T Nation

Case Thread for hankr


-age 55
-height 5' 11"
-waist 43
-weight 220
-describe body and facial hair: Unchanged since youth, no balding, not a particularly hairy guy.

-describe where you carry fat and how changed: predominantly in the stomach and hips, but also a lot on pecs, shoulders, everywhere. This tends to make me look lighter than I am. I guess I should be grateful that I carry it this way. Most people guess me at 200. I look "thick" instead of "fat".

-health conditions, symptoms [history]: borderline hypertension, allergies to pollen, overall good health. Old lower back squat injury still hurts sometimes, and have a 3mm full thickness tear of the right supraspinatus (sp?) tendon at the upper insertion. This in 2001, scarred over, but I feel it when pressing.

-Rx and OTC drugs: benicar 1d for blood pressure, allergy meds. Was on T (Androgel) for 18 months in 2005/2006. Took levels from 294 to 628, and I felt great. Why did I stop? Pain in the ass to put on, I was lean and strong and thought I was fine. No PCT during or after.

-lab results with ranges: full blood work done 1/7/2011
PSA 1.55 Ref range 0 tp 3.9 ng/ml
Triglycerides 95 Normal
Cholesterol 266 High
HDL 54 Low
Test, free: 10.6 Ref range: 9-30 unit: ng/dl
Test, total: 302 Ref range: 240 to 950 unit: ng/dl

All others in normal range, for whatever that's worth.

-describe diet: Currently 1800 cal/day or less with <150 grams carbs, >120 grams protein. Very strict about this, food log, etc.

-describe training: 2 UB, 2 LB, 3-4 cardio per week. Weight w/outs always <45 minutes, usually 23-30 sets. I try to keep rest intervals below 1 min. ( I am trying to lose some ass here guys - I know I could lift more with longer rest periods, etc, etc.) Cardio is 32 min @ 4mph max incline treadmill.

-testes ache, ever, with a fever? NO. Also, no appreciable shrinkage or other problems when on T last time.

-how have morning wood and nocturnal erections changed : As far as I can tell, they are non-existent. Libido over all is low. Too bad, wife is very pretty and ready to rock.

OK, I'm good on training / diet think, although I am always willing to listen. In early 2007, I was 197 and looking very good indeed for an older gentleman. Then: divorce, party ,party, party, food, food, food - did pretty much the typical 50 year old dude meltdown thing and acted like i was 25 for a year or so.

Now: Re-married to a much younger woman, and she wants the guy she knew in the summer of 2007.
SO, I figure that to get the results I did before, do the same thing I did before, at least as a starting point...
Back to the doc - sure enough, T in the dumpster.
So - trying to teach my urol. @ T. got a 100mg injection of ethanate last tuesday, he currently has me on a schedule of 200mg/every 2 weeks. I am trying to get him to:
1 change that to 100mg/week
2 let me do my own injections
3 give me hCG and arimidex

I am to get next injection wednesday or so, and hopefully he will have made the change.

Also - Obviously the chol #s are fucking scary high, so I started the workout / diet protocol on 1/31/11.

I log pretty much everything, and am trying to do a lot at once here: Fix hormonal profile, get back into training, drop a ton of flubber, and so on.
Any knowledgeable input or shared experiences are welcome. Nice to be back on T-mag.


E2, TSH, DHEA-S, CRP and homocysteine would be good.

fasting glucose?

TRT can improve endothelial dysfunction, improve muscle tone of arteries and lower BP.

What supplements?

Fat loss can be complicated by low T, elevated E and hypothyroidism.

If you use a statin drug, be sure to take C0Q10


Supplements are 3 gm creatine / day
Superfood 1 tsp / day
Multi vitamin

Not much.

Not taking a statin - I am working out and dieting very hard now, and I think that my chol #s wil come down as the weight does. Once I hit 195 (current target is 4/24/11 and I am on track) I will get my numbers run again.

Bigger issue is my doc. Although I did get him to change from 200mg / e2w to 100mg, he did not change the timing. So now it has been 8 days since my shot of 100mg, and I am not scheduled for anything else. I have a consult with him on the 21st - that's it. No office visits for another shot, no ancillary scripts - he appears completely clueless.

