T Nation

51 Year Old Needing Advice


I want to thank you in advances for any info you can give me. 2 years ago I was taking test cyp. At 120 mg per week for trt. At the time my test levels were in the 400’s with free test around 9 all other labs were in normal range including red blood cell count. I started the treatment in May and by August of that year I developed a bi lateral pulmonary embolism. During my treatment labs where taken every 4 weeks and all were in normal range including red blood cells.

I was given multiple tests to determine the cause and were found negative. All doctors except one said they did not contribute this to the TRT. My question is 2 years later I am considering TRT again and would like your advice on this matter. I am a little apprehensive at doing this just knowing what happened in the past, any help would be appreciated.


To eval your CV health you need to know if there is an inflammatory process in the arteries, IE endothelial dysfunction. The best indicators are blood pressure and labwork for homocysteine which is a CV specific inflammatory marker.

fish oil
DHEA 25mg depending on labs for DHEA-S, do not do DHEA lab work.
high potency B-complex multi-vits with no iron, trace elements including iodine+selenium
5000iu Vit-D3 per day
natural source vitamin E
1000-2000mg Vit-C
mini aspirin
magnesium supplement

If you get leg or foot cramps, you are magnesium deficient. Magnesium also critical for tone of arterial muscles.

Are you taking a statin drug to lower cholesterol and if yes, do you have sore muscles or chronic low level cough? If yes again, can be statin induced CoQ10 deficiency which can be resolved with 50-100mg ubiquinol, not ubiquinone, form of CoQ10.

If you inject T into a vein, you will get a cough and ticking of lungs from the oil. Seems quite harmless and resolves in 15-30 minutes.

TRT with proper E2 management is CV friendly and a few years ago, a retrospective study of VA patient records showed that TRT guys had ~30% less heart attacks, clots/thrombosis and strokes that comparables not on TRT. That is quite remarkable as we know that TRT is very mismanaged in the VA.

Your TT=400 lab results were half way between weekly injections or at the end of 7 days?

Injections should be twice a week, SC/SQ, not IM to get steady levels. Then anastrozole should be used to keep E2 near 22pg/ml which seems optimal for most guys, but some are exceptions and are wired to do better with more E2.

Ask do do this:

  • 80mg T self injected SQ twice a week with #29 1/2" 0.5ml insulin syringes
  • 0.5mg anastrozole at time of injections
  • 250iu hCG SC EOD to preserve testes and support pregnenolone production

Target is FT at top of range, adjust dose proportionately.

Lets say that your get FT=35 and top of range is 30 and you get E2=28 and target is E2=22. You would change anastrozole by two factors. So new dose = old dose X 30/35 X 28/22, new dose = 0.5mg X 30/35 x 28/22 = .55mg. To get arbitrary doses, dissolve anastrozole in vodka 1mg/ml and dispense by the drop or by volume. A dropper bottle with 1/4ml markings is suggested.

The above shows how you can adjust anastrozole dose with T dose changes at the same time. Do not expect your doctor to understand this.

TRT improves the integrity of tissues and collagen, which also strengthens the lungs.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.


Blood pressure has always been in the 120/70 range. Complete blood work was done not sure on the homocysteine but when they drew blood they took 2 trays of vials and the lab tech said they were doing every test possible. All came back within range. No statin drugs but still on blood thinners and no leg or foot cramps. TT =400 at the end of 7 days. I will start on the supplements and talk to the doc about the dosage. Thanks for the advise big help


Homocysteine is very specific to your issue.

E2 is also bad for arteries if not balanced by T and DHEA. In women, progesterone balances E2.

TT=400 after 7 days does seem low. That is why I suggested 80mg twice a week.

Please do not ignore this: