T Nation

Still Feeling Depressed/Low Libido on TRT

This is my first post here. I am a 31 year old male on 200 mg/week test. cypionate and arimidex every other day. I have been on TRT for about 7 months now.

I started feeling depression/anxiety symptoms along with low libido around 6-8 years ago (I was about 25 at the time) and they tested my hormones just to see if it was low testosterone related.
Here are pre trt labs done in 2014 -
Test total serum - 404 ng/dl
Test Free - 8.6 pg/ml
TSH - 1.520 uIU/mL
My cholesterol was high (total 237)
My glucose was slightly high at 102 mg/dl
Vitamin D low at 22.1 ng/ml

I went to an endo and he started me on androgel which at least noticeably increase sex drive but I went off of it not sure if I wanted to be on TRT forever at that point.
I continued to feel the negative symptoms so I went to a urologist who ended up putting me on 100 mg/biweekly test cypionate injected in the office. First week felt more irritated but slightly higher energy. After about 3 weeks I felt absolutely amazing - very high libido, life didnt feel worthless, interest in fun activities again, my anxiety was dramatically better. Thats how i felt about 4-5 days out of the two weeks before my next shot. After about three months they increased the dose to 200 mg/biweekly but I cant remember if that was the shot that stopped feeling like it did anything positive for me. I ended up moving to another state where I would temporarily lose my insurance so I stopped after that last shot that I felt no effects from.

Fast forward to about 10 months later I moved back CA where I was able to see my old urologist and he put me on 200 mg/biweekly. I waited for the 3-4 week change that relieved all my symptoms like before, but aside from a few good days here and there - it never came. After a few months the urologist increased my dose to 200 mg/weekly. These are the labs after it was increased to 200/weekly

Testosterone Total - 1417 ng/dl
free test - 43.9 pg/ml
estadiol - 64.2 pg/ml
This was taken around the peak day.

He then put me on arimidex every other day in addition to the 200 mg test cypionate per week. Here are most recent labs taken the day before shot after starting anastrozole every other day:
RBC high - 5.84 doctor said will test again in 2 months
Hematocrit high - 52.2
Total T - 1050
Estradiol - 13.3

I feel like about half the time now I feel slightly better but absolutely nothing like the few days every two week injection when I first started. Still relatively low libido, still depressed to the point of just staring at the wall because nothing sounds worth doing, and still high anxiety (though that is what has improved the most and what I feel change negatively the most towards the end of the week.

At this point I don’t know what the hell is going on, my doctor says with the high testosterone I should feel a high libido and he thinks its a depression issue not related to testosterone but the
depression/anxiety/libido/energy is why I went on TRT to begin with. I have occasionally tried experimenting with a lower dose but only for one week and went back due to anxiety increasing. Any recommendations would be greatly appreciated.

You don’t. They are antonyms. Trough is your lowest level, which would be on shot day before the shot. That is the considered the correct time for it, by the medicsal profession not just us. How much arimidex are you taking? How many mg?

Thanks, I edited my post to correct that. I am taking 1mg anastrozole every other day.

Stop doing that. Yesterday. Seriously, that is jacking you up in a bad way. That is WAY too much arimidex for anyone, especially anyoone at TRT doses.
There will be argument on this, but consider cutting your dose to 150mg a week. The reasoning being that you felt better on the lower dose before, do what actually works.

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Ive tried taking 150/week but only for a week and it made my anxiety go up, if you’re already on testosterone for months and lower the dose does it still take several weeks to feel positive changes like when starting?

Up to 8 weeks after any change.

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Thank you, I may try 150 soon. Have you seen too high T levels causing low libido and depression before?

It’s more likely that you needed more time to adjust to the dose and the doc crashed your E2, which is worse than anything high E1 might be blamed for.

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my last test after taking anastrozole every other day my estradiol was 13.3 pg/mL the day before shot, is that low enough to cause my symptoms?

Yes.

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Oh and while I have you, do you recommend glutes or thigh and how long a needle?

I’m a breast man actually…oh, you mean for injecting. Thigh, but I don’t think I engineered for glute shots, there are places on my back I cant reach either. Delts are okay too.

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Ventroglutes. Almost no fat and all muscle.

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Unfortunately there is no manual on how to prescribe TRT, the anastrozole is the first mistake. The low estrogen is causing the lower libido and the reason is anastrozole.

There are ways to decrease estrogen and decrease sides effects on TRT. You may need to dose more frequently and smaller dosages.

I feel very bad with my hematocrit at the top of the ranges, I experience fatigue, light headedness and the benefitsof TRT are lost.

TRT can’t work when there are thyroid problems, do you have any thyroid labs?

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My TSH was in normal range but my endo did have an ultrasound done on my thyroid and it showed a “small nodule” he wasn’t concerned about for whatever reason, maybe the labs were fine. I want to try smaller more frequent doses but the bottles I get are one use unfortunately

So you think because levels were normal that you can’t experience hypothyroidism, rule number one labs don’t always tell the entire story. The initial beginning of hypothyroidism will see high normal TSH (3.0>) and mid-high thyroid hormones, then later…

The normal range doesn’t mean you are in the clear, seen countless examples of members full blown hypo at a TSH of 2.7 which thyroid hormone was given and symptoms vanished relatively quickly.

What were your thyroid lab results?

You will need insulin syringes otherwise you may run out of test before your refill do to typical syringes having a dead space design which traps medicine.

I punctured my single use vials multiple times because I must dose 5mg per injection. People are puncturing vials multiple times per week and not dropping dead. This is just big brother being overprotective.

Back in the day when most men were getting injections 1-2x monthly, we were using the same vials for months without problems. Your vial no doubt also says to inject intramuscular only, but we have members injecting SQ and doing great.

Do you do anything specific to the vial once used once to preserve it? One lab from my endo are as follows
Triiodothyronine,Free,Serum - 3.3 ( 2.0-4.4 pg/mL)
Thyroid Peroxidase (TPO) Ab - 16 ( 0-34 IU/mL)
Thyroglobulin Antibody - <1.0 ( 0.0-0.9)
TSH - 1.440 ( 0.450-4.500 uIU/mL)
Thyroxine (T4) Free, Direct, S - 1.20 ( 0.82-1.77 ng/dL)
LH - 2.3 ( 1.7-8.6 mIU/mL)
FSH - 2.0 ( 1.5-12.4 mIU/mL)
Cortisol - 7.5 ( 6.2 - 19.4)
This lab was done awhile after discontinuing compound cream for a few months (that didn’t make me feel better) and before starting test cypionate with my urologist

Wipe the top with alcohol before you puncture it, every time.

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I do that whenever I draw the medicine but is just wiping it again the next time enough to keep it from getting contaminated for the next use?

Assuming the needle is new, yes.

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