T Nation

56, On Beta Blockers. Started TRT


#1

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, -- all of the recent weight gain seems to have gone to abdomen, which is now classic â??beer belly.â?? 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 â??cleanâ?? and had been for years, so didnâ??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 -- focused 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.


#2

I am thinking that even with the repair to your mitral valve that there is still some stenosis and regurgitation happening. Blood is backing up into the lungs, causing edema and your emergency situation. Both ventricles may be affected by myopathy and blood is backing up systemically leading to weight gain and peripheral swelling.

The beta-blocker, while protecting your heart, is causing more back up of blood and the weight gain. Has your doctor considered a diuretic like furosemide? They would have given it to you when you were having the acute lung issues most likely.

Definitely very serious matters to attend to. Working out will need to be done with greater care and avoid stopping suddenly and be aware that your blood pressure can drop anytime so make postural changes gradually. Are you working out? I didn’t see if you mentioned it. (I wish this forum allowed review of the post to refresh my mind).

Unfortunately beta blockers are boner killers. Maybe an adjustment of dose could improve things slightly(get physician guidance!). Metformin will be stronger acting due to testosterone supplementation so you may need to adjust that too(no worries of hypoglycemia with Metformin). A1C of 6 is still a bit high so you should do what you can to avoid over doing it. Your blood sugars can become elevated without eating refined sugars. A1C is an average overview of 3 months of blood sugar levels.


#3

Oh and keep a close eye on E2 as it will cause more water retention if it becomes elevated and it likely will. Please get E2 checked next possible opportunity.


#4

Dilation of the ventricles is a form of cardiomyopathy that doesn’t thicken the walls of the heart but will reduce cardiac output. Easily fatigued and tachycardia on exertion would result. Any mention of a murmur when the cardiologist was working with you?


#5

C27*** – nice handle btw :slight_smile: — Thanks for your thoughtful response. Clearly you’ve been around the block a bit heart-wise.
One of the strange things about my case has been that there has not been a murmur at all under normal exam conditions. During the tachycardia event, it was there – audible to the naked ear according to the cardiologist – but within a day it was gone. Has not returned during any subsequent exams, stress Echo, etc.

The main thing I’d like to do right now is prep for my next appt with the doc, which is Thursday 12/11. Testing for E2 is definitely on my list as well as going to SubQ Testosterone. I’m trying to educated on other stuff as well – HCG, possibly Cialis, etc. I want to get this managed in the near term while I’m getting the heart stuff sorted out long term.

The beta blockers seem to be a fact of life from here on out – so one thing I want to do with my doc is to manage the side effects. I have never ever before been on prescription drugs long term, and the very thing I feared looks like is about to happen… you know, "one pill makes you larger, and one pill makes you small…"
Here’s the Atenolol for your heart (thats the one that makes you small i guess)… you’ll need this for your johnson, and this for your brain, and maybe a few of these here for your waistline, ad infinitum.

Any suggestions for possibly countering mental side effects? Atenolol isn’t supposed to cross the blood brain barrier, so maybe the thinking slow down is part of the general energy issue.
Thanks again for taking the time to respond. Good stuff!


#6

Thanks – sounds like you know your way around cardiac stuff. I am meeting with doc this week and will ask for E2-sensitive testing. Also discuss options for dealing with b-blocker side effects.

Will also look into other types of cardiomyopathy in addition to HCM.

Not currently working out. I have tried to get back to it over the years, but between the fatigue, and frankly the fear that I would keel over dead in the weight room, I have not worked out. Been driving me crazy. Interestingly, based on ECG and EKG over the years, all docs have cleared me for exercise but cautioned “don’t lift really heavy weights.” Goes to show that most MDs know as much about exercise as the do about nutrition, or about TRT for that matter…


#7

I would want to see you start exercising ASAP. There are innumerable reasons why you should. You will need to take care that you don’t work so hard that your pulse goes too high. You might want to wear a watch and learn to check your radial pulse or if you’ve got the cash, a heart monitor. When you stop or change position after a set or after using a machine just be aware that blood pressure can drop quite low and make you prone to falls. I’ve seen people on several anti-hypertensives with multiple bypass surgeries working out full-bore. It can be done and should be done. It will improve mental function, sexual function, digestion and appetite, blood pressure and vascular tone among other things.

The cognitive issues with the B-blocker may reduce over time or if the dose can be titrated down.

Get lots of potassium from fruits and veggies. A can of coconut water can have almost 4 bananas worth! Increasing potassium will cause a symporter in your kidneys to excrete both potassium and sodium. ENSURE kidney function is ok before increasing K. Sodium at the moment is your nemesis. Be aware sodium takes more forms than just salt, including sodium bicarbonate, MSG etc.


#8

Solid advice on all counts. I’ll especially check out the coconut water idea. Plus it will make me seem hipper I am sure.

I do have a heart monitor so will be sure to use it. The -watch out between sets- advice is much appreciated. I’d hate to add head injury to all this :slight_smile:


#9

Hi Benny:

I’m in a situation not too different than yours. Had an episode of V Tach when I was 55 (first ever heart issue)… about 235 bpm that went all night, and when I got to the ER the next day they shocked me back to a normal rhythm. Admitted to the hospital… lots of tests, my arteries were clear, but I showed dilated cardiomyopathy with an EF (at that time of only 25%. Left the hospital almost a week later with a shiny new ICD in my chest.

