Hello! New to TRT and first post on this forum. Thanks in advance for input on protocols, testing, dealing with docs, etc. All the normal stuff. I have lurked and read for a while, done a fair bit of searching. There is very little dealing with beta-blockers, which is something I am stuck with at the moment. Sorry for the length of the post, but the health section is complicated…
In your case/thread opening post:
-age: 56
-height 5ft 9in
-waist Wore a 34 pants since my mid-30s, crept up to a 36 waist in my early 50s, then recently ballooned. (See Weight, below). I still wear the 36 trousers but they donâ??t really fit, but have a pair of 38 jeans that are actually comfortable. Actual waist measurement right now = 41â??
-weight 190 lbs. This is my max weight ever. Weight was stable between 162-166 since I was in my 30s, but crept up to 168 and stayed there from about 2010-2012. I dieted in late 2013 and dropped to around 160. July 2013 had a super-tachycardia event that almost killed me. (See below in Health conditions section). Started taking Metoprolol (beta blocker) and gained 10 lbs within 2 months. Metoprolol had other undesirable side effects (felt like it shaved off about 20 IQ points) so doc switched me to Atenolol, which does not cross blood-brain barrier. Gained 10 IQ points back, but kept the weight. Stable in the mid-170s for about a year, then started to creep up to 178-180. Started TRT Oct 1, gained a very quick 10 lbs., and have been between 188-191 for the past few months. Aaack!
-describe body and facial hair: Hairy from waist down. Upper body hair has always been sparse. Facial hair is thick on chin and lip. I can grow a great goatee, but no sideburns to speak of. Head hair is fine, but has always been thick. No male pattern balding, but a bit of receding at the natural part on both sides.
-describe where you carry fat and how changed.
All my life carried most extra fat in my thighs, butt and hips. Always had a little bit of belly fat, but never a â??gutâ?? until very recently with the last weight gain. Never a skinny kid – always wore â??huskyâ?? size pants, but never a really fat kid either. By the standards of school kids today Iâ??d be a skinny kidâ?¦
Now I still carry about the same in thighs, butt and hips, Рall of the recent weight gain seems to have gone to abdomen, which is now classic ̢??beer belly.̢?? That has been in the last 2-3 months.
-health conditions, symptoms [history]
In 1996, age 37, my mitral valve ruptured. Cause unknown. May have happened when doing squats, but who knows. Had open heart surgery-- Valve was repaired - no artificial or pig valve. Very little exercise/conditioning after that for several years. All subsequent EKGs have been â??normal.â??
2004 – Vasectomy following the birth of my third child (surprise!)
2003 – 2013: Increasing fatigue, with easily elevated heart rate. HR recovery time was normal, but subsequent exercise made heart race again immediately. Visited several cardiologists, had stress tests, etc. In 2010, found a holistic PCP that concentrated on Lyme disease (Lyme is rampant in Virginia where I live). Had some markers but nothing active. Inflammation was bad though – turned out I am allergic to gluten. Cut out the wheat and improved significantly, but heart problem remained. By the way, cutting out the gluten improved my snoring significantly – snoring was actually putting a strain on my marriage. Also, my cortisol (per saliva testing) was out of whack – very low levels, plus the curve was backwards. Low cortisol in a.m., rising until late night. Have since corrected the curve, but the cortisol levels are still below normal.
2012 blood work came back with HbA1c value of 6. My diet was already ̢??clean̢?? and had been for years, so didn̢??t have a lot of lifestyle changes to make. Did cut back on the wine consumption. Started Metformin, (weight gain! but not too alarming) but it seemed to have no effect. Stopped Metformin in early 2014. No change in A1c. Through 2012-2013 the fatigue and elevated heart rate got worse. It was sporadic, but started to happen every day with minimal exertion, like walking up a flight of stairs. Dr visits yielded no insights Рfocused on diet, cholesterol, diabetes risk, as probable cause of heart issues.
