Curious case of TRT

irs

About 2 years ago I had a pretty serious brain injury. I couldn't work, drive, had memory issues, light sensitivity, exercise intolerance, sleep issues, anxiety, OCD, extreme fatigue and an extremely disregulated nervous system, and regular migraines. Couldn't even go into the grocery store or a busy restaurant.

I was eventually diagnosed with Post Concussion Syndrome. I tried all the therapies that doctors prescribed for me and could hardly make it past step 1 with any of them. Eventually I did make some progress, but most of it seemed to happen just with time and quieting down my nervous system.

There is still a lot I can't do, but I've created a little life that works for me. I still have trouble driving over 45 mins/an hour at a time. I'm back to work but my attention span is nonexistent, get migraines if I push it too hard. Small tasks seem very daunting. I can go outside with sunglasses for a little while.

I went to a functional Dr a few weeks ago, who said I did in fact have hormonal issues: My testosterone was low-ish, TSH high, pregnenolone low, cortisol high, and she prescribed me TRT, a very small dose of 50mg once per week.

I took my first shot of TRT last thursday, within a few hours into the next day I felt noticeably different. I was more dialed in at work. Felt a very calm sense of energy rising up in me. My mental state had done a 180. I was leaping into action instead of feeling exhausted at the idea of doing small tasks, they didn't seem so daunting. My libido was sky-high. Also my brain felt slightly warm and like tension had released from within it.

Things got better and better for a few more days. My concussion doctors always described brain injuries as "injuries of energy" and my brain injury depleting my gas tank - the best way I can describe what I felt was like I finally had my gas tank filled up again. My lingering concussion symptoms seemed to totally resolve.

By Saturday night I was starting to feel the effects wearing off. I had gone to the gym earlier in the day and did a pretty light workout, but definitely had energy to keep going. Saturday night I started feeling a migraine coming on. Went to bed, woke up Sunday and it turned into a full blown migraine. All of the positive things I felt went out the window. It was all gone.

Yesterday same thing, felt ok for a little while but got another migraine. It feels like I'm even worse than where I was last week and definitely feels like some kind of energy management issue. I've been ravenously hungry and probably eating at least 3,000+ calories per day.

My hypothesis is that my testosterone is converting to estrogen but I'm not an expert on this stuff, would explain the migraines which have been under much better control until the TRT. I reached back out to my doctor telling them all of this but the vibe I'm getting is that they're in over their head. Essentially said it was peculiar and they'd look at my labs in our follow up which isn't for another 2 months.

Also worth mentioning, I started taking 10ish mg pregnenolone on Saturday, not sure if that's playing a part.

Any ideas?

oldchem

@irs said in Curious case of TRT:

Any ideas?

dosing frequency comes to mind.

depending on what ester is being used, once per week might result in levels dropping too low before your next shot, especially since 50mg per week is a very conservative dose. lowest dose i usually hear for doctor prescribed injectable trt (assuming enanthate or cypionate) is probably around 75mg.

lets assume levels dont drop too low even 1x per week dosing: less frequent injections usually result in larger fluctuations. in my own experiments its not entirely clear if less frequent dosing (within reason) results in a net increase in markers like e2 or hematocrit given the course of the week (it might reach a higher peak for both but it might lower as levels do later on the in the week, reaching parity with more frequent injections when you average it out) BUT less frequent shots will result in bigger fluctuations and these fluctuations can create side effects.

here is a graph to illustrate the point:

50mg of cypionate once per week:

25mg of cypionate 2x per week:

and just for fun, 14mg every other day (roughly 50mg per week):

i think the current theory is testosterone helps with migraines because for some the cause can be a bad ratio of estradiol to test, so if it provided relief by attenuating this ratio but it fades towards the end of the week then either test levels are getting too low or there are too big fluctuations in e2, in which case more frequent dosing is a good first step.

here is what i suggest:

switch to 2x per week dosing
consider a very conservative increase to 75mg per week

more frequent dosing seems to be the preference among the more forward-thinking people in the TRT space, a lot of MD's especially endos have questionable practices such was prescribing a cypionate or enanthate ester and only giving once every 2 week shots (ive heard of even less frequent).

in your case i would be more curious what your levels are at nadir so maybe ask your doc to pull bloods right before your next dose so you can see if you are getting TOO low, if you are then you guys can switch to 2x per week dosing or up the dosage. that should have you feeling pretty ok, then you can look at e2 and see if you are aromatizing too much. ideally you want to find a dose that you feel good on that doesn't require drugs to manage e2, although this is elusive for many. in my experience e2 management becomes a breeze if bodyfat is low enough (the more adipose the higher the aromatase activity).

irs

@oldchem Thank you so much, this is exactly the info I needed!

To give more context I'm on 50mg of Cypionate, these graphs make perfect sense and is pretty much how I was feeling. Felt amazing for 2.5 days and then 100x worse afterwards.

The e2 thing is especially interesting for a few reasons:

my e2 levels weren't tested recently before going on TRT, but when I did have them checked in the past they were high. So if I'm getting a small dose of TRT based on incomplete test results and I already have high e2, I would assume it wouldn't be outside the realm of possibility that the trt is converting to e2.
My symptoms were super low energy, emotional, my pecs around my nipples hurt, and I had a migraine that lasted 3 days.
I read vit k2 can help block estrogen so I took a bunch yesterday afternoon and by night started feeling better, pulled me out of my migraine at least

My doctor is going to check my hormones next week, a day before it's time for my weekly shot, so hopefully that will give us a good idea of what's going on. While I'm grateful they got me started down this path to begin with, it's becoming clear they're definitely not hormone experts, especially when you throw the complications of a brain injury into the mix. Definitely looking into doctors beter suited to handle this sort of thing.

I also stopped taking the pregnenolone and am feeling better so wondering if that also plays a part in all of this.

Thank you again!

oldchem

@irs

no problem!

aromatization will definitely happen when taking testosterone, the rate at which you convert to e2 can vary and it can change with time even in yourself. i noticed in myself over the years as my baseline bodyfat got lower so did my propensity for e2 side effects. the side effects you list specifically in point #2 are typically what one would associate with high e2, it could also be the case the test levels got too low towards the latter half of the week and your test/e2 ratio was in a bad state (hence the migraine attack).

i definitely advocate getting the most from the lowest dosage you can, especially with trt as it can help mitigate a lot of issues people have with trt like e2, rbc's, hematocrit, etc but i also suspect the total weekly dosage might be on the low end. i know i mentioned the shot frequency but if the total weekly load is far too low that could be a problem for all the same reasons too.

if say hypothetically you switch to something like 37.5mg taken 2x per week (75mg test cyp per week total), you will be avoiding the larger peaks and troughs and thus hormonal fluctuations (possibly useful for keeping stable e2) and you will also be taking a step to avoid test levels from getting too low. this should be a useful strategy. bloodwork will be illuminating but you will also know if you feel amazing again after your next dose and start to feel poorly after a few days again.

the current trend in trt circles is more frequent dosing being ideal, some people are even doing everyday or every other day dosing with enan/cyp and are having a better time managing e2 or hematocrit. i personally do daily with enanthate (subq with an insulin syringe).

irs

@oldchem Makes so much sense, thank you! Also worth mentioning since my brain injury I put on about 20lbs in the past 2 years, so have more bodyfat than before so this is all starting to make sense.