T Nation

TRT Keeping Me Awake at Night?


I’m having a frustrating problem. I am 34, diagnosed low T in my late 20s and prescribed HCG and clomid to boost T levels and preserve fertility. Lab tests showed that it was working great, but especially in the past few years, I’ve been suffering anxiety and insomnia. I normally don’t like to do this, but I tried “z drugs” for the anxiety and insomnia and on many nights, it feels like I may as well eat tic-tacs instead because they don’t help.

I was also diagnosed with sleep apnea a few years ago. I thought that perhaps the anxiety and insomnia were caused by the sleep apnea. Knowing that sleep apnea correlates with low T, I decided to see what my labs would look like after three weeks of CPAP with no meds. I discontinued the clomid first and found that remarkably, I started sleeping well again. Later on, I discontinued the HCG, as well. Three weeks later, I had labs drawn.

After three weeks of no clomid and HCG, the results were in. Free T = 8.0 pg/mL, Total T = 450 ng/dL, Estradiol 25 pg/mL, Progesterone 0.1 ng/mL. The result was similar to what it was years ago before beginning treatment. I immediately restarted the HCG because I was desperate to feel better (recalling that it was the clomid that seemed to keep me awake at night)

I told the doctor that my treatment wasn’t making me feel right and I wanted to try something else. Since it seemed that it was the clomid that was keeping me awake at night, we decided to keep the HCG (150 unit capsule 2x daily) and add compounded T cream (2 mL of 150 mg/mL cream). Seeing that my progesterone was a bit on the low side and knowing that low progesterone is associated with anxiety and insomnia, we added a capsule of 35 mg compounded progesterone at bedtime.

And here’s what happened…

I took these drugs as prescribed. I had my first dose of T cream at lunch time after filling the script and the first dose of P capsule before bed, and my insomnia returned with a vengeance!

I thought that perhaps the medicine was too strong, so I stopped the progesterone and took half the dose of the T cream for the past five days or so. A few of the past days, I slept nearly 10 hours, and a few other days, I slept only 5-6 hours, either taking a long time to fall asleep, or awakening too early. (Last night, I slept from about 10:30 to 4:30). At 5:00, I had a prescription sleeping pill that may as well have been candy because I stayed wide awake!

On the other hand, I feel very hopeful that I am doing something right because I have observed that my anxiety (which is typically accompanied by atrocious intrusive thoughts) subsided greatly during this time. I get a lot less of that crummy, irritated-all-over feeling that I had become so accustomed to. (You know what I mean if you’ve had low T) I also had a sexual encounter this weekend and had an erection that lasted for an hour even after I was done!

So, it’s a round about way of asking, but I’m taking 150 units of HCG twice daily and 150mg of topical testosterone in the morning which is treating my symptoms, but I can’t sleep well. What can I do about this? (I should also note that I have been on adrenal support for years) I hope that isn’t too much information all at once.


When I first started TRT my Cortisol was high, there is no doubt. I would wake up at 4-5 AM and be wide awake and couldn’t go back to sleep. That’s one symptom of it, and there is no question when it happens.


That does not make any sense. hCG must be injected and has ~zero oral bio-availability.

Progesterone: In the adrenals progesterone–>cortisol.
It is known from women and HRT that some people freely convert progesterone–>cortisol and that keeps them awake. Others not affected.
Take progesterone during day on an empty stomach.

Clomid is a drug, foreign substance. Hormones are not drugs, just hormones.

If you used sleeping drugs before, there can be a “rebound effect” when stopped.

TRT typically makes snoring worse compared to prior low-T state.

Most progesterone lab tests do not resolve well at low male levels.

Transdermal T has high T–>E2 potential. Gels are worse than creams. Injected T has least T–>E2 potential - when done correctly. Self-injected T is least cost and you can use tiny insulin syringes.

150mg T cream if 10% absorbed is 15mg/day, decent if absorbed well.

Some TRT effects are transient.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


Thanks for the response, KSman. I’ve read thru most of your stickys, but more recently, I’ve been reading other sources, as well. I try to be knowledgeable about what I’m doing to my body.

I’ve never heard of oral HCG being useless. I get it compounded at a local pharmacy, and a couple years ago, when I had my labs drawn while taking HCG and clomid, my total T was around 950 ng/dL and the free T around 20 pg/mL, which I thought was optimal from my reading. Problem was I was sleeping horribly then because my sleep apnea wasn’t treated and I still felt like a bucket of poo.

