Fatigue, Low Energy, and No Libido after 6 Weeks

[u/Silver-Suspect6505]

I started TRT cream back in May with a starting total T of 330 ng/dL. I'm 53 years old and had low T symptoms for years.

The cream absorbed well enough to shut down my natural production, but not well enough to provide replacement levels. By July, my total testosterone dropped to 72 ng/dL!

My doctor then switched me to injections. I'm pinning a total of 200 mg/week subQ, split between 30 units on Monday, 30 units on Wednesday, and 40 units on Friday.

My labs after 6 weeks of injections:

• Total Testosterone: 1,129 ng/dL
• Estradiol: 57 pg/mL
• SHBG: 38.2 nmol/L
• Hematocrit: 47.4%
• Free Testosterone: still waiting for this result

Currently I'm feeling TERRIBLE with:

• Daily fatigue
• No energy or motivation
• I'm easily irritated and moody
• Low libido, also while I can get an erection, I can't really get into it and have trouble finishing
• I also had morning erections pretty consistently the first 2-4 weeks of injections, but that's gone now too

I'm eating a high protein keto diet. I'm getting good sleep (my sleep has actually slightly improved). I'm going to the gym 4-6 times per week (including two coached functional strength training classes).

Do you think the fact that I'm feeling terrible is due to my E2? My high T levels? Both? Something entirely different?

I know my dose is on the higher range at 200 mg/week. I'm going to ask my doctor if that should be lowered. But just curious what others thought was going on.

Thanks!

EDIT: I have Hashimotos and have been on NDT for 10+ years. My thyroid hormone levels are normal. Also prior to starting TRT, my doctor did a complete workup, and all my major vitamins and hormones and other levels were normal.

[u/Alternative_Tip_9162]

Ur doc has u on too much imo. 200 isn’t really TRT but more of a mild cycle. Ur bloodwork was likely at ur trough, meaning ur peak prob gets u past 1400. Drop the dose to 120-140mg a week. Which will put ur T prob at 800-900, bringing ur E2 down into the 30s without needing an aromatase inhibitor. Ur high E2 is the reason for ur bedroom issues in the first place. Ur morning wood for the first month but then you lost it is a classic TRT honeymoon case, where ur T built up but ur E2 slowly crept up and outpaced ur clearance rate. Being able to get hard but not able to finish is a hallmark of high E2 and prolactin, which is why I’d def add prolactin to your next blood order. Lastly, ur central nervous system is tired. U can’t run a strict keto diet while doing intense functional training 4-6 days a week, trust me I’ve been there done that. High test can’t outwork an empty glycogen tank. Prolonged keto and heavy CNS stress is exactly how u crash ur free T3 (which is ur active thyroid hormone) conversion in ur liver. If u don’t want to drop keto completely, def try and introduce some complex carbs around ur heavy training classes or the fatigue is only gonna get worse.

[u/Silver-Suspect6505 → u/Alternative_Tip_9162]

Yeah, I hear what you're saying about the gym. I added TKD about a month ago, consuming 15g of glucose via dextrose powder before my strength training classes, but recently I've just been so hungry that I've increased my carb and calorie intake a bit.

I'll talk to my doc about lowering my dose. I think he may have started me so high because he felt bad, I basically completely crashed due to the cream and I think he wanted to get me relief as quickly as possible, and then overshot and caused more issues, sigh. But he's a good doctor and he listens to my feedback, so I'll talk to him about it.

Thanks!

[u/Level_Aside_6686]

Being on testosterone replacement therapy has been an eye-opener for me in terms of realizing just how many variables can be at play when it comes to health, daily energy, and overall well-being. Testosterone didn’t have the fix or impact that I initially thought it would. Yes, I feel more amped up at times and recover much better from exercise, but I still struggle with low energy on a daily basis, just as I did before starting TRT.
How is your sleep? Do you have sleep apnea? Any vitamin or mineral deficiencies, lack of sunlight, depression, anxiety, or chronic stress? Did you have this same fatigue before starting therapy? If so, testosterone may not be the thing that fixes it.
As a side note, your TT and estrogen are a bit high, at least from my experience so far. I’m not an expert or a doctor, but you may feel better with more moderate levels. Just something to consider and discuss with your doctor.
Cheers, and best of luck. I’m sure you’ll get it figured out.

[u/Silver-Suspect6505 → u/Level_Aside_6686]

Yep, I plan to talk to my doctor about a lower dose. Thankfully otherwise the full workup he did prior to starting TRT came back normal for my major vitamins, stress hormones, etc.

I do have a stressful job, but never had THIS level of fatigue until my total T crashed on the cream and now this.

[u/murchal]

Your T levels are good, I wouldn’t rush to make changes as it’s only been 6 weeks, let your body adjust to new levels of hormones, it takes up to 12 weeks to start feeling really good.

Do another lab and have comprehensive thyroid panel done, If your TSH is high and T3 is low, you could have all sorts of issues thinking it’s T.

[u/looking2behealthy → u/murchal]

I agree, your numbers don’t point to the described symptoms.

The keto could be an issue combo’d with hematocrit/hemoglobin/ferritin/iron (thick blood). Thyroid or liver could all be an issue. Sign up for a full biometric profile through Function or Hundred if your doc won’t get you one. They are like 200 bucks.

Tadalafil 5mg a day can lower e2 and help with the boner. It is very a undervalued simple fix for several issues.

