TRT - Moon Face & Distended Stomach

I've been on TRT for several years now (150MG weekly) and always checking my blood work. Total test hovers around the 400 range a few days after injection with free test at the upper level ( I took it from 150MG per week to 100 thinking that it may help moon face. Did that for several months.)

So I've been a bit confused why there has been some ED issues. It sure doesn't help when the wife insists on 4am for our husband/wife time (kids) but before TRT it didn't seem to be an issue. I finally broke down and purchased some liquid CIA from RUI and it has made a world of difference. Now I need to address my moon face. Not sure which way to turn about this. I have even had tests done to rule out Cushing's Disease. I also switched from twice a week shots to just once a week just to be different. I'm back on 150MG again.

I have a chart from the endo visits that shows me going from 178 lbs when first started TRT to 233 lbs in 6 months (6 ' tall & 49 years old) Diet never changed. Face is so swelled it looks unnatural. Doctor seems unconcerned that is has anything to do with TRT and says I need to watch what I eat and quotes my age. The ED happened about the same time as weight gain. I felt wonderful for the first month or so after starting TRT but it went downhill. Only other prescription I take is Prilosec.

Have changed around diet in every way, not a lot of salt, cortisol was high when tested the first time at local doc then found doctor that specializes in Cushing's at the Cleveland Clinic, they did MRI of pituitary and did some extensive tests and came up negative for Cushing's. Their advice was to come off TRT completely and see if that helps. I do not like that idea.

My BP is always high. I donate blood every 60 days or it gets out of control. Moon face and very red head like I've been in the sun. Also, the weight gain in stomach is behind muscle. Stomach is like a turtle shell, hard as a rock and reminds me of HGH gut. Distended stomach.

I did start taking liquid Prami at .25 everyday. Started it a week ago. No AI but Estradiol according to the doctor is fine.

RBC 6.23 Range 4.14 - 5.80
Hemoglobin 14.5 Range 13.0 - 17.7
RDW 16.7 Range 12.3 - 15.4
Eos (Absolute) Baso Range 0.0 - 0.4
MCH Range 23.3 Range 26.6 - 33.0
MCV 70 Range 79 - 97
Grans (Abs) 0.2 Range 0.0 - 0.1
Testosterone, Serum 384 Range 264 - 916
Testosterone, Free 3.7 Range 1.4 - 3.2
Estradiol Roche ECLIA methodology 31.6 Range 7.6 - 42.6
Vitamin D, 25-Hydroxy 17.8 Range 30.0 - 100.0
Ferritin, Serum 13 Range 30- 400

6 ft
238 lbs
32.3 kg/m2
166/100 mm[Hg]
83 bpm

Surgery last year on Heart for wolff-parkinson-white (wpw) syndrome and sleep apnea with it actually happening during the day. Sleep apnea and snoring started when TRT

Any advice is welcome as running out of ideas.

If I might ask , you got any blood relative from the Mediterranean basin?

No Sir.

Just started taking Vitamin D prescribe by doc at 50,000 IUs a week and 325MG Iron daily. With high RBC all the time I would think low Iron would not be an issue.

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Originally Posted by harorider

No Sir.

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Noted. I was asking cause your blood cells got a curious configuration - low MCV value coupled with high RBC. That's compatible with a genetic , hereditary disease relatively common in the med area. It's named beta-thalassemia minor (I got that).

What was the RBC before TRT?

Your ferritin is friggin low and you should consider supplementing with iron. Low MCV could also be indicative of Iron deficiency anaemia, but the paradox here is in that case RBC is also low or normal.

Vit D levels are in the gutter and I'd start supplementing asap with no less than 5000IU die.

Is the sleep apnea treated? High cortisol can stem from sleep issues, and lead to symptoms such a moon face.

You should also take a brief look at thyroid function.

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Originally Posted by harorider

Just started taking Vitamin D prescribe by doc at 50,000 IUs a week and 325MG Iron daily. With high RBC all the time I would think low Iron would not be an issue.

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What form of Iron? Ditch crap like ferrous sulphate, it's hard on the gut. Get some Iron bysglicinate.

High cortisol has been my thought for a long time, but 2 days worth of tests at the Cleveland Clinic with thousands I'm making payments on, says otherwise. I mean, if you Google Cushing's Syndrome, the drawing of the person looks exactly the same shape as me. I just don't have the hump on back/neck. I look like I'm on a hefty does of Prednisone or something. When I see people they are always shocked at the size of my head. Yes, ferrous sulphate is what I'm on. I'll switch that, thanks.

