T Nation

T Replacement and Type II Diabetes

I am a 66 year old male with type II diabetes, hypothyroid, low testosterone. I tried the pellets for about 6 months then switched to test. cyp. 100mg/week injection. The doctor added anastrozole 1mg daily as my estrogen levels rose to about 60. Now it seems I am gaining weight and sugar is rising. Also my hemoglobin and hematocrit are higher than normal. Currently my testosterone level is 838 and estradiol is less than 20. Not sure if I should stay on this therapy or cut back the dose for my age??

Were you experiencing elevated E2 symptoms? A 1mg daily dose of anastrozole is what they give women with breast cancer.

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Your doctor is a fool! This is the correct dosage for a female with breast cancer with the intention of driving estrogen to zero. You’ve been quacked and I suggest you find a real doctor and not one who plays one on TV.

Doctors are always eager to prescribe drugs when all you need to do is inject smaller more frequent doses, I inject 21mg EOD just for the purpose of lowering estrogen.

Losing visceral fat will lower estrogen as well.

He is an MD with over 20 years experience in men’s health. I think he was trying to get the estrogen level down fast since it was 60. Yesterday he cut back to .5mg daily. I may cut back more than that. His aim is between 20 and 30 for estrogen level. Who knows maybe I will quit the testosterone therapy all together. Seems to be getting too complicated and a little scary.

How much less than 20? Probably 0 with all that anastrozole.

How do you feel


That doesn’t mean anything, just because he has 20 years experience in men’s health doesn’t automatically mean he’s a competent doctor in the field of TRT, other fields of medicine, well that’s a different story.

Medical school doesn’t teach doctors how to do TRT effectively, you learn either through trial and error or you learn from someone who is experienced in TRT. Your doctor is learning through trial and error, because a experienced TRT doctor would never prescribe that much AI, let alone daily.

It’s a rookie mistake to prescribe AI’s daily. One large injection per week will drive estrogen higher in some men. That’s why I inject 21mg EOD (84mg weekly), because if I was to inject 100mg weekly, I would see estrogen very high as well.

Men who have difficulties with high estrogen do much better on two or more injections per week, something your doctor hasn’t yet figured out. He went into his toolbox and prescribe an AI instead of breaking up the shots into smaller ones and increase the frequency of the injections.

It seems like you lack the commitment to see this TRT through, it’s sad because TRT can be so amazing when you’re working with a skilled doctor, which you are not and sadly you have no chance of success with this doctor.

Out of curiosity, what exactly does that mean? Is TRT the major focus of his practice?

Seven milligrams of anastrozole per week will certainly do that. You might research the drug and see what it is used for and how.

Three and a half milligrams a week is still a lot.

That is one approach some TRT doctors use. Others look more to symptoms and use the lab results as a guide. For example, I feel better without anastrozole and an E2 of 55 than I did with anastrozole and an E2 of 25.

Why? Work with your doctor and determine the best approach for you. If you cannot work with this one, find another one.

It can be complicated for some. What about TRT is scary to you? Living with low testosterone is scary to me.

Are you a healthcare professional or a patient? I was on pellets with another doctor but I couldn’t get him to send in orders for my bloodwork so I switched to this doctor from my hometown. So what kind of doctor do you recommend? My PCP suggested a urologist. I have other problems like hypothyroidism, hypertension, diabetes so I tried an endocrinologist. My PCP and endocrinologist both advised me against TRT. I have different doctors telling me different things. I have been dealing with this for about a year so to say I am not committed is not true. It does make me feel better giving me more energy but when I start gaining weight and my sugar rises all of a sudden it is a little scary. Not to mention the H&H too high.

I didn’t read what anyone wrote but as soon as I read 1mg adex per day I had to reply: Do not take 1mg adex Per day otherwise you will be making a new thread in a very short time asking why your body feels like it’s breaking down, you feel like your joints are literally breaking, and severe depression/thought are coming up!!

