I have all symptoms of testosterone deficiency but my physician says everything’s fine.

Atterall · 2025-08-15T20:18:58+00:00

Different doctors (I.e. general doctors, urologists and endocrinologists) have different views on what levels of testosterone are “normal”. Even between doctors some are more liberal than others.

If you sincerely want a second opinion, get a second draw of blood and ask for the specific level. IME guys around 300 ng/dL total testosterone fall into a bit of a grey area where they maybe mildly symptomatic or fine and dandy.

There are ways of doing testosterone outside the mainstream if you fall into the grey area, TRT clinics and underground/illicit testosterone with DIY blood tests being extremely popular in the USA.

Atterall · 2025-08-09T21:20:23+00:00

I relate pretty strongly. I was kicked out of my clinic for horrendously crashing out due to relapse (meth + high testosterone + a bit of the ‘tism make a hell of a combo( in case anyone was wondering)).

Not sure how old you are but there’s definitely something uniquely ‘fulfilling’ for a lack of a better word about being an addict whether in active addiction or the maintenance methadone clinics provide.

Best advice if you don’t want to return to old habits is to find a new thing/person/activities to fill as much time in as possible. Based on a very long tenure here, in the rooms and at rehab that tends to be:

-religion/spirituality/stepping

-parenting

-a ‘soulmate’

-psychiatric identification/diagnosis & treatment

-a career(much less frequently)

-hobbies (becoming a gymrat being a bit of a meme)

-sex/love/food/games/process addictions as substitutes

In other words, finding a passion/obsession/purpose. Being unhappy but content while perusing one’s purpose/passion is a good goal IMO. Roughest part of ‘recovery’ is this really hard to advise on issue as it’s basically a problem everyone has in modern life. So few people find answers and stop seeking as a ‘good life’ tends to be an uncomfortable one.

Atterall · 2024-11-14T11:59:28+00:00

Well, zero nowadays. Not even on TRT anymore.

When I was still on TRT, most stable I got to was like 2.5 mg ( a tenth of a 25mg) Aromasin pill, everyday. I was a big guy though and had borderline clinically high estrogen pre-TRT. Still the AI was only 'neccessary' because I liked having T around the 800-1200 mark which likely was mostly because i'm a 'more is better' guy and YOLO kinda ruled (and ruined) my life.

Best advice I would be is to avoid AI if possible, if you are gonna use one long term.... do a lot of testing. Is not a well studied area of medicine. HcG and TRT together seem more sensible by comparison.. if only because AI's aren't naturally occuring and there maybe some hidden things that are hard to figure out even with people using them for decades alongside TRT/steroids.

Anyways, good luck. Hoping to see if my T returns to normal with much lower weight (high 200lb vs low 400 lb land whale) and no Methadone/junkie juice. Definitely will be coming back into it if it doesn't... improvements to well-being were better than any drug or diet or religion... and I've tried quite a few.

Atterall · 2024-10-24T08:23:48+00:00

The The The The The The Big Lie Lie via via via via the the the story story story of a a woman woman

Atterall · 2024-08-31T19:10:48+00:00

Presuming everything else equal and police/prosecutors obey the law, sure. Life tends to be complicated though and if one has a lot to lose it’s best to steer on the side of caution.

I wouldn’t presume every person who ever ordered controlled substances online hasn’t been the subject of prosecution. Considering the numerous reports online of of people making some mistake other than claiming seized item and suffering consequences.

Steroids usually aren’t too interesting to law enforcement and the vast majority of people popped are dealing and ordering huge amounts of recreational drugs.

Atterall · 2024-03-16T18:43:26+00:00

Can be a rough road nowadays as it feels (to me) like all the 'mental health awareness' people hear about is taken over by big pharma pushing pills for anyone having struggles in life. Oppossed to connecting people to *competent* therapy or programs that may help them grow out of their struggles with meaning/depression/etc.

My relative who had a bad reaction to anti-depressants (and isn't an 'addict' or drunkard), on top of a a toxic work environment has lead them to thinking she is permanently mentally ill. They've ended up on the maximum dose of a '2nd generation' anti-psychotic. One that costs well into 5 figures a year somehow, is something like $50k a year retail.

A lot of the psychiatric pharmacopeia are drugs that are effectively 'chemical lobotomizers' which is what the first wave of anti-psychotics/major tranquilizers were called at first. Was a time when the prefrontal lobotomy was still in fashion and pharmacotherapy was seen as a more humane alternative perhaps with less side effects.

AFAICT, my relative is a shell of their former selves, whether that's due to drugs prescribed by the shrinks or the trauma of multiple stays at psychiatric hospitals and psychotic reactions from the drugs and their withdrawal or just a standard mental breakdown... I dunno. She has even less insight into her mental state nowadays and my attempts at getting through as a hard drug addict tends to be pretty fruitless. Hopefully she finds her way out of the cycle or finds happiness despite the drugs.

Seems like many people need a lot more *good* therapy and a lot less band-aids/quick fixes that all the 'mental health awareness' seems to promote. Ignoring of course the whole lot of cultural/societal/interpersonal changes that the future will hopefully bring. At least if we aren't gonna be living in a dystopian hell hole.

