T Nation

Road to Recovery (Horrible Hormone Panel, Anxiety, Etc.)

Hello everyone,

I am from the Czech Republic and I want to slowly regain both of my physical and mental health and I know, based on reading the stickies and some threads, this is the great place to start.

AGE:
27 years old on 7th December I turn 28

Height:
169 cm/ 14,03 feet

Waist:
87 cm

Weight:
82kg/ 180 pounds

Describe body and facial hair:
Normal moustache and goatee, little hairy on the chest, armpit, down there

Describe where you carry fat and how changed:
Mainly around midsection

Health conditions, symptoms [history]
At the age of 14 ablation catheterisation of my heart. Since then my heart has been perfectly fine.
Always nervous, emotional and little anxious, my flight or fight response has been always super sensitive.
In 2016 I did my first quite hard diet, and according to Inbody I had (6% of body fat - not precise of course). Photos

After the diet (it was mainly no fat, low carb, high protein diet) that I was constantly nervous and filled adrenaline, could not concentrate, lot of crying outbursts (It was the last year of college for my bachelors degree and I was under a lot of pressure). I was prescribed mild Antidepressant for Anxiety and Insomnia (Trittico 150mg).

Anxiety/Depression runs in our family, mainly from my mother´s side. (My both cousins are on citalopram, my two aunts are on the same drug, grandgrand father went insane…)

Trittico was useless, I ended up and got my hormone pannel checked (fasting, at 7 AM):

TT: 11,1 nmol/l (6,073 - 27,1)
Estradiol 107,6 pmol/l (0-172)
**Prolaktin 6,5 ug/l (2,64 - 13,13) **
**Cortisol 157 (101 - 536) **

**TSH 4,390 mU/l (0,4 - 4) **
**fT4 (Tyroxin vol.) 14,3 pmol/l (11,5- 22,7) **
**fT3 4,4 pmol (2,6 - 5,7) **
S_SHBG 25,8 nmol/l (16,2 - 68,5)

I did Iodine replenishment, selenium, VIT D , hopped od HCG 250 IU EOD, Tamox dissolved in vodka and I was much better,

Since then I have incorporated meditations, cold showers healthy eating, CBT with my psychologist etc.

Beginning of March I had my first bodybuilding show (I was natural among juicers)
Under the supervision of my trainer (diet - zero fats, little carbs, high amount of protein)
Ripped to the bone, had stripes on my glutes. I am in the middle.

I went from 93kg to 69 kg- that was my contest weight. After the show, typical rebound, tons of chocolate and 10 kg up in four days.

I was very tired but happy. Immediately after the show I had 2 months of full of working (I was teaching at school and then from 4 to 8 private language school).

Slowly I had following symptoms: excessive amount of adrenaline, hyperactivity. anxiety I would say.

On the last day of school we had a teachers party where I drunk 7 beers. When I woke up in the morning, horrible adrenaline rush, I didnt want to see anybody, wanted to break up with my girlfriend.

I tried to fight it with training in the gym, cold showers, meditation but nothing worked. At the end of my 2 month summer holiday I could not train anymore I was in bed and only watching TV, I got to the doctor and she gave me Trittico again and Citalopram.

I was so weak and overwhelmed that I thought that it is only just in my head, so I tried Trittico= bedtime, Citalopram 5mg in the morning.
After Citalopram I had to quit because of the sides. I had only trittico 150 mg (I could not sleep, could not eat).
Then I run a smaller hormone pannel:

TSH: 3,420 mU/l (0,4 - 4)
E2: 90,0 pmol/l (0 - 172)
TT: 7,8 nmol/l (6,073 - 27,1)
fT3: 3,7 pmol/l (2,6 - 5,7)

The bad thing is that I did not run before I hopped on Trittico and Citalopram.

I totally panicked and I hopped on TRT 100mg Test Cyp two times a week (I had only two shots because Trittico at night gave me heartpalpitations and I thought it was TST). So I quit and after a week I had almost suicidal tendencies (Due to my total drop of TST I guess). I totaly fucked up myself and I was unable to go to work so since 9th September I have been home.

I went to a new psychiatrist and she gave me a new diagnosis: Anxiety/Depression and was given 30 mg Remeron for sleep/ 10mg Of Cipralex in the morning. I gave up and have tried them.

Current symptoms: Sleepy all the time,physicaly totally week, forgetful, bad cognitive skills, no erections, but at least little calmer. No self-confidence even that I know that there is no valid point being non-confident.

Rx and OTC drugs, any hair loss drugs or prostate drugs ever
Remeron 30 mg bed time
Cipralex 10mg in the morning

Describe diet [some create substantial damage with starvation diets]

4 meals (eggs, chicken/beef/salmon, oatmeal, 300g rice)
No supplements now

I am craving for fast sugars (probably caused by Remeron)

describe training [some ruin their hormones by over training]

Pre contest: 6-7x a week (split), 3x days a week HIT cardio

After the contest: 3x times a week (Variation of full body) 1-2x HIT CARDIO

Now: No training, totally drained, fucked both mentally and physically. 4 sets with expanders (bic, tric) and 20 pushups. At home… no work.