Don’t get over whelmed or quit. Everyone here simply cares. There is a big problem with Docs who prescribe testasterone. They do not understand the chemistry or how test and e2 should be managed.

Not long ago before recent changes in testasteorne therapy they would have clients Taking 1mg a week for 200’mg. Or .5 for 100mg. I found this from reading posts and articles on this board.

Now we know how bad that was and most docs now give .25 per 200 or as needed. Allot don’t even give a blocker. Your dose is very very overkill. Compare your 1mg a day to what we’re used to seeing and you can see why we are so aggressive. We’re looking out for you.

Hope that helps. We all simply care and don’t want our fellow man to be harmed by the nonsense some doctors put us through. It’s unfortunate, but it’s true:

You should go find the trt bible by jay cambell and you’ll gain allot of knowledge and be able to make an educated decision whenever your doc does anything.

Trt is healthy. If it was not men would be dying left and right. Your simply restoring kevels back to normal and that = healthy . Read the book I suggested …

You need a TRT doc. Click my name and Email me : I’ll send you a few to call. Don’t be scared there are men at 60 and 70 taking this since they were 40 and 50. When you go over way beyond normal that’s when you start having issues and it’s no longer trt.

So one of your doctors tells you to quit TRT even though it makes you feel better and have more energy, you would do well to ignore this doctor and should refrain from taking his advice in the future.

I am an intelligent, common sense driven analytical thinker and read all the latest studies doctors have little time to read because the see 30 patients per day and overly focus on reference ranges taken from a population that is sedentary the majority of the time, the reference ranges are taken from a contaminated population.

Endocrinologists and urologists are typically the worst at TRT and their knowledge is on average quite pathetic, TRT is a sword for which they don’t know how to weild, this is why most steer you away from something they know almost nothing about. TRT is preventative medicine, it prevents disease, sick care (managed healthcare) waits for disease to strike before offering prescriptions drugs (often for life) which then big pharma rakes in billions of dollars.

Who do you think puts these doctors through medical school?

Many doctors still believe TRT causes prostate cancer and heart attacks which time and time again has been proven false by countless clinical studies, big pharma want to see TRT fail. TRT can prevent disease and big pharma needs sick people in order to advance medicine.

I wasn’t criticising you, I was trying to motivate you to seek competent care. I don’t want you to quit, I want to see you succeed and optimal your hormones for life. Imagine how long you could live having your hormones optimized for the rest of your life!

I got tired of playing the doctor lottery and joined Defy Medical, a telemedicine clinic that offers extremely knowledgeable TRT doctors, they treat thyroid, adrenal insufficiency and much more. I get all medicine mailed right to my front door, labs drawn at Labcorp the usual way. It’s not as expensive as you think, $100-$150 monthly, pay as you go.

Dr Saya will optimise your TRT protocol and thyroid issues pretty fast, he knows what questions to ask and based on the answers know the correct course of action to take. Dr. Saya used to be an endocrinologists and got fed up with the sick care model of waiting for disease to strike, he wants to get to patients before disease stikes rather than treat those who are already doomed which heart disease and or cardiovascular disease.

Listen to all of these guys telling you to find another doctor, not one of us has anything good to say about what your doctor is doing. I plead with you, find another doctor as the new studies of those who take high dose AI’s shows men with the bones ostriches. AI remove minerals from bones and should only be used for a short time if circumstances are extreme enough.

Alzheimer’s patients show remarkable improvement when given TRT, one cause for Alzheimer’s in women is low estrogen which happens after menopause.

Testosterone Threshold for Increased Cardiovascular Risk in Middle-Aged and Elderly Men:

These data showed that a testosterone threshold of 440 ng/dL was associated with increased Framingham 10-year CVD risk in middle-aged and elderly men. Poor sexual performance, decreased morning erection, and loss of libido had an impact on the testosterone threshold for CVD risk. The threshold level was higher in men with sexual dysfunction.

