T Nation

Experiencing Edema, Doc Mentioned an AI - Other Options?

Hi Everyone,

New guy here. I’ve been on TRT since September, and I’ve been experiencing some edema/swelling for awhile now. My wedding ring is tight, my eyesight seems to have gone down a little, and my blood pressure is on the high side for the first time in my life. My E2 is towards the top of the range, so my endo suggested an AI. After reading some on here, I’d like to skip the AI if possible. The edema is the only high E symptom I have, everything else is all good. Are there other options? Do I just need a diuretic?

Here’s my info and some history.
Age 46, 164 lbs, 13% body fat, ex-triathlete, and I’ve always lifted some, but have been lifting 5 days a week for the past 3 years.
Started seeing an endo in 2016 when my energy tanked. Found out my thyroid had crashed (TSH was 50). I’m on 150 mcg of Synthroid now, and my thyroid levels are great.
Started TRT in September to bring up my T, which my endo thinks crashed along with my thyroid.

Initial protocol: 100mg test cypionate once a week. Felt a dip on days 5 & 6, so switched to 50mg twice a week. E2 was reading just above range, so now I’m injecting 40mg twice a week.

Pre-TRT labs 9/5/19:
Total T: 557 NG/DL - Range = 300-890
Free T: 88 PG/ML - Range = 47-244
SHBG: 52 NMOL/L - Range = 16.5-55.9
Estrodial: <17 PG/ML - Range = <=60.7

100mg Once a week 11/27/19:
Total T: 1251 NG/DL - Range = 300-890
Free T: 283.7 PG/ML - Range = 47-244
SHBG: 41 NMOL/L - Range = 16.5-55.9
Estrodial: 64 PG/ML - Range = <=60.7

50mg Twice a week 1/22/20:
Total T: 1187 NG/DL - Range = 300-890
Free T: 277.8 PG/ML - Range = 47-244
SHBG: 38 NMOL/L - Range = 16.5-55.9
Estrodial: 51 PG/ML - Range = <=60.7

Getting blood work checked the week after next to get the levels for my current protocol. I definitely felt better on 50mg twice a week, but my endo wanted my to dial it down a little.

I know it’s a long post, but wanted to give the big picture. Again, the only issue I’m having is some swelling/eyesight/BP. Everything else is great.

Thanks,
Kraig

Edema can be because your body doesn’t remove waste from your body correctly, in this case a diuretic may be needed. Hydrochlorothiazide is usually the go to diuretic, but be aware you may deplete potassium and may need to supplement it. This is a discussion for you and your doc.

I need a diuretic because I have left vertical dysfunction, diabetes and high blood pressure. You can inject multiple time a week to minimize E2 side effects as well as helping with edema.

The eyesight issues are more than likely related to the edema/high blood pressure which you need to get under control asap! I didn’t start getting fluid retention issues until my blood pressure got out of control.

I would consider injecting smaller doses EOD to minimize sides, but this 50mg twice weekly may create larger T peaks which may also create higher E2 peaks when compared with an EOD protocol.

Water retention is not necessarily due to your estrogen level (which is within range for someone not even on TRT). @unreal24278 has explained it several times before so he can comment if he gets a chance.

For me I gained 14 lbs by week 6 of TRT (all water) and it took about 4-6 months for it to dissapate on its own.

“Alterations in water retention may be in part due to the rapid shifts in hormonal output induced by the dosage of exogenous testosterone given. Many a times on a new protocol regardless of dose water retention will initially appear… as the body re-attains homeostasis this issue resolves by itself” -unreal24278

Thanks guys. I really appreciate the input. I’ll skip the AI for now, and give it time for the slight edema to go away. As for my blood pressure, I’m going to keep an eye on it, to make sure it doesn’t become a problem.

I’d like to inject EOD, but my schedule would make it difficult. For now, I’m sticking with 40mg twice a week.

On a side note, I just tried 25g 5/8" needles, and those things rock! Was using 23g 1", and the 25g seems much better.

Many guys like myself are using 28-30g needles. You can’t feel them. How long does it take you to inject?

Since I’m doing 40mg, it doesn’t take long at all. Maybe 5-10 seconds, and that’s with very little pressure on the plunger. Are you doing IM or sub-Q? I’m doing IM. Also, what length?

A 1/2" syringe is what you want. I do IM in the shoulders and deltoids and hit muscle every time.

I did sub-q for a while but doing IM currently and prefer it. I inject in the delts using 28-30g 1/2 needle 1CC insulin syringe.

Do you still draw with a larger needle, or draw with the 28g as well? Thanks for your patience with all the questions. I’m new to this, so trying to figure out what options are out there. My endocrinologist isn’t up to speed on the latest TRT info, but he’s open to trying things when I bring him new ideas. However, that leaves me to forums like these to get my info.

I’ve done both. No difference whatsoever with the injection itself.

There’s a difference with length of time to draw the medication, takes about 30 seconds to draw .35mL with a 27g needle, compared to about 5 seconds with a 21g needle.

You also will waste medication if using a syringe with an interchangeable needle. If you’re running low on medication before your prescription refill, or have any desire to save medication for a future cycle, then you want to minimize waste wherever possible (I.e. no waste syringe with fixed needle).

I draw and inject with the same needle/syringe. As long as the bottle of T is warm it takes 10 seconds or so. Drawing with one needle and injecting with another may save a few secs but wastes your testosterone and over time that adds up. Warm the bottle in your hand before you inject and it goes fast.

So to recap. Here’s my daily protocol:
Take bottle in hand and make a fist, hold for 20 secs and warm the bottle.
Draw using a 28g+ 1/2 inch needle 1CC insulin syringe
Inject with same needle into delt.
Get erect.
Pound girlfriend or tinder recipient depending on situation.
Go to gym.