July 2013 – woke up in the middle of the night with elevated heart rate, and could hear bubbling when I breathed. Went to emergency room. Wonâ??t even go into the idiocy that ensued there. Eventually got admitted as tachycardia worsened, and I started coughing up blood. Heart rate went up to over 180 for several hours, they brought a bigger bucket for the blood. Finally the morning shift started, a pulmonologist and cardiologist showed up, said â??this man is in heart failureâ?¦â?? and got things under control. Diagnosis is still anyoneâ??s guess, but all the symptoms were â??consistent with hypertrophic cardiomyopathyâ?? (HCM) although there is still no visible thickening of heart walls. Best guess is that the valve repair in â??96 caused some type of deformation or bend in the heart wall/septum that is the functional equivalent of HCM. Went on beta-blocker Metoprolol, which slowed down EVERYTHING. No more tachycardia. Gained a quick 10 lbs., lost a quick 20 IQ points, very bizarre dreams. Switched to Atenolol. Weight stayed, but a much better drug for me. Completely handled the tachycardia which has not reappeared since. However, it killed libido, and erections started to become scarcer and softer. First time I could recall EVER with no morning wood. No ED that actually affected sex, but opportunities were few.
So-- Good News = Youâ??re not dead! Bad News = You will spend the rest of your life fat, stupid, and impotent. And really fatigued all the time.
Since starting TRT I have not seen visible edema, but my hands and face feel swollen.
However, I must say that looking back over the years, this is actually the best Iâ??ve felt in a really long time.
Last labs (summer 2014) not changed much since 2013 (for good or bad) but my PCP noted low T levels. Started TRT about Oct.1
200 mg. T Cypionate every 2 weeks IM
After 2 months of that, without dramatic results, I found the online forums. Got permission to self inject – have switched myself to 100 mg TCyp weekly IM.
PCP did no testing for E2,nor mention of AI or hCG. I am meeting with him next week and will discuss, so any guidance there is appreciated. I have familiarized myself with the basic rationale for all those things in the sticky posts, but case specific stuff would be helpful.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
Currently: 50 mg Atenolol 2x Daily for tachycardia control.
No hair loss or prostate drugs ever.
-lab results with ranges
(Note: why this lab reports TT in ng/dL and FT in pg/dL I do not know. Blood tests did not include E2 at all although some saliva tests from a couple years back did.)
Pre TRT: (July 13, 2014)
Test Result Ref.
HCT 45.1% 39.3-52.5
Free T4 1.19 ng/dL 0.83-1.62
TSH 2.090 uUI/mL 0.270-4.200
Free T3 3.1 pg/mL 2.5-4.3
Total Testosterone 236.7 ng/dL 193.0-740.0
SHBG 25 nmol/L 10-57
Free Testosterone 52.58 pg/mL 30-150
Latest (Oct. 29, 2014)(after 4 wks TRT, just prior to second injection. Test did not include Thyroid panel)
Test Result Ref.
Total Testosterone 359 ng/dL 193.0-740ng/dL
SHBG 21 nmol/L 10-57 nmol/L
Free Testosterone 90.07 pg/dL 30-150 pg/dL
-describe diet [some create substantial damage with starvation diets]
Healthy, whole foods diet. Little or no gluten containing grains - so some oats, a bit of corn meal, virtually no bread, pasta, refined flours. Very little/no fast foods or pre-prepared/frozen meals. I have cut back quite a bit on meat (although I eat a small amount of something pretty much every day). Did okay on Paleo too. Now, lots of veggies, salads, some beans and rice. Some seafood – generally not fried. Little or no refined sugars. Very little dairy – a bit of half/half in my coffee, occasional bit of cheese, a little butter on veggies. So basically, I eat Food, rather than Edible Food-like Substances. Have done so for years. My only weight loss seems to come with cutting back to <1000 calories/day. Metabolism has clearly been out of whack for years.
.
Two diet no-nos left include (for some reason itâ??s a hard habit to kick) Diet Coke (~1/day) and alcohol. Virtually all of my refined sugars would come from wine or tonic water (do love a gin and tonic when the weather is hotâ?¦). Have pretty much cut out daily alcohol now, but still occasionally have a drink.
-describe training [some ruin there hormones by over training]
None recently since heart event. Just walking around. Would like to get back to lifting, but if cardiology makes that untenable, will do kettlebell swing types of sustained load exercise with lighter weights.
-testes ache, ever, with a fever?
Not until very recently. Definitely shrinkage since starting TRT.
-how have morning wood and nocturnal erections changed
Better with TRT. Daily nocturnal and morning.
— Thanks for your thoughtful response. Clearly you’ve been around the block a bit heart-wise.