’ve noticed from TRT is the shrunken testes. I will search the forum some more on HCG use.

Re the antidepressants - I’d love to be off them - it’s part of my whole wish to not be dependent on drugs.

My feeling is I’d taper off venlafaxine first - because that gives me the most side effects - namely lesser erections (if I take a 2 day break from venlafaxine to aid sex, I get much stronger erections.)

As you’ve taken SSRIs etc as well as Klonopin, how did you taper the SSRIs & can you recommend resources to read up on tapering off SSRIs, please?

I’ll give quitting the venlafaxine a go after I’ve read up methodology (I never needed much convincing haha :laughing:)

What is your opinion on more natural mood support like St Johns Wort?

Thanks again

It took me about a year to withdraw off of Klonopin, it was the hardest thing I’ve ever done. Withdrawing off of a benzodiazepine, well it doesn’t get any worse. I’ve withdrawn off of a lot of SSRI’s and they were a picnic in comparison, venlafaxine similar to Klonopin. Don’t be in a rush because the slower you go the easier it will be for you.

I couldn’t withdraw off Klonopin slow enough, I had to use a pill cutter to the point where I had tiny crumbs pieces. It’s a nerve pain medication so it’s going to reduce the nerves in you penis reducing sensitivity which hurt your chances at an erection. The Klonopin did do something for me, it cured my Tourettes Syndrome, but at a cost. This is my first year since the age of 13 where I’m not taking any medication, pure TRT.

Try Googling how to safely taper off medications, you’ll get tons of hits.

Thanks mate. I’ve heard coming off benzos is pretty much the worst from all drugs, and it’s one of the few withdrawals that can kill you. One massive achievement \m/

I’ve engot a taper guide for the venlafaxine now, it’oing to be roughly 8 months, longer if needed.

Would you start the HCG asap or wait for at least one of the antidepressants to be out my system? I’m thinking increased SHBG while still on the venlafaxine versus keeping my testes shut down another 8 months

Thanks again

I’ve read more of the stickies now, so have added info to my first post.

Also, I started taking my temperature 2 days ago & will post those up after a week of readings.

IA question about aromatose inhibitors IE Arimidex.

Do some of you guys manage to have youthful Free testosterone & E2 in the sweet spot of 22, without the use of any aromatose inhibitors?

I wonder why a body would need something not found naturally - an aromatose inhibitor - once healthy Free testosterone levels were achieved

Thanks :slight_smile:

What others have been able to do doesn’t matter, everyone is biochemically different. What’s youthful FT and E2 numbers when some guys have absolutely no symptoms with T levels under 250 ng/dL and FT numbers well below range?

Guys end up converting more T–>E2 because their injecting larger doses than would otherwise be natural and because the guy is fat and overweight and for this reason would not naturally have youthful T levels, that’s unnatural. How many fat obese guys have the T levels of a youthful teenager who is in prime shape? Answer none.

Got you, Systemlord. Taking your obese guy example, I want to lose a few inches off my waist & lose 14 pounds. 14 pounds off would put me into ‘decent’ shape.

From 5 days of temperature taking it looks like I’m hypothyroid - I’ll post temps after a full week.

There’s then going to be a lot going on - Iodine Replenishment - is it fine to start this fat loss now, given its an overall healthful thing to do?

If so, I think I’ll get Thyroid labs, Free T & E2 done soon + after that weight loss & see the effect.

Weight loss is always a good idea, it can only improve your situation. Just know that once your T drops below a certain point there’s no chance to recover, you were extremely hypogonadal and a restart at your age is very unlikely.

Typically restarts are for younger guys under 30.

Yeah I’ve read a lot of the ‘KS Man’ is here thread & the satellite threads of that, and I’ve made a lot more peace about staying on TRT since reading all that.

I felt a bit guilty before - I’d have thoughts I rushed into TRT & I shoulda/coulda come off antidepressants, got fit like I am now, and not needed TRT.

That seems very unlikely, I had all the symptoms of a major crash in T levels from the year 1999/2000. Plus we are where we are :smiley:

Ok so I’ve taken oral temperature for 7 days now, it seems I’m hypothyroid.

I’ve never used iodised salt & was one of those people who avoided added salt because of the hypertension myth until 2015.

I’ve used a multi vitamin sporadically from 2007 - Which had 150mcg of iodine in but I probably used this 6 months out of each year.

From 2016 ive used a multi vitamin every day that contains 120mcg iodine. I also very rarely took 6.25mg Iodoral iodine from 2016, probably 6mg once per week.

I started taking 6.25mg iodine every day, 10 days ago because of reading the thyroid sticky & being quite sure I was hypothyroid (always cold hands & feet). I should’ve waited to make my temperatures a more accurate picture.

I started 200mcg of selenium every day, 4 days ago after reading about its importance here, prior to Iodine Replenishment (IR).

I’m seeing a GP tomorrow to request thyroid blood work but I’m prepared to go private so I can get the correct tests done.

Symptoms of hypothyroid: I always have cold hands & feet. I put on body fat quite easily & it’s quite hard to lose body fat - given I do a lot of exercise - brisk dog walking every day for 45 minutes, weights 3 times per week. I’m about 14 pounds heavier than having 4 abs visible.

My energy levels however are good, sense of well being & mood are also good.

Here are my temperatures

January 25th: 8.00am = 35.7/ 96.26 f

January 26th: 9.20am = 35.6/ 96.08 f
4pm = 36.4/ 97.52 f

January 27th: 9.15am = 35.9/ 96.62 f
6pm. = 36.4/ 97.52 f

January 28th :10.42am = 36.2/ 97.16 f
4pm = 36.5/ 97.70 f

January 29th : 7.30am = 35.3/ 95.54 f
5pm = 36.4/ 97.52 f

January 30th : 8.00am = 35.6/ 96.08 f

January 31st : 6.22am = 36.0/ 96.80 f

I saw a GP this morning, who agreed to some thyroid tests, but basically so incomplete as to be useless: TSH, fT4 & an antibody test to see if auto immune disease is affecting my thyroid.

I asked for 2 other tests - fT3 & rT3 & she said fT3 was entirely at the discretion of the lab - she couldn’t order fT3 (I figured she was lying there ) and she said rT3 is never tested for!

So basically I’m going to pay to get private blood work done.

I’ve now completed

10 days of taking 200mcg of selenium per day

16 days of taking 6.25mg of Iodoral iodine per day.

I’ve not consistently had selenium in my diet prior to the last 10 days.

Have I used enough selenium recently that it’s safe to start IR at 50mg per day?

Thanks :slight_smile:

Yes, your thyroid should be protected by that.

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Thanks KSMan.