For Those That Get Headaches on TRT

[Fortunate]

There are a few threads on headaches, but I thought I’d start one dedicated for anyone who wants to solicit or provide advice and feedback on headaches. If you previously had or currently still experience headaches, please share your thoughts here.

I am prone to headaches and have been my whole life. So, I suspect I am neurologically more sensitive to noxious stimuli than most. When TRT triggers a headache, I usually feel it within a few hours of injecting. I believe there are various different pathways by which TRT can cause headaches, so there is not likely a one-size fits all solution. Over time, I have suspected various offenders that may trigger headaches, but all I have are theories are anecdotal observations. I think some of the possible offenders that may trigger a headache include:

• Carrier oil
• Preservatives in multi-use vials
• Ester (doubt)
• Peak T levels that are too high
• E2 levels that are too high
• T:E2 ratios
• Blood pressure spikes
• Prolactin (newest on my list)

One pretty consistent observation I have made is that enanthate from a multi-use vial (thus with preservatives), even in small doses, is much more likely to trigger a headache than a large, single dose of Xyosted (without preservatives).

I am more or less looking for anyone who has done some successful troubleshooting. I have never given any thought to prolactin, but did notice it was on the slightly high end of normal on my last set of labs. Should I be thinking about that?

I also notice headaches on nandrolone, with less aromitization than testosterone, so it can’t all be E2. That said, the nandrolone is mixed with preservatives, which is still on my suspect list.

Please share your experiences.

 

[Systemlord]

I got bad headaches on the cream even though I didn't absorb enough to sustain me more than 3 hours. The very quick rise in hormones I believe was the cause of the headaches.

I felt the creams effects before I was done rubbing it in, that's fast!

I don't get headaches on injections and Jatenzo taking 2 hours to peak. If I have low vitamin K and start taking vitamin D, I get tension headaches from hell.

 

[madman]

I got bad headaches on the cream even though I didn't absorb enough to sustain me more than 3 hours. The very quick rise in hormones I believe was the cause of the headaches.

I felt the creams effects before I was done rubbing it in, that's fast!

I don't get headaches on injections and Jatenzo taking 2 hours to peak. If I have low vitamin K and start taking vitamin D, I get tension headaches from hell.

Far fetched!




Pharmacokinetics of testosterone cream applied to scrotal skin (2017)


*After testosterone administration, the peak concentration of serum testosterone was dose-dependent with the time of peak being between 1.9 to 2.8 h after doses (Table 2).

A New Oral Testosterone Undecanoate Formulation Restores Testosterone to Normal Concentrations in Hypogonadal Men (2020)


*When the T results of all patients at a particular visit were combined, regardless of the dose of oral TU they received, the mean peak T over 24 hrs. (Cmax24) for oral TU patients ranged from approximately 800 ng/dL at the first dose titration to 1000 ng/dL at the end of the study and occurred at median times of approximately 2–4 hours following the AM dose and approximately 4 hours following the PM dose

Natesto takes the cake when it comes to Tmax!

12.3. Pharmacokinetics Absorption

Natesto delivers physiologic amounts of testosterone, producing circulating concentrations that approximate normal testosterone concentrations (i.e., 300 to 1,050 ng/dL) seen in healthy men. The maximum concentration for Natesto is achieved within approximately 40 minutes of administration and has a half-life ranging from 10 to 100 minutes. Figure 1 summarizes the pharmacokinetic profiles of total testosterone in patients completing 90 days of Natesto treatment administered as 33 mg of testosterone daily (11 mg three times daily).


Figure 1: Mean Serum Total Testosterone Concentrations on Day 90 Following Natesto Administered As 11 mg of Testosterone Three Times Daily (N=69)

 

[Systemlord]

I felt the creams effects before I was done rubbing it in, that's fast!

Far fetched!

I'm dead serious! I also feel a profound difference between cypionate and ethanate. I over-respond to most medicines, caffeine and alcohol.

Call me Mr. sensitive.