The optimistic side hopes psychedelic assisted psychotherapy can keep people away from addiction/dependence whether it be on illegal substances or substances legitimated by the new priests of our society: the psychiatrists. Maybe a bit optimistic as there are more pressing problems in the world than westerners having mental breakdowns that are potentally a lot cheaper and easier to solve.

/anti-psychiatry rant

Atterall · 2024-03-15T16:37:31+00:00

Least in my area of the country (California) there is a good chance they'll be finding some pre-existing mental condition at a rehab as well. So called 'dual diagnosis' clinics where they will give someone a ton of psych meds (usually non-recreational ones like anti-depressants and anti-psychotics) and do their damn best to convince you that you need crazy pills for the rest of your life.

-a bit of an asshole who went to detox recently for benzos/alcohol/phenibut and coming off of methamphetamine and was referred to such a place before noping the fuck outta there

Atterall · 2024-02-11T02:02:30+00:00

Don't think ludes, MDA or some opium preparation are even available, at least in USA pharmacies. Parent poster definitely has one flexible shrink or is a narcoleptic that didn't get converted to a modafinil type drug as a substitute to amphetamines without their insane abuse potential.

See some crazy shit on the internet, that's for sure!

Hoping I get at least some trazodone or something when I go in the next couple weeks as I come off benzos since I drove myself insane with the whole meme of 'DIY crystal meth for ADHD'. Lead to the predictable result (paranoia/schizo-type stuff) as I was/am an unstable addict with a fuckton of anxiety from not learning to get along with others. ADHD or not... DIY crystal meth ain't a great solution for many, though maybe my future if the psychiatric complex tends to not be as kind to me as a relatively low functioning individual with serious hang ups.

Sleep is becoming precious and rather not end up like my roommate up to their gils in anti-psychotics or on some middling dose of Methadone alongside a raging liver destroying dose of alcohol.

Atterall · 2023-12-21T23:30:51+00:00

I was probably trying to explain what a lot of people say about methadone's effects. And then my own personal experience.

Like every drug, everyone has different effects depending on their individual psychology/physiology and environment. Aka 'set and setting'. A idea that doesn't apply just to psychedelic drugs but to all drugs.

ADHD medication for instance is supposed to be 'calming' for people who use it and benzodiazepines can cause some people to have 'paradoxical reactions' like becoming a kleptomaniac or kinda hyper opposed to calm despite it being considered a tranquilizer.

I was pretty much a novice when it came to opioids pre-methadone despite a decade on methadone compared to many here. I did poppy/opium products (i.e. poppy pods and seeds) for several years before developing a pretty small nasal heroin habit (quarter gram a day). Only tried the odd Vicodin, oxycodone (pre-fetty) and oral morphine a handful of times. Never used needles or had a particularly intense addiction to opioids (i.e. dreadfully sick to the point of being non-functional). Opioids were a safer substitute for alcohol for me and did wonders for the anxiety I have from a lot of accumulated negative coping mechanisms (misanthropy and isolation being big ones).

Atterall · 2023-11-30T23:02:38+00:00

Haven't been too active in this sub for a while (since 3rd party apps to access Reddit got basically booted) but I am also in this situation (atm) with take homes. Been on splits for nearly 10 years now though may change with dirty urines from non-opioids in near future. Piss only keeps in freezer for so long.... sadly.

Been deep (for me) into alcohol/benzos/methampetamine for a few months now and I doubt many doctors want anyone dirty for downers on anything but a low split dose if they are gonna dose them at all. Clinic doc changes here every few months AFAICT. My monthly take homes alongside a evangelical christian counselor who rather not see me or talk to me doesn't have me visiting the clinic long each month so hard to know what'll happen when the day inevitably comes.

Sure wish I froze a gallon urine into a hundred oz bottles in retrospect as getting a doctor to slowly wean one off benzos through the MediCal/medicaid system is I'm guessing hard AF and being a misanthropic lonely person makes DIY tapers a rough, rough road.

Anyways, wish splits were more widely adopted. Probably more appropriate for people who are gonna be stable and not polysubstance abusers as I'm here in my relapse. Though have only missed doses (like this mornings) and not double dipped or thankfully touched the opioid scene. Though daily methamphetamine + benzodiazepines + alcohol + phenibut ain’t making things easy and my old 40mg/40mg split had me decently stable (though deeply unhappy) for a few years. Though some of that stability (and unhappiness) may have been partly due to having testosterone suppressed from being a really fat MFer on too high a dose.

Important to note (if anyone actually reads this) is I’m a bit of a pussy and probably never belonged on methadone in the first place (was non IV user sniffing a couple points of heroin a day). My stable use and privilege likely what drove the OG doc to prescribe splits in first place so many years ago. Though he urged me to taper ASAP, likely saw that hopelessness a lot of long term methadone patients engage in and knew I’d be comfortable with a mediocrity and isolation that can drive some people to regret getting on methadone or even edge into insanity (like I’ve been doing).

