What would cause sore joints on TRT?

[Duece12345]

Relative newbie getting this thing dialed in. I have worked through a number of issues with help of this board (much thanks!!!). I am stronger and more sexually active than I have ever been, enjoying life finally. My newest problem is sore joints. Specifically elbows and wrists. I have never had this problem and used to lift more volume before TRT! Any ideas?

I have read that E2 can cause this? My E was 25 (11-42) after 6 weeks after starting, go back for Nex5 bloods Next month.

thanks

 

[UCFguy01]

Yes, E2 can affect joints and cause joint pain. I assume you're taking an AI?

For me personally, my joints and back hurt when my E2 is in the 20's. I used to get testosterone pellets inserted every 4 months or so. I'd always know when I needed more pellets when my joints would start hurting. What was happening was my E2 was in the 20's when my T was low, then I would get a new round of pellets inserted and my E2 would rise to 40-50'ish and all pain would go away.

Now I'm on injections and the same thing would happen to me if I took too much AI. Joint pain!! I'd say lower your AI dose.

 

[Guided_by_Voices]

While not directly related to hormones, a big issue for me that caused joint pain was a food sensitivity, in my case to whey protein. Wheat is another prime suspect.

 

[Nelson Vergel]

Dehydration.
Infections.
Low magnesium.
Low estradiol.
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[Duece12345]

Yes, E2 can affect joints and cause joint pain. I assume you're taking an AI?

For me personally, my joints and back hurt when my E2 is in the 20's. I used to get testosterone pellets inserted every 4 months or so. I'd always know when I needed more pellets when my joints would start hurting. What was happening was my E2 was in the 20's when my T was low, then I would get a new round of pellets inserted and my E2 would rise to 40-50'ish and all pain would go away.

Now I'm on injections and the same thing would happen to me if I took too much AI. Joint pain!! I'd say lower your AI dose.

no no Ai here. I was naturally 25 with test around 600 at trough

 

[Hammer]

Relative newbie getting this thing dialed in. I have worked through a number of issues with help of this board (much thanks!!!). I am stronger and more sexually active than I have ever been, enjoying life finally. My newest problem is sore joints. Specifically elbows and wrists. I have never had this problem and used to lift more volume before TRT! Any ideas?

I have read that E2 can cause this? My E was 25 (11-42) after 6 weeks after starting, go back for Nex5 bloods Next month.

thanks

If you take an aromatase inhibitor to block estrogen, that can cause sore joints.

 

[UroPA]

In my practice, I have a lot of men who get on HRT, get normalized (or supranormalized, as I prefer) and feel great. They pick up their work outs and see gains and hit their goals and beyond. Often, older men come back to me saying "I feel great, but my joints are killing me". If labs prove to be normal, or expected, I recommend adding Nandrolone Decanoate at a 2:1 Testosteroneeca ration (If injecting 200mg weekly of test, add 100mg of Deca). The results have been more than favorable.

 

[Duece12345]

If you take an aromatase inhibitor to block estrogen, that can cause sore joints.

no AI which is what baffles me

 

[FLguy123]

This is purely my subjective opinion:

I believe there is another factor other than the typical "you have low E" comments from most. When I look back in time from my years on and off TRT I would go through periods of achy joints, mostly first thing in the morning, and an overall feeling that I can only define as inflammation. Which goes against the thought process that TRT decreases inflammation (which I think is true for periods of time but not forever for everyone). During all this time, AI's were never part of the equation, and my E was often slightly above range but nothing way out of whack. One of the things I suspect could be a contributing factor is high hematocrit. My joints that felt it the most were my knees and ankles, and I have poor circulation in my legs. Perhaps the high HCT was contributing to this even more resulting in starving these areas of the ability to transport nutrition to and inflammation away from.

Again this is purely a subjective thought, but I will say i'm 5 weeks now from my last injection and around day 3-4 after my last injection my achy joints were 90% better. Just prior to my last injection, my TT was 600's, E2 was a smidge above range, and HCT was 52%. This was on 15mg/day of Cyp. I'm not sure that my HCT would drop this quickly after my last injection and haven't got bloods yet, but this has been my experience thus far.

 

[Duece12345]

This is purely my subjective opinion:

I believe there is another factor other than the typical "you have low E" comments from most. When I look back in time from my years on and off TRT I would go through periods of achy joints, mostly first thing in the morning, and an overall feeling that I can only define as inflammation. Which goes against the thought process that TRT decreases inflammation (which I think is true for periods of time but not forever for everyone). During all this time, AI's were never part of the equation, and my E was often slightly above range but nothing way out of whack. One of the things I suspect could be a contributing factor is high hematocrit. My joints that felt it the most were my knees and ankles, and I have poor circulation in my legs. Perhaps the high HCT was contributing to this even more resulting in starving these areas of the ability to transport nutrition to and inflammation away from.