 

[Jerajera]

Only time I got headaches in my life was on TRT and when my blood pressure rose to 160/80 despite a perfect 115/75 my entire life until that point.

I was on 160mg/week in E3.5D injections and obviously that turned out to be too much for me.

I was bloated like the Michelin man, so I'm guessing high E2 -> water retention -> high BP -> headaches, something like that

 

[Fortunate]

Follow up: I felt strongly that my headaches might have been related to preservatives. I am not rethinking this, as I may have been wrong.

In the past, I injected Xyosted (which is preservative-free) into a sterile vial and then drew up small amounts for daily injections. I did not trial it very long, so I tried it again.

For a few days in the past week, I injected 10mg of preservative free enanthate (sourced from Xyosted) and still wound up with low grade headaches. Major bummer, as I thought I may have solved my headache conundrum. Current list of culprits: the carrier oils (some kind of inflammatory reaction) or factors related to aromatization (E2 and/or DHT).

My next step in troubleshooting will be to try alternative oils. I have no interest in black market or home brewing. I have tried grapeseed, cottonseed and sesame. None stand out as clearly "better" than others for me. Does anyone have experience with less common oils (like MCT or others)? Can you share your experience with alternative oils? Did you find a compounding pharmacy to make it?

 

[sammmy]

I would start shifting the injection time up and down and observe if the time of the headache is related to the injection time. If it's not, that suggests some other origin of the headaches. Gazillion things can cause headaches.

 

[Fortunate]

I would start shifting the injection time up and down and observe if the time of the headache is related to the injection time. If it's not, that suggests some other origin of the headaches. Gazillion things can cause headaches.

I hear you. I am well-versed with headaches. Has been an issue my entire life.

That said, I record injection time and notice onset of headaches within a few hours of injections typically.

 

[sammmy]

The problem is you inject probably at the same time each day and a headache happening at a particular time of day is not necessarily related to the injection but could be part of another body cycle such as the ones of eating, immune system (yes it is cyclic too), other hormones etc.

The only way to find out is to skip TRT injections on a given day.

I have been having headaches for 10 years and only recently noticed that 50% of those occur 2 hours after a meal by shifting the time of meal or not getting a headache when I skip a meal. Before I realized that, the headaches seemed random and I ascribed them to taking this or that supplement.

 

[Beken]

Only time I got headaches in my life was on TRT and when my blood pressure rose to 160/80 despite a perfect 115/75 my entire life until that point.

I was on 160mg/week in E3.5D injections and obviously that turned out to be too much for me.

I was bloated like the Michelin man, so I'm guessing high E2 -> water retention -> high BP -> headaches, something like that

What was the solution? I'm getting high BP, pulse and headaches in the evening at 120mg. I'm titrating down and slowly feeling better... I think I may be one of those 60mg a week/ daily shot guys. It feels like I'm sensitive to Testosterone...

 

[Jerajera]

What was the solution? I'm getting high BP, pulse and headaches in the evening at 120mg. I'm titrating down and slowly feeling better... I think I may be one of those 60mg a week/ daily shot guys. It feels like I'm sensitive to Testosterone...

Blood pressure went back to normal when I switched to daily injections of the same weekly total dose, 22mg/day = 154mg/week ~ 160mg/week.

That said, I always felt terrible on daily injections regardless of dose. I tried everything from 160mg/week to 125mg/week total on ED injections and always ended up feeling completely flat and anhedonic; zero drive or motivation, no enjoyment of anything, no dreams/vision for the future, no creativity, extreme brain fog, etc...

