Starting testosterone replacement therapy (TRT) & have some concerns

[MCS]

Starting trt & have some concerns

I am about to embark on a testosterone replacement therapy (TRT) program through my physician. I am 53 and am in good health other than the following issues. I've discussed such with my physician, but he thinks most of these will resolve and not worsen with testosterone replacement therapy (TRT) as long as we monitor everything on a regular basis. My purpose for this email is to get other opinions. I am also looking at stacking some pharm-grade rhGH to help with fat loss.

My scrip is for 200mg/week of cyp. My most recent TT was 425, FT was
9.70 (ref range: 9.0-46.0ng/dL).

1) BLOOD CLOTS: I had two clots in my legs last year. Knowing that exogenous T can raise RBC/HCT/HGB, is there anything else besides monitoring these levels and getting regular therapeutic phlebotomies when necessary that I should be aware of given my prior issues?

2) SLEEP APNEA: I have mild sleep apnea. Sleeping on sides to avoid it. Trying to avoid CPAP. Knowing that exogenous T is a double-edged sword: if low T, then it improves sleep apnea, but it can also worsen it over time via central apnea.

3) HYPERTENSION: I am controlling this naturally. Will only resort to meds if absolutely necessary.
From what I researched, it is from the increase in blood volume that cause this, so same, thing phlebotomies?

4) LIPIDS: LDL-C (153) has improved, but is still elevated; HDL-C (46) has improved, but needs to increase. testosterone replacement therapy (TRT) can reverse that (increase LDL and decrease HDL).

5) HYPOTHYROID - I have been treating my hypothyroidism with dessicated thyroid/T3. I've read that testosterone replacement therapy (TRT) can reduce thyroid function.

But my biggest dilemma has been the inability to lose excess body and visceral fat no matter what I try diet or training-wise (and I have tried everything over the last 4 years - i.e. low carb, intermittent fasting, keto, counting calories, etc.). In addition to hypothyroidism, I believe insulin resistance is still an issue which obviously plays a major role in preventing fat loss. I also have a MTHFR (methylation) genetic defect which I am treating with targeted methylated B-vitamins, etc..

I agree with my doc that much of the above issues will improve by reducing body and visceral fat via testosterone replacement therapy (TRT) but still am concerned.

I would say I am 25lbs overweight based on my body composition (which doesn't help BP). My bf runs 25-29% no matter what I do. Losing weight isn't the issue; it's losing the fat.
Stats:
AGE: 53
WT: 179
HT: 5-07

My latest BodPod showed I weighed less but had more bf and less lean mass which was really disappointing:
BODYFAT %-31.10%
BODYFAT-LBS: 53.9
LEAN-FFM: 68.90%
LEAN-FFM-LBS: 119.6
TOTAL WEIGHT: 173.5
RMR: 1500

Training routine (up until I had to eliminate press movements in the last two weeks because of my shoulder impingement got much worse):
Resistance training: every other day - 45 min. 30 sec. rest; 25 sets total
Cardio: 3 x's/week on off days - 30-45 min.; elliptical/bike; outdoor (until my lower back became inflamed). I do both steady state and HIIT, depending on my energy level.
I am also engaged in a 6-week PT protocol for the shoulder and back which is a workout in and of itself.

I have been training fasted with 20g BCAAs and 5-10g glutamine to try and shed bf, but it has done nothing. I have 2 main meals/day and one snack following workouts. I am gluten-free and soy-free, eat organic only, no processed anything, lean meats, fish, poultry, eggs, Healthy fats are from whole avocados, coconut oil, seeds, nuts and nut butters, olive oil, flax oil. Carbs are mostly from veggies and a small amount of fruit (berries). Only grains are wild rice and quinoa which is technically a seed which I eat maybe once a week.

AVG MACROS:
CALORIES: 1500-1800
PRO: 150-170g
CHO: 40-50g (will cycle carbs so I eat a little more post workout; but no more than 50g)
FATS: 80-100g

I have not attempted to eat less than 1500 calories/day than the above because it's already at a low threshold and any lower I would fear would put me into starvation mode, damage my metabolism and worsen my thyroid function.

