Hormones balanced, Libido still low

Hey guys I would love some feedback here. Ive been on TRT for two years now, started with injections but recently switched to creams due to ease of application and feeling really fatigued on injections. Ive had roughly 8 sets of bloodwork over the last 2 years and my recent one looks as good as ever. I dont have the numbers off the top of my head but Test levels look optimal (roughly 24 scale being 8-28) my e2 levels are in check so Im not sure where else to look. The only thing a little suspect was prolactin being 13 on a scale peaking at 15 (dont know the units). My doctor seems really knowledgeable and says its fine but I feel like thats too high.

Libido was one of the main reasons I got on TRT two years ago and regardless of my hormones being optimized its still barely any bit better. I will admit I am struggling with lots of anxiety and some depression as well so I am sure this factors in quite a bit as well

Do you know your SHBG and Free T levels?

Are you taking, or have you ever taken, finasteride or any other 5 AR inhibitor (even saw palmetto?)

What was your protocol (dosage, timing) with injections?

Moderate elevation in PRL can be due to low DHT or mild hypothyroidism.

Are you on HCG? Don't consider your system balanced otherwise.

Thanks for the responses. I have never taken a 5AR inhibitor but seeing as changing from injections to creams provided no benefits wouldn't that suggest dht isn't the issue? I was going to get dht pulled last bloodwork but the lab I went to couldn't do it. I am not on hcg atm but I have been in the past and the only thing it did for me was lower my libido further and make me feel really depressed.. It did provide some support for fatigue though

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Originally Posted by bizzarro

Are you on HCG? Don't consider your system balanced otherwise.

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We agree

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Originally Posted by Rjay

I will admit I am struggling with lots of anxiety and some depression as well so I am sure this factors in quite a bit as well

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You probably answered your own question.

Agree with everything, particularly ^^^ last one.

I have a question, was the depression & anxiety there initially, before TRT and part of the symptoms you had hoped the TRT was going to address & improve?

I know for a fact anxiety screws me over and its something im working super hard to fix but it is easier said then done without medication which makes matters worse with a lot of drugs for anxiety.

Proximal yes I did have it before TRT and definately thought it would improve with treatment. I think the depression is more situational from dealing with anxiety and low libido for so long and being young still. After all this time a cure seems farther and farther away especially when bloodwork is coming back looking optimal.

Appreciate your openness. I ask because I've dealt with anxiety & depression my whole life & still do (meds help me considerably). I just thoughtI noticed something that I've picked up on more than a few threads-that is, my impression is some guys are using the TRT as the sole treatment for it instead of more traditional meds. If you don't mind, have you tried to address the depression/anxiety in other ways?

hows your dhea-s.....progesterone and pregnenalone...try toget these balanced as well,
might help your anxiety and depression....The meds you are taking for depression
or anxiety probably mess up your hpta as they are quite harsh....also check
your t3 and t4....tsh is good to know only if you are diagnosing thyroid problems,
you want t3 and t4 in mid range not high or low....if it 12 low 20 high...you want
in the 15 16 range....if you experience drastic mood swings, i would check your
thyroid

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Originally Posted by Rjay

I am struggling with lots of anxiety and some depression as well so I am sure this factors in quite a bit as well

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I was diagnosed with generalized anxiety disorder with low t, but was never depressed. Since being on TRT, anxiety lifted but some kind of depression kicked in, until I got thyroid stabilized. Unmanaged E2 also was partly responsible for moodiness. It just works differently for everyone.

Sure I was also offered several drugs (including benzos) but never took any, I knew I could make it without them.

And still, no matter how happy and relaxed I can be, my libido is nowhere. It's four years by now.

See? TRT won't solve all of the issues you have - it can even make some of them worse. Of course a balanced protocol will indeed be of help.