Testes ache, ever, with a fever

Never.

How have morning wood and nocturnal erections changed:

No erections.

I am in a pathetic and really dark place now and it would be great if someone knowledgeable can give me some info where to start.

I will be home for two more weeks and then go to work again.

I am in the Czech Republic where some sort of TRT simply exists in only 1 or 2 clinics and it is really expensive.

I can afford one more blood panel, what should I order? I have HCG,Tamoxifen and Test cyp at hand (From Vojta Koritensky IFBB pro athlete).
I cant get rid of the brain meds yet I have been taking them for 2 weeks now.
I know that I pretty much fucked myself up and now I really need to slowly recover (if it is even possible).

Any help will be greatly appreaciated!!

I would be shocked if you didn’t have those symptoms on Remeron. That stuff is like a wrecking ball to your brain. I took it once and slept for three days.

I don’t have all the answers for you, but I’ll say this: you obviously have tremendous discipline and know how to make your body into contest shape. You look outstanding in those pictures. It would be unusual for someone with poor testosterone levels to be able to get that kind of body and maintain it for very long.

Your TT dropped a lot after your show, which is interesting. That’s when your mental health started to deteriorate. I doubt it’s a coincidence.

I used to need SSRIs until I started TRT. Now my experience is mine alone, so there’s no guarantee that you will have similar results. But we hear about a lot of guys whose anxiety and depression fade away when their hormone levels are properly controlled.

You are fortunate to be in a part of the world where good quality testosterone is cheap and plentiful. You may have to take matters into your own hands. Others will chime in and probably have some questions or suggestions about your thyroid (which is outside my core competencies). But I would say that any TRT approach should be done with lower doses at the start. For men with anxiety it can be tough to dial in at first. I would venture that starting out at the top end of the clinical range was a mistake.

As for the sleep… I have strong feelings when it comes to drugs and sleep. I personally had to use benzos to sleep for almost two years. I don’t think we as a species were designed to need drugs for sleep. It’s so counter to our evolution that it makes me wonder what it is we’re missing. I was able to fix my sleep (for the most part)by fixing my hormones and changing some of my habits. I don’t have an answer for you with regards to sleep, but I know it’s a dangerous road to go down when you start relying on pills to fulfill that most basic need.

Also, get more fat in your diet. Low fat is probably great for a contest but it’s not good for overall health. You need fat. It’s essential to so many different processes in our bodies.

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Thank you very much for a quick response
Where would you start with your dosing? Also 2 times a week? Or ED? Split 100mg of test 3x or 4x times a week

I forgot to mention that I have avocado, peanut butter, bacon and olive oil in my diet.

Trittico has toxic effects on male reproductive systems via disrupting hypothalamic-pituitary-testicular axis and inducing testicular oxidative stress. I’m afraid you traded once problem for another using SSRI’s, this is usually how medications workout in the long run causing damage to hormonal glands.

Citalopram also lowers testosterone levels, a double whammy. These antidepressants damage your endocrine glands and unless you want more medical problems in the future, you need to stay away from these harmful drugs and find another solution.

I have found often that people with anxiety do much better on very frequent dosing because injectable T causes spikes in T and E2 which can increase/trigger anxiety.

You also have high TSH and more than likely hypothyroidism, rT3 is more than likely elevated and is a reason for high TSH. The common issues I see with high TSH is almost always depression and/or anxiety. Your good fT3 levels are meaningless if rT3 is elevated.

TRT can’t work if there are thyroid problems, in fact I expect a worsening of anxiety on TRT when there are thyroid problems.

I would say that smaller, more frequent doses is best for your situation. At least in the beginning. @systemlord is correct that this has been an easier transition for guys with anxiety issues. I think you could do 3x a week without getting any huge, unwieldy spikes. Try 40mg MWF and see how that goes, maybe? I know some guys do ED, so if that’s what ends up being necessary then it’s not the end of the world.

Thank you @systemlord for a reply.

So what do you suggest? Should I first adress the stressors in my life and eliminate them? Then try to slowly get rid of the meds. Try to be physically active and try to restore my T levels naturally?

Or as @iron_yuppie has adviced to try 40mg MWF?

Thank you again for your responses.

Do this and inject your doses very frequent which can only have a large impact on results. Don’t shortchange yourself by going in halfway.

Honestly the difference between twice weekly and MWF isn’t a big move, going from twice weekly to daily is a big move expected to show a bigger affect.

Some guys don’t like ED and I think it is tougher to get someone on that protocol. Three times a week isn’t as tough of a sell. But when you plot out an ED program the stability is very obvious, at least on paper. But maybe within real life he doesn’t notice the peaks and troughs of a MWF schedule, in which case he could be spared from pinning more frequently.

Hello,
Thanks for the reply!
Do you recommend SubQ shots or IM ones?

