Need some guidance. Palpitations / Anxiety.

[unknownwhom]

Hey All. I have been experiencing palpitations and frequent anxiety for the last few weeks. Sometimes its debilitating. It causes insomnia. Sometimes thoughts of something life threatening happening in my sleep. I am 33 yr old. Workout 6 days a week vigorously. Eat a good diet. I'm 5' 10" and around 190lbs. I've been on TRT for about 9 months now. I abused PEDs in my 20s and after coming off all of them and after some time, I had a lot of brain fog, weight gain, loss of muscle mass, etc. I ended up seeking TRT therapy.

I got prescribed the 200mg of T / 1mg of anastrozole once a week regime. I didn't initially take the AI. Felt good for months. But, I started to get gyno symptoms. Bloods showed

Total T - 1512ng/dl - lab range 250-1100 ng/dL
e2 - 74pg/ml - lab range < OR = 29 pg/mL

So I backed it off to 140mg a week and did not touch AI. After 4 weeks, this brought me down to:
Total T - 1147ng/dl - lab range 250-1100 ng/dL
e2 - 53pg/ml - lab range < OR = 29 pg/mL

IMO, still too high. Nipples were also still sensitive. Doc wanted me to take AI @ 140mg weekly as he likes e2 in the 20-30pg/ml range. He wanted me to take 1mg anastrozole once a week. I didn't listen and only took .5mg once a week for a few weeks. Shortly after latest labs, is when symptoms started.

Latest labs
Total T - 1155ng/dl - lab range 250-1100 ng/dL
e2 - 10pg/ml - lab range < OR = 29 pg/mL

Before getting labs back I stopped AI as I started to get described symptoms. I am now at 120mg a week EOD administration with no AIs. And, I haven't felt great since my e2 was around 53pg/ml but was having gyno symptoms.

I ended up going to see my PCP about the palpitations. I naturally have a low resting heart rate (44bpm) due to me being highly athletic the last 12 years. Blood pressure around 129/70. He listened to my heart and said it sounded great.

He did his own labs to check for possible reasons and an EKG. He saw some concerning things on the EKG. Specifically elevated QRS duration and elevated QT Interval. I have a halter monitor coming and an echocardiogram scheduled.

This has me spooked. Looking for some general advice. Should I stop exogenous therapy? Should I maintain 120mg a week? Is my EKG off and symptoms due to a disproportionate T/E ratio? Should I wait for the echo to make a decision? Thanks!

 

[Systemlord]

e2 - 10pg/ml - lab range < OR = 29 pg/mL

Low E2 can cause your mind to race, and even panic, and also cause palpitations. I believe all your problems are from crushing your estrogen.

It appears all your issues started after taking the AI due to what you describe as gyno symptoms.

Low E2 isn’t healthy for the cardiovascular system.

 

[Systemlord]

I get sensitive nipples on and off for years and I have never had gyno. Sensitive nipples doesn’t mean you have gyno. In order to get gyno, this requires a specific gene.

 

[unknownwhom]

Low E2 can cause your mind to race, and even panic, and also cause palpitations. I believe all your problems are from crushing your estrogen.

It appears all your issues started after starting the AI due to what you describe as gyno symptoms.

Low E2 isn’t healthy for the cardiovascular system.

I’m considering coming off. But, if my e2 is still low and I quit, my thought process is it would stay low until my HPTA gets back to normal (back to what my normal is) because there wouldn’t be any test to aromatize which could take awhile.

Do you think I’d be better off waiting for it to come back up with exogenous test and then consider coming off?

 

[sammmy]

You can decrease your T dose further: your trough (lowest level before next dose) Free Testosterone (measured with dialysis or calculated with SHBG) should be in the MIDDLE of the normal range, not at the top or above it.

With a lower T dose, you may not need any AI and all the problems associated with it.

 

[Ogarg]

Hey All. I have been experiencing palpitations and frequent anxiety for the last few weeks. Sometimes its debilitating. It causes insomnia. Sometimes thoughts of something life threatening happening in my sleep. I am 33 yr old. Workout 6 days a week vigorously. Eat a good diet. I'm 5' 10" and around 190lbs. I've been on TRT for about 9 months now. I abused PEDs in my 20s and after coming off all of them and after some time, I had a lot of brain fog, weight gain, loss of muscle mass, etc. I ended up seeking TRT therapy.

I got prescribed the 200mg of T / 1mg of anastrozole once a week regime. I didn't initially take the AI. Felt good for months. But, I started to get gyno symptoms. Bloods showed

Total T - 1512ng/dl - lab range 250-1100 ng/dL
e2 - 74pg/ml - lab range < OR = 29 pg/mL

So I backed it off to 140mg a week and did not touch AI. After 4 weeks, this brought me down to:
Total T - 1147ng/dl - lab range 250-1100 ng/dL
e2 - 53pg/ml - lab range < OR = 29 pg/mL

IMO, still too high. Nipples were also still sensitive. Doc wanted me to take AI @ 140mg weekly as he likes e2 in the 20-30pg/ml range. He wanted me to take 1mg anastrozole once a week. I didn't listen and only took .5mg once a week for a few weeks. Shortly after latest labs, is when symptoms started.