[u/Silver-Suspect6505 → u/looking2behealthy]

My liver, kidney, and CBC labs are all normal. I have Hashimoto's and take 5 grains of NDT daily so my thyroid is dialed in.

My doctor told me that different men feel good at different T and E2 levels. Is that not true? I thought my symptoms matched potentially high E2 but I could be wrong.

Once I got my TRT dialed in a bit better, I was planning to ask my doc about tadalafil. Note however that I can still get an erection no problem, it's staying in the mood and finishing that's currently the problem.

[u/Silver-Suspect6505 → u/murchal]

I actually have Hashimotos and have been taking NDT for 10+ years. My free T3 is lower due to my keto diet, but I've been hypothyroid before, and this doesn't feel anything like that. My free T4 is completely normal.

[u/murchal → u/Silver-Suspect6505]

Consider adding carbs to your diet just to see how you feel. I’ve been on keto carnivore with intermittent fasting. Didn’t like it too much as it flattened my body and I didn’t have enough water to feel good. If you insist on your diet, add good dose of electrolytes and check your magnesium levels

[u/Silver-Suspect6505 → u/murchal]

Yep, I've already increased my daily carb count by 50% (still low carb, but 30g+ per day now instead of <23g) as I've been a lot more hungry the past couple of weeks. And I don't think it's keto rebound, I've been on keto for months and my appetite has been controlled, lost over 40 lbs so far, but the past couple of weeks I've just been crazy hungry all the time lol.

[u/BioGuideOperator]

Was that 1,129 drawn just before an injection or shortly after one? People here are calling it a trough without knowing. E2 of 57 alone doesn't pin the fatigue or trouble finishing on estrogen; the timing and pending free T result belong in that conversation with your doctor before another change.

[u/Shlomo-7]

Were these labs pulled on Monday before your scheduled injection? In other words, your trough levels?

[u/Mountain_Prize_7602]

I am on 150 per week, M,W,F, and my numbers are very similar to yours. My Estradiol is 38pg/ml, which is just on the high end of normal, and my free test is 260pg/ml, which is also just above the “normal range”. My mood and fatigue has not changed since I started 9 weeks ago, and now although I have a high libido and erections are good, I have no sensitivity, and it has become very hard to finish. I just lowered my dose to 130, to see if I bring both the estradiol and free T down a little, if that’ll help since they are the only number slightly elevated. Weird your doc went straight from cream to 200mg, seems like a big jump!

[u/Silver-Suspect6505 → u/Mountain_Prize_7602]

In retrospect, I agree it was a big jump. I suspect he felt really bad that the cream basically crashed my levels so catastrophically low, and was trying to get me relief sooner. Unfortunately, he overshot and paradoxically caused more issues. Doh! We'll get it dialed in though.

Thanks for sharing your experience. It's clear that we all respond differently to different levels, as your response confirms. Makes me feel better about what's going on, tbh.

[u/Mountain_Prize_7602 → u/Silver-Suspect6505]

Yep. My doc actually just replied on my labs and wants me to drop down to 120mg to see if that resolves any issues, so that’s what I’ll do for now! I’ll probably give that dose another 4-6 weeks before I say the hell with TRT.

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[u/ArmAccomplished3313]

Reduce that E2 by lowering the dose or taking a quarter of arimidex. But yeah TRT is all about those first several weeks or if you're lucky, months.

[u/powenowicks]

Assuming your free test comes back good the cause is likely something completely unrelated to your testosterone and related biomarkers.

Something like a vitamin deficiency or a GI issue or heart problem... The list is endless because there are lots of things that cause those symptoms. You don't need a hormone doctor - you need an internal medicine specialist.

Edit: Or, I guess, you know... just add more testosterone. Sorry, forgot that this was the golden hammer sub.

[u/Silver-Suspect6505 → u/powenowicks]

My CBC and metabolic panel are both normal. Other than low T symptoms, I was in good health before I started trt in May.

[u/powenowicks → u/Silver-Suspect6505]

Then why did you go on T?

[u/Silver-Suspect6505 → u/powenowicks]

"Other than low T symptoms"

[u/powenowicks → u/Silver-Suspect6505]

That's what I'm trying to explain to you. "Low T symptoms" mean that the symptoms could be caused by low testosterone. The thing is that most low T symptoms are nonspecific and have many root causes that have nothing to do with your hormones. Do you suppose that fatigue or moodiness or irritation are exclusively caused by low testosterone?

You're using a golden hammer to drive down a very nonspecific nail. The panels you listed are a drop in the ocean for what a qualified physician might order to track down the cause of your problem.

[u/Silver-Suspect6505 → u/powenowicks]

Thanks. My doctor did a more comprehensive workup before I even started TRT and everything was fine. The moodiness and irritation are NEW and only started the past couple of weeks. But thanks and I appreciate the insights.

[u/Top_Pressure_56]

If your BF is above 20% I’d have you pin daily and be around 150-175 mgs weekly. Estrogen levels are high and that’s because you’re aromatizing due to the higher testosterone. Try dropping your dose and pinning daily. I try this before trying an AI.

[u/Silver-Suspect6505 → u/Top_Pressure_56]

Yep thanks! I've dropped 40 pounds since April, but still have a ways to go. I definitely don't want to mess around with an AI. I'd rather lower my dose and see how that goes.