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Originally Posted by Rjay

Thanks for the responses. I have never taken a 5AR inhibitor but seeing as changing from injections to creams provided no benefits wouldn't that suggest dht isn't the issue? I was going to get dht pulled last bloodwork but the lab I went to couldn't do it. I am not on hcg atm but I have been in the past and the only thing it did for me was lower my libido further and make me feel really depressed.. It did provide some support for fatigue though

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Topicals usually drive DHT higher than injection. If HCG made you depressed that might suggests lowish E2... what assay does your lab use? Is it standard or sensitive oestradiol? Ever tested for thyroid?

Last question... any history of smoking?

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Originally Posted by Proximal

Appreciate your openness. I ask because I've dealt with anxiety & depression my whole life & still do (meds help me considerably). I just thoughtI noticed something that I've picked up on more than a few threads-that is, my impression is some guys are using the TRT as the sole treatment for it instead of more traditional meds. If you don't mind, have you tried to address the depression/anxiety in other ways?

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For me, it just came out of the blue. Worst part, I was unaware that I was actually experiencing anxiety, having never dealt with it before. It was an alien feeling which I had no explanation for, it really caught me of surprise, but nevertheless managed my way over it.

Besides my personal experience, let me tell you something about "traditional meds". They don't treat anything at all. They only address the symptoms, not the underlying issue. Often, it's just temporary relief, then tolerance and sides develop. It's a trade, and it's up to you to commence with it, but in my opinions psych meds are the most widely abused drugs worldwide, both by docs and patients alike. I've witnessed psychiatrists throwing them at you like candies, and people getting addicted to them. Some folks I know myself have been taking them for years; that's not health.

most here has been covered well, consider supplementing with 5HTP, make sure you aren't on any SSRI's though.
Last thing you need is serotonin syndrome.

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Originally Posted by Simon1972

make sure you aren't on any SSRI's though.
Last thing you need is serotonin syndrome.

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Explain please, thank you!

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Originally Posted by bizzarro

Besides my personal experience, let me tell you something about "traditional meds". They don't treat anything at all. They only address the symptoms, not the underlying issue. Often, it's just temporary relief, then tolerance and sides develop. It's a trade, and it's up to you to commence with it, but in my opinions psych meds are the most widely abused drugs worldwide, both by docs and patients alike. I've witnessed psychiatrists throwing them at you like candies, and people getting addicted to them. Some folks I know myself have been taking them for years; that's not health.

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Agreed 100% here. But, there are indeed folks out there suffering from clinical depression that do benefit from them. But again, with you 100%.

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Originally Posted by Proximal

Explain please, thank you!

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5-Hydroxytryptophan (5-HTP) | University of Maryland Medical Center

Very involved, read this, are you on SSRI?

Y

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Originally Posted by Simon1972

5-Hydroxytryptophan (5-HTP) | University of Maryland Medical Center

Very involved, read this, are you on SSRI?

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For about 20 years now, mild dose, but very helpful/life-changing.

O.K., did some reading on it. From what I saw though in the literature is that some Docs combine SSRIs and Testosterone specifically because the T opens up more receptors for the Serotonin.

The Serotonin Syndrome is definitely not something to take lightly though.

Rjay, sorry my intent was not to hijack your thread.

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Originally Posted by bizzarro

And still, no matter how happy and relaxed I can be, my libido is nowhere. It's four years by now.

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By chance have you experimented with PT-141?

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Originally Posted by Simon1972

most here has been covered well, consider supplementing with 5HTP, make sure you aren't on any SSRI's though.
Last thing you need is serotonin syndrome.

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I've experimented with l-tryptophan a while ago, it gave me a flu-like feeling. Same for any serotonin boosting stuff.

Another route worth trying is methyl donors, for increasing adomet, a molecule required for neurotransmitters synthesis - trymethyglycine, methylB12, sometimes provide some kind of stimulation for me.

P5P, the active form of vitamin B6, is a very powerful and effective for some, but requires enteric coating as stomach acid degrades it.