How can a Dr. not have at least some curiosity about this?
How can you expect to inject a fucking hormone and not think about what the body will do in response?

I tried to get my old doc that gave me the Androgel, although he is an hour away - but he is retired.
Looks like I am fucked. the only other doc listed as doing this in my area wanted me to see someone else first - she was going to tough my fingers / toes to "check my systems" LOL. He does "all natural bio-identical hormone replacement" with "herbs". Fuck.

At this point, I have a gram of test eth in hand, and a source for arimidex that I trust. If I can line up the hcg, I will start my own treatment. So far as the test goes- I will push hard for home injections - then I am in control of timing.

My doc will become a clueless drug dealer, which is what he is so far as this stuff goes, and i will run my own health - which is as it should be, I think.

Down side is for his other patients. If I come in with perfect #s he will think that all he has to do is prescribe test for everyone...


You can get your own syringes and inject the weekly dose any way that you see fit. You can get insulin syringes in some states without a script. Inject T with those EOD. See protocol for injections for further suggestions.


Yep. I just have to make sure he will continue to refill script. Actually, if I can get the go-ahead to do my own injections, that pretty much solves all the Dr bullshit, except for an hcg script.

With regards to hcg - since I did the gel for 18 months with literally no side effects that I could see, I ma wondering if I would be OK with just test till we redo the blood work - the doc wanted to have me on for 6 weeks then do labs again. if my e2 is right, and I see no shrinkage, does that mean I am ok?


Any form of TRT that is effective will shutdown the HPTA of normal guys. However we have one abnormal guy here who states that he does not need hCG and his testes are normal and hang properly. I don't recall that he has posted his FSH/LH numbers.

You dose anastrozole to manage levels at a target value and the calculation for dose corrections is very simple. If that calculation indicates a dose of zero, there you are. An pigs can fly. "Normal" levels are typical without anastrozole, but the high normal [elevated] E2 levels can have a terrible effects on QOL. You will do better with optimal levels.

So you are on office injections. Bummer - pun intended.


Went in today and what a great surprise. I had printed out the protocol sticky and left it for my doc. he read it - wanted me to find some long term studies if I could. He is on board. nice.

Gave me a script for syringes, and a shot of 50mg. We agreed on the following:
I will self administer 50mg Mon / Thurs.
After 6 weeks, I will schedule lab work for a wednesday.
We will check levels, and also be noting any testicular shrinkage or other side effects.
He states he is unfamiliar with hcg, but it willing to look at it, if it seems needed.
Based on E2 numbers, arimidex is also no problem.

We also agreed that the important thing is how I feel - not the numbers...he also brought up human growth hormone, and stated the he is seeing more and more about this, and is considering it in tiny doses - but he says it is very expensive, so i will most likely pass.

So really, a 180. The stickys strike again! Now I just need to teach my girl to inject, and I am good to go. Yay!

Based on last time - once my levels are at about 650 I will be dropping fat like crazy, and workouts will become easy again. I have been keeping my schedule, and making my weight and rep counts for the most part, but it is a struggle.


First home injection today, 50mg.
Had my wife use a 25 ga 1" to draw from vial and inject.
Completely painless. Injected at approx 1/2" depth.

So far no side effects at all, unless better workouts and fat loss are a side effect.
In conjunction with the TRT am hitting it fairly hard (for me, anyway).
Diet is Berardi's Get Shredded with some modifications.
I think before / after pics will be dramatic, to say the least.

Until I have info re: med changes, side effects, etc I will not post again - no need to clog up the forum.
I do expect that my numbers @ 6 weeks will show some negative changes that will send me back here.


6 weeks in and got my first numbers back. We've been injecting 50mg test ethanate twice weekly on mon and thurs mornings. No problems or site pain. Workouts going well. I seem to have more energy, and while I haven't lost mush weight, I am definitely losing fat. Shirts tight, pants lose - confirmed by photos and tape measure, so I am happy with that.

Libido is back, and I am sleeping better, working harder. So far, so good. I have felt that my testes have shrunk slightly, wife says no, and my doc says he sees no change either. No acheing in testes or other evidence of any issues.

