T Nation

TRT Sub-Q. Need Assistance w/ Mood Problems


#1

I have been on TRT for over a year (Testosterone Enanthate)I was doing IM injections but am sensitive to the highs and low.My whole life I have had mood problems (anxiety and depression)at times the TRT helps give me a better mood. To get to the point,I decided along with my Endo to do sub -q injection instead of IM because it is suppose to have a slower absorbtion and should have less highs.

The day I started the sub- q injections I had my blood work done before the injection. The endo said it was right were it should be before the next injection.I was doing injection of 50mg on Tuesdays and Fridays IM.The blood work results were at the higher end of the range bio T at 8.77nmol/L range is 4.00 to 10.00nmol. My Total T was 15.6nmol/L range is 10.00 to 28.00 nmol/l. That same day after the blood work I came home and did a sub- q shot of 50mg in the belly fat.

That day went fine .I did not get the high I got with IM shot. It was a nice more relaxed feeling. The day after the shot though, after about 24 to 30 hrs after the shot I felt it but it was not too bad. After the second sud-q shot of 50mg I felt really good again the day of the shot but after about 24 to 30hrs I felt it again,but this time I felt much worse. My mood was horrible. I was in a coffee shop and felt a really bad panic attack coming on. I never get panic attacks.

I managed to get my coffee and went to my car.I have not felt good for the past 3 days. My question is. Is it possible that the T levels have gone way to high.Given the slower absorbtion rate of sub-q. Tomorrow is the day for another sub q shot. I am going to lower the dose to 30mg and try this dose for the next two injection putting it at 60mg a week instead of 100mg.

Plus,I will be starting hcg in the near future, perhaps this week. My E levels have always been consistently good. Feed back on this is appreciated.If all else fails I will go back to im injections at a slightly lower dose.Also,I have tried other forms of TRT with bad results.

Age 46
Height 6.2"
weight 205 pounds with a lean build.Very little body fat.

Thanks...


#2

When monitoring TRT it is crucial to look at e2. e2 imbalances can cause symptoms such as depression, anxiety, fogginess, lack of libido, ect. The optimal level of e2 ranges between 18-30. Every ones sweet spots varies. If you can not get your dr to do testing you can get it done by lef, or directlabs.com. The proper test you want is e2 sensitive. As e2 goes up it can cause shbg to go up as well resulting in decresae of bio T. So please check your e2 levels on the mid to lowest part of your treatment. If e2 comes back 20-30 range then I would look into other areas such as adrenals and thyroid with a competent dr such as overbeck, crisler or marino. If all comes back in check then the next place if neurotransmitters which are highly over looked by drs in HRT.


#3

seconded


#4

Read the stickies!

I think the best part of this post is someone having a panic attack adding a caffeine hit from coffee! Way wrong.

We can't get far here without your lab results. Also report the ranges!

Testosterone cypionate releases slower than ethanate. Also note that eth yields more T than cypionate.

If you inject IM or SC EOD [you can use insulin needles - more in the protocol for injections sticky] your levels will be very steady and you can eliminate the effects of changing levels. SC EOD would yield the smoothest T levels.

Part of your intolerance of the higher T levels could be that the increased metabolic demands from that are out pacing what your thyroid or adrenals can manage. You can check your waking, when you first wake up, body temps. Write these down and come back when you gave some numbers and that can indicate the functional state of your thyroid hormones. Tell us about your energy levels and patterns during the day. How do you react to major stress? How emotional are you VS being more analytical and dispassionate about things.


#5

How is 1 mg of testoserone not 1 mg of testoterone despite what type? I guess it would depends on duration and half life which only differ. KSMAN please elaborate


#6

OP suspects that the T injectable that he has is under strength. It would be helpful if he told us about what the labeling is on the box and vial.

There is more T in a given weight of T eth than T cyp. You need to look at the difference in molar weights that occurs from the different weights of the ester groups, or compare the molar mass of testosterone.


#7

Thanks for the reponses.

I am not sure what to make of these responses. I would like to know what a good dose of T would be if I were to inject every other day sub q or IM. It has been 3 days sinse doing an injection of 50mg sub q and I feel like shit. I have great strength but my mood is horrible. I did not feel this way 3 days after doing 50mg IM. I really am not sure if I should do a sub q tomorrow or go back to IM. Perhaps the aborbtion sub q is not what it should be. I feel like I need more T, but I am not feeling physically weak so not sure what to make of all this.