 

[CKO]

I've been getting terrible headaches at night. Always around 8pm. Protocol 50 mg test cyp x 3 week, 400 iu hcg x 2 week, arimidex 1/8 x 3 week. I also sweat like crazy when I work out and am frequently heat intolerant. Provider suggested excess fluid retention and recommended reducing sodium. I'm getting close to dropping trt due to the excess sweating. I want to get back into jiu jitsu, but cannot due to the crazy amount I sweat. Ugg

 

[Fortunate]

I've been getting terrible headaches at night. Always around 8pm. Protocol 50 mg test cyp x 3 week, 400 iu hcg x 2 week, arimidex 1/8 x 3 week. I also sweat like crazy when I work out and am frequently heat intolerant. Provider suggested excess fluid retention and recommended reducing sodium. I'm getting close to dropping trt due to the excess sweating. I want to get back into jiu jitsu, but cannot due to the crazy amount I sweat. Ugg

Maybe scale back before dropping. If you drop the test cyp dose and drop hCG, you may be able to drop arimidex. Once you simplify your protocol, you may be able to isolate your issues.

Blood pressure ok? Take thyroid meds? Supplements?

 

[Belekas]

Bump. Been suffering headaches a long time as well, but mostly when on testosterone. Been off TRT for the last 3 years and they def been well down and acceptable fwiw. 8 weeks back on and already starting to get them again. BP elevated since starting TRT worth to mention as well so that might contribute to the case as well. Other thing for me is I have a serious injury at my neck or/and back and it gets worse once I get up in the morning. Think this also contributes to my headaches. Can't rule them out till I get MRI and hopefully get it fixed. Blood tests EOM so will have more data to work with. My TRT dose is 80-100mg/week split e3.5d of Sustanon IM. Also increased food to grow so that will have an effect on BP as well fwiw.

 

[Jerajera]

BP elevated since starting TRT worth to mention as well so that might contribute to the case as well

Only time in my entire life I ever got headaches was on a higher TRT dose when my BP became elevated. In my case it was 100% from water retention -> elevated BP

 

[Belekas]

Only time in my entire life I ever got headaches was on a higher TRT dose when my BP became elevated. In my case it was 100% from water retention -> elevated BP

What was your dose and injection frequency?

 

[Jerajera]

What was your dose and injection frequency?

80mg E3.5D (160mg/week) of Test Cyp. I got more and more bloated over a period of ~2 months and eventually started having 24/7 headaches for the first time in my life.
Checked my BP and it had gone from a lifetime at 115/75 to 160/80.

Interestingly, very soon after I moved to daily injections on the same weekly dose (22mg/day = 154mg/week ~ 160mg/week), the bloating subsided for the most part and my BP normalized.

I didn't feel as good on daily injections though, always felt flat even after I dropped down to 18mg/day. For me, super stable levels lead to complete anhedonia and lack of drive. I'm not suicidal, I just don't give a shit about anything. I also feel as if I dropped 30 IQ points

 

[Belekas]

80mg E3.5D (160mg/week) of Test Cyp. I got more and more bloated over a period of ~2 months and eventually started having 24/7 headaches for the first time in my life.
Checked my BP and it had gone from a lifetime at 115/75 to 160/80.

Interestingly, very soon after I moved to daily injections on the same weekly dose (22mg/day = 154mg/week ~ 160mg/week), the bloating subsided for the most part and my BP normalized.

I didn't feel as good on daily injections though, always felt flat even after I dropped down to 18mg/day. For me, super stable levels lead to complete anhedonia and lack of drive. I'm not suicidal, I just don't give a shit about anything. I also feel as if I dropped 30 IQ points

Def not worth it then. So what was your solution or you hung the gloves? I'm currently on e3.5d as well but only 80/100mg week. It works but I got elevated BP as well as pulse, also heart beating stronger and breathing is heavier. Also breathing through nose gets harder and harder. Don't like it but will see what bloods show next month. Headaches still not bothering too much fwiw.

 

[Jerajera]

Def not worth it then. So what was your solution or you hung the gloves? I'm currently on e3.5d as well but only 80/100mg week. It works but I got elevated BP as well as pulse, also heart beating stronger and breathing is heavier. Also breathing through nose gets harder and harder. Don't like it but will see what bloods show next month. Headaches still not bothering too much fwiw.