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Originally Posted by kelkel

By chance have you experimented with PT-141?

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Nope I haven't tried any peptides. My drug of choice would be selegiline, I took it for a month last winter and after a couple of weeks libido was sensibly enhanced. It also seems to be effective for many other "central" symptoms I have been experiencing, like brain fog. The only sides were rather tolerable orthostatic hypotension and the very same "dumbing" feeling I got from oral pregnenolone, if you remember the other thread.

However I'm not going to try it again soon, I'm struggling to get my TRT protocol straight and I've recently upgraded my LT4 dose, and I'll be adding HCG in a couple of weeks. Too much stuff going on alrealdy...


Getting my thyroid straight is proving very hard, I was finally feeling better last december (even libido was up) and BW was optimal back then, but somehow both FT4 FT3 were reduced again after a couple of months (TSH only mildly elevated), so I'm working up dosage until full replacement is achieved, other than that, I don't know what to do. I tried liothyronine but couldn't tolerate it, I get some some weird ADHD-like behaviour from it.

Obviously impaired thyroid function will negate most of the benefits of TRT, no matter how hard I try to get everything in check, so I'm not really surprised it's just not working for me.

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Originally Posted by bizzarro

I've experimented with l-tryptophan a while ago, it gave me a flu-like feeling. Same for any serotonin boosting stuff.

Another route worth trying is methyl donors, for increasing adomet, a molecule required for neurotransmitters synthesis - trymethyglycine, methylB12, sometimes provide some kind of stimulation for me.

P5P, the active form of vitamin B6, is a very powerful and effective for some, but requires enteric coating as stomach acid degrades it.




Nope I haven't tried any peptides. My drug of choice would be selegiline, I took it for a month last winter and after a couple of weeks libido was sensibly enhanced. It also seems to be effective for many other "central" symptoms I have been experiencing, like brain fog. The only sides were rather tolerable orthostatic hypotension and the very same "dumbing" feeling I got from oral pregnenolone, if you remember the other thread.

However I'm not going to try it again soon, I'm struggling to get my TRT protocol straight and I've recently upgraded my LT4 dose, and I'll be adding HCG in a couple of weeks. Too much stuff going on alrealdy...


Getting my thyroid straight is proving very hard, I was finally feeling better last december (even libido was up) and BW was optimal back then, but somehow both FT4 FT3 were reduced again after a couple of months (TSH only mildly elevated), so I'm working up dosage until full replacement is achieved, other than that, I don't know what to do. I tried liothyronine but couldn't tolerate it, I get some some weird ADHD-like behaviour from it.

Obviously impaired thyroid function will negate most of the benefits of TRT, no matter how hard I try to get everything in check, so I'm not really surprised it's just not working for me.

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How much by BW is elevated thyroid ?

Mac

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Originally Posted by macmathews

How much by BW is elevated thyroid ?

Mac

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Very mild, since the start I got low FT4/FT3 with a TSH of 5.8 and that suggest the issue is both central and primary.

Low t also is central and I got autoimmune thyroiditis too.

TSH levels seems to be poorly correlated with FT4 for me, so it's not a reliable indicator.

These are readings from last december

TSH 1.58 (100mcg levothyroxine) (0.5 - 5.00)

FT4 1.42 ng/dl (0.8 - 1.5)

FT3 3.5 pg/ml (3.0 - 5.0)


then february, 2016

TSH 3.76 (still 100 mcg)

FT4 1.21

FT3 2.2

last readings, april

TSH 0.79 (125 mcg l-t4)

FT4 1.02

FT3 3.0


See? It just makes no sense.

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Originally Posted by bizzarro

Nope I haven't tried any peptides. My drug of choice would be selegiline, I took it for a month last winter and after a couple of weeks libido was sensibly enhanced. It also seems to be effective for many other "central" symptoms I have been experiencing, like brain fog. The only sides were rather tolerable orthostatic hypotension and the very same "dumbing" feeling I got from oral pregnenolone, if you remember the other thread.

