To TRT or Not to TRT

[Andrewhf]

Hi Dr Nagler,

I am 15 months into "intrusive" tinnitus. I had it a few months before it became a problem but was not concerned about it and only rarely noticed it - however after an afternoon nap one day it become noticeably louder so I though I would have a search on the Net... needless to say that scared the beejeepers out of me and put me in a tail spin of high anxiety/stress etc. for a few months. I worked through that without meds etc. and I have significantly improved in terms of my reaction to the tinnitus to the point where it very rarely causes an emotional response, but I still find it distracting and a "nuisance" at times. I can sleep fine with it (no meds), as the tinnitus itself is not particularly aggravating but I do struggle psychologically a bit with the thought of it's permanence. I have a lot of "stressors" in my life at this point and just see tinnitus as another to be endured and added into the mix - not catastrophic but another niggle...
I feel I am half way habituated (am I?) in that with any sort of significant mental engagement the tinnitus disappears from my consciousness. I can go some hours (maybe a couple) in the day and more than once a day, without being aware of it. I can awake in the morning, get up etc. and after a while realise that I haven't heard the tinnitus for some minutes.

I am wondering if TRT would be worth while in that would it; a) increase the speed of a more comprehensive habituation, b) lessen the annoyance of the TRT all be it of a low level annoyance to me, c) possibly give me the perception of some sort of "control" of my tinnitus. I can see that the downside of TRT could be that it would make me more aware of the tinnitus as I would be "actively" managing it - which is something that I don't do at the moment (no masking, avoidance etc.) and that I may be on a (very?) slow but sure path to a decent (full) habituation anyway. Your thoughts would be appreciated. Many thanks in advance.

PS Thank you for taking the time and energy for being available on this forum. I am sure your benevolence has helped many people with their trials with Tinnitus. Salutations...

 

[Dr. Nagler]

I am wondering if TRT would be worth while in that would it; a) increase the speed of a more comprehensive habituation,

It might, but you seem to be doing pretty well as is.

b) lessen the annoyance of the TRT all be it of a low level annoyance to me,

It might, but you seem to be doing pretty well as is.

c) possibly give me the perception of some sort of "control" of my tinnitus.

TRT really doesn't do that - but the less annoying your tinnitus is, the better you feel about it overall. So in that sense, there might be a feeling of more control for some people, but I have never seen it that way.

I can see that the downside of TRT could be that it would make me more aware of the tinnitus as I would be "actively" managing it - which is something that I don't do at the moment (no masking, avoidance etc.)

TRT does not involve "actively managing" your tinnitus. It is very passive.

and that I may be on a (very?) slow but sure path to a decent (full) habituation anyway.

I myself think that the idea of "full habituation" is a myth. When I say I have habituated my tinnitus, I mean that I have largely habituated it. I have often stated that habituation is a process rather than a state. Full habituation would be a state. Perhaps you are aiming a bit too high?

Your thoughts would be appreciated.

Here's one way to look at it. Consider a scale a 1 to 10, where 1 is "I have tinnitus, but I really do not care about it," and 10 is "My tinnitus has totally and irrevocably destroyed my life." (I have loads of patients who put themselves at 9-10 on that scale.) Anyway, if you are a 7, 8, 9, or 10 and would like become a 1, 2, or 3, then you should seriously consider TRT. If you are a 5 or 6, I'm not sure that the benefit would be worth it - but that's a personal call. You sound to me like you are already a 3 - perhaps even a 2. Were you sitting opposite me in my clinic right now, I'd wish you well and send you on your way. You do not need to be investing the time or expense in TRT.

Many thanks in advance.

You are most welcome. I hope it helped.

stephen nagler