Mental health complications 3 months on T

[Leo]

Hello,

I am facing unexpected difficulties in my transition and realize that I do need help/support from the community and those who are farther down the road. I'd value the opinion of more experienced folks on this:

I've been on T for a little more than 3 months now (low dose Testim gel). My doctor started me on gel at a low dose for fear that average dose injections would exacerbate my pre-existing mental health issues.

Turns out this happened regardless of the "safe" T regimen I have been following for the past 3 months. My depression and anxiety turned from a familiar, latent state that I had learned to manage and coexist with, to suicide ideation and panic attacks. For the past week it became so bad I felt like I was turning crazy and would not make it. 

My doctor took me off T for a week upon hearing that. She is just a physician's assistant and listened to my situation for less than a minute before taking this decision which, for her, means avoiding to be placed in a situation she is not qualified to handle, but for me, much more.

I realize that this regimen was not working for me, and I am willing to change it (it became unbearable). I can differentiate between my pre-existing mental health (I am "wired" for depression and anxiety regardless of exterior circumstances), the psychological effects of transitioning, and the direct effects of testosterone on my mental health. Being on T is what I need. I know this, and I am uncomfortable stopping although I had finally just started. I believe it does not have to be such a difficult experience though, and I was thinking that adjustments to my dose/delivery method/brand could make the ride smoother.

My question is: did anyone experience dangerous effects of T on your mental health, effects that are *purely* hormonal (not a result of your circumstances)? Is this a stage I have to go through and just "suck it in" until the storm passes and my body adjusts to the hormonal changes? Is there such a thing as not being "wired" for T? I used to think my brain was wired male, and therefore my body would react positively to being on T rather than E...

Has anyone experienced this? I need to be on T again (have been 2 days off), yet I cannot live with such unbearable depression and anxiety. Not to mention the fatigue, irritability, mood swings, etc. I experienced as well. Is there a solution? Meds, healthy living, dose adjustments...?

[Kreuzfidel]

I'm sorry to hear this.

I think that when you get into pre-existing mental health conditions and T, YMMV.  It gets complicated.  You can always seek a second opinion from another doctor in regards to perhaps adjusting your dosage vs. completely stopping T.  Are you seeing a psychiatrist at all?

I have only seen others (including myself) have positive mental health changes on T - which I DON'T think are "hormonal" for the most part, but are primarily psychological.  Maybe someone who has experienced negative effects can comment on that, but it's not common and I don't believe that having severe mental health issues is a physiological response to T at all.  It certainly isn't the "norm" and it isn't a normal "phase".

[Tysilio]

Leo, welcome to Susan's.

I'm sorry you're going through this.

I'd say your experience is definitely not the norm, and I agree that you need a second opinion. It sounds like you really need a provider who knows more about this stuff than a PA does. (And if she knows she's not qualified to handle your situation, why the [bleep] hasn't she referred you to someone who is??)

Is this PA also the person who handles your mental health stuff? Are you seeing a therapist, and a psychiatrist for meds? The latter arrangement is sort of the norm -- at least, it has been for me, and I also have a history of major depression. I don't know where you're located or what your access to health care is, but what you're describing seems far from ideal.

[Jared]

It might be the type of the T? I was on injections and gel too, but the gel isn't for me, I couldn't sleep. My doc said it was probably from one ingredient my body didn't like. How are you doing now? Could you find a way to get back on T safely?

[Mufasa]

Hi Leo, I started using T in 1990 and about a year ago I started having the same problem as u did. I went off T for nearly a year but was very emotional but tried to handle it. I went back to my doctor 2 months ago and he said I should try the new Nebido. What a difference from T. Nebido is a natural thing. Go and read about it. It did wonders for me and I'm my old self. Bit expensive but worth it. After injection it lasts for 3 months then you need your shot again. My testosterone levels are perfect and I'm feeling human. Go and read the articles of Nebido. Good luck. I know what you are going thru and its not nice!!

[Leo]

Thanks for the replies, guys...It's been quite the ride!

After that week off T, I went back to the PA and there was no convincing her, she refused to prescribe me any more T - or at least for a few months, until I get my "mental health in check"...which is quite unrealistic since, as some of you pointed out, the mental health stuff was something I have been dealing with for years and will not go away in a few months. She just freaked out and preferred not having to deal with me, I think. So I'm done with her.

Kreuzfidel and Tysilio: I do see a therapist, and I accepted to start taking Wellbutrin to stop smoking and possibly aid depression. If there is one thing I do care about nowadays it's my transition, so if not smoking and taking meds is what reassures providers so they feel safe prescribing me hormones, I'll do it! We'll see how that goes.

I found a qualified endo in the meantime, who confirmed taking me off T was not the solution. He gave me a prescription for the same regimen (Testim,  without hesitation...now I just have to deal with my insurance who just decided to stop covering Testim so it would be $600/box (instead of $15...). So if that doesn't work out, I might try a compound cream (apparently cheaper), or I might have to start injections.

Jared: I'm curious, what gel were you on?

Mufasa: awesome to hear you're doing great, and thanks for the encouragement...do you live in the US? Up until now I thought Nebido was only prescribed in Europe, I'll look into it if it's also available in the US

edited for dosages

[Mufasa]

I am in South Africa.

