T Nation

TRT, Joint Pain & Tendinitis


#1

-age - 41
-height - 6’ 1"
-waist - 34
-weight - 229
-describe body and facial hair - normal I guess. Nothing really to report.
-describe where you carry fat and how changed - midsection and love handles
-health conditions, symptoms [history] - below
-testes ache, ever, with a fever? - no
-how have morning wood and nocturnal erections changed - for the better since TRT

I have been on TRT for about 1 year now. I went to an endo in Nov '14 and he suggested TRT after doing blood work and seeing that my Total Test was 234. I wanted to try and fix things without going on Test so he suggested trying Clomid to see if it would raise it. It did. Peaked at about 550. I was still feeling run down and tired, (I have sleep apnea and have used a BiPap for several years) AND EMOTIONAL so he talked me into the Test at 200mg weekly and 1mg anastrozole once a week. Estradiol got has high as 64 with T. Test around 1100. He wanted the Estradiol to be lower so we eventually went to 1mg every other day. That kept my E around 23. If I remember correctly, I think I felt my best when my Test was kept around 800-1100 and my E was 50-60.

In an effort to get my hereditary cholesterol under control, we started Crestor last October. I have since read that Statin drugs can have an affect on muscle tissue in some people. I stopped the Crestor 3 months ago to see if there was any improvement. None. Actually got worse.

HGB and HCT are both elevated. I have an order to take blood off (donate) every 30 days for the next 5 months, and then on the 53 day schedule that is the norm.

Vitamin D was low so I have been on 6000 every day for a few weeks now.

I have attached some blood work. It is not all of them but enough to paint the pic I think. TRT was started in the middle of May '06. This last test in March was done on the last day right before the injection and on 1mg anastrozole twice a week.

I can’t tell if my issue is joint pain or severe tendinitis, or both. I have lost a great deal of strength. I can not really do a chest or shoulder workout anymore. It hurts for days. Actually keeps me from sleeping well for the first 48 hours after that workout. The ache and pain is in my (what feels like) infraspinatus, supraspinatus, teres minor and major, and bicep tendon. Pretty much the whole area. On both sides. However, the right is far worse than the left. It is at a point now where a back workout (especially deads) leaves the teres minor, major and lat feeling on fire. Just decimated.

Diet is good. Sleep is good (7-9 hours). I also take daily: Animal Flex joint compound, Low dose aspirin, multivitamin, coQ-10, 2600mg Primrose Oil, 6g fish oil, and Avmacol (Broccoli Seed & Sprout extract).

Not sure where to go from here. Suggestions? If I forgot to include something just let me know and I will edit the OP.


#2

Can speak from personal experience that when my E2 got low the old joints hurt. Your E2 levels look okay and not really low but if taking an AI you may want to skip a week to see if this helps the joints. If so talk with your doc, maybe you can pull back on the AI a bit.


#3

Yeah, I think that’s what I am going to do. I figured that my E would jump up quite a bit when I changed from 1 mg every other day to just 1 mg twice a week. But it only jumped up 3 points. I think I may move it to half a milligram twice a week. The good thing about my Endo is that he is very willing to let me play with the dosages and frequency as long as it puts me in a range that has me feeling good and that does not put me at risk for some other issue.


#4

Good call.
Even 2mg per week of arimidex is kinda high. It is a tiny tablet but very strong. When my E was high I was doing a 1/4 tab 2x a week.
Do remember my own experiment of 2mg per week and my E numbers were below 1 when I had my blood drawn. I felt horrible and achy joints all over.
Ideally try to aim for your E to be in the high 20’s or around 30 and see how you feel. E gets such a bad rap but is really necessary for both men and women.


#5

High 20’s is where it is at now. I think I may let it ride up a little higher in to the 30’s or even 40’s and see how I feel. Assuming this has anything to do with the E and not something else lol


#6

You cannot get good results with weekly injections, T levels changing a lot and lab T results more of a function of lab timing than anything else.

Inject T twice a week and take anastrozole at time of injections.
Try to always do labs half-way between injections to eliminate lab timing artifacts.

Do labs fasting - glucose and cholesterol
Do AM cortisol at 8AM or 1 hour after waking.
Doing labs in doctors office at random times is a bad idea.

Glucose levels are worrying. See note above re fasting. Get A1C tested to eval overall average glucose levels.

Not testing free Testosterone [FT] is nuts.

AST/ALT can be high from muscle damage/soreness. Test again after taking a break from training.

Your blood thickening is increased by high T levels.
Avoid foods with added iron, read the labels.

HDL may increase with high potency B complex multi-vit. Should have a good spectrum of trace elements including iodine+selenium AND should not list any iron.

Your shoulder issues might stem from your neck, but now swollen and tight muscles may be trapping nerves creating a persistent problem. Ask around for a good massage therapist that does deep tissue work with athletes. Fish oil can help with inflammation. Magnesium deficiency can prevent muscles from relaxing. If you get leg or foot cramps, or can tighten a muscle and make it lock up, you are deficient. This site sells a good magnesium+zinc supplement.

Try to get cholesterol closer to 180.

Statin drugs can induce CoQ10 deficiencies that reduce mitochondrial production of ATP, leading to sore muscles. This can also result in a persistent low level cough from high blood pressure in the lungs because the left side of the heart cannot move blood from lungs to the body fast enough. That is also the same mechanics of congestive heart failure. CoQ10 supplements can correct that, Ubiquinol is the best form.

Your T levels are up. Persistent fat can be from low thyroid function, perhaps from not using iodized salt. See last paragraph in this post.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.


#7

I recently have been dealing with some patellar tendonitis on both legs. In my search for helpful supps, besides glucosamine/chonrdroitin, I found something called Cissus. I had never heard of it before but the anecdotal stories/evidence was too good to believe. Its suppose to work by increasing collagen turnover, but im not sure. Anyway, people stated that they had really good pain relief and joint repair using the stuff. Ive been taking it for a few weeks and im not sure if its helping with the tendonitis or the PT exercises are, but it is feeling better, when I was convinced I was going to be hurting the rest of my life… CISSUS. Check it out.


#8

Alphagunner: If T levels are good, you should be anabolic and there should not be collagen issues. Have you tested IGF-1 to eval your GH status?

Once things get sticky and inflammation occurs, NSAIDs are useful. Rx 15mg meloxicam is very interesting and worth a try. Take 15mg before bed and that is it. Very small load on liver and kidneys. Inflammation can cause a self perpetuating problem.


#9

It was a self inflicted (stretching) injury.