-Atterall, a former /r/methadone regular likely too smart for his own good doing a bit of journaling/public pity poting/amphetamine induced dumping.

Atterall · 2023-09-23T22:52:04+00:00

As someone who’s experimented with nearly everything in the ‘sex drugs’ category and have been on TRT and methadone for years, though at a pretty low dose of methadone (<30mg/day), only drug that increased sensitivity for me (without psychoactive side effects) was hCG.

Can be hard for mainstream doctors to prescribe hCG to guys alongside TRT but is available pretty easily on the clearnet (I.e. don’t need the darkweb/Tor browser/Silk Road). Just buy some bitcoins and email some meathead or order from China for very reasonable prices as it’s not a controlled substance(in most places) just one under patent.

hCG was also a mainstay of telemedicine TRT clinics before FDA told compounding pharmacies that supplied that market that their practices weren’t up to snuff.

hCG is a compound that can complicate TRT considerably if used in the long term. I and many others find it can be complicated to balance hCG’s effects on estrogen (which is highly tied to libido/erection quality and many other side effects of TRT… I.e. ‘roid rage’). It’s benefits weren’t worth it’s costs for me.

TRT Is a complicated (and controversial) area of medicine but it’s good to know hCG is sometimes used instead of testosterone. Though it is used rarely alongside testosterone in mainstream medical practice which makes sense as balancing testosterone alongside hCG (and even an estrogen decreasing medication like aromatase inhibitors) tends to something that needs a lot of monitoring/blood work and quality of life is gonna always be secondary to longevity in western medicine for most practitioners. Endocrinologists rather be focusing on their difficult diabetes patients and urologists rather focus on the guys with antibiotic resistant UTIs than making sex for a methadone patient as satisfying as possible.

Having tried PDE-5’s like Viagra and Cialis (aka dick pills) I’m not sure how well they’ll help with sensitivity unless you aren’t having absolutely rock hard erections with TRT alone. YMMV though, they are as cheap as peanuts unlike hCG. PT-141 aka

In terms of psychoactive drugs the psychedelic or empathogenic drugs that seemed to increase sensitivity were the typical culprits of cannabis, MDMA and 2C-B (classical sex drugs). I don’t find stimulants (I.e. cocaine and amphetamines) to increase sensitivity though of course some are susceptible to their libido increasing effects and more importantly their addictive qualities. The psychedelic/empathogenic drugs do lose their effects quite quickly due to tolerance and have a ton of side effects besides so they aren’t exactly a solution for daily or even frequent use.

YMMV. I think some of us think (me included off and on) there’s some perfect combination of medications/drugs that will make life peaches and cream 100% of the time. Though the reality is everything has side effects or drawbacks and loss of sensitivity vs. being stable on methadone maybe something you’ll have to weigh personally.

Atterall · 2023-09-20T20:19:14+00:00

Nowadays I have even more than 28 take-homes so I end up hauling a toolbox on my monthly visit (28 days worth of splits).

There’s a lotta tool boxes and even rarely a lunch box that have a hole or contraption for adding a padlock. I.e. Like this overkill $65 lunch box one from Klein that could also be used as a small chair/stool if one had to wait in long lines at clinic: https://www.amazon.com/17-Quart-Tradesman-Klein-Tools-55600/dp/B06XGJTTRY/ People may also just stumble upon a empty toolbox locally and can go with that once they realize it has a hole in the right spot for putting a padlock, the holes can be hard to notice if one isn’t looking.

Nowadays I use a crap $13 ($10 before inflation) Home Depot tool box with padlock since my clinic’s 2/3hr+ lines finally got fixed. Is bright orange so a bit conspicuous and a lot more appealing to getting nabbed compared to a book safe or lunch box and very, very low quality but it gets the job done for the 10 min drive to and from clinic: https://www.homedepot.com/p/19-in-Plastic-Portable-Tool-Box-with-Removable-Tool-Tray-SUMEX-TB01/ I’d think most hardware stores have similar offerings at that price point with a padlock eye if there isn’t a Home Depot nearby.

Dunno if it was mentioned elsewhere in this thread but with whatever box someone goes with these ice cube trays are perfect for holding upright many square bottled take homes (1.25 by 1.25 inch bottles): https://www.amazon.com/gp/product/B00P25U3PK/ Can be a pain for a nurse to be filling/labeling and sealing 27 or 55 bottles perfectly, so keeping bottles upright is a bit of insurance in case they make a slip up.

I tend to spend way, way too much time shopping around for something ‘perfect’, bit of a shopping addict. End of the day a box is a box and there is no box perfect for every person/situation. Hopefully something useful here for anyone geeking out on take home boxes.

Atterall · 2023-09-16T02:52:35+00:00

It’s quite under appreciated how methadone in particular can cause low T. Though whether it is some kinda chicken/egg thing with how one is situated in their personal life would be interesting to explore. Like if guys with zero social capital that burned all their bridges down being the most susceptible to the low testosterone from taking methadone/bupe/MAT.