I’m now 61, and have been shocked a number of times to recover from V Tach/V Fib, most often after a time of high stress and moderate physical exertion (once after sex… she said she felt the shock as strongly as I did. That’s not supposed to happen). My EF is up to about 30-35%, and I’m classified as NYHA Class II heart failure (unless I get decompensated and fall back to Class III).

After my most recent shock (about 18 months ago) my Cardiologist/EP did put me on Metoprolol ER (metoprolol succinate, the once a day extended release version) at a daily dose of 25mg… the lowest available without splitting a pill. I haven’t been shocked since, however I was paced out of a couple or episodes that might have otherwise shocked me by a new (smarter) replacement ICD I got about 6 months ago.

I’ve resisted any suggestion that I go on an antiarrhythmic drug (especially amiodarone… I would use Sotalol if that became necessary, dropping the Metoprolol since Sotolol is also a beta blocker).

I can’t say that I’ve had nearly the trouble that you did on Metoprolol… wondering what type (standard or extended release) and dosage you were on. I’ve only relatively recently started on TRT, but even before that the “boner-blocker” effects of the Metoprolol didn’t seem serious, and could generally be overcome by a blue pill if need be. Can’t say that I’ve noticed feeling “dumbed down” or added any weight that I can attribute to the Metoprolol.

I was on Androgel for several months without side effects… but the results were not stellar, either. Just switched to SC T Cyp injections…being slow and cautions with the dose and in adding HCG and arimidex… don’t want any suprises with unwelcome heart side effects.


#10

Goodoldan – that’s quite a saga! I’ve been lucky enough to not have to go the implant route. Never had fib problems. I don’t recall the Metoprolol dosage, but it was twice a day. This is the first time I’ve ever been on prescription meds for an extended period, and I’m amazed at how little is really understood about them except at the highest, most general level. The individual effects seem to vary so widely.

However, my cardiologist did not seem surprised by the side effects I reported. I had some of the trippiest dreams ever while taking Metoprolol. I’ve never delved into the world of Viagra or other such meds, but looks like maybe it’s time. Could be fun…

I just found this paper suggesting that Atenolol actually shuts down T production at the Leydig cells. http://www.ncbi.nlm.nih.gov/pubmed/15762058
Here’s another where you can access the whole text-- shows basically the same thing
http://www.jpathology.com/Issues/Previous%20Articles/9(3).html

Your sex related shock happened after, not during? Better watch it – if it happens during the act your partner might start to like it, depending on the pathway of the current :slight_smile:

For all my complaints about it, I’ve got to say that the beta blockers have literally been a life saver, and have also made my daily life a lot better! So my goal right now is to manage those side effects and get a bit of mojo back.


#11

[quote]Benny58 wrote: I’m amazed at how little is really understood about them except at the highest, most general level. The individual effects seem to vary so widely.
[/quote]

Hence the reluctance of physicians to jump to use of prescription meds. There are a lot of movements to reduce polypharmacy where possible. A lot of elderly patients can be near delirium from the variety of medications never mind any onset of dementia. I think prescribers should take some of the meds they are prescribing so they feel first-hand how it feels. You can’t go by a list of side effects because every drug has about 5-10 for each major body system. Many of the side effects are so subjective that thy can’t be described in a word so they just put drowsiness or something like that.


#12

Labs two weeks after injection are quite meaningless. Suggest that you inject twice a week so future labs are more representative.

  • note risk of diabetes

To loose weight you need to alter your metabolism in several ways.

  • High normal TT, FT
  • in lower 20’s, using anastrozole as needed, this requires steady T levels so you can have a steady anastrozole dose. You can do that with EOD injections with EOD anastrozole. However, if you inject twice a week, levels will vary and you can take anastrozole at time of injection and the variations of anastrozole will at least be moving in the same direction as T levels.
  • thyroid levels need to be optimal. See the thyroid basics sticky. You need to have been using iodized salt steady for years or you are probably deficient.
  • your thyroid labs are the correct ones. But everything is slightly off the mark. Check your body temperatures when you first wake up and also mid-afternoon.

Your cells run on one fuel, ATP, which is made in the antimitochondrial bodies in your cells. The rate if antimitochondrial function is controlled by the thyroid hormone fT3 which has to get inside the cells. Your body temperature is regulated by fT3. If the level of fT3 that gets inside your cells is low, your body temperature and metabolic rate drops and you get fat and/or cannot loose weight; you also have low vitality and all systems in your body slow down. The mitochondria also burn sugars and fats, including cholesterol which is then also converted to pregnenolone, the foundation of all of your steroid hormones.

Check and report temperatures and describe your long term use/disuse of iodized salt.

Stickies to read:

  • advice for new guys
  • thyroid basics
  • protocol for injections

Supplements:

  • fish oil and other EFA’s from nuts and/or flax seed meal/oil
  • high potency B-complex multi-vits with trace elements including iodine and selenium, vitamin K would also be a good component
  • DHEA 25mg, then test later for DHEA-S
  • vitamin C, natural source vitamin E,
  • 5,000iu vit-D3 as tiny oil based caps
  • Ubiquinol form of CoQ10, 100mg [not cheap] (critical for mitochondrial function]
  • health fats, too little fat is bad for you

List all labs, including cholesterol

TRT with lower E2 can be cardio protective and will promote weight loss if thyroid levels are good.