Failing TRT ...

Hi All -

TRT is a treatment protocol that takes 8-16 months on average before the desired result is achieved, if it is to be achieved at all. And for many who ultimately succeed, there is no discernible improvement 6 months or more. (Indeed, in my own case there was no improvement at all for the first 14 months!)

So here is my question. How long would you say a person should have "done" TRT before that person can legitimately conclude that he or she has "failed" TRT?

Dr. Stephen Nagler

 

Hi Dr. Nagler,

I would think that one must persist for at least the time in the protocol--16 months. Kind of like when the doctor tells you that you need to take a course of antibiotics--you have to do it all. I have not tried TRT because my strategy seems to be working--not as quickly as I would like-- but I'm much better than I was 11 months ago.

 

I start with trt next week i hope my ttts and hyperacusis fade m tinnitus is not à problem

 

Kathi. What is your strategy? Please let me know.

 

Hi Martin,

These are the things that I've done as part of my strategy.

I went to my physician--not my ENT--my family doctor and got a prescription for anti-anxiety meds. He gave me a referral to a CBT therapist. The CBT therapist enrolled me in a six week group workshop on how to reduce anxiety. I learned about relaxation exercises (which I do daily upon awakening), mindfulness, tapping (although that is one tool that I don't use), challenging and restructuring how I think, finally, I learned about exposure--which meant to let go of my masking and listening to my tinnitus. At first it was short periods but they have gotten longer. After the workshop, I continued with my therapy until my therapist said I was ready to stop but to remember that he is there if I need him. I plunged myself back into my life--I had always worked but mostly hid after work and on weekends. I started going out with my GF's for dinner again, started attending family functions and started exercising again--I am now on a two week camping trip (although we have a motor home so it is hardly camping). I see my doctor every few months as he supervises my Xanax and also makes sure I am staying healthy. At onset of tinnitus, he tested me for everything that could possibly lead to tinnitus. He is a compassionate and caring physician.

I have good days now when T is lower and bad days but the bad days are not at all like they were. I have coping mechanisms now and also, I have hope as I have seen major improvement in just about 11 months.

If I find at 18 months that I haven't habituated then I will revaluate and try TRT but I am partially habituated now so I don't know if it will be necessary. I just remember that Dr. Nagler told me in one of my older threads that we need to be flexible and try something else if our strategy doesn't work.

I know you are dealing with a lot right now Martin. I am always willing to help if I can. We are all in this together.

All my best and prayers for you and your family.

 

@Dr. Nagler

The prescribed time is 8-16 months. Your T was severe and took 14 mos. Therefore, a person should consider the severity of their T. The lower the severity of T then less time spent with TRT should be required (8 mos min). However, the more severe and intrusive the T, one would need to commit to a longer amount of time with the treatment (16 mos min). If a person has found no relief within these time frames, then perhaps they need to consider other options.

May I ask the question about hearing loss and TRT? If a person has substantial hearing loss or deafness and has T, would TRT be a viable treatment for them?

 

My question is when should you do TRT? Does it make a different if you wait a couple of years to try to habituation or the early the better?

 

I never recommend TRT for people who do not have severe tinnitus and/or severe hyperacusis - so whatever the time frame, I do not think that severity should play a role in its determination.

For TRT to be effective you need to have some degree of useful hearing in at least one ear. You can be totally deaf in your tinnitus ear, as long as you have some degree of useful hearing in the other ear.

Dr. Stephen Nagler

 

Generally, the earlier the better.

But that said, I am personally aware of three individuals who suffered from severe intrusive tinnitus for more than twenty years before starting TRT that was highly successful within a year after that.

Dr. Stephen Nagler

 

Thank you Dr. Nagler for such clarification. Time is very important element for the body to turn around. I can say in my case for sure during my first few months, doesn't matter what strategy and what treatment I did, it probably wouldn't be able to stop the relentless anxiety and panic attacks and T would still rule my days. Meds were my only weapons at first. I would then make the mistake to hastily conclude that the strategy or treatment doesn't work for me. But those things I learned from the principles of CBT, about the role of cognitive distortions in my T suffering, these then become much more effective to help me habituate than if I had no such strategy.

 

You raise an important point, @billie48. There are many roads to Rome. TRT is but one of them. Good thing to keep in mind.

Dr. Stephen Nagler

 

For milder tinnitus would you still recommend TRT?
Or it is all about the reaction? If reaction is ok and one can deal with T by himself no need for TRT?

 

TRT is all about reaction. But so is tinnitus severity.

You can have VERY LOUD tinnitus that is not severe, and you can have very soft tinnitus that is incredibly severe. (And all sorts of combinations and permutations imaginable.) But the bottom line is that if your tinnitus does not bother you much, then no matter how loud it is, you don't need TRT.

Dr. Stephen Nagler