Latest labs
Total T - 1155ng/dl - lab range 250-1100 ng/dL
e2 - 10pg/ml - lab range < OR = 29 pg/mL

Before getting labs back I stopped AI as I started to get described symptoms. I am now at 120mg a week EOD administration with no AIs. And, I haven't felt great since my e2 was around 53pg/ml but was having gyno symptoms.

I ended up going to see my PCP about the palpitations. I naturally have a low resting heart rate (44bpm) due to me being highly athletic the last 12 years. Blood pressure around 129/70. He listened to my heart and said it sounded great.

He did his own labs to check for possible reasons and an EKG. He saw some concerning things on the EKG. Specifically elevated QRS duration and elevated QT Interval. I have a halter monitor coming and an echocardiogram scheduled.

This has me spooked. Looking for some general advice. Should I stop exogenous therapy? Should I maintain 120mg a week? Is my EKG off and symptoms due to a disproportionate T/E ratio? Should I wait for the echo to make a decision? Thanks!

I have PVC'S (premature ventricular contractions) and heart palpitations when my hormones are off. They were very noticeable when I had low testosterone. I have had two EKG's in my life and both doctors said they saw something and referred me to a cardiologist. After a halter monitor and an echocardiogram they diagnosed me with PVC'S. But they could not telle why. They said they are not life threatening so there was no attempt to find a cause. Fast forward years later when I finally got a test for total testosterone. My total T at the time was 188. I got on TRT and don't have them very often at all anymore.

So I definitely believe that hormones affects heart arrhythmias. It did for me anyway. The halter monitor and echocardiogram will give you a much better picture of your heat health. I feel for you brother. Good luck.

 

[t_spacemonkey]

I am on 200mg as well. in my case switching from Cyp to Tprop took care of all the anxiety I had. one way would be to lower the cyp dose, but I either feel like crap when its too low, or too revved up when its too high. no good middleground. i think using prop helps as you get quick peaks and fall back pretty quick. ED injections needed.

 

[Systemlord]

think using prop helps as you get quick peaks and fall back pretty quick. ED injections needed.

That’s why Jatenzo works so well for me, cypionate and enanthate causes overstimulation because in the span of a few days, levels don’t change much at all, and moving injections closer together creates even more overstimulation because now hormones are virtually static.

 

[unknownwhom]

I am on 200mg as well. in my case switching from Cyp to Tprop took care of all the anxiety I had. one way would be to lower the cyp dose, but I either feel like crap when its too low, or too revved up when its too high. no good middleground. i think using prop helps as you get quick peaks and fall back pretty quick. ED injections needed.

Interesting. I was under the impression pinning more frequent would be better for SHBG levels and would cause less aromatization of test into estrogen to keep levels more at bay. I’m taking 120mg EOD of cyp.

 

[unknownwhom]

That’s why Jatenzo works so well for me, cypionate and enanthate causes overstimulation because in the span of a few days, levels don’t change much at all, and moving injections closer together creates even more overstimulation because now hormones are virtually static.

If I am taking cyp, would you recommend twice weekly instead of EOD?

 

[Systemlord]

I was under the impression pinning more frequent would be better for SHBG levels and would cause less aromatization of test into estrogen to keep levels more at bay.

If you’re injecting the same dosage, only more frequently, your levels are about the same, only less peaks and valleys. If you can get by with less T injecting more frequently, then you can lower estrogen.

 

[Systemlord]

If I am taking cyp, would you recommend twice weekly instead of EOD?

There’s no shortcuts to this experimenting to find out what works for you. You need to figure out what’s best for YOU. Neither one of those protocols worked for me.

 

[unknownwhom]

There’s no shortcuts to this experimenting to find out what works for you. You need to figure out what’s best for YOU. Neither one of those protocols worked for me.

I get that. But your comment of “constantly overstimulated” describes my current protocol pretty well. I naturally tried 140mg EOD of cyp. Thinking 120mg E3.5D may be better for me.

 

[Systemlord]

But your comment of “constantly overstimulated” describes my current protocol pretty well. I naturally tried 140mg EOD of cyp. Thinking 120mg E3.5D may be better for me.

You started out way too high, your dosage was and still may be excessive. It would have been more reasonable to start out 75-100 mg weekly, split up however you prefer.

There are some members (outliers) who feel optimized on 50-80 mg. There is a member who for 12 years struggled with libido and erections, then found 50 mg once weekly to resolve all his issues.

 

[swolg8r]

I get that. But your comment of “constantly overstimulated” describes my current protocol pretty well. I naturally tried 140mg EOD of cyp. Thinking 120mg E3.5D may be better for me.