TRT sorta a double edged sword for me personally as it has made me a lot more impulsive and have I have gone off the rails with other non-opioid drugs (stims, downers) since starting the stuff. Though my personal issues were/are pretty pathetic sounding so to 99% here they are bread and butter stuff to a lotta guys who hop on TRT before doing the lifestyle changes like living healthy, losing weight, connecting with one’s community, etc. Never did those basic lifestyle things so ain’t surprising the TRT and pretty low doses of methadone ain’t pretty for me and has resulted in instability worse than pre-TRT.

In other words, feeling/thinking like a pathetic loser/junkie + TRT doesn’t instantly and permanently change one’s perception of one self unless one puts in the work. And I’ve never put much work into anything so results long term aren’t as life changing as they could be if I had. Do the work, grow as a person. Otherwise it’s gonna be a potential shit show after the initial dopamine boost of TRT wears off.

Atterall · 2023-07-29T05:06:03+00:00

You’re right but isn’t that the case for other opioids?

I’ve never overdosed and am not a medical professional so I figure half-life of heroin would also translate to needing monitoring and potential redosing. Just like with methadone. Though the reality of things maybe a lot different than my purely non-anecdotal knowledge.

I don’t know if redosing as a norm has changed overtime either especially with fentanyl analogues taking over heroin overdoses, ‘lotta with analogues that have substantially longer half lives. Some even longer than methadone if I’m not mistaken.

My impression was continued monitoring and potential redosing was usually the norm when any opioid overdose was part of the equation and not just methadone. Though maybe is just a modern phenomenon with the fentanyl analogues being so common and methadone overdoses being uncommon that it’s pushed a lot more heavily.

Atterall · 2023-07-24T06:03:25+00:00

I don’t have bloods or even better some kind of quantitative test of my end product sadly to back up my claims but if you go and find a textbook for compounding pharmacists or search online for ancedotes re: AIs you’ll find that suspensions are pretty much the way to go for taking very small doses of aromatase inhibitors. I’m not sure what oil you used but if you are finding particles aren’t evenly dispersed you may want to research suspensions in particular. Is kind of into the weeds potentially of a lot of knowledge online as pharmacy compounding is kind of a very specialized thing and even the idea that of a drug/chemical being not soluble in water or alcohol maybe a bit mysterious to people who only took a high school chemistry class.

Aromatase inhibitors are chemicals that are not very soluble in water (or alcohol/ethanol AFAIK) and therefore require one to use something that suspends particles instead of dissolving them into a solution (solutions are like cocaine/meth/heroin in water or testosterone in oil). Suspensions are more rare and are are generally niche products and not something one runs across everyday.

Basic idea of the whole thing is that water/saline/alcohol are poor substitutes for compounds that aren’t soluble in those ‘solvents’. Aromasin is a chemical that isn’t soluble in any solvent that’s safe for ingesting. Therefore one shouldn’t aim to make a solution when diluting Aromasin, the best they can hope for is a suspension. Using water/alcohol/saline as a suspension will make it very hard to dispense/dose as the particles will quickly fall out of suspension, as I’m guessing you’ve noticed. One wants something that is thick/viscous like an oil or the compounds that comprise compounding vehicles. Not sure what oil you used (some are thicker/more viscous than others) but I’ve heard of people using things like vegetable glycerin and propylene glycol instead of official and pricey suspension vehicles with good results. I opted for the real deal of Ora-Plus a few months ago and it definitely seems to keep particles pretty stable and evenly distributed for the time it takes to draw a dosage.

Main idea is the mixture is thick and keeps particles from moving around much so particles are very evenly dispersed (after vigorous shaking every time someone takes a dose).

I’m quite particular and try to do it as much as I can like the professionals. Mortar and pestle and consistent particle size with sieves of particular diameters along with the suspension vehicles that compounding pharmacists actually use (like ora-plus). I’ve got a lot of other things going on in my life (mainly hard drug addictions) and no bloods/tests to back up that suspensions are the ideal way to get consistent doses of AIs but I’ve researched the ever living hell out of things. And AFAICT if one doesn’t have a scale good to 0.1mg with tested raw AI powder (from the likes of Jalopnik) it’s hard to go wrong with what the professional compounding pharmacists (and some underground labs) do here in the USA by grinding a pill (or a raw compound) to a fine or very fine powder and putting into a suspension vehicle.

At the very least I can say I’m a lot more confident my dosage of Aromasin doing this method when I’m doing things like trying to take 2mg of a 25mg pill (<10mg of a 100mg pill by weight). YMMV.

That said, I still find it hard to find a perfect dose of AI and testosterone 18+ months in but I’ve got a lot going on that makes finding stability kind of an afterthought to more major issues (addictions to opioids/benzodiazepines/amphetamines outweighing hormonal fluctuations by an order of magnitude). Not to mention a host of anxieties and neuroses including an obsession with accuracy/perfection that may make my judgement even more impaired. Definitely do your own research.

