I apologize for the length here, but it's always extensive and never easy with my issues.
I am about to embark on a TRT program through my physician. I am 53 and am in good health other than the following issues. I've discussed such with my physician, but he thinks most of these will resolve and not worsen with TRT as long as we monitor everything on a regular basis. My purpose for this email is to get other opinions.
My scrip is for 200mg/week of cyp. My most recent TT was 425, FT was
9.70 (ref range: 9.0-46.0ng/dL).
1) BLOOD CLOTS: I had two clots in my legs last year. Knowing that exogenous T can raise RBC/HCT/HGB, is there anything else besides monitoring these levels and getting regular therapeutic phlebotomies when necessary that I should be aware of given my prior issues?
2) SLEEP APNEA: I have mild sleep apnea. Sleeping on sides to avoid it. Trying to avoid CPAP. Knowing that exogenous T is a double-edged sword: if low T, then it improves sleep apnea, but it can also worsen it over time via central apnea.
3) HYPERTENSION: I am controlling this naturally. Will only resort to meds if absolutely necessary.
From what I researched, it is from the increase in blood volume that cause this, so same, thing phlebotomies?
4) LIPIDS: LDL-C (153) has improved, but is still elevated; HDL-C (46) has improved, but needs to increase. TRT can reverse that (increase LDL and decrease HDL).
5) HYPOTHYROID - I have been treating my hypothyroidism with dessicated thyroid/T3. I've read that TRT can reduce thyroid function.
But my biggest dilemma has been the inability to lose excess body and visceral fat no matter what I try diet or training-wise (and I have tried everything over the last 4 years - i.e. low carb, intermittent fasting, keto, counting calories, etc.). In addition to hypothyroidism, I believe insulin resistance is still an issue which obviously plays a major role in preventing fat loss. I also have a MTHFR (methylation) genetic defect which I am treating with targeted methylated B-vitamins, etc..
I agree with my doc that much of the above issues will improve by reducing body and visceral fat via TRT but still am concerned.
I would say I am 25lbs overweight based on my body composition (which doesn't help BP). My bf runs 25-29% no matter what I do. Losing weight isn't the issue; it's losing the fat.
My latest BodPod showed I weighed less but had more bf and less lean mass which was really disappointing:
TOTAL WEIGHT: 173.5
Training routine (up until I had to eliminate press movements in the last two weeks because of my shoulder impingement got much worse):
Resistance training: every other day - 45 min. 30 sec. rest; 25 sets total
Cardio: 3 x's/week on off days - 30-45 min.; elliptical/bike; outdoor (until my lower back became inflamed). I do both steady state and HIIT, depending on my energy level.
I am also engaged in a 6-week PT protocol for the shoulder and back which is a workout in and of itself.
I have been training fasted with 20g BCAAs and 5-10g glutamine to try and shed bf, but it has done nothing. I have 2 main meals/day and one snack following workouts. I am gluten-free and soy-free, eat organic only, no processed anything, lean meats, fish, poultry, eggs, Healthy fats are from whole avocados, coconut oil, seeds, nuts and nut butters, olive oil, flax oil. Carbs are mostly from veggies and a small amount of fruit (berries). Only grains are wild rice and quinoa which is technically a seed which I eat maybe once a week.
CHO: 40-50g (will cycle carbs so I eat a little more post workout; but no more than 50g)
I have not attempted to eat less than 1500 calories/day than the above because it's already at a low threshold and any lower I would fear would put me into starvation mode, damage my metabolism and worsen my thyroid function.
I can lose weight; but all I do is get skinny fat. My doc think it's largely because my free T is in the dumps (despite my TT being in the 400s) and this is primarily why I continue to have a hard time gaining lean mass and dropping bf. My SHBG has been a bit high (42), but that's because of taking T3. My E2 is actually too low (4)!
Appreciate any input.