My endo is semi retired. He is in his early seventies and I thought he would know this type of T best given he has worked with it for so long. I printed off KSman's T protocal and gave it to him a week ago.He read it and agreed to it. Except he was not sure about giving me arimidex because he said my E will fluctuate.

My energy is best in the afternoon. I have much more energy and strength now that I am on T. My endo said I have been lacking T my whole life,but had enough to delvelope. I have been running on empty so to speak and this has caused me to develope ostoperosis of the spine and my hip is osteopenia.To look at me you could never tell I had a problem with low T.I have always pushed through the low energy and strength somehow and was very active but exhausted all the time.I have a muscular build and well toned for my age.

I do not react well to stress but T at times does help with that. Usually after the peak.

I am emotional a lot of the time but again when the T is doing its job I feel mentally stronger.

I am analytical.Its in my nature. I am Dispassionate about things when I am not feeling well like right now I could care less what happens until I get this T shit balanced out.

I live in Ontario Canada so references in my area would be helpful.

Delatestryl, Testosterone Enanthate 200mg/ml it a 5ml bottle.

bio T at 8.77nmol/L range is (4.00 - 10.00)nmoL

Total T at 15.6nmol/L range is (10.00 - 28.00) nmol/L

Estradiol <100 (0 - 175)pmol/L

Thyroid tests have been perfect

Looking forward to the feed back.

Thanks.


#8

That estradiol test is useless. You need one that will resolve a males low levels. Knowing that it is less than 100 is not telling us much. That works out to less than 27.24 pg/ml. That is a lot better than most guys will get on TRT. As the optimal level is near 22 pg/ml, from an energy and libido point of view, you would need labs that resolve to below that to manage E2 with Arimidex/anastrozole.

You will find this useful: http://www.unc.edu/~rowlett/units/scales/clinical_data.html

TSH should be near or below 1.0

fT3 and fT4 should be in the middle of the range. It is important to check free values. Waking body temps are the bottom line. Please report in F, not C. Note that one can have middle range fT3 and fT4 and have symptoms of hypothyroidism as rT3 can block the T3 receptor and the cells will not get enough T3. Low ferritin can stop the cells from utilizing thyroid hormones. Thyroid hormones are quite complicated compared to TRT.

TRT in Canada seems to be terrible. There is no incentive for doctors there to do things better, they are too controlled and do not have business or profit motivations like here in the USA. I lived in Ontario most of my life, so I know both sides of the fence.

What pharmaceutical company produced the T?

Your bio-T would appear to be good. But you need youthful ranges and yours might be age adjusted.

Did you change brands or T or switch to a different ester?

Go back to IM injections and see if problems resolve. A few do metabolize T different SC VS IM.


#9

I am starting HCG soon.Does anyone know if this will help with my issues? What is the best way to inject HCG sub q or IM?

Thanks.


#10

Inject 250iu SC/SQ EOD. That plays well with the half life of the drug. A study was publish a few years ago that determined that that protocol took intratesticular T [ITT] levels back to base line after the HPTA was shutdown with T injections. The ITT was measured by taking fluid out of the testes with fine needle aspiration. Strange than any guys would volunteer to do that.

IM will work well, but SC works too and avoids muscle damage.

Press in site of injection for 10-15 seconds to allow any injured blood vessels to seal up. That will prevent the bleed-bruising that always occurs from time to time with IM or SC.

Many report an improvement in mood, most of which might be transient. Main advantages is preservation of appearance and size of the testes, fertility and it supports pregnenolone production. When on T and not using hCG the testes will likely shrink and can undergo irreversible degeneration. AKA therapy induce organ failure.


#11

Thanks Ksman. I appreciate your feed back.It is most helpful. I am very frustrated with my treatment. At the beginning of T injections I felt incredable well for the first few injections until my body become saturated with T. At that point I started gettting the ups and downs and depressed/ anxiety moods which are a little better sinse dosing and injection changes. Do you know of any specialty TRT clinics in Ontario? or in the USA that might be close by. Tomorrow I see my GP. I will ask for a differnet E test if possible for her to have it done.Do you know what dosing is good for T eod or e3d? I might try this dosing at some point.

