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Messages - Kierkegaard

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A little update for anyone interested.  Week five on TRT (200mg testosterone cypionate once every two weeks) starts tomorrow.

-Today has marked the fourth day of longer sleep.  Was getting around 6 hours a night, now around 8-9.  Even though I'm sleeping longer, I'm noticing I'm having more awakenings after the sun is up, and am pretty sure I'd be sleeping better if I didn't have this, er, light pollution problem.  These sleeping patterns are becoming more and more like when I had the month or so of seeming recovery this last December, where I'd also sleep 8-9 hours, wake up a few times by the light outside, and feel fatigued throughout the day.

-Fatigue is still present despite better sleep, but has gotten better and more manageable.  Related to this, light sensitivity (which I didn't mention above) is clearly better, as evidenced mostly by the fact that I'm able to view things on my computer on much higher light settings than a month ago.

-Last week I started working out at my usual optimal level, and have been able to lift more than my level pre-TRT.  Running, which I haven't done consistently in about two months (I used to run 8-10 miles a week, putting out up to 1.5 miles before having to break from a jog to a walk), has been a challenge.

-I've gained about 8 pounds or so since starting TRT.  This correlated initially with a *huge* appetite increase for about five days after my second shot, but the appetite was noticeably increased only for a day after the third shot.  The second shot clearly had a big water retention element to it, but this has also gotten better since the third; I remember running 2 miles or so and sweating like I've never sweated before (running indoors on a treadmill as well) after my second shot.  Muscle gains seem to be a big part of weight gain now, but there's clearly a fat element as well.  Actually, the muscle gains are pretty nice, and a little shocking in such a short amount of time.  I was able to do almost 300 pushups in a single workout a few days ago, which I've never done before, including 50 pushups in a row at a fast pace before becoming moderately tired and stopping (I could've made it to 60 at least if I pushed myself).

-Brain fog is considerably better but still noticeably present (probably down from a 9/10 at the beginning to a 4/10 now).  I've been able to read a little on the more complicated side rather than "just" novels and lighter stuff; e.g., sneezing through Sapolsky's "Why Zebras Don't Get Ulcers", which a month ago would have overwhelmed me with its amount of factual details. 

-Libido is clearly up, both in terms of sexual thoughts and erections.  However, I'm noticing a little testicular pain at times when I'm erect (hasn't happened in the last two days or so), probably related to the testicular atrophy I've noticed as well (probably 20% reduction).

-Mood has gotten darker and I've noticed that I'm both more hopeless and much angrier (in the brooding, to-hell-with-the-world sort of way), but this probably has been caused by stuff I've been thinking about and things that have been happening (including a really twisted and possible lawsuit-worthy screwup by my employer with my insurance and an MRI).  But, I have been slipping on my Wellbutrin, taking only 75mg a day rather than the prescribed 150, so maybe there's a dopamine difference?  I don't really know, and to my knowledge the 150mg dose is pretty low; most people see therapeutic benefits at double the amount.

I'm a philosophical sort of hardass person when it comes to causality, but I have to say that these gains are *very* likely not due to chance.  For my next shot I'm going to try and man up and inject myself, and start going to 100mg/week rather than 200/2 weeks.  Maybe this will add to the gains.  In any case, I still have a lot of room to go before I'm feeling like my old self.  With 0 being dead, 5 comatose, 50 halfway, and 100 the best I've ever felt in my life ever (ever), I'd put myself at 50 or so, up from 20 about a month ago, and like a freaking 7 when all the symptoms mentioned above were fullblown. 

How long was it after starting TRT that your sleep got better, Peak?

Well, I'm not the best one to ask, because originally I tried a Low Fat Diet, which helped me, and my urologist put me on a compounded cream which got me up to the upper 400's.  The combo of those two helped me quite a bit - maybe 50% or two thirds.  Cypionate, when I went on that, had powerful brain effects and vanishes everything almost overnight for me.  No exagerration:  sleep up, anxiety and the "blues" down, libido up, etc.  Not everyone is like that though...

So I've read.  A few folks actually have insomnia as a result of TRT around injection days. 

I know that for me I was doing everything I could for insomnia except sleep restriction (which was too painful for me at the time to really try): stimulus control, sleep hygiene, exercise, eating well.  Because my weight was so low (which was probably due somewhat to the fluoxetine, somewhat to depression), I had to pretty much eat like crap for about a month to six weeks to get my weight up. 

I'm just hoping that the insomnia (anxiety-related or not) and the fatigue have always been explainable to a testosterone deficiency.  We'll see, and overall sleep has appeared better, but still nothing like it was before all this started. 

Sorry to be slow to respond:  it was man versus nature in our house tonight - an infestation of carpenter ants.