Again this is purely a subjective thought, but I will say i'm 5 weeks now from my last injection and around day 3-4 after my last injection my achy joints were 90% better. Just prior to my last injection, my TT was 600's, E2 was a smidge above range, and HCT was 52%. This was on 15mg/day of Cyp. I'm not sure that my HCT would drop this quickly after my last injection and haven't got bloods yet, but this has been my experience thus far.

interesting. When I first got on Trt I struggled with high HCT. maybe that’s the case again. I agree with that feeling. It feels like I lifted wayyy too heavy, but I am not lifting heavy at all! I go in for bloods in a few weeks and will pay attention to HCT. Thanks for the input.

 

[Stylo]

Its temporary. Dont change a thing. Your body is simply going to take about a year to fully adjust. Drink plenty of water and keep banging away. I developed a sore elbow 2 months ago and Im still feeling it a bit, but its slowly getting better. During quarantine I was very active fixing things and that was when I noticed some soreness due to laborious tasks.

 

[UroPA]

I also think there is something significant to be said for keeping an appropriate T:E ratio. I haven't found anything definitive yet that can be used to govern care for all patients, but like almost all aspects of HRT, I have to tailor my treatment regimen to the person. All factors have to be considered, like age, weight, body fat %, activity level, total and free T, and E2. In general, I find that a 15:1 TT:E2 (meaning in TT = 675 in the trough, then E2 should be around 45) ratio seems to be the general area where my patients feel their best. Again this is relative to the patient. Or, when looking at Free T rather than total, I tend to prefer a 1:1.75 or 2 ratio (meaning is cFT = 25 then E2 should be around 43.75 - 50). I have found in the past that pushing the E2 too low, especially using an AI, has the tendency to cause return of malaise and joint aches along with a lowered sense of well being. Again, I cannot back this up with any studies or mass numbers, this is just my experience and what I have seen be successful. Just throwing it out there.

 

[Stylo]

Just let your body do its thing. And take it easy... your body is asking you to.

 

[Gman86]

I also think there is something significant to be said for keeping an appropriate T:E ratio. I haven't found anything definitive yet that can be used to govern care for all patients, but like almost all aspects of HRT, I have to tailor my treatment regimen to the person. All factors have to be considered, like age, weight, body fat %, activity level, total and free T, and E2. In general, I find that a 15:1 TT:E2 (meaning in TT = 675 in the trough, then E2 should be around 45) ratio seems to be the general area where my patients feel their best. Again this is relative to the patient. Or, when looking at Free T rather than total, I tend to prefer a 1:1.75 or 2 ratio (meaning is cFT = 25 then E2 should be around 43.75 - 50). I have found in the past that pushing the E2 too low, especially using an AI, has the tendency to cause return of malaise and joint aches along with a lowered sense of well being. Again, I cannot back this up with any studies or mass numbers, this is just my experience and what I have seen be successful. Just throwing it out there.

I’ve seen the 15:1 ratio of total test to E2 ratio getting thrown around before a few times. It’s obv a ratio that greatly favors higher E2 levels. So u’ve seen with ur patients that they tend to do really well with higher E2 levels? I would assume that most of ur patients are quite a bit over the top end of the range, at their peak, but also in their trough as well, for E2. I currently feel like well being and libido are slightly down, and I’m thinking my E2 is too low.

So most of ur patients seem to unanimously do better with pretty high E2 levels?

And do u think that it’s all about the T to E ratio, opposed to someone having a fixed E2 sweetspot range? So in other words, do u think as a guy raises his total T level, say from 800 to 1600, that he would then require a higher E2 to feel better at this higher testosterone level? Or if he felt amazing at a total of 800 and E2 of 50, that he would most likely feel amazing with a total T of 1600, while keeping E2 at 50? Or do u think a total T of 1600 would most likely require him to have a higher E2 level to feel good now? Just curious on ur thoughts, and if u’ve seen the ratio be what’s important, more so than a guy having a fixed E2 sweetspot regardless of the total T level. Thanks.