However I'm not going to try it again soon, I'm struggling to get my TRT protocol straight and I've recently upgraded my LT4 dose, and I'll be adding HCG in a couple of weeks. Too much stuff going on alrealdy...

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Well, it may benefit you on an as needed basis. It's one of the few items sold that actually work as an aphrodisiac, imho. Yes, I remember the Selegiline conversation. I'm a big fan of it. If that doesn't work, there's always Tri-Mix.

Wow this post blew up. To answer a few questions all at once...

No history of smoking cigarettes but a few years of frequent marijuana use ending 4 years ago.

I have had my thyroid checked I got tsh pulled 3 times all coming back around 1.5-1.8 on a scale of 1-4.8 roughly. The last time was a few months ago so I will get free t3/t4 checked next round of bloodwork as I definately get mood swings, almost bi-polar like mood swings.

I am not currently on medication for anxiety but recently I started a cognitive behavioural therapy workbook and I also do some form of breathing exercise every night. Still isn't enough sometimes so my doc prescribed me klonopin and I will take it only for panic attack situations maybe 1-2x/week.

My dhea has always come back high via bloodwork but I should also get my pregenelone checked.

What exactly is this pt141? I should mention my libido problem stems more from lack of desire as opposed to lack of erections. If on occasion the desire is there the erections always follow..

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Originally Posted by Rjay

Wow this post blew up. To answer a few questions all at once...

No history of smoking cigarettes but a few years of frequent marijuana use ending 4 years ago.

I have had my thyroid checked I got tsh pulled 3 times all coming back around 1.5-1.8 on a scale of 1-4.8 roughly. The last time was a few months ago so I will get free t3/t4 checked next round of bloodwork as I definately get mood swings, almost bi-polar like mood swings.

I am not currently on medication for anxiety but recently I started a cognitive behavioural therapy workbook and I also do some form of breathing exercise every night. Still isn't enough sometimes so my doc prescribed me klonopin and I will take it only for panic attack situations maybe 1-2x/week.

My dhea has always come back high via bloodwork but I should also get my pregenelone checked.

What exactly is this pt141? I should mention my libido problem stems more from lack of desire as opposed to lack of erections. If on occasion the desire is there the erections always follow..

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Remember to get Free T4/T3, total ones are of no use. Anyway, to my understanding, fluctuation in E2 are responsible for mood swings.

Well a couple in a weeks isn't going to hurt you... breathing exercise are good. Also try PMR exercises, they helped a lot for me.

High DHEA might be just a narrow lab range issue... what's the value? Cortisol is what you want to check, not pregnenolone (which isn't available in most labs).

Pt-141 or bremelanotide is an highly experimental molecule that can activate the nervous system in a way that can stimulate arousal; it's nothing you should be interested in.


Good thing your dick is working. That means testosterone is doing its work where it is supposed to; the problem is elsewhere.

What about SHBG? I went reading through your old threads and it was something like 47. That's high, have you pulled it recently?

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Originally Posted by kelkel

Well, it may benefit you on an as needed basis. It's one of the few items sold that actually work as an aphrodisiac, imho. Yes, I remember the Selegiline conversation. I'm a big fan of it. If that doesn't work, there's always Tri-Mix.

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I was curious about trying a D2 agonist of the non-ergoline class, like prami. It's more difficult to get hold of than caber or bromo but ergot derivates also mess a lot with 5-HT receptors, which I don't like.

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Originally Posted by bizzarro

Remember to get Free T4/T3, total ones are of no use. Anyway, to my understanding, fluctuation in E2 are responsible for mood swings.

Well a couple in a weeks isn't going to hurt you... breathing exercise are good. Also try PMR exercises, they helped a lot for me.

High DHEA might be just a narrow lab range issue... what's the value? Cortisol is what you want to check, not pregnenolone (which isn't available in most labs).

