Experiencing Gastrointestinal Problems Post-TRT
Age: 33, Height: 5'9", Weight: 215 lbs (muscular build) Current Medication: Testosterone Replacement Therapy (TRT), non-smoker. Since November 2022, I have been struggling with ongoing gastrointestinal issues, which began shortly after I initiated TRT in April 2022. I’m reaching out to see if others have encountered similar problems or can offer suggestions regarding tests I might consider, such as those for SIBO, leaky gut, or GI-MAP analysis. **Description of Symptoms:** - Urgent and frequent bowel movements, often occurring within half an hour post-meal. - Stools are predominantly liquid, occasionally resembling small pebbles. - These symptoms have persisted for over two years. **Test Results (July 2023):** My primary care physician recommended a comprehensive stool test. The results were mostly normal, with the exception of a borderline calprotectin level of 53 µg/g. - White Blood Cells (WBC) in Stool: None observed - Ova & Parasites: Not detected - Stool Culture: No pathogenic bacteria found - Neutral Fats and Fatty Acids: Within normal ranges - Occult Blood: Negative - Calprotectin: 53 µg/g (borderline abnormal) **Interventions Attempted:** - Elimination of gluten from my diet: No noticeable changes. - Kratom use (15 g/day over a 3-month period in late 2023): This is the only treatment that managed to fully normalize my bowel movements, resulting in 1-2 solid stools each day. - L-Glutamine (3 g/day): This has made my stools thinner but still solid; however, the urgency persists. - Florastor (a probiotic): Two capsules caused constipation, while one capsule helped decrease urgency and somewhat firmed up my stools. - Discontinued L-Glutamine yesterday due to concerns around glutamate; I experienced several bouts of diarrhea today. Has anyone else gone through similar gastrointestinal issues after starting TRT? I would greatly appreciate any insights or shared experiences that could assist me.
Answers (1)
3/26/2025, 8:10:47 PM
OpenHealth AI
It seems that you are experiencing significant gastrointestinal issues since starting testosterone replacement therapy (TRT), with symptoms that have been persistent for over two years. Given your individual situation and the impact on your daily life, let’s break down your concerns and actionable steps you can take.
Main Points:
- Persistent gastrointestinal symptoms after starting TRT could be related, but other factors may also be at play.
- Normal test results suggest that serious conditions like infections or tumors are less likely.
- Explore dietary modifications and additional diagnostic options.
Explanation:
Your symptoms of urgent bowel movements, liquid stools, and the impact of interventions like diet and probiotics indicate that your gastrointestinal system might be sensitive or reacting differently since starting TRT. Testosterone can influence gut motility and flora, which may explain some of these changes.
The borderline calprotectin level raises mild concern about potential inflammation or irritation in the gut, but your other test results look reassuring. Your experience with kratom helping to normalize stools is significant but poses risks and should be approached with caution.
Next Steps:
-
Dietary Review:
- Keep a detailed food diary to track what you eat and how your symptoms respond. Sometimes, specific food intolerances or sensitivities may not be immediately apparent.
- Consider maintaining or expanding an elimination diet to identify if there are other triggers. Certain high-fiber foods or sugars (like FODMAPs) can be culprits.
-
Hydration and Fiber:
- Stay well-hydrated, especially if experiencing diarrhea. This will help maintain electrolyte balance.
- Include soluble fiber sources (like oats or psyllium) to help firm up stools over time. Gradually increase the intake and observe changes.
-
Probiotics and Prebiotics:
- Since Florastor (a probiotic) improved your symptoms but also caused constipation at a higher dose, continue with a lower dose and rotate different strains (like lactobacillus or bifidobacterium) to find what works best.
- Prebiotics may also help stabilize gut flora.
-
Consider Further Testing:
- Given your symptoms and treatment response, discuss with your healthcare provider about tests for Small Intestinal Bacterial Overgrowth (SIBO) or further assessments for conditions like leaky gut or more comprehensive stool testing (like GI-MAP), which can provide detailed insights into gut health.
-
Communicate with your doctor:
- Continue to share your experiences and concerns with your healthcare provider, especially if your symptoms change or worsen. Collaboration will be crucial as you explore potential treatments or adjustments to TRT.
-
Monitor Symptoms:
- Keep a symptom diary in conjunction with diet changes to identify patterns and share this information with your healthcare provider for a more tailored approach.
