T Nation

Started TRT About a Month Ago - Terrible Mood (Lab Results)

Hi All,

Long time lurker - I think my doc (and subsequently me) went awry in not prescribing (or me requesting) an AI.

Anyway, long story short, I have OCD (taking Duloxetine for it) and anxiety. My symptoms have shot through the roof over the past couple of weeks, and now I just feel like “blah.” It hasn’t stopped me from doing my normal day to day thing, but I constantly have butterflies and I’m not excited about much…which is far from who I am normally.

Doc sent me a new lab script that I’m going to get filled tomorrow to hopefully get some more answers.

Pre-Test Labs
age : 34
height : 6’2"
waist : 38"
weight : 254, 27% bf
weight changes : gained around 20-25 lbs since last summer
Injection Protocol: 50mg of Test Cyp E3.5D

LH: 3.8 (1.5-9.3 mIU/mL)
FSH: 4.0 (1.6-8.0 mIU/mL)
TT: 400 (250-1100 ng/dL)
FT : 74.0 pg/ml (46.0-224.0 pg/mL)
Bio-T: 149 ng/dL (110.0-575.0 ng/dL)
E2: 38 pg/mL (< OR = 39 pg/mL)
PSA: 0.4 ng/mL (< OR = 4.0 ng/mL)
PSA, FREE: 0.2 ng/mL
SHBG: 23 (10-50 nmol/L)
TSH: 1.83 (0.40-4.50 mIU/L)
T4, FREE: 1.3 (0.8-1.8 ng/dL)
T3, FREE: 3.1 (2.3-4.2 pg/mL)
T3 REVERSE, LC/MS/MS: 14 (8-25 ng/dL)

Can you please provide lab ranges. You’re missing some important tests which I’m sure you’ll have in the coming days, SHBG is a protein that for which testosterone and estrogen bind, so it’s an important biomarker for determining a proper TRT protocol.

SHBG is likely part of your problem, when SHBG is elevated it can grab onto testosterone hard nose and handcuff your Free T. Your body fat percentage is high enough that I would expect to see estrogen high when testosterone is lower. Based on your body fat percentage and the fact that you’re converting a lot of your testosterone into estrogen, you need to inject smaller doses more frequently.

This will do two things, keep levels more stable and lower estrogen, no AI needed.

sure thing - will update initial post

@systemlord updated to include more information + lab ranges. I got a pretty comprehensive test prior to starting, so if I need to provide anything else I’ve likely got it.

I expect estrogen to become a problem injecting 50mg every 3.5 days, smaller doses EOD or daily would drop estrogen easily at least until weight is lost, if significant weight is lost and body fat percentage is lower, you might get away with twice weekly dosing.

Your SHBG is very sticky, meaning its grabbing on to testosterone quite strongly indicated by lower than midrange Free T, this is why I thought you were SHBG was higher, because it behaves as such.

Everytime I increased injection frequencies and injected small doses estrogen always decreased moderately each time, quite dramatic going from 50mg twice weekly to daily. 70-26 pg/mL.

We all use insulin syringes (29G/1/2) to inject our testosterone, not those big harpoons some doctors like to prescribe. I inject in shoulders and quads rotating sites.

Thyroid labs look good, fT3 is midrange, midrange or slightly higher is best. Also rT3 is less than 15 ng/dL which is perfect. JFYI Rt3 if elevated can block the active hormone fT3 which isn’t in your case.

Normally we should be seeing the pituitary gland increase LH hormone to stimulate the testicles to produce more testosterone when free testosterone is low, in your case the pituitary gland isn’t doing its job which is more common of those with low testosterone.

Thank you. So if I’m understanding correctly, although my SHBG isn’t necessarily high, it behaves as though it is. This means its binding itself to testosterone but allowing the increased estrogen to run freely through my body…which would be the cause for my ocd & anxiety symptoms to be exacerbated and me feeling like crap?

I will start dosing smaller on a daily basis, but will also post my 4 week labs here when I get them.

SHBG binds estrogen as well, a bit weaker binding action. That’s why the correct course of action is frequent injections (more the better) which decreases the chance of converting testosterone to estrogen on super small doses.

If you make dosing changes you will have to wait 6 weeks until you draw labs, if you then change dosing midway through 6 weeks, you must reset the clock and another 6 weeks until levels are stable.

Ah gotcha ok, makes sense. I haven’t switched my dosing yet and am due to get labs tomorrow. I’ll keep all of this in mind.

@systemlord @KSman Just got lab results back after first 6 weeks on TRT. I know I’ve seen on diff threads that E2 isn’t the end all be all, but anxiety is up and libido is down. Taking 100 mg of test cyp in small doses every day.

LH : not tested (1.5-9.3 mIU/mL)
FSH : not tested (1.6-8.0 mIU/mL)
TT : 599 (250-1100 ng/dL)
FT : 121.7 pg/ml (46.0-224.0 pg/mL)
Bio-T : 239.6 ng/dL (110.0-575.0 ng/dL)
E2 : 57 pg/mL (< OR = 39 pg/mL)
PSA : 0.5 ng/mL (< OR = 4.0 ng/mL)
PSA , FREE : 0.2 ng/mL
SHBG : 21 (10-50 nmol/L)
TSH : 1.42 (0.40-4.50 mIU/L)
T4 , FREE : not tested (0.8-1.8 ng/dL)
T3 , FREE : not tested (2.3-4.2 pg/mL)
T3 REVERSE, LC/MS/MS : not tested (8-25 ng/dL)

Your E2 was too high before you started TRT. Even if you don’t want to use it, your doc should have prescribed an AI. You should consider a low dose. If daily injecting works fine, but don’t count on it. When are your next labs?

I’m guessing 6 weeks from now…just got these labs taken last Monday. My e2 was probably even higher about a month ago, which scares me.

You will be needing an AI unfortunately, estrogen is very high only 6 weeks into TRT and will likely increase with time, you start eating healthier and exercising.

Add to it your Free T isn’t optimal, you need more T and with that comes more estrogen. In comparison to most people, your SHBG is binding androgens very well and I would have expected a higher Free T at the given Total T level.