What do you mean that my Bio- T might need to be ajusted. Ajusted higher or lower? I thought I was in the youthful range.Actually, I was thinking if I do IM tomorrow I will lower the Tuesday dose from 50mg to 40mg but on Friday keep the 50mg dose.

I will check my morning body temp and get back to you.How many mornings should I check my temp and what time is best in the morning?

My T is made by Theramed Corp. I have used this brand from the beginning of TRT.

Thanks.


#12

A couple of thoughts, when introducing T, not just T is supressed but other hormones like dhea and prenenolone which could make u feel like crap as well, also if low in preg/cortisol this could also cause hypothyroidism thats not shown in thyroid testing. I have read that a few docs upto date on TRT are supplementing pregnenolone with their TRT patients to back fill the hormones that are supressed by T.

Also, have u tried T creams as this may give a more stable T level.

cheers!!!


#13

Danny880 thanks for your input. I will be starting HCG soon.I think HCG should help with pregnenolone and other hormones produced by the testicals. I am not sure about DHEA though.

I tried Andro Gel quite a few times. Each time it made me severly depressed. My endo is curious if now that I am tolerating T injection for the most part. What would happen if I were to try the gel again. He ask me a couple of times,and I am not willing to go there because of previous out comes from the gel. It was horrible, even at very low doses.

Take care.


#14

HCG can be an option for other hormones that are supressed but heard there are a small number who dont get pregnenolone, dhea from HCG injections. Another option is to try a T cream made from a compounding chemist, it could be additives in the gel that make u feel unwell. But the main thing is to wait and see what your E2 levels are, its all speculation at the moment.

Maybe try a 4 times a day cortisol saliva test and get dhea checked, if low could be adrenal fatigue, then pregnenolone is required as it is used to make cortisol and dhea.


#15

Before adding HCG it is advisible to get your total T and e2 in check for 4-5 weeks. When this is stable then you can add in hcg 100-200 ius EOD. It is essential to measure e2 as hcg can increase the rate of aromatase in the testicale. Once On T, hcg, and adex if needed, the next step would be to check DHEA. It is known that HCG and T can deplete the hormonal pathways such as dhea and possible pregnenolone. When adding in DHEA one also needs to keep in mind its ability to influence estrodial as well the estrogen metabolites 4,16 OHE. As you can see it can get to be pretty complex process needing to montiored by competent HRT dr. After a 6 month period, the dr needs do re examine the thyroid and adrenals as TRT can adversely affect these both positively or negatively. In my clincal experience I have noted decrease in thyroid production as the cellular tissue begins to finally heal occuring from 6 months to 1 year.


#16

Dr. Johnathan Welchner has an office in Markham, Ontario. I am seeing him Monday. I would not suggest seeing Dr. Larry Komer in Burlington, he was terrible in my opinion.


#17

When I had my first test after starting TRT, without hCG, my DHEA and pregnenolone went down. My HPTA was shutdown and testes were shrunken. My interpretation is that pregnenolone production in the testes was reduced, lowering the production of DHEA from pregnenolone in the adrenals. Adding hCG would be expected to restore testicular pregnenolone production to a higher than baseline level if one was primarily suffering from secondary hypogonadism as the stimulation from hCG would exceed what a low level of LH was producing.

However, that is expected from theory and individual variations can be much different.


#18

Adding dhea is more likely to increase E2 but adding pregnenolone for some reason can also increase dhea without the increses of E2 seen by dhea, but then again everyone is different. To start with i would just add pregnenolone without dhea and see what happens.


#19

KSman. You wanted a few morning temperatures. Here they are.

97.7 F
97.7 F
97.9 F
97.3 F

I am dosing EOD and do not feel well. I am going to give EOD sub q a try. I did sub q twice a week and had a problem with panic feelings,but this time I will use a much smaller dose Sub q EOD..T makes me feel more anxious than it did when I first stared it over a year ago.Any idea why? My mind and body never feel relaxed. Still have not started HCG.Still waiting for the Endo Doc to send the paper work to my GP. Perhaps HCG will be helpful.


#20

Dhea oral is what causes e2 to go up not your own endogenous production. Its the conversion through the liver responsible for rise in e2 from first and second passes. TD DHEA will not increase e2 due to the fact it only goes through liver once. Only problems with TD DHEA is finding one that absorbs. I have been through versabase no luck, now on lipoderm 25 mgs.