I can lose weight; but all I do is get skinny fat. My doc think it's largely because my free T is in the dumps (despite my TT being in the 400s) and this is primarily why I continue to have a hard time gaining lean mass and dropping bf. My SHBG has been a bit high (42), but that's because of taking T3. My E2 is actually too low (4)!

Appreciate any input.

 

[LittleJohnny]

Cut your cardio down to 10 minutes. Use it only on resistance training days as a warmup before hitting the weights. Use heavier weights and less reps. Mix up your routine so your muscles don't get accustomed.

This may be totally crappy advice, but it works for me. I'm about your age, have low thyroid, and tried super clean dieting. Until I went very heavy on the weights I didn't get much results. I actually lost more fat while on an average diet than I did on a strict diet. The difference was the weight training. I only do 2 exercises per body part, 3 sets of 8-10 reps for each exercise for a total of 6 sets per body part. Before doing my heavy sets I start with one set of 20-25 reps with a light weight to warm up whatever muscle(s) I'm hitting. I hit each body part just once a week, but I usually end up at failure on my 6th set.

 

[Megatron28]

Let me start by saying that I think getting your TT higher in the normal range will help you a lot. I suspect that in a month or two that you are going to feel like a new man.

Would you be worried about all the concerns you listed if your natural TT was 950 instead of 425? If not, getting into that range by taking exogenous test should not concern you.

For 1 and 3, donate blood regularly and monitor your hematocrit. If regular blood donations isn't enough (I think you can do it every 10 weeks) your doc can write a script so you can donate more often.

2, I found it helped my mild sleep hypopnea (similar to apnea). Have you considered a dental device instead of a cpap? Addressing sleep apnea is VERY important to you overall health. No sleep = not healthy in every facet of your life.

4, testosterone replacement therapy (TRT) should improve your LDL. It can reduce your HDL though. LDL is the more important one though. Taking fish oil can help your HDL. I wouldn't use niacin though.

5, I haven't heard that before regarding impact on the thyroid. Again, ask yourself if your Natty T was higher would you still have this concern?

As for weight lifting, have you looked at Strong Lifts? This would be a good approach for going heavy as LittleJohnny recommended. Don't worry, the "go heavy" is a relative to how much you can lift. You can concentrate on your primary muscle groups and work on adding muscle mass/strength. And follow his advice about reducing the cardio. When you do cardio you burn calories for the time ypou are doing it. When you add muscle you are burning calories 24/7 as my friend Halfwit likes to say.

Your estradiol is dangerously low. You must have incredible joint pain and fatigue. The good news is that the higher you get your TT, the more of it that aromatizes into estrogen. For most guys they really have to watch this, and often use an aromatisation inhibitor, because their E2 gets too high. This process should help you get back into the normal range and feel a lot better. Most guys like to be in the 20's or 30's. Don t get me wrong, taking 200mg/week may push your E2 above the normal range, but you can use an Aromatase inhibitor (AI) to lower it if it becomes a problem. Just keep monitoring your E2 on a regular basis.

 

[MCS]

Cut your cardio down to 10 minutes. Use it only on resistance training days as a warmup before hitting the weights. Use heavier weights and less reps. Mix up your routine so your muscles don't get accustomed.

This may be totally crappy advice, but it works for me. I'm about your age, have low thyroid, and tried super clean dieting. Until I went very heavy on the weights I didn't get much results. I actually lost more fat while on an average diet than I did on a strict diet. The difference was the weight training. I only do 2 exercises per body part, 3 sets of 8-10 reps for each exercise for a total of 6 sets per body part. Before doing my heavy sets I start with one set of 20-25 reps with a light weight to warm up whatever muscle(s) I'm hitting. I hit each body part just once a week, but I usually end up at failure on my 6th set.

Thanks, but wouldn't one want to be doing more cardio to lose fat, not less?

How are you treating your thyroid?

Are you on testosterone replacement therapy (TRT) and if so, what's your dose and what type of T and for how long?

