question from a user
I started on testosterone pellet therapy in late October (100 mg) and it took about 4 weeks for me to notice a response. When I did, my sex drive was crazy high and I felt euphoric, energized, sleeping well. It only lasted about 5-7 days and I was back to feeling like crap. Tired all the time again, not sleeping well and my sex drive tanked. My doc at the time had me do labs at 6 weeks and my testosterone was around 180. He offered at 50 mg pellet booster and I took it. It was more of the same result — feeling great, energized, high sex drive but again, only for about 5-7 days. I switched providers in late December/early January to pursue injections and try to better dial in my dosage and I still have been experiencing the same thing. What I’ve noticed is that every time I feel great, energized, sleeping well with a high sex drive is always at the start of my period to the end of my ovulation. My injections are currently .15 mg twice weekly, testosterone concentration 50mg. Any thoughts on why I only feel benefits during menstruation and ovulation and advice on how to better dial in for the rest of the month? I’m also on 100mg of progesterone for the last 2 weeks of my cycle because I become super irritable and easily agitated (along with not sleeping well).
AlphaMD's Answer
First, we never recommend starting with pellets. Because absorption rates are variable, you may be under or overdosed, and you are stuck with that for awhile. It is always better to dial in a good injection dose first, and then converting to a pellet once you find your therapeutic level.
Logically, if there is a cause for you feeling bad, it would potentially be the progesterone. For one, this makes sense as this is when you are adding the progesterone in your cycle. Also, women can produce already too much progesterone when they are already on testosterone. Adding additional progesterone means that your body recognizes the excess, and then converts progesterone into cortisol. Too much cortisol makes anyone feel bad.
To help you visualize this, click on the link below to the hormone cascade, and imagine it is like clogging up pipes. Any time you add an exogenous hormone, it overflows in the direction of the pipes, many of which only flow one way.
By adding testosterone, you clog that and it overflows into estrogen production, but also backs up to the cortisol pathway. Now when you add progesterone, any excess is going to overflow into the cortisol pathway. So you have the potential to get twice the cortisol. Too much cortisol is a miserable feeling.
Also bear in mind that your natural progesterone production spikes at ovulation and remains high until menses.
You very well may be adding exogenous progesterone on top of your natural production during the later half of the month.
My first impression would be for you to reduce your progesterone dose and see if that helps. But talk to your doctor as well.
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