I would start somewhere <= 120mg. In your labs, your e2 was still a bit on the higher end. Your test levels themselves were also out of range (albeit not way off). You should leave AI out of the picture and titrate down from 120mg till you feel no heart palpitations, normal resting heart rate, etc...

 

[Belekas]

You started out way too high, your dosage was and still may be excessive. It would have been more reasonable to start out 75-100 mg weekly, split up however you prefer.

There are some members (outliers) who feel optimized on 50-80 mg. There is a member who for 12 years struggled with libido and erections, then found 50 mg once weekly to resolve all his issues.

I agree here. Seems the general consensus is "fear anything below 100mg" lol. Outliers not outliers, there are plenty of men who have top of the range TT/cFT with 100mg/week say split E3.5D's FWIW. I'm just N=1 but I've been training for close to 20 years, eating properly, doing my heavy cardio, taking minimum supps, abused some PEDS in my younger days, abused drugs and alchohol heavily for years as well before all that and still 100mg/week puts me right at the top of the range, bit above on TT and same with calculated FT FWIW. Thus I decided to explore even lower and right now I'm on 75mg/week and feeling fine in all departments and very similar if not the same as on 100-120mg/week. Will be very interested to run bloods after a good 3-6 months to see where my levels are at, but so far I'm happy.

So basically what I wanted to show and say that a lot of times "less is more" and it pays to explore all the venues as we all are very different and unique not even talking about deeper context, etc.

Hope you get better, hang in there!

 

[DJXS]

Hi estrogen levels can also cause anxiety and feelings of panic: High-Estrogen and Anxiety: Is There a Link? - Body+Mind Magazine

 

[unknownwhom]

You can decrease your T dose further: your trough (lowest level before next dose) Free Testosterone (measured with dialysis or calculated with SHBG) should be in the MIDDLE of the normal range, not at the top or above it.

This is honestly really great advice. Which I plan to follow. I've switched to 120mg a week - test cyp IM - E3.5D. Ill see how I feel after a couple of week. Get some blood work and get schedule it morning of right before next dose to see where Free T, Total T, SHBG and E2 line up. And go from there.

...
Hope you get better, hang in there!

Appreciate all the words.

 

[excelnelg]

Don’t overlook any supplements that you may be taking as a possible suspect.

 

[pumacorp]

Hey All. I have been experiencing palpitations and frequent anxiety for the last few weeks. Sometimes its debilitating. It causes insomnia. Sometimes thoughts of something life threatening happening in my sleep. I am 33 yr old. Workout 6 days a week vigorously. Eat a good diet. I'm 5' 10" and around 190lbs. I've been on TRT for about 9 months now. I abused PEDs in my 20s and after coming off all of them and after some time, I had a lot of brain fog, weight gain, loss of muscle mass, etc. I ended up seeking TRT therapy.

I got prescribed the 200mg of T / 1mg of anastrozole once a week regime. I didn't initially take the AI. Felt good for months. But, I started to get gyno symptoms. Bloods showed

Total T - 1512ng/dl - lab range 250-1100 ng/dL
e2 - 74pg/ml - lab range < OR = 29 pg/mL

So I backed it off to 140mg a week and did not touch AI. After 4 weeks, this brought me down to:
Total T - 1147ng/dl - lab range 250-1100 ng/dL
e2 - 53pg/ml - lab range < OR = 29 pg/mL

IMO, still too high. Nipples were also still sensitive. Doc wanted me to take AI @ 140mg weekly as he likes e2 in the 20-30pg/ml range. He wanted me to take 1mg anastrozole once a week. I didn't listen and only took .5mg once a week for a few weeks. Shortly after latest labs, is when symptoms started.

Latest labs
Total T - 1155ng/dl - lab range 250-1100 ng/dL
e2 - 10pg/ml - lab range < OR = 29 pg/mL

Before getting labs back I stopped AI as I started to get described symptoms. I am now at 120mg a week EOD administration with no AIs. And, I haven't felt great since my e2 was around 53pg/ml but was having gyno symptoms.

I ended up going to see my PCP about the palpitations. I naturally have a low resting heart rate (44bpm) due to me being highly athletic the last 12 years. Blood pressure around 129/70. He listened to my heart and said it sounded great.

He did his own labs to check for possible reasons and an EKG. He saw some concerning things on the EKG. Specifically elevated QRS duration and elevated QT Interval. I have a halter monitor coming and an echocardiogram scheduled.

This has me spooked. Looking for some general advice. Should I stop exogenous therapy? Should I maintain 120mg a week? Is my EKG off and symptoms due to a disproportionate T/E ratio? Should I wait for the echo to make a decision? Thanks!

When my estrogen dropped below a certain level my heart palpitations we're so bad I was under cardiac care by electrophysiologist.. I almost qualified for ablation ... You have to remember Women who go through menopause and they get Afib the number one contributor to a-fib is low estrogen... Trust me been through hell raise my estrogen all gone.. Really horrible shortness of breath when I lower estrogen as well... You are not alone buddy just raise those estrogen levels...