Your ongoing symptoms deserve attention, and while it may take time to find a resolution, working closely with your healthcare team and implementing gradual changes can help improve your situation. If you have additional questions or symptoms arise, please don’t hesitate to reach out.
Related Questions
Can Eating More Fiber Alleviate Menstrual Cycle-Related Constipation?
Every month, during the week and a half leading up to my menstrual period, I experience constipation. I'm curious if boosting my fiber consumption might ease this issue. I already ensure that I drink plenty of water throughout the day. I am a woman in my mid-20s.
Seeking Relief from Mild Fecal Impaction: Should I Go to the ER?
At 20 years old, I find myself dealing with a frustrating issue: fecal impaction. It's not something I've faced before, or at least I can’t recall, but I’ve had chronic stomach difficulties throughout my childhood, including constipation from ages four to twelve. Recently, I've been experiencing more digestive challenges after a few years of feeling normal. Currently, I’m under the care of a gastroenterologist, and we’re working on diagnosing the underlying problems. For about five days now, I haven't been able to relieve myself. While I’ve had considerable gas, that’s been the only symptom. Today has been particularly difficult; I’ve spent the last 11 hours in the bathroom grappling with severe discomfort and impaction. Each attempt to relieve the situation is excruciating, to the point where my body is resisting the effort—it’s so painful that I find myself in tears. I imagine this is what birth must feel like. I suspect this intense fear and pain are remnants of my past struggles, as for many years I’ve feared using the bathroom due to the agony it causes. Despite trying various remedies like Miralax mixed with coffee, a bullet suppository, and even a manual approach with gloves, nothing is yielding results. I’m genuinely tempted to head to the emergency room and ask them to put me under so they can help me without the pain. My mother suggests they would likely opt for a liquid suppository treatment like they did during my childhood, which was quite traumatic. I’m torn—it feels like the ER might be my last resort, but I'm concerned they won’t take me seriously since my situation doesn’t seem dire. How foolish would it be to bring up wanting sedation? I desperately want to avoid this pain; it’s becoming increasingly difficult, and I’m fighting back tears from the frustration. Can they truly provide sedation for this type of issue even when it isn’t severe? I worry that my parents might react negatively to my quest for relief and think I’m being dramatic. I’m utterly drained and don’t know where to turn. When there’s no painful push against my body, I can’t even sense the severity of the issue, yet, I am experiencing leakage, leaving me unsure. Would it be unreasonable to pose this question to the doctors in the ER? I apologize if this message is jumbled; I’m also dealing with a migraine, making it hard to focus. For context, my daily medications include phentermine, iron supplements, and vitamin D. I stand at 5’4” and currently weigh 204 pounds as part of my ongoing weight loss journey.
Did My Appendectomy Resolve My Digestive Issues?
I’m a 27-year-old non-binary person who had their appendix surgically removed due to appendicitis early last October. Since that procedure, I’m experiencing something I never thought possible: regular bowel movements. Remarkably, this newfound routine hasn’t faded away, contrary to what my doctors predicted. Historically, I have struggled with constipation throughout my life. As a child, I often felt compelled to mislead healthcare professionals about my bowel habits, claiming I had daily movements out of fear that something was amiss. In reality, I would only have a bowel movement every three to five days. I also live with autism, ADHD, dysthymia, and PTSD. Given my history of burnout, it would be logical to attribute my digestive struggles to stress. However, these issues persisted even during holidays and rarely intensified during particularly stressful times. Most of the medications I tried, including SSRIs and various birth control options, had no impact, except for Ritalin, which occasionally provided some relief when not taken consistently. Prior to the appendectomy, I underwent two surgeries: one for a fractured arm and the other a double procedure to remove my uterus and breasts. Unfortunately, neither operation had any effect on my bowel function. Since my surgery, my dietary, hydration, exercise, and substance use habits have remained unchanged. A bit of additional context: My thyroid hormone levels are normal, although I occasionally have low Vitamin D, for which I take supplements. I receive B12 injections to address low levels since dietary sources aren’t effective for me. Additionally, I deal with a persistent mystery of chronic fatigue that shows no signs of improvement post-surgery. This leads to my question: Could my appendix have been the source of my gastrointestinal issues? Alternatively, did the surgery trigger some other change that resolved my long-standing problem? I’m curious if anyone else has encountered similar experiences. What are the chances that I’ll revert back to my past issues with constipation? Any insights on this would be greatly appreciated, mostly out of interest.
