T Nation

55david Case/Thread


I see that the pic I attached went on top of this post sorry and I don't see a way to delete it I will post all 3 of my labs after this post.

I have been reading the sticky post and trying to absorb everything. I will keep reading of course. But wanted to post my case thread just to get the feed back started. I am going to post my first labs before I started and post my stats at that time in this first post then I will do a post for my second labs and the stats at that time then I will do the third labs that brings me up to date. I have been on TRT for 16 month's started with 150mg no HCG for the first 3 months then got on it.

My Doc is part of Live Well out of FL. From the start he had me on the 150mg IM of T every 6 days and when I started the HCG it was 2000IU IM in the arm every 6 days with the T shot. 2.5mg EOD of Finasteride and .5mg 5 times a week of Anastrozole. Also OTC DHEA 25mg a day, Resveratrol 250mg a day, D 2000iu a day, L-Arginine 2000 mg a day.

Stats when I started 02/29/12
-age 49
-height 6ft 5in
-waist 52in
-weight 380lb apx

-describe body and facial hair = Big Guy but not big hands or broad shoulders, big feet size 14, long torso I can carry 350lb and people guess 250lb. Little facial hair never shaved until my 18th birthday and that was just a few hairs never needed to shave everyday until mid 20's very little body hair on arms or legs.

-describe where you carry fat and how changed. carry fat like a woman, belly, hips, butt, not to much in the chest.

-health conditions, symptoms [history] type 2 diabetes at age 39yrs weight loss and exercised got it under control never took any meds except OTC vitamins. Other than weight issues most of my life I haven't had health issues.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever= Took lots of the normal gym rat supplements through the years when I was in the gym, creatine, L-Arg, L-Gul, protein drinks, took 1 cycle of Anavar in the 80's and one cycle of test in the 90's. Then took the Finasteride when I started the TRT in 2012 I got some side effects and got scread after reading and got off of it after talking to my Doc and he had started taking guys off of it at that same time. We used some prostate cream "Kokoro" but hated that so I quit it, then Doc put me back on Finasteride 1.25mg EOD. He stated the Finasteride was to prevent prostate issues.

-lab results with ranges posting pic's of them if they are not clear please let me know. Looks like I will have to post them each in its only post please look below for them.

-describe diet At the start of TRT I eat like crap and was not working out, at about 3 months in I felt better and started working out 3 days a week and started eating a lot better dropped 50lbs in 6 months went from about 35+BMI to about 28 +- BMI using tape measure method.

-describe training [some ruin there hormones by over training]= As a side note* I was a very late bloomer was never strong for my size when I went through puberty I lost baby fat but kept some of it like a girl lower belly and butt. Joined US army at 22 PT 5 days a week. When I was in my late 20's joined a gym and I over trained big time for about a year or more then quit altogether packed on fat quick. The rest of my 30's not in the gym much but when I was I over trained. I worked hard physical labor until mid 30's and my weight stayed in check fat but not obese. Then from late 30's to 49 packed on lbs went from say 285 to 385 and yoyoed from the high 3's to 330 and back up a few times.

-testes ache, ever, with a fever? = No ache in my test that I can remember.

-how have morning wood and nocturnal erections changed. Before TRT started they were non-existent, after 3 months or so started having some but not much then they got better but not great!
************************ Ok that's all for the before I started TRT **************************


OK here are my Labs from LabCorp I guess I have to do a post for each page if there is a way to put all 3 pages in one post please let me know.






Second set of labs
Page 1
I felt very good at this point sex drive was up adding muscle like crazy good attitude motivated. I felt like I was in my 20's again! Doc upped me to 200mg IM of T cyp every 6 days and HCG 2000IU IM in the arm every 6 days. ANASTROZLE .5mg 5 times a week, FINASTERIDE 1.25 EOD OTC DHEA 25mg a day, Resveratrol 250mg a day, D 2000iu a day, UPED the L-Arginine to 5-6000 mg a day.


Second set of Labs


Second set of labs


Second set of labs


My current labs 05-03-13
I don't feel as good any more but still better than before TRT. My motivation is down some and I seam to get agitated easy. I also realized that I am having almost non-stop cramping in my calves it been going on for weeks, I didn't think about it until I read on here guys asking others if they were having leg cramps.

I have not been in the gym for over 5 months and this month... 6 weeks actually I have had a lot of extra stress my mother had a stroke we almost lost her twice but now she is getting better with rehab but I have been at the Nursing Home every day for 6 to 12 hrs helping her she has gotten a lot better and I have been able to back off to 3 to 4 hrs a day. I had kept my weight stable at the max loss + 3-5lbs this whole 5 months out of the gym but this month I have gained 14 lbs.

My morning wood is seldom but my drive is still good. Doc had me start taking the HCG 2 days before the T shot that is when I lost the AM wood. Still at 200mg IM of T cyp every 6 days and HCG 2000IU IM in the arm every 6 days. ANASTROZLE .5mg 5 times a week, FINASTERIDE 1.25 EOD. Still taking OTC DHEA 25mg a day, Resveratrol 250mg a day, D 2000iu a day, L-Arginine 5-6000 mg a day.