Numbers 6 weeks in:
Start: Test, free: 10.6 Ref range: 9-30 unit: ng/dl
Now: 11.03

Start: Test, total: 302 Ref range: 240 to 950 unit: ng/dl
Now: 400

Estradiol: 46.3


estradiol is your numbers now or then?
what was the test type? Quest Sensitive? if valid 46.3 is extremely high for males.


Your T is NOT showing up as decent T levels and E2 is very high. Not working. We have a few other guys who are hyper T metabolizers. Where the T goes is unknown. They need 300mg to get decent levels.

Something here is very abnormal. E2 lab range available? Might be a bogus lab result. Weight loss definately contradicts the E2=46.

SHBG is gobbling up your FT, result of high E2 to some extent.

Testes are OK? Wondering if your odd/low T situation does not have you fully HPTA repressed.


Yes I did not think that 400 was too high - but overall I do feel better. I recall that with the Androgel, it took several months but I did get up to the mid 600s.
And yes, if the ref range on the E is the typical, with a 50 max, then it is very high.

Mt thinking is that T should be where it was when I felt my best (mid 600) and E should be below 20, with free T at the upper half of normal - but what is that for a 55 year old.

max credit to my doc who is earnestly trying to bring himself up to speed on this now, as he thinks it will be a growing part of his practice. He seems ready to help any way he can, but requests that i find him something more than forum printouts...

We discussed arimidex today and he is willing to write a script...

I think my next steps will be to first, make sure I get all details on ref ranges, testing methodology, etc. Then pull together some reference material for my doc and either

a) ask him to up the dose ( it seems ot me that this may be counter=productive - what is the point if I am just going to create estrogen?)
b) get a script for arimidex.

I truly appreciate all the input thus far from everyone. I see this as a process - one where at the end I will have my T levels restored, and all side effects minimized.


Weight loss definitely contradicts the E2=46.

I want to clarify here - I have never been more than 8 lbs down from my starting wight of 224. I have lot considerable fat. But I did a solid month at <1800 cal / day with workouts 5 or 6 days per week. These are OK results - but not near what I have achieved in the past with similar effort.

Testes are OK? Wondering if your odd/low T situation does not have you fully HPTA repressed.
I think they are a little smaller. Doc & wife disagree. Libido high, no ache...


Ok Looks like I am getting the script for Arimidex. I plan to use 1.0 mg / week in divided doses. Given my current protocol of 50mg Test E on Mon / Thurs is there some specific dosing schedule? take it same day as Test, maybe?


did you ever test your thyroid and 8am Cortisol?

the reason I ask is that (in my opinion) low cortisol is a core contributor of T aromatasing to E2. Arimidex can help the problem, but it can be at times just a bandaid masking the actual cause, and Arimidex brings its own set of challenges (can cause too low brain E2 levels, can not stop or limit intratesticular aromatase, etc.)


WTF? I have a whole new set of BS to worry about? Crap. If the Arimidex doesn't dial it in, I may just dump the whole idea.

There are worse things than being a little fat and unable to sleep - and one of them is the mood swings I have had the last week. My gf asked me which one of us was the man last night! :slight_smile:

I wonder if I fell through the "sweet spot" in the last 2 days and now have so much E that it is making me a lady-man.


Have you started the adex? You have to get that E2 under control ASAP....


yes, the human body is complicated. there is no single cure all, just take one thing and your perfectly healthy till you drop dead at 120 years old.

all of your systems (thyroid, hormone, cortisol, etc.) are all interwoven and have countless interactions. It takes time and patience to work through the process, but the end result is definitely worth it.


@catfish74, yeah I know. Waiting to hear from my doc on the script. Does anyone know how long it should take to get the E squelched once I start the adex? I'm thinking it would be a good idea to have labs done at that point, and see if I have it dialed in.

@PureChance - yes, I guess I should have realized - everything is connected, after all. I just want to feel like I used to.


we all do.

I realized how complex and simple things can be when I had such huge improvements from taking freaking sea salt after trying countless different combinations of prescription, supplements, and vitamins (some of which were helpful), but then salt was great.