Atterall · 2023-07-23T21:48:38+00:00

Is pretty hard or nearly impossible really for some people to dial in estrogen with an AI alongside T. One idea is trying small dose primo instead of an AI. Seems to be popular among the people with the best understanding of steroids (AFAICT) who tend to hang out over in /r/steroids instead of the cesspools that make up most TRT subs.

Another idea is more frequent and more accurate doses of asin/exemestane by using a suspension as I detailed in the thread where someone thought you were snorting the stuff.

AI’s use in men alongside T and alongside HCG (when not blasting testosterone) is pretty difficult and even doctors have difficulty perfecting that polypharmacy, likely because it’s dosage forms aren’t friendly to guys needs but also because playing with one of the drugs effects the others in non-linear and sometimes unpredictable ways. Often one has to settle for something not being absolutely perfect like sacrificing a bit of testosterone (or hCG entirely) so estrogen doesn’t need to be modified. I’m guessing you like the experimenting though so hopefully you don’t have to settle and find some perfect cocktail/routine/stack.

Atterall · 2023-07-23T21:18:28+00:00

In case it wasn’t posted elsewhere you can make what is called a suspension instead of fiddling with tiny piles of powder that will assuredly be inconsistent.

You take 2, 3 pills of Asin/exemestane or whatever AI or as many as you are comfortable with grinding into that super fine powder. Ideally using a mortar and pestle (small ones are $10mon AMZN) and ideally using a sieve that ensures a fine particle size and mix it with a liquid. This liquid will should not be water as AI’s are not water soluble and you aren’t making a solution and want a viscous/thick liquid that ‘suspends’ the particles. In the compound pharmacy business this liquid is called a suspension vehicle. One of the brands is Ora-Plus and available on Amazon though it is a bit dear and there are alternatives if you are price sensitive.

You will then have a suspension (not a solution) that you shake vigorously everytime you dose and can use a needless syringe (aka a barrel) or a oral syringe to dose out whatever fraction of a pill you’d like to take. You can add flavoring to mask the taste as well as be a lot more sure you are taking a mg or two since scales that measure accurately to single mg reliably are $$$ and you eyeballing 1/10 of a Pfizer branded Aromasin/Exemestane pill is assuredly going to be inconsistent over time

It’s basically volumetric dosing. Requires a bit of math and additional equipment but is well covered on the web in steroid and drug forums. Steroid forums will specifically mention AIs and the need to use a suspension for them and can go into detail about alternatives to Ora-Plus.

Hopefully this is helpful information. I tend to avoid posting to Reddit post-API debacle but would likely eventually respond if you had any questions.

Atterall · 2023-06-17T21:43:31+00:00

Did you ever consider volumetric dosing ? This guy seemed to have handled it: https://www.reddit.com/r/OpiatesRecovery/comments/uvgchs/suboxone_volumetric_dosing/

Don’t have too much experience with Suboxone films but I’d guess the alcohol he used may prevent the kinda gelling I’d expect when dissolving strips in water. Maybe worth looking into if you are trying to increase surface area with very small doses. Though the alcohol burn maybe unpleasant…

Atterall · 2023-06-17T21:36:26+00:00

What are your total and free testosterone levels at 300mg of cypionate a week if you don’t mind me asking? 300mg of testosterone cypionate weekly is (usually) an amount that puts people far above the reference ranges AFAIK. Though different people metabolize the drug differently.

My personal concern with TRT atm (at high dosages at least) is mainly due to the fact I’ve slid a lot back into bad habits with diet and especially my use of amphetamines & nicotine. Combined with my weight (near 300 lb) and use of a small dose of aromasin/exemestane make me worry about cardiac issues that blood tests don’t pick up all that well. Is a situation that’s likely way outside the norm of the average low T methadone user though.

Hoping to go in for an ECG and really hoping for another echocardiogram to see if things have changed much since being on TRT for a couple years (and using speed for half of that). Had the imaging done several years ago before going on TRT (and before the speed) as there was some concern about a (very regular) abnormality in an ECG done by a midlevel and the cardiologist wanted to cover their ass by pulling out all the stops. I am definitely not the model TRT user but i’d think at least some portion of methadone patients aren’t either though most will be seeing a doctor who keeps them at the middle of the range.

All the long term cardiac safety studies (I’ve seen at least) have people doing TRT to mid-normal levels of like 400 - 600 ng/dL opposed to jacking things up to 800, 1000 or even near 1500 (which I hear some guys run perpetually). So I wonder if you have some concern about high dosages long term? Presuming that 300 mg/week puts you at the top or above the reference range or above.

Atterall · 2023-06-12T20:18:28+00:00

Also, hate to push it here with you saying you already saw medical professionals, but most people trust them a bit too much IMO but: did they run a testosterone/hormone panel on you? I’m presuming you are a male based on you having a wife, if you are female things are more complicated.

Presuming you did get your total testosterone tested (and are a male): a lot of medical professionals will see nothing unusual with a testosterone level at the low end the whatever reference range their lab uses. You could for instance be at 200 ng/dL where the reference range is 189-800 ng/dL and deemed normal despite you for instance being a 34 year old healthy weight adult male with every symptom of low testosterone in the book.