Current labs


Current labs


You need to change your diet, you are insulin resistant.
- drop: potatoes, white rice, bread, sugar, sodas, pasta

You should be using metformin. - cheap for 90 days at Walmart. You should do this soon, not waiting for a series of labs. Your very high glucose on your pre-TRT labs should have started action then.

Get a glucose meter, you can get one for $17 at Walmart that has low cost test strips.
High glucose wrecks protein structures in your body.
DO NOT let doc put you on a drug that increased insulin, that will increase your insulin resistance. You want to improve your response to insulin, not increase it.

Your insulin resistance is the greatest threat to your QOL. If you do not manage your insulin resistance, your current concerns will seem trivial in comparison. Eval history of type II diabetes in your blood relatives.

Read the protocol for injections sticky: Inject twice a week.

Your units for T and hCG are very confused. Please clarify and report T-mg and hCG-iu

- 5000iu vit-D3, tiny oil based caps, Walmart has these
- high potency B-complex multi-vits with trace elements and iodine, [may be two tabs per dose]
- anti-oxidants, Vit-C 1000, natural source vit-E and others
- EFA's fish oil, flax seed oil or meal, nuts
- health fats such as olive oil

FINASTERIDE: PSA= 0.5 | DHT and T do not cause BPH. Estrogens are the problem. I do not know why you need this drug. DHT is mission critical for libido and maintenance of the sex organs. Suggest that you stop and see how you feel. Otherwise this drug can be very dangerous for a few guys.

Anastrozole: Your E2 is enough to make you feel like shit!!! Reduce dose by this factor: new-dose = old-dose * 7.7/22
Your doc is an idiot. [most are]
Anastrozole dose needs to match your T levels.

Have you donated blood yet? HTC says that T dose is too high.

Reduce T dose, inject more often.

Are you self-injecting?

When do you do labs relative to prior injections?

Have you read the protocol for injections sticky?

Loss of AM wood probably more from low E2, not hCG.

Standard protocol:
- 100mg T cyp / week injected at least twice per week
- 1mg anastrozole in divided doses
- 250iu hCG EOD SC
- you are so far from there

Too much T is causing high HTC, that can limit blood flow in brain and other areas.
Your TT needs to be around 900, note that FT is quite high. If labs are on day 6, this is all very wrong. Self inject more often so that labs represent something useful instead of a snap shot of something rapidly changing. Anastrozole needs to match T levels, T levels are changing so anastrozole dose and E2 management is a mess. E2 is essential for brain function and libido. If to low, its all bad.

I guess that I can't find anything good about your protocol.

Need time of day for cortisol. Should be done at 8AM after a normal night's sleep, not getting up too early either. No food or caffeine.

There is a shit load of things above to deal with. Make a list of all of the action items for you. Clarify your T and hCG dosing. Stop finasteride, reduce anastrozole, explain lab timing for T and time of day for cortisol, get the supplements and glucose test meter, are you self injecting ...

more ...

T3 should be near 8
Do this lab set: TSH, fT3, fT4 [data for globulin bound hormones in T3, T4 sort of useless]
- read thyroid basics sticky
- post history of use of iodized salt and vitamins that list iodine
- post oral waking and mid afternoon body temperatures

  • ping me @ ksman is here thread with link to this


Is this cramping or tingling numb diabetic neuropathy? Did your doctor check for peripheral artery disease in your legs?

What precipitates this leg pain? Upon waking? After certain foods? Is it bad enough that you cannot walk?

You have to make yourself move.

Fight through whatever funk you are in. No more time for woulda, coulda, shoulda or you will lose feeling in feet / extremities including your ding-ding. I am not kidding about this diabetic neuropathy.

Walk, swim, peddle stationary bike or lift weights with low amount of weight high repetitions (15-25 reps, then slowly add more weight) If legs cramp find something you can do to move.

If you are gonna fall back on old eating habits eat the high glycemic foods after a good workout. Smart cheating - just don't go overboard.

Overeating is another cause for your high triglycerides - a type of fat (lipid) in your blood. Triglycerides and cholesterol can't dissolve in blood, they circulate throughout your body with the help of proteins that transport the lipids.

If you do as KSman said (which I suggest you do) and purchase a glucose meter and find your glucose is high 1 1/2 - 2 hours after a meal you need to MOVE. Glucose binding to proteins, called glycation, will destroy your nerve cells structure and their function.

L-Arginine can be taken out and replaced with citrulline malate. It does a better job at what you are using L-Arginine for. Trust me I've used for past four years and originally took L-Arginine. These can be mixed together as well, but studies rate citrulline malate as being more effective. Neither do well with food so take on empty stomach or you will be throwing your money away.

Find alpha lipoic acid and take it as well. It works.