 

[MCS]

Let me start by saying that I think getting your TT higher in the normal range will help you a lot. I suspect that in a month or two that you are going to feel like a new man.

Not only want to feel better, but to lose this excess bf! I need to drop it by more than half and like I said, nothing diet or training-wise has worked that I've attempted. I don't want to reduce cals too much more nor protein intake. I already eat very low carb and train fasted. Do you recommend cyp over E? What dose? When to run post cycle therapy (pct) (HCG, clomid, adex)?

Thoughts on stacking T with HGH at 2-5IUs/day E5D?

Would you be worried about all the concerns you listed if your natural TT was 950 instead of 425? If not, getting into that range by taking exogenous test should not concern you.

But exo T isn't same as endo T, as endo T doesn't suppress your own T, whereas exo does as soon as you inject it. Speaking of which, I also worry about ruining my libido and function which is one of the few things that's always held up.

For 1 and 3, donate blood regularly and monitor your hematocrit. If regular blood donations isn't enough (I think you can do it every 10 weeks) your doc can write a script so you can donate more often.

Already have a scrip ready to go.

2, I found it helped my mild sleep hypopnea (similar to apnea). Have you considered a dental device instead of a cpap? Addressing sleep apnea is VERY important to you overall health. No sleep = not healthy in every facet of your life.

Yes. Am considering a SomnoDent appliance. I really need to tackle this!

4, testosterone replacement therapy (TRT) should improve your LDL. It can reduce your HDL though. LDL is the more important one though. Taking fish oil can help your HDL. I wouldn't use niacin though.

Why no niacin? I use a safe form that does not cause liver issues.

5, I haven't heard that before regarding impact on the thyroid. Again, ask yourself if your Natty T was higher would you still have this concern?

No, only studies have been done showing that exo T suppresses thyroid function.

As for weight lifting, have you looked at Strong Lifts? This would be a good approach for going heavy as LittleJohnny recommended. Don't worry, the "go heavy" is a relative to how much you can lift. You can concentrate on your primary muscle groups and work on adding muscle mass/strength. And follow his advice about reducing the cardio. When you do cardio you burn calories for the time ypou are doing it. When you add muscle you are burning calories 24/7 as my friend Halfwit likes to say.

Yes, know StrongLifts very well. Great program. Madcows 5x5 and all that. The problem is I am now in PT because of shoulder impingement and lumbar disc pain - both most likely from old injuries.

I try to do HIIT cardio when I do it.

Your estradiol is dangerously low. You must have incredible joint pain and fatigue.

As a matter of fact, I have bad shoulder impingement syndrome and lower disc degeneration and minor disc bulges. Believe it or not, I got a scrip for 200mg/ml of deca to be run with the cyp. I have heard it is very good for rebuilding collagen. Along with the T and HGH, I'm hoping this will help repair my joints along with the PT I'm already going for 6 weeks.

The good news is that the higher you get your TT, the more of it that aromatizes into estrogen. For most guys they really have to watch this, and often use an aromatisation inhibitor, because their E2 gets too high. This process should help you get back into the normal range and feel a lot better. Most guys like to be in the 20's or 30's. Don t get me wrong, taking 200mg/week may push your E2 above the normal range, but you can use an Aromatase inhibitor (AI) to lower it if it becomes a problem. Just keep monitoring your E2 on a regular basis.

I think it's my elevated SHBG from taking T3 for my thyroid the last 3 years that suppressed my FT and E2. I already have some adex waiting for me when E2 starts to elevate.

Thanks a bunch for responding

 

[Megatron28]

Not only want to feel better, but to lose this excess bf! I need to drop it by more than half and like I said, nothing diet or training-wise has worked that I've attempted. I don't want to reduce cals too much more nor protein intake. I already eat very low carb and train fasted. Do you recommend cyp over E? What dose? When to run post cycle therapy (pct) (HCG, clomid, adex)?

Thoughts on stacking T with HGH at 2-5IUs/day E5D?


But exo T isn't same as endo T, as endo T doesn't suppress your own T, whereas exo does as soon as you inject it. Speaking of which, I also worry about ruining my libido and function which is one of the few things that's always held up.