Pt-141 or bremelanotide is an highly experimental molecule that can activate the nervous system in a way that can stimulate arousal; it's nothing you should be interested in.


Good thing your dick is working. That means testosterone is doing its work where it is supposed to; the problem is elsewhere.

What about SHBG? I went reading through your old threads and it was something like 47. That's high, have you pulled it recently?

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Last time I pulled cortisol via a 24h saliva test. My cortisol came back low which could very well explain my persistent fatigue. I actually got shbg tested last round of bloodwork but forgot to ask what it looked like.

On another note.. Would seregiline be worth looking into or has its hype faded?? Something dopamerginic could totally explain my mild depression accompanied by low libido and fatigue..If it has any promise I would definitely discuss with my doctor next time around

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Originally Posted by bizzarro

I was curious about trying a D2 agonist of the non-ergoline class, like prami. It's more difficult to get hold of than caber or bromo but ergot derivates also mess a lot with 5-HT receptors, which I don't like.

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I think you'd be fine with caber at about a .125 mg x 2 per week. Sides and impact on GH levels both short and long term are dose dependent.

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Originally Posted by Rjay

Last time I pulled cortisol via a 24h saliva test. My cortisol came back low which could very well explain my persistent fatigue. I actually got shbg tested last round of bloodwork but forgot to ask what it looked like.

On another note.. Would seregiline be worth looking into or has its hype faded?? Something dopamerginic could totally explain my mild depression accompanied by low libido and fatigue..If it has any promise I would definitely discuss with my doctor next time around

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How can you forget something that interests your health and well being... you need a more "active" approach to your problems imho.

Selegiline could skyrocket your anxiety, it enhances norepinephrine along with dopamine, although that might help with fatigue. It is rather unlikely your doctor will prescribe it, folks use it as an aphrodisiac or anti-aging but its main therapeutic indications are for parkinson's disease.

Yes low dopamine leads to anxiety (particularly, social anxiety) and depression that is characterized by anhedonia as a prominent feature. Melancholic, sad kind of depression is linked to low serotonin. Lethargy and fatigue are usually due to poor norepinephrine, but I'm doing an oversemplification here.

I'm not sure about the saliva test, but you mentioned you have high DHEA-s and that would point to over-active (or just normal) adrenals.

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Originally Posted by kelkel

I think you'd be fine with caber at about a .125 mg x 2 per week. Sides and impact on GH levels both short and long term are dose dependent.

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Perhaps. Another thing worth trying is adding an ACh precursor like alpha-GPC, to see if it compensates the dumbing effect I get from dopaminergics. Of all the symptoms I got with hypothyroidism and low t, cognitive dysfunction is what I hate the most. I used to be very brilliant, but very little of the sharpness I used to have is left. I'm currently taking choline from bitartrate but haven't felt anything from it.

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Originally Posted by bizzarro

How can you forget something that interests your health and well being... you need a more "active" approach to your problems imho.

Selegiline could skyrocket your anxiety, it enhances norepinephrine along with dopamine, although that might help with fatigue. It is rather unlikely your doctor will prescribe it, folks use it as an aphrodisiac or anti-aging but its main therapeutic indications are for parkinson's disease.

Yes low dopamine leads to anxiety (particularly, social anxiety) and depression that is characterized by anhedonia as a prominent feature. Melancholic, sad kind of depression is linked to low serotonin. Lethargy and fatigue are usually due to poor norepinephrine, but I'm doing an oversemplification here.

I'm not sure about the saliva test, but you mentioned you have high DHEA-s and that would point to over-active (or just normal) adrenals.