 

[Duece12345]

I also think there is something significant to be said for keeping an appropriate T:E ratio. I haven't found anything definitive yet that can be used to govern care for all patients, but like almost all aspects of HRT, I have to tailor my treatment regimen to the person. All factors have to be considered, like age, weight, body fat %, activity level, total and free T, and E2. In general, I find that a 15:1 TT:E2 (meaning in TT = 675 in the trough, then E2 should be around 45) ratio seems to be the general area where my patients feel their best. Again this is relative to the patient. Or, when looking at Free T rather than total, I tend to prefer a 1:1.75 or 2 ratio (meaning is cFT = 25 then E2 should be around 43.75 - 50). I have found in the past that pushing the E2 too low, especially using an AI, has the tendency to cause return of malaise and joint aches along with a lowered sense of well being. Again, I cannot back this up with any studies or mass numbers, this is just my experience and what I have seen be successful. Just throwing it out there.

great info. Using your math, I need to double my E2. Never read or heard of anyone trying to increase estrogen. Any ideas? have never taken an AI

 

[Duece12345]

Just let your body do its thing. And take it easy... your body is asking you to.

funny thing is I am taking it easier than I was pre-Trt! But I hear you and I’ll ride this out

 

[lemonflavor]

Its temporary. Dont change a thing. Your body is simply going to take about a year to fully adjust. Drink plenty of water and keep banging away. I developed a sore elbow 2 months ago and Im still feeling it a bit, but its slowly getting better. During quarantine I was very active fixing things and that was when I noticed some soreness due to laborious tasks.

This is often the answer for a lot of stuff unfortunately. You can look at E2 (too much focus on this, I think) and all sorts of things, and you should investigate, but for me and so many others I've read about, it's a matter of time. My shoulders, elbows, biceps tendon, and wrist flexors were so sore at the beginning that I could hardly even bench press. After a little over one and a half years, it's gotten a lot better so that I can bench press with no problem. I still have a little shoulder stiffness and a little bit of wrist flexor pain sometimes, but it's not bad at all considering I'm 55.

Also, I do not think this was because of getting stronger from weight training, for a number of reasons.

 

[Duece12345]

This is often the answer for a lot of stuff unfortunately. You can look at E2 (too much focus on this, I think) and all sorts of things, and you should investigate, but for me and so many others I've read about, it's a matter of time. My shoulders, elbows, biceps tendon, and wrist flexors were so sore at the beginning that I could hardly even bench press. After a little over one and a half years, it's gotten a lot better so that I can bench press with no problem. I still have a little shoulder stiffness and a little bit of wrist flexor pain sometimes, but it's not bad at all considering I'm 55.

Also, I do not think this was because of getting stronger from weight training, for a number of reasons.

probably right. I am only a 4 months in. I am just surprised that I didn’t have this for the first 3 months and Out of nowhere it started. I’ll keep the course and press on. Thanks.

 

[UroPA]

I’ve seen the 15:1 ratio of total test to E2 ratio getting thrown around before a few times. It’s obv a ratio that greatly favors higher E2 levels. So u’ve seen with ur patients that they tend to do really well with higher E2 levels? I would assume that most of ur patients are quite a bit over the top end of the range, at their peak, but also in their trough as well, for E2. I currently feel like well being and libido are slightly down, and I’m thinking my E2 is too low.

So most of ur patients seem to unanimously do better with pretty high E2 levels?

And do u think that it’s all about the T to E ratio, opposed to someone having a fixed E2 sweetspot range? So in other words, do u think as a guy raises his total T level, say from 800 to 1600, that he would then require a higher E2 to feel better at this higher testosterone level? Or if he felt amazing at a total of 800 and E2 of 50, that he would most likely feel amazing with a total T of 1600, while keeping E2 at 50? Or do u think a total T of 1600 would most likely require him to have a higher E2 level to feel good now? Just curious on ur thoughts, and if u’ve seen the ratio be what’s important, more so than a guy having a fixed E2 sweetspot regardless of the total T level. Thanks.

It's been my experience that men, especially men actively working out and trying to gain mass and strength, feel better with a slightly higher E2. But again, I want to be clear that I don't think you can treat HRT like a cooking recipe. Its as much art as science. The "numbers" may tell me that this patient should have a lower E2 or a higher ratio but the patient feels great. I don't concern myself with numbers as much as signs and symptoms. I mean, of course, the numbers are a good reference point. I would also mention that I prefer NOT to use AIs if I can avoid it. I see a lot of E2 crash with them and secondary sexual dysfunction. There seems to be this tendency to blame E2 for normal physiologic responses to increased testosterone.
With my patients, we start with a baseline addition of T, then go from there and chart their treatment course based on their response, goals, activity level, diet, etc. But in general, yes, I see better results with a slightly higher E2 ratio. But I also think men do better overall at the high end of normal and even frequently supranormal testosterone levels as well.

 

[UroPA]

great info. Using your math, I need to double my E2. Never read or heard of anyone trying to increase estrogen. Any ideas? have never taken an AI

Honestly? You may need a little more T in your dose. Or maybe some Deca added on 2:1 to your test dose. I don't like AIs and really prefer tamoxifen IF I think there may be some gyno presenting. I don't chase E2 levels unless the patient is having E2 symptoms. Each guy is different and knowing your patients is crucial to finding their sweet spot. Thats why I really discourage TRT mills / franchise clinics.