After getting treated with CPAP, I stopped my sex hormone meds for three weeks and had labs drawn again to see if using CPAP alone would get my hormones back up to par. Here are the results of my hormone tests, in case I left out something important from my original post (with units and reference ranges, as urged in the stickies)

Immature Granulocytes 0 %
Immature Grans (Abs) 0.0 x10E3/uL 0.0-0.1
Testosterone, Serum 471 ng/dL 264-916
Free Testosterone(Direct) 8.2 pg/mL 8.7-25.1
DHEA-Sulfate 123.5 Low ug/dL 138.5-475.2
Estradiol 25.2 pg/mL 7.6-42.6
Progesterone 0.1 ng/mL 0.0-0.5
Sex Horm Binding Glob, Serum 38.7 nmol/L 16.5-55.9
LH 2.8 mIU/mL 1.7-8.6
FSH 1.8 mIU/mL 1.5-12.4

What I find remarkable, KSMan, is that I slept so much better while off of my clomid and HCG. I thought that I had the cause of my insomnia nailed down: I was sure it was the clomid. However, the low T symptoms were awful. I felt tired and irritable all the time, especially in mid-afternoon and I constantly had brain fog.

Now, I’m taking just half the prescribed dose of T cream and seeing the symptoms the low T disappear.
The cream seems very effective to me. To repeat, I felt the irritability and anxiety fade away and had an erection that lasted even for an hour after the deed was done! But in spite of the improvement in low T symptoms, the insomnia came back bad. Choosing between low T and insomnia is like choosing between being hanged or poisoned!

Maybe I can just stop the HCG since you tell me it’s useless, KSMan.

I’m just trying to find a way to get a decent night’s sleep while treating my low T symptoms. Maybe this is one of those “transient” effects you refer to. Can you steer me towards anything that might help with the insomnia?

I’m also not taking any of the progesterone right now. Is the low reading on the progesterone test something I should be seriously concerned about, or is it just background noise behind my low T results? My doctor does have me taking a big dose of adrenal glandular plus 20 mg daily of hydrocortisone for adrenal fatigue, but I was taking that during the three weeks I slept well, so I don’t suspect it of causing the problem. I don’t know a whole lot about progesterone; do you have any good resources to recommend?

I am willing to “do my homework” and learn on my own, as needed.


What time of day are you taking the HCG? It can cause some people to be alert and not sleep so it is sometimes better tolerated in the AM. The lititure with the drug does list trouble sleeping as a possible side effect in <10% of patients.


I’ve been taking 150 units upon awakening and then 150 units again the evening. The insomnia usually strikes around 4 AM or so. I become wide awake several hours before I’m ready to get up. As before, HCG alone seemed just fine; it was HCG+clomid that seemed to cause insomnia, or so I thought right up until I took HCG+test and the insomnia came right back, sometimes striking earlier in the night.

I’ve also read that low progesterone is linked to awakenings around 4 AM or so.


I thought I’d give a quick update. I went ahead and re-added the 35 mg progesterone caps, 1 per day, but now in the morning instead of at night. I’m still taking only half the prescribed dosage of compounded T cream. I’ve slept okay the past three nights, getting about 7 hours of sleep on nights 1 and 3 and nearly 10 hours of sleep on night 2.

I’m still feeling a bit tired, but definitely better than before adding the T cream to my treatment. Hopefull, the insomnia was one of those “transient” effects.


I know I haven’t posted here in a while, but I didn’t want to leave this thread hanging. Last month, I became sick with what I thought was a simple cold, but the doctor referred me to an allergist, saying that there is no evidence of infection.

I was prescribed an inhaler to help keep my sinuses open, and it immediately improved my sleep! i was able to take the full dose of hormone replacement prescribed by the doctor and the insomnia continues to improve. I am preparing for allergy skin testing, so hopefully, there can be a long-term treatment for what ails me without having to buy these expensive inhalers for the rest of my life.

I T-levels are up to about 1100 with the free T up to about 40. Doctor says that if anything, I could probably reduce the dosage of testosterone cream I am taking. Hopefully, once the allergy testing is complete, this story will have a happy ending! I’m finally feeling optimistic about the situation.


Same thing happened to me, I got a nasty sinus infection out of nowhere 3 months into TRT, remember sinuses just swelled shut one day. I’ve had two sinus surgeries with minimal success, my doctor also stated there was no sign of infection remaining yet my sinuses are still swelled up tight.

Let me ask you this, if you get up and move around do your sinus clear up somewhat?