T Nation

Long Term T and Pec Tear

So I was diagnosed with low t three years ago. Started injections twice weekly. 130 mg weekly in two injections. Felt much better as far as muscle pain. Gained twenty pounds of muscle. Recently tore pec muscle. Complete. Surgery done Tuesday. Doc says he was concerned about the quality of the tendon. I haven’t injected anything else.

I was only into tenth rep with 190 and not even straining though I work out hard daily. My question is have I done something to screw up my body? Tendons in particular? My grip was wide. Mistake. I’m 46. So I should know better but still. This has been a deveststing injury and a year or rehab. Might my test have hurt me? Blood levels been running between 600 900 consistently

Have you use ever used corticosteroids like prednisolone? That can lead to tendon failure.

Now that you are here; please read the ‘advice for new guys sticky’ and the ‘protocol for injections’ sticky.

No. Never. Could be that overuse just lead to weakness. But even my surgeon said my tendon looked muscinous And fragmented

Corticosteroids like prednisolone cause severe catabolic damage and things lick Achilles tendons can simply break, even for those who are not doing anything athletic that would create high loads. A few doctors avoid long term use of these drugs because of this effect. Where these drugs are essential, a few will add testosterone to counter that catabolic state. That has serious implications for females.

Studying the stickies, T alone is typically not a very good protocol.

What drugs, Rx and OTC. Any exposure to chemicals or fumes? Any exposure to metals or bromine?

Any prohormones or internet T boosters?

Any other issues other than the tendons? Energy levels, libido, mood/depression body temperatures, diet, appetite, changes in fat patterns? We very often see guys and doctors get tunnel visioned on T, missing the big picture.

Honestly nothing I can think of. Again. I identified low t levels. 250 range. Starts t therapy three years ago. Made me feel great. Stayed on it then just had this weird injury. Was just looking to replace myself to high end of normal range. Not do much of anything else. Prolactin normal. MRI normal. I’m thinking maybe too much muscular development. To much unrecognized strain in the tendon. Maybe t his the pain some. I don’t know. Though about hgh to strengthen the tendon during recovery but got a big no on that from surgeon. Also said no to prolotherapy

Shot in the dark, but have you used Cipro or Proquin XR, Levaquin, Floxin, Noroxin, Avelox, Factive at all in recent months or past year ?
I was prescribed Cipro a couple years back, and while on it I developed a serious tendon issue in my forearm
and thumb. Reading the pamphlet that came with it said its a rare side effect (tendon issues and tendon rupture). I Googled it and found lots and lots cases. Not sure T-Nation will let me post this link but here it is http://www.webmd.com/osteoarthritis/news/20080708/fda-warning-cipro-may-rupture-tendons
If they won’t post it type cipro and tendon rupture into Google.

Ok so I’m a doctor but you really know your stuff! Thanks so much for all this help!!! Nope. I read the thread on t replacement. Being part of the medical community I can tell you nobody uses aromase inhibitors and hcg along with t replacement in low t patients so my next question is where do I get those ?

I do two shots a week and don’t seem to have any issues with mental sharpness. Maybe I’m moody but who isn’t sometimes. Do get sweats occasionally. My testes did shrink but honestly I don’t care. And I’m done having kids. Still think I should try the whole soup of medications to see if it makes a difference overall?

Can’t find any research that shows just t hurts tendons below 200 mg a week and I’m well below that. Any thoughts on hgh? Thank you so much for helping. What’s your background if Incould ask

Low T is a catabolic state, connective tissue weakens and collagen structures are lost. And that is a major factor in bone loss. Takes time.

The medical community that practices T+hCG+LH does exist. They are specializing in these things. An enthusiastic GP is way better than endocrinologists and urologists. Is any of this taught in med school? -no

From a functional medicine point of view, anastrozole is what it is, an aromatase inhibitor. It happens to be used for female cancers, but that should not be an issue. Small amounts 1mg/week instead of 1mg/day are used to modulate E2 levels to get to an optimal E2 level. All of the major side effects for this drug are secondary effects from E2–>zero. That is not an issue for TRT use. And TRT shuts down the HPTA, LH/FSH–>zero. This can lead to testicular aches/pains for some and one of the major sources of pregnenolone shuts down. Ongoing the testes cam become undifferentiated small blogs of collagen. That is organ failure. hCG prevents these problems and should be regarded as HRT. One lobe of hCG is identical to the active lobe of LH. That works very well and is not a foreign substance to the human body. Many also report that they feel a lot better with hCG, mood improves, sometimes within one day. So there is some brain activity that is not understood, but positive. Perhaps injecting LH would do the same. [Pregnenolone has some important roles in brain function.]

T only protocols create E2:T imbalances and cause testicular shutdown and failure. Is this malpractice? Many here would argue that it is. Drug reps are not going to detail their T delivery system and then tell docs that they need to Rx hCG and anastrozole to get proper results. Do docs will not learn that way. Docs do not react well to guys delivering info that they found on the internet [here]. There are a lot of problems and issues. The biggest problem is the doctors and because the problem is more social than technical, it cannot be fixed. What can you do about it?