[Jared]

I was on Androgel. I know a couple of guys who haven't got a problem using it, but I had, so could you with Testim. I'm on Nebido too now, and I aggree, it's really good. I'm glad you found another doc who seems to be more professional.

[Declan.]

Hello,

I am facing unexpected difficulties in my transition and realize that I do need help/support from the community and those who are farther down the road. I'd value the opinion of more experienced folks on this:

I've been on T for a little more than 3 months now (low dose Testim gel). My doctor started me on gel at a low dose for fear that average dose injections would exacerbate my pre-existing mental health issues.

Your doctor's mentality strikes me as a bit odd. My partner and I both suffer from multiple mental health issues (depression and anxiety are only two of many), and we're on injections. Your testosterone levels are easier to maintain consistently on injections, and you can go on a low dose. There are also several ingredients in gels that can cause negative side-effects. Testosterone injections are just testosterone suspended in oil. It doesn't get much more bare-bones than that.

My question is: did anyone experience dangerous effects of T on your mental health, effects that are *purely* hormonal (not a result of your circumstances)? Is this a stage I have to go through and just "suck it in" until the storm passes and my body adjusts to the hormonal changes? Is there such a thing as not being "wired" for T? I used to think my brain was wired male, and therefore my body would react positively to being on T rather than E...

Not at all, we are both much better than we were prior to starting testosterone.

I personally think you need to be on injections instead of the gel. That said, I'm not your doctor - just echoing what our doctors have told us and the research we've done into different forms. It is possible that your mental health complications are a coincidence.

[SWNID]

I don't think your PA is providing good enough care for you. Taking away your necessary medication is apparently not helping your mental health at all. I suggest that you see a provider who is more experienced with trans people and has the compassion to want to truly help you.

My doctor started me on gel at a low dose for fear that average dose injections would exacerbate my pre-existing mental health issues.

This is not true either, because the transdermal delivery is only around ~10% as efficient, the amount you use is actually much higher than injection.
source: http://ftmguide.org/ttypes.html#gelcream

[Emerson]

I have severe anxiety. I have been taking: celexa, propranolol, xanax, and a sleep med for about a year before I started T. My anxiety did not increase on T. I use the injection. 

Finding a good psych regimen can be tough and takes a while.  If you need to figure out psych meds first, that sucks, but you gotta be healthy to be happy (I mean you obviously have to be on T to be happy too)

Maybe you can find a psychiatrist who will work with the endo? Psychiatrists are usually used to working with other doctors or therapists or whatever.

Wellbutrin can be a good med for some people, but I have heard that it can increase anxiety, especially at the beginning.

I took zoloft and lexapro, before celexa. It also took about 9 months to find an effective med combo.

[Leo]

Thanks for the support, guys...

It turns out that the depressive episode that made the PA freak out was more of a random chemical imbalance than directly related to T, as most of you suggested...I started T again with a new endo and I have been feeling much better for the past 2 weeks. For some reason my physical changes have picked up after the 10-day hiatus, so that might be one reason for my better mood, since the slowness of the process usually gets me down.

But who knows? There are so many factors involved in emotional stability. But at least now I realize that I have to get my mental health under control, precisely because it is a separate issue from my transition. Well, not entirely, but I mean that there are some chemical imbalances that T will not solve. And I don't want to run into the problem of being taken off T again just because of misdiagnosing.

I have to find a good regimen for myself, which probably includes medication (thanks Emerson). I know staying sober for a month has also considerably stabilized my mood. The self-destructive trajectory I've been on for the past decade doesn't make much sense anymore now that I am on a path of self-love, so my familiar crutches are just bad habits at this point, and I feel stronger and more able to let them go little by little.

I hope my situation can help others. Transitioning is hard. Being transgender is hard. I still don't understand how "preexisting mental health issues" can be a hindrance to accessing HRT, because I can't imagine how one can be perfectly serene living as a trans person in this society. I'm assuming all transgender folks have dysphoria at the minimum, and that's already such a pain and obviously leads to depression/anxiety etc. My doctor reacted to her misconception that T was causing me harm, when in fact, a. I most probably have an unrelated chemical imbalance b. Transition is hard - not because it is the wrong thing to do, but because it's so difficult and requires a lot of strength. There are so many things involved, so many challenges that are unrelated to T - such as self-acceptance, patience, facing discrimination, etc. - that it's unrealistic to expect us to be 100% peaceful. Or at least for those with a more anxious nature, since anxiety blows things out of proportion...

I guess my point is that transition is hard, and we know that right from the start. The waves that will come in our path are expected, although we can only find the skills to overcome them when they show up because they are new challenges we haven't experienced yet, but these waves in no way make the path less worth it. It's easy to be overwhelmed by the challenges, especially when mental health troubles double their intensity, but we have to stay strong and take some distance, to see that they are only waves and that the sea gets calmer at some point beyond the turbulent waters. I'm just a newbie, and from what I've learned in only 4 months, I can only imagine how much the more experienced guys have learned. But I'm just using this brief respite from the constant fog in my brain to put this out there in case it can help some of those who tend to feel hopeless like I do...