Already have a scrip ready to go.


Yes. Am considering a SomnoDent appliance. I really need to tackle this!



Why no niacin? I use a safe form that does not cause liver issues.



No, only studies have been done showing that exo T suppresses thyroid function.



Yes, know StrongLifts very well. Great program. Madcows 5x5 and all that. The problem is I am now in PT because of shoulder impingement and lumbar disc pain - both most likely from old injuries.

I try to do HIIT cardio when I do it.



As a matter of fact, I have bad shoulder impingement syndrome and lower disc degeneration and minor disc bulges. Believe it or not, I got a scrip for 200mg/ml of deca to be run with the cyp. I have heard it is very good for rebuilding collagen. Along with the T and HGH, I'm hoping this will help repair my joints along with the PT I'm already going for 6 weeks.



I think it's my elevated SHBG from taking T3 for my thyroid the last 3 years that suppressed my FT and E2. I already have some adex waiting for me when E2 starts to elevate.

Thanks a bunch for responding

You are confusing cycling with TRT. testosterone replacement therapy (TRT) is for guys with hypogonadism who want to restore their natural levels. Once you start you stay on for life, unless you can cure your hypogonadism. There is no need for a post cycle therapy (pct). There is no need to worry about suppressing natural hypogonadal T levels or trying to restore them after taking exogenous T. If you do testosterone replacement therapy (TRT) you are most likely doing it for life. If you want to run 12 weeks cycle there is a different area in the forum for discussing that. My recommendation though is to not even think about a cycle until you get your testosterone replacement therapy (TRT) dialed in which can take longer than you think. It takes a lot of guys sic months to a year.

Test E or Cyp doesn't matter. Essentially the same thing. Go with whichever one is cheaper and more easily available.

Higher test levels will help you lose fat. But it isn't a miracle drug. It took you a long time to put all that fat on. It may not start dropping over night.

Sure exo test suppresses natural test. Why would you care? Your natural test is essentially nonexistent.

Higher TT and Free T levels will increase your libido. Tell your wife/girlfriend to get ready for you to very likely will feel like a healthy 17 year old again.

I have not used HGH, but it should help if your levels are deficient and you can afford it.

There are studies that niacin really does raise HDL but that doesn't translate to reduced heart disease risk. Naturally high HDL helps reduce, but for some reason the niacin induced higher levels doesn't work the same. So you are dealing with painful flushing, etc for apparently no benefit according to recent studies in the last 3 years or so.

Once you get through physical therapy you should be able to begin a decent strength building program.

Deca is amazing. It will make your joints feel better. But the underlying injury is still there so you need to be very careful. And once you stop deca the pain will most likely come right back.

What did your doc give you for managing the likely increase in prolactin that the deca is going to give you? Unless you want Deca Dick which isn't as cools as it sounds. It basically means you can't get an erection despite your raging libido. Oh, and the lactaying caused by prolactin isn't a fun one either.

Just remember -- these drugs will help you a lot. But don't expect them to be miracles. You still have to put in the hard work and be smart.

 

[Good.2.Go]

The next time you have labs performed request your Dr. to perform a CRP test. If you are concerned that the extra fat your carrying around has put you at risk. It may put your mind at ease. 3J in the diet forum should be able to help.

A special type of CRP test, the high-sensitivity CRP test (hs-CRP), may be done to find out if you have an increased chance of having a sudden heart problem, such as a heart attack. Inflammation can damage the inner lining of the arteries and make having a heart attack more likely.

C-reactive protein - Wikipedia, the free encyclopedia

 

[MCS]

The next time you have labs performed request your Dr. to perform a CRP test. If you are concerned that the extra fat your carrying around has put you at risk. It may put your mind at ease. 3J in the diet forum should be able to help.

A special type of CRP test, the high-sensitivity CRP test (hs-CRP), may be done to find out if you have an increased chance of having a sudden heart problem, such as a heart attack. Inflammation can damage the inner lining of the arteries and make having a heart attack more likely.