Also my symptoms got much better like 2 years ago on HCG monotherapy (added AI when needed).
I would do it according to KSman sticky- 250iu of HCG EOD 4-6 weeks, then 4-6 weeks tamox, along with HCG and Nolva, AI 0,5mg EOD. After stopping Nolva, 0,5 mg AI for 2 weeks and 0,25mg the third week (AI dissolved in vodka). During the HCG try to taper off brain meds (Cipralex 10mg, 30mg Mirtazapine).

Do you think that it is also an option to try it before jumping on TRT?
Thank you for your response.

That’s a shit load of AI. Don’t get hung up on those old stickies. Much has come to light fairly recently about better ways of doing things. I’m sure Iron can give you a better program to go by.

I wish someone would take some of those down or at least edit/update them or something.

Watch that it will help. You should start at 175-200 mg a week. Quick resolution and do daily. Low t causss anxiety.

Your thyroid is wonky. I’d start t4/t3 asap. This is the main cause for sleepy all the time.
Without thyroid meds you’ll probably never feel the T work. I’m speaking from experience.

Expect anxiety until your body eats used
To both hormones again. It will go away and you’ll be a new man. Think positive as you do this. Your body needs these hormones. .

I use insulin needles to pin my delts and lats. I don’t like subq into belly fat at all. I also will occasionally do IM into my glutes just for the hell of it.

Using a SERM while on hcg does not make a lot of sense. You’re pushing and pulling at the same time. Unless the hcg dose was so high that you were getting gyno you wouldn’t have any reason to incorporate something like Nolva into that program.

Thank you everyone for posting this info. I’ve read other threads (mental impact of TRT). And I have a question concerning mental health.
Last year I started as a teacher and I was pretty nervous at the beginning since I didnt know how good I would do. I managed all of it and I did pretty good. I also started the prep for my first competition.
I was quite well during that time and I was like full of adrenaline but I had a great goal ahead of me and I accepted that my flight or fight responde is higher.
Then when I was 2 months away from the comp. that was the best time, ripped, confident, two girls wanted me, but I stayed faithful to my gf.
After the comp I slowly begun to feel rush of adrenaline and 3 months into I was terribly hijacked and could not focus.
I got that lab results 4 month from the competition.
My family members (2 aunts, 2 cousins) are on citalopram. So maybe I am genetically predisposed to anxiety/depression problems.

What are your opinions should I try SSRI a longer try (not stop my current dose) since I’ve read somewhere that T emphasize the personal traits that you already have.
Or should I try 20mg Test ED and see how it goes?
I dont want to do anything rushed since I did everything wrong during last almost 4 months.
Thank you

This is your best option, minimizing the hormonal swings that affect those predisposed to anxiety.

Your family traits may also be lower than thyroid hormone levels then needing drugs to counter, I wonder what you other family members hormones look like and are they as bad as yours…

You thyroid could not be anywhere close to optimal with TSH at the top of the reference range, I don’t expect good results with TRT without addressing your thyroid problem, in fact I expect a worsening of symptoms.

Low thyroid hormones causing depression and anxiety go together like peanut butter and jelly.

Reference ranges for TSH and thyroid hormones

First of all the distribution of TSH reference range is not normal, with median values (also depending on population iodine intake) usually between 1-1.5 mU/L. On the other hand, upper TSH reference limit is (assay-dependent) usually around 4.2-4.5 mU/L. There is also an argument that significant number of patients (up to 30%) with TSH above 3.0 mU/L have an occult autoimmune thyroid disease.

Thank you for your response @systemlord.

So what would you advise me to do? Should I do another set of labs? I would do:
TT, E2, TSH, fT3, fT4, Prolactin, SHBG (I can’t do fT there is no lab in my area, which can do that)
Health care in the Czech republic is sick, these hormones are all within range, therefore completely normal therefore all my symptoms are in my head. So they are treatig me with SSRI.

Should I buy some thyroid meds? Can you advisee what kind?

I also bought aschwagavandha (powder) and a Damien leaves (also powder). It cam help me witj my thyroid.
Should I postpone TRT daily and try to “fix” my thyroid with med you advise me?
I kind of lost now because no doctor would help me with my labs.
Thanks for the response.

And what do you think about suplemmenting Aschwagavandha 600 mg a day (split into 2 servings)
Cordyceps 600 same dosing as Aschwa.

I have read some studies that these two herbd really can help wit TSH.

What do you think guys?

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I use 1200mg. I have noticed that many of the brands out there are shit and have zero effect. My favorite so far is this one. I can tell I’m on it.

So do you think that Aschwagavandha and Damiena powder in a span of 6 weeks can improve my TSH? My brand is Indigo Herbs

And finally do you thinkt that I should postpone my TRT route until my TSH is better? @systemlord expects worsening of the symptoms, so I dont know where should I direct myself. Any thoughts @iron_yuppie, @dextermorgan ?

You won’t feel all the benefits of TRT until your thyroid is under control. It’s like the traffic cop for all hormones and if its not functioning properly then everything suffers.

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