I am not the least bit surprised by your story as you might well imagine (if you've read mine).  I went through dozens of theories trying to feel better with very minimal results.  And, as you may know, I also experienced tons of anxiety in various forms, chronic dysthymia, mental fog, poor sleep and on and on.  Suffice it to say, I can relate to a lot of things that you wrote.  And, of course, it is very difficult, because it's not like you have an arrow sticking out of your back or a bullet hole in your quad so that someone will definitely have sympathy for you.  Basically, you just feel lousy and can't think straight and you have to limp through life as best you can.

And, by the way, this is what I find to be so cruel about the anti-HRT response of the endocrinology societies in the last few years.  We're not doing this for sexual enhancement or to be the next Arnold - we're just trying to survive day-to-day life and have a libido and be able to think straight at our job and sleep through the night and have a relationship and occasionally have sex.  Is that too much to ask all you endos out there?

Anyway, I'm glad you finally found the answer.  Here are some pages that you'll (I believe) find helpful:

--Other tests that you may want to discuss with your doc:


--Here are labs where you can pull almost any test you can think of and for a reasonable price:


--I really enjoy HRT.  But I would still never tell you that it is not without risks.  Here are some that I have come across that docs either do not know or do not discuss with you:


Thanks for these.  For me, I felt so much like death -- or wanting to die -- that these risks are minimal.  Thankfully my red blood cell count and hematocrit are in the middle-lower ranges, so we'll see how that ends up.

How long was it after starting TRT that your sleep got better, Peak?


Wow your symptoms sound familiar.   I dealt with similar stuff for decades.

Something tells me your user name is a hat tip to the emotional states you were struggling with?   :-)

It gets better.


I love me some Kierkegaard, even though I only understand about a third of what he says (way up from about a tenth when I started reading him ten years ago).  All through this terrible experience his statement, "I suffered indescribably during this period" (when he broke off his engagement with his gal Regine Olsen) kept flashing through my mind.  Also his quote, "I'm so misunderstood that people misunderstand me when I tell them I'm misunderstood" -- that's a huge one.  To this day I know I haven't expressed half of the suffering involved with this shit, because all the words I use are classified away by my recepients as not too bad: "oh, you have insomnia?  Try warm milk and relaxing music," or "it's fatigue?  Hm." 

Thanks for your support.

Yeah, that's pretty much me, except I never got referred to an endocrinologist to begin with! The vast majority of the blame goes with my last doctor (God knows why I stuck with him as long as I did), who ran a decent amount of blood tests when I was complaining of fatigue late last year and then stopped with prescribing SSRIs and speaking of chronic fatigue when things weren't getting better.  Only the doc I've been with for the last 6 weeks thought to run testosterone, after running a complete thyroid panel and other tests (ferritin, B12, etc.) and finding my health was completely fine -- except for my total T, of course. 

I suspected anemia months ago before this all started (see my incredibly long and rambling story thread), but my hemoglobin, ferritin, and hematocrit were all within range (although hemoglobin was, I think, 13.8, on the low side).  What are the symptoms of *low* estrodial?  I have somewhat clicky/poppy joints, and I'm not sure if they've always been this way or not.  A few days after my second cypionate shot I got *super* hungry for five days or so, to the point where my weight is up to where it was a year ago (173), and it was down to 158 when I had my breakdown a few months ago (six feet tall, decent muscle).

Your articles are awesome, and I read a lot of them before I signed up for this forum (please keep referring them though).  Thanks so much for your work!  You have a super rare ability to read scholarly articles and actually understand them.

There's no doubt something is tipped over in the cognition/memory department.  Everyone and their mother thought I was suffering from plain old major depression before I got my T results back.  That really drove me crazy.

Testosterone, Hormones and General Men's Health / My Story (A Doozy)
« on: April 10, 2014, 12:19:06 am »
This is a bit of a mess, but I know you'll all find this all interesting (so get comfortable).  :)

I'm a 30-year-old guy who was in great health, lifted weights 2-3 times a week, ran two other days per week, ate relatively well, and took his fish oil religiously.  In late 2012 I got a comprehensive metabolic panel just for kicks; I have a family history of health problems (confounded by a family history of bad nutrition and lifestyle), and wanted to make sure there wasn't anything under the surface.  I get the results back and everything (glucose, triglycerides, cholesterol, etc.) looks good, except a TSH of 4.9.  The nurse practitioner asks if I had ever experienced fatigue; I could only respond by saying a fish doesn't really know it's wet, i.e., I've experienced some degree of fatigue all of my adult life, if not my childhood as well -- always problems with sleeping too much and not feeling refreshed, always problems with waking up, and likely had dysthymia (moderate depression) in college.  So the doctor prescribes 50 mcg of levothyroxine (based on a single TSH reading of 4.9 and no testing of free T3 or free T4), which I start in late November 2012. 