Because of the above problems, many guys are forced to self medicate. Anastrozole is available, hCG is very difficult to get.

We have a finding a TRT doc sticky. Read that.

TRT did not cause the problem, but perhaps increase muscle strength exposed a weakness in connective tissue.

How about some stats about you and lab work. See the advice for new guys sticky.

Working out daily does not allow for recovery! That may be a significant factor.

GH would probably be helpful. Can you post IGF-1 lab numbers?

Ok. I’m doing a battery of labs. There is a way I can get both hcg and aromase inhibitors. 1500 for six months. Online doctor eval then they send you everything though the dose of t is 200 mg a week. Along with hcg. They have an hgh protocol as well. I don’t want to turn into a giant but I could modify their program. I’ll post labs after I get my blood work. I think the big barrier is that all this hasn’t been tested. Double blind studies drive therapies

Wait, you are a doctor, and you are resorting to an online clinic and paying $300 a month for Test + Ai + HCG ?
Can’t you find a colleague or just a good local GP ?

[quote]PKNY wrote:
Shot in the dark, but have you used Cipro or Proquin XR, Levaquin, Floxin, Noroxin, Avelox, Factive at all in recent months or past year ?
I was prescribed Cipro a couple years back, and while on it I developed a serious tendon issue in my forearm
and thumb. Reading the pamphlet that came with it said its a rare side effect (tendon issues and tendon rupture). I Googled it and found lots and lots cases. Not sure T-Nation will let me post this link but here it is http://www.webmd.com/osteoarthritis/news/20080708/fda-warning-cipro-may-rupture-tendons
If they won’t post it type cipro and tendon rupture into Google.[/quote]

Used IV and pills of levaquin at the ER a year ago my knee started making clicking noises and popping, I stopped the pills after doing my research and switched zpack. After a few months it healed. I started curling from 80 lbs and moved up to 155 a few months ago. My right elbow tendon now hurts after any lift. Nobody warned me either when I was at the ER and I was too sick to be able to go home and do usual research.

My theory would be the same as KSMAN, you probably built muscle up so quick the tendons and ligaments weren’t ready, age just aggravates it.

I live in vancouver Washington. Nobody I know of endocrinologists included do anything other than straight testosterone. In fact it’s frowned upon. Again. At the end of the day you mind of have to practice evidenced based medicine or you can get in trouble I’m a gp. Fifteen years of experience and never came across anyone being treated with that complete list of meds. UP TO DATE is kind of the bible of advanced medicine and there’s nothing about using t hcg and aromase. In fact I called an endocrinologist about t and tendon rupture and her first comment was “YOUR NOT USING AROMASE INBIBITORS!” Are you? If someone is in portland I’m open to it but insurance won’t cover hcg and aromase anyway

[quote]Cstamata wrote:
I live in vancouver Washington. Nobody I know of endocrinologists included do anything other than straight testosterone. In fact it’s frowned upon. Again. At the end of the day you mind of have to practice evidenced based medicine or you can get in trouble I’m a gp. Fifteen years of experience and never came across anyone being treated with that complete list of meds. UP TO DATE is kind of the bible of advanced medicine and there’s nothing about using t hcg and aromase. In fact I called an endocrinologist about t and tendon rupture and her first comment was “YOUR NOT USING AROMASE INBIBITORS!” Are you? If someone is in portland I’m open to it but insurance won’t cover hcg and aromase anyway[/quote]

As a fellow medical professional do they respect your opinion if you present them with what you’ve learned? Who frowns upon doctors who prescribe things other than T?
The medical system is indeed screwed up to the core, it sounds like intimidation that doesn’t allow doctors to prescribe patients proper care.

Lets look at it from a different perspective. There have been many roads in medicine that made sense based on physiology. Lab tests people’s feelings whatever. And when put to the test of large double blind placebo controlled studies failed! Recent large study from the veterans admin shows multi vitamins in people over fifty increase cancer risk. Hrt for women increases risk for cad. We believed the opposite for years asked on women’s cholesterol numbers. And to date I don’t think there has been research on the combos you speak of though there surely should be. You do the best with the evidence you have. Right now all we have is t replacement at mid levels 400 500 seems to help people feel better and doesn’t seem to cause problems. Problem for me is I felt better a little higher then that. And yu also make lots of sense with what you say so I’m willing to try but hell no. I won’t get any of my peers to write that for me. But I’d love to become more educated on the topic and feel better. And spread the word for sure. You’ve already started that process with me and I really appreciate it

Ahhh, Whats up DOC (sorry, I always wanted to say that).

Many Doctors, Uros, Endos, GP’s are behind the anti aging, low t clinics that you find everywhere on line.
From what I have been told, their business hinges upon being compliant with the DEA WRT treating
men that truly have low t (documentation of blood and a physical). Some will stretch the definition in order to sell you $300 per month therapy of T + ai + Hcg. BTW, the meds they RX you are all from compound pharmacies. I am sure $300 a month is affordable for you, but why waste your money ?