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Originally Posted by harorider

I have a chart from the endo visits that shows me going from 178 lbs when first started TRT to 233 lbs in 6 months

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Wouldn't the "moon face" simply be the by product of gaining 55 lbs? Not saying there's not an issue elsewhere.

Are you exercising?

It very much could be. That was my original thought as I see myself in the mirror everyday and became used to it. It was the wife and others who said, no, a face that bloated can't be just because of the weight. Exercise is mainly done each day on a Total Gym. I know it's not going to build me up muscular but right now my cardio is horrendous. For since 2001 I've been into Jiu Jitsu and hit the wrestling mats a few times a week, but with the weight gain and cardio, I've been away from that for a year. I used to cycle, hit the weights as heavy as possible, but I feel cardio is the main goal now. I just got over the Flu last week and when I went to a Quick Care, they told me I have COPD from the X-Rays (don't smoke) but I have not had this confirmed by my main doctor yet.

Take a look at this: https://en.wikipedia.org/wiki/Superi..._cava_syndrome Similar symptoms to Cushing's. You mentioned heart surgery.

Did you say that your not on an AI?

Not saying there isn’t anything else going on, but diet is most likely a big culprit based on that amount of weight gain. Being as honest as possible, what does your total daily diet look like? Everyone is different, but for me carbs play a huge role in bloating and water retention. I do much better on a very low carb Keto diet than anything else.

My face and my gut is the first place that my weight goes. Get that diet dialed in and think about a low dose AI. Look at HIIT type of cardio and go for low weight and high reps on the gym.

Also might want to go donate some blood. It will help with your cardio.

Thanks for the response. No AI. Diet is not the best, but not the worst either. I'm always aware of it at all times. Except for the once a week Chinese buffet :-) The diet hasn't changed at all when the weight hit. The weight hit within weeks of the TRT. I walked around at 180 until then. Yes, I donate blood regularly every 60 days. As for the diet, I probably need to change it up and be more strict. I've been working on that this week. Thanks again.

I think part of the advice that should come with starting trt is to be very careful with diet and exercise due to the high probability of initial weight gain. I experienced something similar, gaining about 25lbs in the first 2-3 months. Same as you, I did not make any major changes to my diet, and I was already an avid lifter and that wasn’t new either. But, for a while it seemed like every day my weight was jumping up. If you have been low T for a long time before starting treatment, I think it makes you even more susceptible to this phenomenon as the massive changes in hormone levels throws everything for a loop and it can easily take 6-12 months to normalize. I got it under control by getting a lot more strict with my diet and really counting macros in a way that I hadn’t needed to before. Now that I’m several years in on trt, that’s not an issue anymore, it was just that first year. So, I guess what I’m saying is that even though your diet/exercise may not have changed much, the problem still most likely lies with your diet. I hope this helps.

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Originally Posted by harorider

Just started taking Vitamin D prescribe by doc at 50,000 IUs a week and 325MG Iron daily. With high RBC all the time I would think low Iron would not be an issue.

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Soooo are you dead or did the iron supplements work? 98% sure you've got at least iron deficiency anemia. I had the same ferritin and RDW ratio numbers as you, with the same ninja turtle belly, moon face, breathing problems, water weight gain etc. when I was diagnosed. I've also had teammates who went through this type of anemia who said their face looked like a balloon or chipmunk cheeks.

Also was your B12 ever checked?

I'm still alive. Doing 325 Iron twice a day and don't feel any difference. Have not got new labs done yet but soon.

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Originally Posted by David LoPan

My face and my gut is the first place that my weight goes. Get that diet dialed in and think about a low dose AI. Look at HIIT type of cardio and go for low weight and high reps on the gym.

Also might want to go donate some blood. It will help with your cardio.

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How will donating blood help with his cardio..
If he's anemic won't he be more so and then donating he'll have less oxygen in blood and be even more winded ?

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Originally Posted by macmathews

How will donating blood help with his cardio..
If he's anemic won't he be more so and then donating he'll have less oxygen in blood and be even more winded ?

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Pretty much. Even less iron each donation, body has to overcompensate by producing more blood cells, blood pressure goes up to force circulation, but useless because not enough iron to transport the oxygen.