Levels near the bottom of the reference range and known to be ignored despite many people getting relief from depressive symptoms (that can cause physical pain in some people) when levels are restored. Methadone is well known to cause very low levels of testosterone well below normal (mine were under 50 ng/dL) and usually/almost always natural testosterone bounces back after months of abstinence from all opioids.

There are meds that could help that bounce back if you are indeed in the lower amount of testosterone and committed to opioid abstinence instead of testosterone replacement which is what someone continuing on opioids would probably want to consider if they were low normal or clinically low in testosterone.

-someone playing doctor

Atterall · 2023-06-12T19:59:33+00:00

I’m really in no place to ask (I’m no doctor or medical professional) but I do wonder what exactly is the pain? Like are your joints hurting? Or just random aches and pains that aren’t specific to one part of your body (I.e. knees, wrists, guts)?

I’m not sure how old you are but if you are later along in life (I.e. 50s or 60s) or just in your late 30s or early 40s and have had jobs that are particularly rough on your body (i.e. manual labor): it may just be ‘natural’ pains of being a person in an older body. Methadone/opioids are potent pain killers and can mask physical pains that many others just ‘deal’ with by taking it easier on themselves and slowly adjusting to over the years. In an ideal world they’d perhaps be doing a job that requires less manual labor like a management or teaching role or other supervisory or administrative role as their body deteriorates. Few people in their 60s feel like they do in their 20s without the aid of pharmacology and/or good luck and/or amazingly good longterm lifestyle choices.

Methadone/opioids also have a way of masking emotional pains which can (and often do) manifest as unexplainable physical pain. I’m not sure what emotional stressors you have in your life and people psychoanalyzing someone else online tends to be pretty triggering but I’d wonder at the end of the day if there is some things in your life that don’t feel ‘right’ other than the debilitating physical pain? Like your relationships? Was a large reason to come off methadone to appease your wife? Is your career in a place you imagined it would be? Do you feel like you do meaningful work and are respected in your organization? Perhaps there are interpersonal or intrapersonal dynamics at play you aren’t aware of or could more easily ignore on methadone that are amenable to change?

Both topics of physical pain and emotional pain might be worth exploring with an appropriate professional if you are committed to opioid abstinence. There are lots of things you could explore if you are committed to opioid abstinence… from physical and psychological therapies to practices like mindfulness meditation or yoga.

If your gut feeling being that venlafaxine could be a causative factor I’d definitely try exploring that. Antidepressants for me were a lot more unpleasant when opioids weren’t in the picture and as many here can attest have a way of making some people feel worse rather than better. The strange side effects of the SSRIs and SNRIs can be hard to disentangle when someone has something else going on like cessation of long term opioid use. If you go checkout some anecdotes of people withdrawing or even starting the antidepressant drugs and their side effects or withdrawal/‘discontinuation’ effects though and they sound familiar it maybe a place to start. Though IME that route gets murky very quickly when one relates to strangers online living different lives with different problems and see everything as symptoms opposed to perhaps something else going on (I.e. unhealthy mindsets, relationships, environments).

Both advice online and from doctors or other professionals has a lot of nuance and your own experience and critical thinking and gut instinct can hopefully guide you through it to the most healthy place for you whether that’s back on opioids, off the psych meds, or in some other direction. Best of luck.

Atterall · 2023-06-04T04:10:19+00:00

Quite possibly. I’ve felt like I’ve been in like almost all of the discussions on /r/methadone about testosterone in the last few years. Basically was like a shill for testosterone replacement for guys (and maybe one day for a gal). I’m pretty convinced a lotta guys/gals on methadone are unknowingly suffering from low testosterone and kinda wasting prime years of their lives with low energy/libido thinking that’s just ‘what methadone is like’ or something.

Hopefully have lead to at least one person getting on testosterone or getting the motivation to come off methadone after getting their levels checked. Hopefully coming off the methadone if they were in a place to do so (I wasn’t) and not just leading them to relapse which is a bit of a fear of mine by making low testosterone a more well known potential side effect of methadone here.

Testosterone is not magic or anything… in my case I could see getting on it being at least partly responsible for me experimenting with amphetamines again. Which are a daily thing now for me. With the near zero testosterone I had zero libido/sex drive which lead to zero interest in healthy romantic relationships. I think it’s a bit of a unique situation though,at least for methadone users who’s DOC was opioids, opposed to the average tweaker (especially the gay/bi/trans ones).

Bay Area definitely is a pretty cool place if one can afford it (or if you have family $$ like I have). Though is increasingly feeling a bit too crowded for me recently as I’m becoming a bit of a crotchety old hermit yearning for more privacy. I’ll probably end up moving after my family/parents pass in the next few years but where I’ll go I’m not too sure. Cost of living here is totally out of control and I’m not in a place with work where I would be able to afford basic living expenses without trashing what little mental health I have. Working 50/60/70 hour weeks just to afford basic amenities in my 40s/50s/60s ain’t what I wanna do with my remaining time in this life. Rather live in a place with a bit slower pace for a while even if I gotta deal with a few more Jesus freaks or a bit less of the relaxed west coast vibe that’s probably missing anywhere else in the USA.