I really seemed to be feeling better, but looking back, there's a big chance that it was placebo.  Things truck along until August 2013, when I have a relatively big stressor for a few weeks and my anxiety goes absolutely through the roof when I'm alone to think about things, and with it insomnia -- like, "I don't know if I slept for sure, but it looks like some time passed, so I guess I did" insomnia.  So I go to a new doc, who says to get off the levo (he said he doesn't advise putting people on thyroid meds until their TSH is at least 10), and kicks me some Ambien for sleep.  Here was the weird part: after two weeks or so of tapering off I felt this godawful, debilitating fatigue (tapering from 50 mcgs to 25 to 12.5 to 0), which lasted for two long months.  The fatigue was especially bad after lunch until around 4pm, and got so bad that I had to reschedule a client mid-session (I'm a counselor), call my wife to pick me up and take me home, and was extremely close to going to the ER.

So the doc orders a lot of tests -- CBC, CMP, sedimentation, a few others.  I remember the experience of reading these 20 or so tests and being amazed that everything snugly fit within the different ranges, except for my free T4, which was at the not-so-shocking level of 1.73 (cutoff 1.70), influenced by the exogenous thyroid hormone still running through my blood.  At this time I was down to 25 mcgs of levothyroxine, and my doc said that the elevated FT4 was "likely causing a lot of your insomnia," and advises me to continue my taper.  So I stay with the taper, things remain bad with the fatigue but somewhat manageable, and after two months or so I start feeling relatively normal.  Meanwhile the doc starts talking of chronic fatigue, and writes a prescription for fluoxetine, which I didn't take at the time.  Strange note about the fatigue: I was getting into meditation and Yoga at the time, and noticed that when I was feeling pretty stressed after work and felt the fatigue, it would greatly diminish when I did a quick set of stretches and mindful breathing.

So then I decide to send an anonymous death threat to my first doctor via email, which I accessed from my university in town to prevent IP detection.  Actually, that didn't happen at all, and hopefully that's a rewarding jolt of adrenaline for being a diligent reader so far.

So.  Things go well for a month: I'm sleeping a lot better, gave up the Ambien, but *still* feeling a bit of that strange fatigue lingering around, which I shrugged off at the time.  In early January I remember the exact stressor that triggered my insomnia again (because I wrote about it for some strange reason): my wife started an internship and had to get up at 6:30am from now on, and I remembered feeling a bit of anxiety about falling asleep and having to wake up an hour earlier the following mornings.  So the insomnia comes back, I put up with it for a week, go back to my doctor, get more Ambien, and I start waking up at 4am at the drop of a hat.  I can't expressed how strange it was to wake up in darkness and scramble for my phone to find 4am plus or minus 5-10 minutes each and every time.  I eventually get to a conference in February and the fatigue comes back with a vengeance, this time hitting me all day long

God, the fatigue was awful.  It felt a bit like being lightheaded, at the worst times feeling like I would pass out (which I've never done before), almost like depersonalization -- as if my body was just mechanically functioning while I thinned out to the point of near nonexistence.  Add to this terrible, uncontrollable anxiety, and I mean uncontrollable when I say it: cognitive restructuring, controlled breathing, progressive muscle relaxation, mindfulness, meditation, Yoga -- absolutely nothing would moderate this anxiety.  The feeling of helplessness was probably the worst part.  Actually, this might be the worst part: I had an uncontrollable focus on my heart when I would try to nap during the day, and just at the moment when I would drift off to sleep my body would snap awake, as if I were being surged with adrenaline. 

I finally gave in and set up an appointment with my doctor to talk about getting on fluoxetine, especially since I was talking so much about anxiety, and it's a symptom of depression to have early morning awakenings.  The fluoxetine was a big mistake.  Everything got worse, and it didn't help at all that norfluoxetine (the active metabolite in fluoxetine) has a half life of eight freaking days.  I got depressed to the point of serious suicidal thoughts.  What really freaked me out (aside from the "shocking" feeling when trying to nap) was the memory and cognition problems.  I began to forget everything, and reading became impossible, which killed me.  I pushed through (God knows how), and even after getting seven hours of sleep a night for a week (with the help of Ambien CR), I didn't feel any better.  My weight dropped from an already low 163 to 158.  I remember going *back* to the same doctor (by now you should know how messed up my thinking was), and what does he do?  Gives me another SSRI, Lexapro, and a 20 day supply of Klonopin, the latter I tried for a few days (for fear of dependence), the former I didn't try at all -- too much of a risk making my insomnia worse with another SSRI.  Another weird note: the few times I tried Klonopin, I started feeling *less* fatigued, and was even able to stay up later than I planned on.

