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7 years ago, at 41 years old, I started TRT for the first time. My total T was 199 (forgot what my free T was but it was low as well). That was all my doctor tested for at that time. I got started on 150mg EOW, then 200mg EOW, then 100mg weekly. After about a year, my highest total T was 850. I requested for vitamin D and estradiol blood work. My D was very deficient and E2 was normal. I’ve been on Vitamin D supplements ever since. Unfortunately I ended up having some major side effects. My prostate became enlarged, my RBC was extremely high and I had inflammation in my great saphenous veins. I was told to donate blood, but I had a condition that prevented me from donating and the process of getting it drawn at medical facilities was time consuming, which caused me to not get it drawn regularly. My PSA was always in normal range and digital rectal exam was good. No treatment was provided for the itchy veins. Due to the side effects, I quit TRT after 2 years. My prostate decreased back to normal, my RBC went back to normal, but my veins remained inflamed and itchy for years. Only now after 5 years is it mildly itchy. After 5 years of no-TRT, I’d like to start again, but worried about my prostate and veins. Thanks to the pandemic, I’m able to donate blood now. However, my dad has an enlarged prostate that he’s had multiple surgeries for so I’m concerned of that. And I’m also afraid of my veins becoming severely itchy again. Do you know if there any treatments to prevent enlargement of prostate and inflammation of my leg veins if I were to restart TRT? I’m 49 now, around 18% body fat, exercise regularly, get 7.5 hours of sleep, eat fairly healthy, good mental health. I am on medication for gout, Familial hypercholesterolemia and adhd. Other than that, no other medical conditions.

AlphaMD's Answer

Regarding the prostate enlargement, that would be secondary to elevation in DHT, which is a downstream byproduct of testosterone. T is converted to DHT through 5-a reductase. You could take a 5aR inhibitor while on TRT to prevent this problem. Finasteride is the most widely available one. Side effects may include decreased libido and erection quality, so it is often taken with Cialis to counteract this. Cialis also helps prevent prostate enlargement, so you are basically using two medications to prevent BPH.

Regarding the venous itch, this is usually known as venous eczema or venous stasis dermatitis. It is associated with varicose veins and poor venous return. You should know that testosterone actually reduces the risk of varicose veins, but estrogen is a known risk factor. If you developed varicose veins while on TRT, then logic would suggest you aromatized and had a high estrogen level.

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