T Nation

Why Does TRT Make Some People Feel Worse?


This is from another board, but I thought it would make interesting discussion:

I am aware of most of the mechanisims involved here but i would really like to discuss this a little further as i couldn't really find any other indepth threads regarding the subject.

I have noticed allot of people trying to restart after failing TRT, the big question is - why is this? Why do people describe a roller-coaster ride when referring to testosterone levels? Could adrenals be causing the mood swings, poor mood, etc?

When i did injections the last time (125mg weekly), i ended up feeling worse in the libido/ED/Shrinkage department than before. I felt a little stronger, maybe a little sharper mentally and didn't have as many muscles aches and pains. In most aspects i did see "some" improvements but nothing outrageous. However the ED was absolutely terrible, allot worse than before and i had times where i simply couldn't get erections. Even now they are hard to get, but some times allot better than others.

I am aware that testosterone does the following:

1) Can raise total testosterone too high resulting in excess Estridol due to armotization.

2) If a person is low on thyroid hormone and high E2 is introduced, this will further down-regulate the effects of thyroid hormone due to recepter competition.

4) Supressing adrenals (ATCH/LH) will down-regulate DHEA and Progesterone production.

Does this mean everyone doing TRT should be doing full HRT? Should everyone be treating themself with Melrom/HC and thyroid?

Are perfect responders to TRT people with no outstanding adrenal fatigue and hypothyroidism?


I agree with 1), add too infrequent injections. Some will get estrogen poisoning with lower levels of T, individual variations may be just as significant as "high doses". The major problem does fall back on idiot doctors.

Not sure about how you explain in #2. The way that I explain is that the body cannot step up to the increased metabolic demands of TRT with low thyroid [or cortisol]. I do not see that there are common receptors. Am I missing something?

Please link me to data re #3.

TRT and HPTA shutdown can reduce pregnenolone and DHEA then follows from that. Part of #3 if that is valid.

I think that these points are well made. TRT outcomes are limited or negative with some co-morbidities.

Elevated E2 is the big offender and a very common or expected issue.


If im not mistaken, people use HCG to combat those problems and sometimes HCG isnt effective but find adding pregnenolone helps as it replaces all the down stream hormones that have been suppressed by Testosterone.



I can't provide you data re: point 3, as this was not my post. It also opposes what my understanding was ie: TRT suppresses both FSH and LH severely, but does NOT suppress ACTH, which is responsible for the production of cortisol.

I have been back on TRT for 6 weeks now and am still experiencing many issues - incredible fatigue, emotional imbalance (I was in tears at work on Friday, tho I am unsure if this was a result of the unrelenting fatigue), depression, anxiety....

My TRT doctor placed me on TRT based only on a low TT number - not looking at adrenal function, thyroid function, etc.

So part of my struggle (outside of finding proper care in Canada, where I apparently can't even get access to a proper E2 test), is piecing together issues with thyroid/adrenal whilst already being on TRT.


Looking back through your posts, it seems that you were humming a different tune around 9/15/10 after 6 months of TRT. So you were getting better on TRT. Are you back on that same protocol? I would give it more time and go get some lab values to make sure that your treatment is effective.


Looking back through your posts, it seems that you were humming a different tune around 9/15/10 after 6 months of TRT. So you were getting better on TRT. Are you back on that same protocol? I would give it more time and go get some lab values to make sure that your treatment is effective.


Yeah - what happened was my wife and I are undergoing fertility treatment. Around the time you mention, I went OFF therapy as the request of our fertility doc in the hopes that it would raise my abysmal sperm count. It did not, and at about 6 weeks off, I was in really bad shape. I went back on, it's now been about 6 weeks, and I'm still trying to achieve some sort of homeostasis.


If you cannot support #3 at this time, please edit that out of your posts in this thread. I don't want that mislead guys here who are trying to learn and understand their own issues. If something wrong gets repeated on the WWW, it starts to look like a fact.


Noted, and done as requested.


I think there are so many things that play into these issues it's hard to pinpoint a cause. For example:
1) First time on TRT exploded out of depression and sexual function returned to normal in a day. (Transdermal) After one week back to baseline, as one would expect without an AI at the time.
2) TRT round 2. T cyp 200mg a week shot once a week. (Clueless family Dr and I was uninformed at the time) Improved mood and great sexual function for 2 days after injection. Then back to baseline. Caused premature ejaculation when I always have the opposite problem.
3) Proper TRT round 3. T cyp every three days with an AI and HCG. Perfect labs. Other than in the gym zero results. Libido and mood at baseline. ZIP!
** Add in Requip and nothing... Add in Zoloft with the Requip and I'm walking wood for two weeks and then back to baseline**
*** Add HGH and sexual function and mood improved again. Faded after a month but remained above baseline.***

For me I've narrowed the problem down to severe unipolar depression. After months of reading and studying what I've already tried I'm at the conclusion I have overactive MAO. A helpful way to determine if you have an underlying depression is to work with your TRT until you have perfect labs. Even drive E2 to low and let it rebound. If you never experience nocturnal erections you have an underlying severe depression. In men when depression gets to the point of being severe nocturnal erections disappear. Us guys being guys could give a crap less about emotion and only start to worry when libido fades and ED becomes an issue. I know that was the case with me.

I think as a whole us men want to ignore or discount the brain in all of these issues. I think that's a huge mistake. One thing that a Urologist told me that stuck with me and made me research further is that he has several patients that have had their testicles removed and have normal sexual function. They just have no desire to use it. ZERO testosterone and normal wood!

I think we put way to much weight in Testosterone alone. It's one piece of a huge puzzle. To have a robust response to TRT alone I think you'd have to be issue free and have a normal range of emotion. More than anything I think T triggers an emotional response, libido, with a properly functioning nervous system. If the communication lines are faulty T is not going to trigger a response.

Just my opinion after three years plus of reading and experimenting. One day I'm going to post the "tale of a lab rat" and write about all of the combos I've tried. I swear I've tried it all and I would sure like to help other guys and save you a lot of trouble.


Great post, brent.


Yes there can be complications that are hard to understand. There are limits to what we can deal with in a forum.