So my mom (who works at a hospital) tells me about a doctor that "all" of her patients recommended, and I set up an appointment, dragging my wife with me because I was unable at the time to carry a conversation competently.  He runs (finally!) extensive testing of my thyroid, as well as other stuff my previous doctor didn't run a few months before, including ferritin, B12, and (aha) total testosterone. 

We really had our hopes on the thyroid being out of whack, given how the symptoms lined up so well with hypothyroidism.  But no, my thyroid results had to come back perfectly in range.  But!  My total testosterone came back at 158, with bottom of the barrel (but still barely within range) readings for LH and FSH (I had an MRI and there were no pituitary problems).  All I heard was "low", but only later did I realize after reading a study that something like 250 makes you within the 1st percentile for a sample from all ages!  Summarizing my symptoms: brain fog, memory problems, dead libido, intense fatigue, intense insomnia, anxiety, depression, a few other things I'm forgetting (see brain fog, memory problems). 

Doc puts me on testosterone cypionate, 200 mg every two weeks, and 75 mg of Wellbutrin two times a day (which is actually a pretty small dose).  Tomorrow will be my third shot, and so far there's clearly a change, but there's a long way to go.  The fatigue has a much smaller window and feels lighter overall, I'm sleeping less terribly, anxiety and depression are a fifth of what they were, I'm able to carry a conversation pretty well, can read, am able to take daytime naps (no "shocked awake" feeling), have a functioning libido, more energy and interest in pleasurable activities.  My weight is up to around 173, and I'm able to lift as much and even a little more than I could before with a few noticeable changes.  The only bad news is that I'm on the verge with my family medical leave time, and I like my job very much.  The good news is I finally have something to hang my hat on, and hopefully something that explains my fatigue when I was younger as well.  I really don't give a shit what happens externally anymore, and just want to keep getting better. 

Anyways.  There were a few tests that none of my doctors took: estradiol, cortisol, prolactin, SHBG.  My newest doc (who I like very much) was reluctant to run estradiol because, to him, my light weight meant it was likely fine.  Whatever, he's a primary, I'll take what I can get, and I know I can squeeze at least an estradiol test out of him if my blood tests for free and total testosterone and a CMP come back awry. 

That's all.  Feel free to ask or state anything.  It's good just getting this off my chest.  This site has been a godsend in terms of information and support.  One question: any thoughts on the tapering off levothyroxine bit with extreme fatigue?  Could that have been related to (undiagnosed) low testosterone at the time, and/or some sort of hormonal reaction in coming off levothyroxine?

That makes sense.  I would definitely be interested in that link by Sam, even a word in the title and I'll try searching myself.  Thanks a million.

BTW, my baseline was 158!  I felt absolutely horrible: it started with insomnia, then suddenly "popped" into an all-day overwhelming fatigue (at times it was almost unbearable), suicidal depression, incredible anxiety, loss of libido, etc.  Currently on a long medical leave. 

Anyways, the doc has me on 200mg/2 weeks (tomorrow will be my third shot), and basically said to wait things out till my first blood draw in a few weeks before breaking down the dose.  I'm unambiguously feeling better, but there's still plenty of room to go with symptoms. 

Folks, this site is wonderful, and I'm thankful for all of your thoughts and comments.

I've read in multiple places (including, of course, on this site) how, with injections, splitting a dose to 1-2x/week is better than a bigger dose every two weeks.  The takeaways I have from this are that putting a bigger dose into your system jacks up your testosterone level and with it estradiol, as well as other problems.  Okay, good. 

But a lot of people talk about a "washout" effect and "crash" if you inject every two weeks, and I guess I'm not getting how this works in terms of half life.  I've read that cypionate has a half life of as little as 5.6 days, and up to 12, so let's just say for simplicity that it has a 7 day half life.  This means if you inject 200mg in your system, one week later you'll have 100mg, and two weeks later 50mg.  If you were instead to inject 100mg weekly, you would also have 50mg one week later.  So whether you inject 100mg weekly or 200mg every two weeks, you still have 50mg of exogenous testosterone in your system by the time you inject again.  Two questions:

1) Is there any influence with how cypionate affects your body in terms of half life, or are the crashing and washout problems (including conversion of higher levels of testosterone to estradiol) explainable by another mechanism? 

2) Considering that you have 50mg at the end of a 100mg/week or 200mg/2 week cycle, is there a stacking effect that takes place, where the hormone builds up in your system until it reaches some sort of steady state?  If not, what "happens" to the extra 50mg in your system at the end of each cycle? 


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