TRT Anxiety Question

How’s it going guys? I have been a long time reader of this forum but this will be my first post. I recently started TRT on the 1st of April after blood work showed that I had very low testosterone levels. Many of the symptoms of low T I was experiencing and after trying to get my levels up naturally through diet, exercise and supplements but nothing seemed to improve the situation. Initial labs below.

LH: 6.4 (1.7 – 8.6)
FSH: 2.2 (1.5 – 12.4)
Total T: 272 (264 – 916)
Free T: 9 (8.7 – 25.1)
Prolactin: 6.2 (4.0 – 15.2)
DHEA: 147 (138.5 – 475.2)
IGF: 158 (88 – 246)
E2 Sensitive: 8.3 (8.0 – 35)
SHBG: 26.4 (16.5 – 55.9)

After starting TRT the first few weeks I felt great, renewed energy, libido and ED issues dissipated, more confidence and a general overall well feeling. I was put on .35ml of 200ml/mg test cyp twice a week, HCG 400iu twice a week and anastrozole .125 twice a week. The honeymoon period was short lived however and I started to experience unusual anxiety which I was at first just attributing to the hormone shift going on with everything changing. So I gave it some time and then reached back out for additional labs after the problem did not seem to get better. New labs below we taking roughly 7 weeks after starting.

Total T: 872 (264 – 916)
Free T: 22.9 (8.7 – 25.1)
DHEA: 153.8 (138.5 – 475.2)
TSH: .993 (.450 – 4.5)
E2 Sensitive: 31.0 (8 – 35)

We made some adjustments which did not really seem to help the situation. After a few more consultations we tried to take away the HCG which caused atrophy but did not really improve the symptoms of anxiety/nervousness that I was having. Also, they recommended reducing the amount of test shots to .30ml to see if that would help as well and trying to get my E2 more toward 22. The labs below I took myself, I was getting cheap on all of them because of the cost.

Total T: 724 (264 – 916)
E2 Sensitive: 20.6 (8.0 – 35.0)

Still not really any sign of improvement in the symptoms with the new protocol. So we tried to take out the AI which I did for about 6 days and then restarted due to some after feeling like I was losing a lot of the test that I was injecting to estrogen. During the time of no AI I did take DIM and calcium gluconate. Probably jumped the gun on restarting the AI but I was hitting the gym hard and didn’t want to lose that edge. Without the AI, I was actually starting to feel better after a few days. More energy, mental clarity and the general sense of feeling like myself.

Long story short. Since going back to the old protocol and trying to space my shots out over three days instead of two to hopefully make this more stable I am still back to the same spot with the anxiety, nervousness, brain fog, body weakness and surprising coordination issues for some reason which may coincide with body weakness.

I am trying to avoid coming off TRT as I feel that I will just return to the way I felt before but at a loss of what I could do. Any suggestions on what may be happening? Has anyone experienced issues like this and then dropped the AI for an extended period of time and felt better? Any insight is appreciated. Thanks!

My experienced with anastrozole is it caused the symptoms you described even though estrogen was fine, as with all drugs they have side effects independent of estrogen.

You said you started feeling more energy, mental clarity and the general sense of wellbeing after stopping the AI, but you were concerned about losing the edge in the gym and made your choice to sacrifice mood and wellbeing be going back on the AI.

It seems the solution is simple, drop the AI for good, if you want to lower estrogen either decrease your dosage or inject smaller doses more frequently to decrease the FT–>E2 conversion.

This way by injecting smaller doses more frequently you can feel the mood and wellbeing benefits and keep your physical appearance without needing an AI.

It doesn’t sound like the TRT is causing the anxiety, but it is the AI causing the problems. Also take into account that estrogen when not on TRT isn’t always at the top of the ranges 24/7, but is lower at certain times of the day.

So in fact estrogen is high the majority of the time on TRT and you may need it closer to 20-25 to find a better balance. It’s not natural to have estrogen at the top of the ranges all of the time and this may be a problem for some men.

Thanks Systemlord for the info on your experience. Are you still not using an AI, if so what do you use to manage your estrogen? What kind of protocol are you running? Interesting that you had the same side effects, I dont see that mentioned much on the forums.

I had a very similar situation when I started TRT. When I stopped taking the AI it took a good while before I started feeling better. Dim is basically an AI so you stopped taking an AI, started taking another drug with AI like effects and then started back on the AI. Try not taking anything but T and give it 2-3 months. My body takes longer than the 6 weeks most say. I take 2-3 months to acclimate to any dose or change.

Everything I thought was being caused by estrogen was actually just the shit my body goes through before it gets acclimated to a dose. It only took me 6+ months of feeling like shit to figure that out. Turns out of I just give myself 2-3 months everything starts to even out and I feel good. My estrogen is much higher than yours. Like way higher.

I inject IM 7-10mg daily, this pushes TT 400> and E2 <35, this is when everything started falling into place. The 7mg daily protocol got my TT to 417 ng/dL and FT 15 pg/mL (ranges 6.8-21.5) in only 3 weeks.