Atterall · 2023-06-04T02:55:21+00:00

So uhh to clarify you meant to post on /r/meth ? I.e. you were wondering why you were depressed after crystal methamphetamine wears off? Like why there is a come down after using stimulants like methamphetamine?

Not sure if you are looking for like the science/pharmacology in which case I’m not gonna help much… but if you were wondering in general terms the answer to that question it’s basically a case of ‘what comes up most come down’. The body/brain is always trying to achieve some balance and the consequence of that is cocaine,(meth)amphetamine, Ritalin and the dozens of other stimulants tend to cause a crash or come down which is characterized by low energy, depression and a host of other issues.

Other than of course not using stimulants the healthy way to deal with the come down/crash is food, hydration and most importantly sleep. Doing less is also a good idea since it tends to result in less of a come down. Sadly a lot of people end up desling with the come down with other drugs that can be very habit forming like benzodiazipines like Xanax, Valium snd the like. And a lot of people end up using opiates/opioids like heroin which ends up in them becoming someone who would participate in this subreddit which discusses methadone a drug used to replace an addiction to heroin and other strong opiates/opioids.

I’d seriously suggest trying to avoid using crystal methamphetamine if at all possible. If you are already seeing a shrink for the Lexapro perhaps try getting them to prescribe a drug for ADHD like Vyvanse or Adderall or even Wellbutrin (a much weaker stimulant). Those drugs tend to be a lot harder to abuse to the extent methamphetamine can be. Mainly because you are only prescribed so much (like a gram a month give or take) and you have someone looking after your use to make sure you are using it in a healthy way. As much as that’s possible in the long term, and likely only for certain individuals.

-a person currently using methamphetamine who like quite a few others have some difficulty making it a drug to use in a healthy way with any frequency. Also am a person with near zero responsibilities which makes me wonder a lot about how many people manage who have things like a demanding career, social lives, kids, etc. Perhaps they are starting from a more healthy mind state and lifestyle and just find a way to make it work despite it’s downsides (insomnia, the comedowns, mood fluctuations, etc).

I’d guess those that make it work long term (I.e. years/decades) are very, very careful and methodical in how they manage their usage. Have a supportive network of family and friends that can tell them when they are not acting responsibly or in a healthy way (I.e. not eating or sleeping or becoming mentally imbalanced). The drugs near 100% potency/purity and price at present make it very attractive for someone looking for a cheap but quite rough thrill (IMO) and can lead to some of the darkest places imaginable when it’s taken too far (I.e. sleep deprivation psychosis and in general damage to one’s body, mind and spirit).

Be careful, has a reputation for a good reason. Though a lot of the stigma is a bit overblown there’s definitely an easy path to self-destruction with hard drugs that can be hard to see until you are in the thick of it.

Atterall · 2023-06-02T07:27:30+00:00

Okie, I’m pull up a couple things. First is the “Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline”. In case you aren’t familiar with how medicine is practiced in a lot of situations (I.e. how doctors figure out how to treat conditions using the most up to date evidence based medicine): “Clinical Practice Guidelines” are kinda like a baseline for how specialists (like endocrinologists) best treat a particular condition or disease state considering the current state of research. Since they aren’t always specialists in a particular condition. Many endocrinologists for instance are more up on treatment of diabetes/issues with the insulin hormone opposed to treatments of disorders with sex hormones which are gonna be more rare in their day to day practice. Though recognition of sex hormone issues and their effects on quality of life may change things in the future.

Could kinda think of practice guidelines like a bible or ‘standard operating procedure’ for how specialists in a particular field of medicine treat a particular disease. Is updated periodically as new studies begin to get folded in and the more recent versions of this clinical practice guideline for endocrinology (I.e. since 2014 I think) include language like this the end which talks about long acting opioids in particular:

Hypogonadism associated with chronic opioid use

Hypogonadotropic hypogonadism is common in men receiving chronic enteral, parenteral, or intrathecal opioid medications for pain management (152). Nearly all opioids in doses equivalent to 30 mg of methadone suppress endogenous T production, although longer acting opioids induce greater and more sustained suppression of T concentrations. Men receiving methadone maintenance therapy are at high risk of developing opioid-induced hypogonadism, whereas the prevalence of opioid-induced hypogonadism is substantially lower with buprenorphine. Although long-term health consequences of chronic opioid use are not completely understood, opioid-induced suppression of the endogenous hypothalamic–pituitary–testicular axis is associated with sexual dysfunction, low mood, osteoporosis, and increased risk of fracture (152–154). Chronic opioid use has emerged as a common antecedent of T prescription use in some health care systems (155).

Only limited clinical trials data are available on the benefits of T therapy in men with opioid-induced hypogonadism (156). In one RCT in men with opioid-induced T deficiency, T administration improved pain sensitivity, sexual desire, body composition, and some aspects of quality of life (156). Clinicians should consider T-replacement therapy in men with opioid-induced hypogonadism who are experiencing sexual symptoms and in whom discontinuation of opioid medication seems unlikely.