Do you know what your blood pressure is? After that episode I got a BP cuff that I use on a regular basis just in case. Either way the headaches are a deal breaker obviously, but still it'd be good to keep an eye on your BP.

I didn't have any problems on 100mg/week with E3.5D injections but everyone has a different threshold.

As far as solutions, I think if you moved to daily injections on your 100mg/week, there's a good chance it would take care of the headaches and elevated BP if that's where they come from.

One thing I didn't try at the time was to stay on E3.5D injections but add a bit of AI to bring down E2, which I personally believe is largely responsible for water retention -> elevated BP.

If you absolutely don't want to touch AI's and daily injections don't work, I personally saw much lower E2 levels on the compounded cream, especially when applied to areas other than the scrotum.

My E2 on 18mg/day of Cyp ran around 60pg/mL with Free T around 25ng/dL. When I got the cream, I got a prescription for 8 clicks/day of the 200mg/mL compounded cream since I expected to need a lot more when not applied to the scrotum.

Not wanting to waste my time if I didn't absorb well, I applied the whole 8 clicks at once on my arms every 24 hours. My free T at trough (after 24 hours) came back at 65ng/dL, but despite that my E2 sensitive was only 40pg/mL, which is kind of crazy but perhaps not that surprising due to DHT's antagonistic action vs E2 and the presence of a high number of 5a-reductase enzymes in the skin; typically transdermals lead to much higher DHT levels.

So you could try that also.

Lastly what I'm trying right now is daily Test Prop subQ, but if fluctuations are your problem, which is likely, Prop is probably going to lead to the same negative side effects. People are often confused thinking that daily Prop must lead to very stable levels since it's injected daily, however daily Prop is actually not any steadier than once/week Cypionate, assuming a half-life of around 5-6 days for Cyp and ~20 hours for Prop.

Daily Prop still leads to quite a lot of variation in levels, which is good in some ways (less desensitization of Dopamine receptors over time probably) and it seems for a lot of people leads to subejctively much better mood/energy/libido, less water retention, etc...but on the downside doesn't prevent negative side effects if you're sensitive to fluctuations.

However if you struggle with feeling flat on Cyp or in general not as sharp mentally or with subpar libido, Prop might be worth a shot. In that case, I would strongly recommend starting subQ, which theoretically should significantly narrow the amplitude between peak and trough levels, and at a low dose around ~10mg/day.

Given what you've said though, I'd look at your E2 levels and either try a small dose of AI (maybe 0.125mg or even 0.0625mg twice/week), or the cream. Personally the cream applied to the scrotum led to insanely high DHT levels which I'm not comfortable running "for life".
Even on just 1 click (50mg) every 12 hours, my trough DHT levels were 360ng/dL (range 12-65), so yeah...brutal.

 

[Belekas]

Do you know what your blood pressure is? After that episode I got a BP cuff that I use on a regular basis just in case. Either way the headaches are a deal breaker obviously, but still it'd be good to keep an eye on your BP.

Yes, ofcourse. Have a hospital/paramedic-grade machine. It's now 22:00 here and I'm after a heavy chest workout around 6hrs ago and 5 meals (around 4500kcal) in and my BP is 128/78/80 so IMO not too bad but the pulse could really be lower. The main thing is I'm breathing heavier and my nose is getting stuffed more and more each day it seems. Even started snoring which I never did since been off test the last 3 years. Mind you I've put on 8kg lately in quite a quick period of time and weighting just around 82-83kg now fwiw. Yes BP is major player and killer of libido and mood at least for me. I'm still only 8-9 weeks in but feeling wired and very sensitive to everything which I don't like. My BP actually is coming down from what I see in my book so thats a good thing and hope that continues. Need to work on the pulse, prefer it to be lower.

I didn't have any problems on 100mg/week with E3.5D injections but everyone has a different threshold.