I stopped TRT to deal with other medical problems and plan on restarting TRT soon and returning to 7mg daily, my dosing lies between 7-10mg. I seriously doubt I’ll need 10mg daily.


What was your free T on 400 total?

I’ve been at 400 total and I feel terrible. I’m just curious why in your situation that’s what felt best

Why would you think you need to do that?

My e2 is 73.

The whole need to manage e2 thing is being proven wrong and completely unnecessary at best.

Drop the AI for good. You might have some water retention or something for a few weeks but it will pass and you will feel a lot better in the long run.

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Mostly from reading that e2 should be running around 20 to 25 from so many. We have been thinking that because my e2 was low to start that it was causing the issue. I still would like to have it controlled by something for now while everything gets settled and then work from there to see what my sweet spot is. Hopefully it has been the AI that has been causing the anxiety.

The things you’re reading are wrong and or outdated. You can do what you want obviously but the sooner you drop it the sooner you’ll feel better

There’s no reason to control something that is benefiting you. A lot of the positives from TRT come from estradiol, believe it or not.

My FT was 15 pg/mL (ranges 6.8-21.5). I’m sensitive to everything, recently 250mg vitamin C caused serum ALT elevations which normally occur with extremely high doses of vitamin C which cause a minimal toxic effect on the liver.

Give me any medication and I’ll over-respond to it, give me a little of anything and I’ll thrive!

Do you consider CDG in the same boat as DIM?

Thanks, will I need to increase my dosage of test that I inject? Or does the AI not provide any test boosting effects?

I don’t know what CDG is but if it has AI like effects then it’s like DIM (which people use to lower estrogen).

The AI for many people is used because they read it in a forum, written by people that read it in a forum, by people that read it in a forum. The thought around estrogen has changed over the past few years. When you go back and read things look at the date. Ksman no longer posts here. You won’t see the E2 in the 20’s anywhere now except from a couple folks who have such low SHBG that they have no choice but to take tiny bits of T and some an AI.

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After discontinuing an AI how long do you beleive it will take for my estrogen to level out? I have heard of a rebound effect after stopping an AI but it does not really specify how long that period would be. After stopping the AI even for just the past few days I am feeling better, more mentally clear, energized and less muscle weakness which is crazy. Cant tell if I am noticing slight withdrawl symtoms from stopping the AI or just elevated E2 that I will have to find a way to deal with. Thanks again for all the info guys.

You just have to keep in mind that your body is going through changes that will take a little time to get used to. When I came off the AI I didn’t immediately feel amazing. It took some time. I know from crashing E2 several times that it takes me about a month to recover. I don’t think it would be far fetched to say that there is a period where your body is a little out of whack going from the usual levels it’s become accustomed to (while on the AI) until it normalizes the new levels (not using an AI). Each person will react differently and you may not have any issues during that time. I don’t remember any significant issues when I came off the AI.

What’s up guys. It has been about 3 week since going off the AI and all of the symptoms of anxiety and some of the other issues that I believed were being caused by the AI have gone away. Was curious and got some bloods done to see where I was at. To control my E2 I have been using 600mg DIM, 1500 CDG and passion flower which all seem to have been somewhat effective for me. Here are my latest labs:

Free T: 16.8 pg/mL (8.7 - 25.1)

DHEA: 120.9 ug/dL (138.5 - 475.2) LOW - tried cheap Walmart 25mg DHEA at one point and made me feel like garbage, possible try micronized better quality and a lower dose

Estradiol, sensitive: 29.3 pg/mL (8.0 - 35.0)

Total T: 810 pg/mL (264 - 916)

SHBG: 28.7 nmol/L (16.5 - 55.9)

Interestingly, my free T and DHEA took a hit while my total T and estrogen stayed relatively the same. The bloods were taken at 9:45 at trough. I have noticed since getting off the AI that I have lost that T “on” feeling of confidence etc. and wondering if that has to do with a almost a 30% decrease in my free T. What do you all think about increasing my dosage from 22mg(200mg/ml test cypionate) 3 times a week to 25mg three times a week to increase the free T to the low 20s at least?

This will probably drive me E2 up which I am trying to get down into the mid low 20s if possible. I would continue the supplements that I would be taking and continue to hit the gym to lose some of the body fat that is contributing to the aromatization of T to E to hopefully compensate for the increase of test to 25mg.

I’m sure it has nothing to do with the 3 drugs you added to “control E2”. Why not stop those and see how you feel after a while? Your free T is fairly low.

Correct. Time is helping you more than anything else IMO. Drop the other stuff and you’ll still be fine.

Your free T is pretty low still. There’s def room to go up.

Appreciate the input Dex and NCSU(GO PACK!). Do you believe pumping up my dosage to 25ml 3 times a week would be a good course of action to take to get my free T up or hold and see what happens?