C-reactive protein - Wikipedia, the free encyclopedia

Yes, have had this test many times. I have been trying to lower mine forever. Last level was 1.51. Another good thing about T is that it lowers inflammation.

 

[Megatron28]

Get on cholesterol medication.

 

[MCS]

Get on cholesterol medication.

That is the last drug I would ever take. They are the worst over-prescribed meds on the market. There's no reason to be on statins. I even took my parents off them because they cause more problems than they help. Can all be controlled via diet. The only candidates to consider statins are those with familial hyperlipidemia which I don't have. I would rather increase niacin, berberine, and other non-toxic remedies. The niacin I use is extended-release. There is zero flushing.
chriskresser.com/the-diet-heart-myth-statins-dont-save-lives-in-people-without-heart-disease

 

[MCS]

You are confusing cycling with TRT. testosterone replacement therapy (TRT) is for guys with hypogonadism who want to restore their natural levels. Once you start you stay on for life, unless you can cure your hypogonadism. There is no need for a post cycle therapy (pct). There is no need to worry about suppressing natural hypogonadal T levels or trying to restore them after taking exogenous T. If you do testosterone replacement therapy (TRT) you are most likely doing it for life. If you want to run 12 weeks cycle there is a different area in the forum for discussing that. My recommendation though is to not even think about a cycle until you get your testosterone replacement therapy (TRT) dialed in which can take longer than you think. It takes a lot of guys sic months to a year.

Test E or Cyp doesn't matter. Essentially the same thing. Go with whichever one is cheaper and more easily available.

Higher test levels will help you lose fat. But it isn't a miracle drug. It took you a long time to put all that fat on. It may not start dropping over night.

Sure exo test suppresses natural test. Why would you care? Your natural test is essentially nonexistent.

Higher TT and Free T levels will increase your libido. Tell your wife/girlfriend to get ready for you to very likely will feel like a healthy 17 year old again.

I have not used HGH, but it should help if your levels are deficient and you can afford it.

There are studies that niacin really does raise HDL but that doesn't translate to reduced heart disease risk. Naturally high HDL helps reduce, but for some reason the niacin induced higher levels doesn't work the same. So you are dealing with painful flushing, etc for apparently no benefit according to recent studies in the last 3 years or so.

Once you get through physical therapy you should be able to begin a decent strength building program.

Deca is amazing. It will make your joints feel better. But the underlying injury is still there so you need to be very careful. And once you stop deca the pain will most likely come right back.

What did your doc give you for managing the likely increase in prolactin that the deca is going to give you? Unless you want Deca Dick which isn't as cools as it sounds. It basically means you can't get an erection despite your raging libido. Oh, and the lactaying caused by prolactin isn't a fun one either.

Just remember -- these drugs will help you a lot. But don't expect them to be miracles. You still have to put in the hard work and be smart.

My last prolactin level was 12.3. If it increases from deca, we can look at some cabergoline. Yes, I know the warning about deca dick, but doesn't that only occur when using deca alone without test?

 

[halfwit]

My last prolactin level was 12.3. If it increases from deca, we can look at some cabergoline. Yes, I know the warning about deca dick, but doesn't that only occur when using deca alone without test?

No, that's a misconception from the older days when dopamine agonists like caber weren't widely known or available. It's prolactin elevation that causes it. I'm not honestly sure where the practice of having deca at a ratio of 1:2 with test came about. Megatron has pretty much pointed you in the right direction. I do agree with you though, statins are garbage and cholesterol will not only go down with exogenous test usage, but changes in diet can also help lower levels.

My .02c

 

[Megatron28]

I agree there are lots of good ways to lower LDL. Eat 20-30 grams of soluble fiber a day for example. But the truth is, most people aren't capable of making and sustaining these LDL-lowering changes. On the other hand, statins are proven to lower LDL with minimal side effects and most people can pop a pill every day. Statins do lower risk of heart disease. More power to you though if you can get your LDL down naturally and maintain it.