Yes agree. Same protocol that I'm currently on, but I'm running Sustanon. So had a thought maybe the fast acting Ester don't agree with me as I get that strange wired feeling. I also have some Test-E but don't want to mix variables yet till I get bloods done end of next month.

As far as solutions, I think if you moved to daily injections on your 100mg/week, there's a good chance it would take care of the headaches and elevated BP if that's where they come from.

Good point. I will measure my BP when/if headache persists and see if theres a clear trend. The thing with daily injections is I think they are not sustainable for me and honestly I don't want to be pinning myself daily. I felt ok before starting TRT even with barely in range FT (calculated) had good libido, lower BP, was cool, calm and collected, if you know what I mean. Wanted just to see if raising FT would help me in any way.

One thing I didn't try at the time was to stay on E3.5D injections but add a bit of AI to bring down E2, which I personally believe is largely responsible for water retention -> elevated BP.

That is exactly what me and my experienced buddy was talking about the other day. So far I couldn't get any AI where I'm at and since I'm medicating myself and not through clinic it will take a while, as buying online without knowing whats in the bag is like throwing money into the water. I also believe my E2 are elevated at this point but I can't tell without getting bloods first and even then I'm not sure if i'll be able to get the proper sensitive test to measure them right. If I see a bodybuilder in my gym will go have a chat and ask to get me a few AI tablets

If you absolutely don't want to touch AI's and daily injections don't work, I personally saw much lower E2 levels on the compounded cream, especially when applied to areas other than the scrotum.

My E2 on 18mg/day of Cyp ran around 60pg/mL with Free T around 25ng/dL. When I got the cream, I got a prescription for 8 clicks/day of the 200mg/mL compounded cream since I expected to need a lot more when not applied to the scrotum.

Not wanting to waste my time if I didn't absorb well, I applied the whole 8 clicks at once on my arms every 24 hours. My free T at trough (after 24 hours) came back at 65ng/dL, but despite that my E2 sensitive was only 40pg/mL, which is kind of crazy but perhaps not that surprising due to DHT's antagonistic action vs E2 and the presence of a high number of 5a-reductase enzymes in the skin; typically transdermals lead to much higher DHT levels.

So you could try that also.

I always thought about cream and have read some great reviews from different guys as well but since I'm stocked up on Sustanon and some Test-E, sadly thats not an option for now. Very interesting though and def woud like to try in the future if I persist going this way further.

Lastly what I'm trying right now is daily Test Prop subQ, but if fluctuations are your problem, which is likely, Prop is probably going to lead to the same negative side effects. People are often confused thinking that daily Prop must lead to very stable levels since it's injected daily, however daily Prop is actually not any steadier than once/week Cypionate, assuming a half-life of around 5-6 days for Cyp and ~20 hours for Prop.

Daily Prop still leads to quite a lot of variation in levels, which is good in some ways (less desensitization of Dopamine receptors over time probably) and it seems for a lot of people leads to subejctively much better mood/energy/libido, less water retention, etc...but on the downside doesn't prevent negative side effects if you're sensitive to fluctuations.

However if you struggle with feeling flat on Cyp or in general not as sharp mentally or with subpar libido, Prop might be worth a shot. In that case, I would strongly recommend starting subQ, which theoretically should significantly narrow the amplitude between peak and trough levels, and at a low dose around ~10mg/day.

Given what you've said though, I'd look at your E2 levels and either try a small dose of AI (maybe 0.125mg or even 0.0625mg twice/week), or the cream. Personally the cream applied to the scrotum led to insanely high DHT levels which I'm not comfortable running "for life".
Even on just 1 click (50mg) every 12 hours, my trough DHT levels were 360ng/dL (range 12-65), so yeah...brutal.

Will see if I'm able to get some AI and try a tiny dose to see what happens and how I feel. Will have coprehensive blood test done end of next month then will have more data to work with. Re cream I heard that it raised DHT like crazy so maybe one day I'll get my hands onto it and give it a go

Thank you for your time and this detailed post. Will post more updated when I figure out next piece of the puzzle.