Exploring Probiotic Effects and Antibiotic Strategies in Gut Health
Greetings, M30. Is it possible that consuming an excess of probiotics could lead to SIBO or a similar condition? Earlier this summer, I suffered from a campylobacter infection, and in an attempt to remedy that without realizing its full extent, I resorted to high doses of probiotics. This approach, however, only aggravated my situation. I experienced severe bloating, intensified brain fog—especially after consuming carbohydrates—and following a comprehensive examination of possible causes, including an initially misleading negative test for c. jejuni that later revealed IgG antibodies in my blood, I was prescribed rifaximin (200mg four times a day). Unfortunately, after five days of rifaximin treatment, my symptoms escalated dramatically, resulting in excruciating lower abdominal pain and a marked intolerance to carbohydrates. Through my research, I discovered that the probiotic strains I had been using were sensitive to antibiotics, so I requested that my physician switch my medication to amoxicillin, which promptly resolved the issues I was facing. Complicating matters, I later learned that I had been contending with an acute bartonella infection, which likely contributed to my motility problems. As the year progressed, I indulged in kimchi after having been on antibiotics for bartonella treatment for about a month. However, I had to stop the antibiotics over the Christmas holidays when I developed rashes from herpes on my face and required alternative treatment. Following my kimchi overindulgence, I began to experience bloating again, cognitive fog intensified, and I felt a toxin-like sensation after consuming larger amounts of carbohydrates, alongside a newfound intolerance to wheat products. My doctor once again prescribed rifaximin as the primary treatment, but I am starting to notice that familiar acidic sensation in my abdomen returning. Is this reaction indicative of die-off symptoms, or could it mean that rifaximin is targeting competitors of the kimchi bacteria in my gut, resulting in their proliferation and creating a cycle where lactic acid bacteria alter the colon's pH, promoting further growth of lactic acid producers? I suspect this situation mirrors what transpired during the summer months. Would switching back to amoxicillin be advisable, or might I need to consider amoxiclav instead, given that the kimchi contained fish sauce which might be a source of beta-lactamase? Best wishes,
Seeking Guidance for Persistent Abdominal Pain and Bowel Issues
I am a 54-year-old male reaching out to seek advice regarding ongoing complications related to bowel movement and abdominal discomfort. I have been experiencing a tendency for stools to become backed up in the ascending and transverse sections of my colon, coupled with persistent, diffuse pain in the central right side of my abdomen, particularly at the junction of the terminal ileum and cecum. The discomfort around the ileocecal valve manifests itself with noticeable grunting noises, especially after eating and during movement or when sitting upright. The pain intensifies with physical activity and tends to alleviate when I lie down. I frequently experience a nagging pressure in my lower abdomen, especially while standing or sitting. Following meals, I notice pain in the midgut area and at the terminal ileum-cecal juncture, surfacing about 30 to 60 minutes post-ingestion, alongside a late-day increase in tenderness in the ascending colon, which is exacerbated by movement or bending sideways. In a previous visit to the emergency department, a CT scan with contrast was performed, and the attending physician indicated that I was experiencing stool buildup without any obstruction. They noted an unusual angle concerning my terminal ileum's alignment with the cecum, suggesting it appeared taut. Unfortunately, this evaluation did not lead to any conclusive treatment or diagnosis, which leads me to wonder if there might be a congenital or mechanical issue at play in the ileocecal region. My medical tests have indicated elevated calprotectin levels of 804 and 360, alongside a C-reactive protein reading of 26. A CT angiogram on September 25 revealed the presence of stool in the terminal ileum, contributing to my concerns. I am inquiring whether there are additional tests I should consider beyond a supine CT. Thus far, I have undergone a CT scan with contrast, a CT enterography (which did not reveal Crohn’s disease), a pill camera test (the results were inconclusive), abdominal X-rays, and a Sitzmarker test (which passed through successfully). I have also had three colonoscopies; two of them were unable to navigate to the terminal ileum, while the last one managed to reach enough depth to perform a biopsy that revealed some minor erosions, supposedly related to stool buildup. I have not yet undergone any dynamic imaging or barium studies. My primary concern is that my symptoms are consistently recurring without any periods of relief or improvement. I would greatly appreciate any suggestions regarding further testing I should pursue prior to my upcoming gastrointestinal appointment. Thank you for your assistance!