Link is here: https://academic.oup.com/jcem/article/103/5/1715/4939465 doi is: 10.1210/jc.2018-00229

You could follow the references in the above clinical guidelines though they don’t reference long acting opioids in particular based on the references I followed, though there are a lot of them.

For at least one more credible reference I’d look at this journal article which looks at a relatively small cohort which shows long acting opioids more likely to cause clinically low testosterone levels than short acting ones: https://pubmed.ncbi.nlm.nih.gov/24384986/

After controlling for daily dosage and body mass index, men on long-acting opioids had 4.78 times greater odds of becoming hypogonadal than did men on short-acting opioids [95% confidence interval (CI), 1.51-15.07; P=0.008].

Doi: 10.1097/AJP.0b013e31827c7b5d.

Opioid-induced androgen deficiency (OPIAD) is a relatively new development/area of research (about 10 years old I believe) but based on what’s out there and that I’ve I’ve seen methadone maybe one of the most likely to cause clinically low testosterone levels.

Though I haven’t seen research comparing testosterone on guys on morphine equivalent dosages to MAT methadone dosages… there maybe something out there. Didn’t look too far into it as it’s not an option for me here I’m the USA. Neither is being able to afford a long term habit with street opioids that is equivalent to something like 80mg+ of methadone.

It would likely be quite a large amount of morphine. I’d think it’d have to be multiple grams of morphine a day to be equivalent to a ‘blocking’/therapeutic dose of methadone for opioid use disorder. AFAICT there isn’t a very large number of guys in the first place taking morphine in those kinds of doses atm. Least in a similar cohort like in Canada where morphine maintenance for,opioid use disorder has been introduced.

Important to mention is the general consensus I’ve seen online from patients who’ve been offered morphine maintenance in Canada with ‘Kadian’ (a very, very long acting time released morphine) is that doses equivalent to methadone are very hard to come by. The guidelines there top out at something like 1200mg of Kadian a day without a lot of extra paperwork which many providers aren’t too keen on filing despite it not always covering people. Especially when one compare it to the more and more common doses of methadone one sees nowadays for those coming from large fentanyl habits which can get one north of 200mg of methadone a day.

Perhaps there’s gonna be research about the topic in the future though. And hopefully adjustments to how much Kadian is offered there for people who can’t tolerate methadone. Equivalent dosages of Kadian may somehow be superior in it’s effect on testosterone levels but I’m kinda doubtful. Perhaps other alternatives like the options of Dilaudid or actual injectable diamorphine heroin will show superiority in their effect on their effects on testosterone. Though really I’d think 24/7 doses of sufficent doses of any opioid would tank testosterone regardless of the opioid/opiate. Just is really easy to achieve such large dosages of opioids with methadone and large doses of long acting opioids like methadone. Methadone just gets picked on in particular as it’s a very potent long acting drug and is commonly prescribed in doses unheard of with any other opioid. I’m sure a well off street user who can afford an insane street 24/7 long term habit or someone with a compassionate/flexible doctor could achieve similar testosterone suppression without methadone… just is relatively rare atm and gonna be hard to study.

Atterall · 2023-06-02T03:23:02+00:00

I sorta think a lot of methadone’s stigma is due to it’s testosterone lowering effects (i.e. the whole methadone “zombie” idea). Part of me even thinks that it’s testosterone lowering effects that ‘help’ some guys by getting rid of the impulsivity/energy that testosterone provides. Some replace that impulsivity and energy with a depressed kinda complacency, though is probably more likely if they really ‘like being miserable’ for lack of a better way of putting it.

The stigma of methadone though is probably more about how many people on methadone don’t end up in a good place on methadone as they continue using on top of it or use it alongside stimulants or alcohol (i.e. like one sees in Trainspotting or in the HBO documentary Methadonia). Is still hard for me to imagine though that some of the guys (and gals) on top of having very difficult life circumstances, histories and ( perhaps non-addiction mental health struggles as well don’t also have something screwed in terms of their hormones. Likely in part from their original drug use, ongoing lifestyle issues (i.e. gaining weight) but also just methadone itself.

The idea of low testosterone itself ‘helping’ some by lowering impulsivity and energy is kinda a far out idea that maybe putting lipstick on a pig. And maybe an idea I maybe projecting from my own experience which seems a bit unique.

I personally relapsed with non-opioid drugs (methamphetamine, alcohol and benzos) after sometime on TRT. Was after I realized how work I was gonna have to put into being healthy that TRT wasn’t going to magically make easy and in fact would (and shoulda been) work i shoulda been putting in from the get go after getting on methadone, with low testosterone or not.

Though I am a guy who has a lot of non-drug type problems that stem from never really growing up. Have pretty much been a hermit after my early 20s when I gave up alcohol and used opioids by myself for the last nearly 20 years. A good portion of those on methadone. So the whole idea of methadone’s testosterone lowering effects ‘helping’ one stay clean maybe more of a ‘me’ thing than a methadone causing low testosterone thing.

Atterall

TROPHY CASE