Look for a book called NO More Heart Disease at your library or here. http://www.amazon.com/More-Heart-Disease-Prevent-Even-Reverse-Heart/dp/0312335822

And check out The Anti-Aging Solution http://www.amazon.com/The-Anti-Aging-Solution-Looking-Feeling/dp/0471705381


*First off I want to thank you and KSman for the replies. I am going to do what KSman laid out starting with his protocol. When I get the rest of the info he asked for I am going to post it and hit him up.
*Second I should have explained in my post better about my type 2 diabetes I first found I had it in 2003 I refused meds and got it under control with diet and exercise I went from about 380 down to about 330 and my sugar was all good for years I would only occasionally have a high reading and even then my Hemoglobin A1C test would be at or below the "6" high range. So I had quit worrying about it. The high test numbers on my labs are not fasting and all were with in 1-3 hrs after eating. All my labs have been in the afternoons 1 to 3 pm. The last one was less that an hour after lunch and when I told doc that he said ok no big deal and did a A1C right then that showed 5.8 so I didn't pay any attrition to my test number. I am sorry if leaving all this out made it confusing.

You asked: Is this cramping or tingling numb diabetic neuropathy? You know what I was about to say cramping but sitting here thinking about it with this past few month's lack of exercise and this last 6 weeks of very bad eating I know it is diabetic neuropathy my feet have been hurting also. "Did your doctor check for peripheral artery disease in your legs?" No I have not told him about my legs because I just realized it my self and I also know if I get my butt back in the gym and eat right it will go away... I hope?
"What precipitates this leg pain? nothing I have it all the time I just don't pay attrition to it all the time but if I sit still for a few min I start needing to flex my caves and stretch my legs. The pain is not intense or debilitating. I am going to get me a new glucose meter and get my good habits back.
" L-Arginine can be taken out and replaced with citrulline malate. It does a better job at what you are using L-Arginine for. Trust me I've used for past four years and originally took L-Arginine. These can be mixed together as well, but studies rate citrulline malate as being more effective. Neither do well with food so take on empty stomach or you will be throwing your money away."
I have read about citrulline malate and had meant to add it to my L-Arg but forgot about it... so you say take it instead of L-Arg or with it, witch way it what's better?

"Find alpha lipoic acid and take it as well. It works." I take alpha lipoic acid 10mg a day it in a multi pack I take that I forgot/ didn't think to list it.


That is good that the A1C numbers are better than expected. This does not go away, you have to be diligent about MOVEMENT.

Sitting is the new smoking is what they are saying now.

The foot and calf neuropathy may improve if you can get to the gym and do serious lower body workouts. Squats and deadlifts are your friend here, but the leg pain may not go away completely.

The insidious side of diabetes slowly destroys nerve endings in your body. Watch your blood pressure as well so you don't lose your kidneys. Movement. Sex life is no fun when certain parts become like your feet and calves.

I'd get a high quality citrulline malate powder and use it instead of Arginine. That will save you some money. Put the spoonful dose in water and stir. Search citrulline malate powder on google.

Originally it was thought that the two must be combined to do their magic. I take it when I do rough workouts like squats and dead lifts and feel like I can just keep on and on.

Cialis / tadalafil (generic name) works similarly. Both it and viagra (a PDE5 inhibitor) have been used by athletes to help with endurance. They help to improve blood circulation and that won't hurt your neuropathy. Research is ongoing and it seems to have more uses in the future.






One of the reasons I started the L-Arg was Doc said use it but after reading about it I upped the dose to 5-6000mg a day to help to improve blood circulation and erections it seamed to work. I took Cialis one time and had a headache for 12 or more hrs. I hope citrulline malate wont do that...??? I am going to get some and use it. I am getting back to the gym that will fix a lot of my issues. Thanks


The book NO More Heart Disease is written by the doctor that won the Nobel Prize for discovering the Nitric Oxide connection to improving circulation and reversing some heart conditions. In it he discusses the L-Arg and L-Cit are to be used together but newer research reveals citrulline malate is the one to use on empty stomach.

I will sometimes take it a half hour into my workouts and save the roughest lifting as it kicks in.

Cialis - you took too much. No citrulline malate does not have similar side effects. But do not take both. Use one or the other, alternate.

You can break/cut the Cialis tablets into smaller doses 9-10mg dose. It does initially give a dull feeling in head that goes away and some stuffy nose. The more frequently you take it the better it works. I'm guessing you should try the lower dose and take it about two hours before a workout. Higher dose can cause color vision changes and pulse rate but that usually goes away in an hour or two. Aspirin helps.


Thanks I ordered both those books I got some reading to do. I just got a 1lb jug of L-Arg last week that last a few months but I will get some CM also and use it. Since I have the L-Arg would it hurt to take them both or is that counter productive?


You can mix them together. Remember use on an empty stomach. At least an hour after a light meal has worked for me.

Check your library so you don't have to spend money on every book, however those two are golden. KSman is light years ahead of me on your lab and medical questions. He's the best.


Hey out of curiosity what dose of cialis were you prescribed that messed you up with headache for twelve hours 100mg, 50mg?