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I have not read anything about selegiline and anxiety, going to bring it up with my doc and see what he thinks. As for DHEA I didn't go into detail last time but I had a saliva test done roughly a year ago and my dhea came back quite low, then only a few months later had it tested via blood and it was just over the top of the range with no change in protocol. There always seems to be contradicting values between saliva and blood.. I usually believe blood more but I do believe my DHEA via blood may be incorrect as I believe my adrenals are one of my biggest problems. I have been feeling run down and just exhausted for years which slightly worsened when I started trt two years ago (Im talking tired before lunch everyday wanting a nap). I had a 24h cortisol curve done via saliva done maybe 6 months ago which showed my cortisol super low which explains my fatigue but not my anxiety.. My anxiety has been better the last two weeks but then my fatigue skyrockets. The next visit with my doc I am planning to discuss pregenelone cream but Im not too sure how I feel about it as HCG generally makes me feel worse across the board even at doses <300iu/week.

I noticed you mention feeling worse after starting TRT mood wise. I did on and off for awhile too before having quite real depression for roughly 6 months. I was on injections this entire time but over the two years Ive been on TRT ive tried a compounded cream twice the first time my mood was much better so as a last ditch effort before considering an anti depressant I switched to creams again and my mood is MUCH better. This last month has been the best month mood wise I can remember Im back to enjoying life. Don't feel like injections are your only option, Im personally never going back. (Also I haven't lost any strength or ability to make gains)

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Originally Posted by bizzarro

I'm currently taking choline from bitartrate but haven't felt anything from it.

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Probably a waste of time unless the dose is quite large, and even then doubtful.

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Originally Posted by Rjay

I have not read anything about selegiline and anxiety, going to bring it up with my doc and see what he thinks. As for DHEA I didn't go into detail last time but I had a saliva test done roughly a year ago and my dhea came back quite low, then only a few months later had it tested via blood and it was just over the top of the range with no change in protocol. There always seems to be contradicting values between saliva and blood.. I usually believe blood more but I do believe my DHEA via blood may be incorrect as I believe my adrenals are one of my biggest problems. I have been feeling run down and just exhausted for years which slightly worsened when I started trt two years ago (Im talking tired before lunch everyday wanting a nap). I had a 24h cortisol curve done via saliva done maybe 6 months ago which showed my cortisol super low which explains my fatigue but not my anxiety.. My anxiety has been better the last two weeks but then my fatigue skyrockets. The next visit with my doc I am planning to discuss pregenelone cream but Im not too sure how I feel about it as HCG generally makes me feel worse across the board even at doses <300iu/week.

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Good luck with your doc.

I don't trust saliva tests either... you should pull DHEA-S and cortisol for assessing adrenal function.

Talking about fatigue, I wake up every morning feeling like I haven't rested for two-three days, and that's when I feel best. It started when I was still a teen and progressively got worse every year.

I've started HCG less than a week ago for the sole purpose of restoring pregnenolone; if it didn't help for you, neither will the cream - but you can give it a try.

Don't try to find an explaination for your anxiety. Take it as a physiological, transitory hassle. My 2.

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Originally Posted by Rjay

I noticed you mention feeling worse after starting TRT mood wise. I did on and off for awhile too before having quite real depression for roughly 6 months. I was on injections this entire time but over the two years Ive been on TRT ive tried a compounded cream twice the first time my mood was much better so as a last ditch effort before considering an anti depressant I switched to creams again and my mood is MUCH better. This last month has been the best month mood wise I can remember Im back to enjoying life. Don't feel like injections are your only option, Im personally never going back. (Also I haven't lost any strength or ability to make gains)

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I tried gels... they did nothing for me. My skin absorbs them super-fast. I don't even care much about mood as for functionality. I'd be contented to be my old self even with depression (which I had most of my life); I don't care.


Lastly, if your going for an antidepressant, try the good old bupropion. It works by enhancing cathecolamines just like selegiline, but in a different manner. It's great for low energy and fatigue but won't help with anxiety and the "melancholic" features of depression.

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Originally Posted by kelkel

Probably a waste of time unless the dose is quite large, and even then doubtful.

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I started taking it for methylation support but agreed, there is no data supporting any effect on cognitive function.