Niacin only raises HDL. Does nothing for LDL. And slow-release is supposedly less effective on raising HDL. You're better off building up tolerance to several grams of the regular niacin. But again, the studies I have seen show that despite raising your HDL, niacin does nothing to lower your risk of heart disease. Sometimes medications change your numbers on a lab test but don't actually result in a different outcome.

 

[Good.2.Go]

My purpose for this email is to get other opinions. I am also looking at stacking some pharm-grade rhGH to help with fat loss.

The research that I have seen show that HGH is wonderful for many things but, assistance to weight loss is not one of them specifically if your BMI falls within the obese category. However, I can't remember the last time a seen an obese MLB player

Your CRP level is not alarming so that's good to know!
***8226;You are at low risk of developing cardiovascular disease if your hs-CRP level is lower than 1.0mg/L
***8226;You are at average risk of developing cardiovascular disease if your levels are between 1.0 and 3.0 mg/L
***8226;You are at high risk for cardiovascular disease if your hs-CRP level is higher than 3.0 mg/L

You seem fairly educated about the subjects that you have brought to surface & seem to have performed your homework. Weight is easy to lose quickly but fat loss is a long term battle and comes with patience & I know this from experience. It was once thought that it was simple as calories in/calories out but knew research reveals that this is not true. There are many foods considered to be clean but actually increase the storage of fat. If you are basing your macros off of these foods then it is in vain ie....Shredded wheat actually has a higher GI than sugar alone. I happen to stumble up on a website that has helped me tremendously in losing body fat & put on lean muscle. Musclehack.com Don't mean advertise as if I have private stock vested but it a great site! Best of luck.

 

[MCS]

I agree there are lots of good ways to lower LDL. Eat 20-30 grams of soluble fiber a day for example. But the truth is, most people aren't capable of making and sustaining these LDL-lowering changes. On the other hand, statins are proven to lower LDL with minimal side effects and most people can pop a pill every day. Statins do lower risk of heart disease. More power to you though if you can get your LDL down naturally and maintain it.

Niacin only raises HDL. Does nothing for LDL. And slow-release is supposedly less effective on raising HDL. You're better off building up tolerance to several grams of the regular niacin. But again, the studies I have seen show that despite raising your HDL, niacin does nothing to lower your risk of heart disease. Sometimes medications change your numbers on a lab test but don't actually result in a different outcome.

Berberine is probably more effective than niacin anyway. But if I was going to use a med, it would be metformin (glucophage). It's getting a lot of attention these days for many metabolic problems other that diabetes. I am one of the few that have had the discipline to stick to a VLC paleo diet for the last year +. I figure, I have no choice. I guarantee, I would be a lot worse off if I hadn't.

 

[MCS]

The research that I have seen show that HGH is wonderful for many things but, assistance to weight loss is not one of them specifically if your BMI falls within the obese category. However, I can't remember the last time a seen an obese MLB player

Your CRP level is not alarming so that's good to know!
***8226;You are at low risk of developing cardiovascular disease if your hs-CRP level is lower than 1.0mg/L
***8226;You are at average risk of developing cardiovascular disease if your levels are between 1.0 and 3.0 mg/L
***8226;You are at high risk for cardiovascular disease if your hs-CRP level is higher than 3.0 mg/L

You seem fairly educated about the subjects that you have brought to surface & seem to have performed your homework. Weight is easy to lose quickly but fat loss is a long term battle and comes with patience & I know this from experience. It was once thought that it was simple as calories in/calories out but knew research reveals that this is not true. There are many foods considered to be clean but actually increase the storage of fat. If you are basing your macros off of these foods then it is in vain ie....Shredded wheat actually has a higher GI than sugar alone. I happen to stumble up on a website that has helped me tremendously in losing body fat & put on lean muscle. Musclehack.com Don't mean advertise as if I have private stock vested but it a great site! Best of luck.

Speaking of food that increases fat storage, as I sit beside my glucose meter, lol, I can say with confidence that I have no problem keeping my carbs low. I am gluten and grain-free with the very occasional bite of wild rice or quinoa. Today I had some rolled oats, a no-no on the paleo diet, but I had a small serving and dowsed myself with apple cider vinegar to blunt the insulin spike.