Testosterone and the Heart

Testosterone (T) has a number of important effects on the cardiovascular system. In men, T levels begin to decrease after age 40, and this decrease has been associated with an increase in all-cause mortality and cardiovascular (CV) risk. Low T levels in men may increase their risk of developing coronary artery disease (CAD), metabolic syndrome, and type 2 diabetes. Reduced T levels in men with congestive heart failure (CHF) portends a poor prognosis and is associated with increased mortality. Studies have reported a reduced CV risk with higher endogenous T concentration, improvement of known CV risk factors with T therapy, and reduced mortality in T-deficient men who underwent T replacement therapy versus untreated men. Testosterone replacement therapy (TRT) has been shown to improve myocardial ischemia in men with CAD, improve exercise capacity in patients with CHF, and improve serum glucose levels, HbA1c, and insulin resistance in men with diabetes and prediabetes. There are no large long-term, placebo-controlled, randomized clinical trials to provide definitive conclusions about TRT and CV risk. However, there currently is no credible evidence that T therapy increases CV risk and substantial evidence that it does not. In fact, existing data suggests that T therapy may offer CV benefits to men.

Before I started treatment my testosterone level was in the 150-283 range. I started with the pellets at Peak Performance about a year ago and got it up to 463 in May. That wasn’t high enough so they increased the dose and got my levels above 800. I was having trouble getting them to send in my blood work orders so I switched to my current doctor. We started the injections which I give to myself. My whole point in doing all of this was to improve my health. It seems like I started gaining weight after the increase in dose and my sugar levels are rising. A1c went from about 6.5 to 7.3 and they want to put me on meds. My LDL cholesterol is down to 120 but unfortunately my HDL went down also which is not good. My current test. level is 838. I am trying to find out what my estradiol level really is as the report simply said less than 20. It really bothers me about the anastrozole and the high dose he put me on. I just quit taking it for a couple of days and may just take 2 per week. I am in the Cincinnati area. Any good docs I can trust here?

Also my hematocrit went up to 51.5 and hemoglobin up to 17.8. Doc said that usually doesn’t happen until you get in the 1100 range of testost. He wants me to donate blood every three months.

Anyone had any experience with Lo T Center? Looks like they have an MD and PAs and deal with other health issues along with low T.

These Low T Centers (T-Mills) are bad news, they don’t care about your health and their only goal is to sell you as much Test, HCG and AI’s as they can. Men who are unfortunate enough to use one of these Low T Centers make their way to these forums f****** up! Typical is 1mg anastrozole everyday and months down the road have osteoporosis.

There’s a highly regarded hormone specialists in Springboro, Dr. Rob Kominiarek doesn’t take insurance, most hormone specialists do not. This guy is thorough, 3 hour visit and doesn’t miss anything.

See Dr Rob on youtube.

I guess at least my doc cut me back on the anastrozole after he got the labs. I was started out at 1mg twice a week then when my estradiol was 66 he put me on once a day for a month. Now cutting back to .5mg daily but I think I will do .5mg every other day or back to 2mg per week.

I will check out Dr Rob. I was hoping to find someone who can manage my thyroid and diabetes issues also.

Dr. Rob does everything, even treats those with TBI’s. Dr. Rob teaches other doctors.

Thanks I will check him out. Only about half an hour from me.

You can educate your self and understand your blood work through education. What you really need is a doc who understands this trt to an expert level. They are worth your time If they don’t force protocols on you or make stupid comments like taking you off TRT or not resting free t or saying you have to take ai…

The simplest way to deal with start symptoms I’d by dosage and injection frequency.

Too high HMCT or e2 you try more frequent . That doesn’t work? Ok lower dose by 10 points. Im in this process now and it’s frusttatyong but I know it will workS. I jsut don’t feel like I need to take a ai until it’s absolutely necessary.