Finding the right Dr. would cut that cost to about $20-$30 per month for you.
Perhaps you will have to drive a half an hour or hour to get the right person (many people in this forum are in the same boat), but I think you would agree that it would be better to have in person access to the treating physician.

There is a sticky on how to find a TRT doc in your area http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/finding_a_trt_doc

Good Luck.

@ TUNA
I know the exact noises and symptoms you are talking about.
Three days into a cipro script if you held my forearm while I wiggled my fingers you would swear that I had a couple old twigs or pieces of rusty metal in my arm.
FYI…be really careful with heavy weights, I have read accounts like the OP here, guys years after have
torn and popped tendons even with lighters weights as a result of treatment with floroquinolones.

Never used any floroquinalones. I think overtraining and a freak accident caused this. Anyone out there make full recovery from pec tear. I’m gonna be pretty nervous lifting again. Still waiting on my labs

Read the finding a TRT doc sticky and explore the suggestions there.

You seem to arguing to talk yourself out of doing what is known to work:

  • men on TRT mostly have E2 levels that are too high.
  • AI lowers E2 levels
  • Low dose AI effectively modulates E2 levels
  • E2=22pg/ml is known to be a good target levels, because guys report that they feel better
  • The side effects of AI are from E2–>0 which by definition does not occur with the above
  • testes ache for many, wither and die on T without hCG, smells like organ failure to me
  • above caused by LH–>0 from TRT
  • low dose creates the same LH receptor activity as baseline LH activity, define HRT

I can’t believe that that I have to repeat this to a doctor. Stop looking for reasons that you cannot, and get motivated. You only need to find a doc who will script off-label use of drugs that are documented as safe.

We know that dealing with endocrinologists is mostly stupid. Welcome to our world.

BTW, a year or so ago, a doctor was here [Florida] who was looking at what was going on. He studied what is here then did his own research. Then he started PM’ing me and stated that he had changed his medical practice. He was no longer satisfied treating people’s diseases. He wanted to be in health management, not disease management. He modelled his new practice based on the protocols recommended here. What he found, and what he read that I wrote, made a lot of sense to him. You might compare and contrast your thinking to that professionals epiphany. And note that this type of thing is practised by a large number of physicians, however, they are a relatively rare. And they are making a lot of money as well.

You think that someone is going to do hugely expensive combined double blind medical trials to verify that these things work? How about a study of T without AI where men go postal and grow tits? And T without hCG where men, some young men, will go sterile, testes become irreversibly tiny, crashed pregnenolone and DHEA levels, and scrotums that pull up tight and make men look like prepubescent boys.

Internet clinics are a huge rip-off. And they have a opportunity to make money, and over prescribe, because the rest of the medical community to address these problems effectively.

I do not hesitate to call out doctors. Do not take this personally. I am, in my own way, trying to help you in the best way that I know. Yes, I get angry with doctors who are idiots, welcome to my world.

i dont take it personally at all. and as ive said i actually am willing to explore these options. but i have yet to find a doctor in portland who does this and knows what they are doing. my search continues. i run the biggest practice in my county and its hard to find time but im going to continue for sure. and i agre the internet thing seems like a money machine. and i agree that this should be looked into by the medical community at large with viable research. and im nit talking myself out of anything at all. understand all this has been quite traumatic. been a bad year. i dont know you or your backround but yes i understand physiology and everything you say makes sense. and i appreciate that you are passionate about the topic and are trying to help people you dont know. your a saint for doing so. i should be paying for your knowledge.

just a couple things you should know about “doctors” i treat my entire practice like they are family. i bleed for them. most of my co workers do as well. medical community has some of the highest suicide rates of any profession. and its no way to get rich. believe me. average doc comes out of school with 300000 in debt payed back over ten years so you have to love what you do and love people. and hers the problem. being a “pioneer” and using stuff off label can and will get you sued. and if something happens you have no leg to stand on, period. and remember, whatever you do doesnt necessarily have to have caused the problem. you just have to have a good enough lawyer and doctors for the plaintiff convincing enough to pursuade the jury you did something wrong. and then guess what. your fucked. you can be perfect at what i do, someone can die and your fucked. period. welcome to america. and no tort reform.

i and my cohorts wish it was that easy to always do what we feel is best but its not always possible. having saud that i want to feel better. im going to find someone and give this a try. and if i cant find anyone ill do it myself with expensive internet stuff.

dont stop helping me. dont give up on helping others. just try to see the other side of things as well. and recognize that not all of us are bad, oney grubbers, lazy, stupid, etc. in general we are really compassionate people sometimes shackled by our training or lack thereof. rememebr, i have to do my best to know everythign about everything, lol.

again, thanks for your help and my test results will go up soon. where are you from?

Two sides to every story.
Well said Doctor…and good luck!