Managing BP, lipids and blood sugar on proposed cycle

[Manualtrt]

Hi, I need your advice on most appropriate protocol. I am wanting to do my first lean bulk cycle, however I want to manage and optimise my BP, lipids and glucose as I titrate up.

Current
M40

BP – average 123/77 last month (with 40mg telmisartan)

Goal – minimise increase whilst on cycle and long term reduction to 110/70

Lipids (LDL 104mg/dl) – no dedicated meds currently

Goal -reduce LDL level (<70mg/dl) and manage further HDL reduction

Low blood sugar (multiple low (<3.9) glucose events per day) – have had a CGM for the last 10days, trying to isolate potential causes – symptoms include headaches and fatigue


Current protocol

Test c – 160mg per week

HGH – 2.5iu per day (split AM and PM) - started 3 weeks ago

Reta – 2.5mg per week

Proposed cycle c.16 weeks
Test C/ sust - titrate to 375mg
Hgh - titrate to 4iu
Reta - 3.33mg or max where I can sustain a 200-300kcal surplus

Considering adding NPP or mast at c.150mg

Meds on hand - what should I incorporate to manage BP and lipids?

Telmisartan 40mg
Telmaheal trio — telmi 40mg, cilnidipine 10mg, chlorthalidone 6.25mg
Cilnep T- telmi 40mg, cilnidipine 10mg
Ezetimbe 10mg
Rosuvastatin 10
Pitavastatin1mg


Current thinking, is to keep at telmi 40mg until bp goes to >130/80, replace with Cilnep t, hopefully that will have a material impact. Replace with telmaheal trio if BP creeps up again past 130).

On lipids - start with pita at 1mg and reevaluate at 8-10weeks when I get updated bloods.

What do you think, what else would you recommend?

I am concerned about the low glucose events - wasn’t expecting the CGM to be reporting those given Reta and Hgh - what do you recommend I should do with this?

Many thanks!

 

[cousinmuscles]

That is a very small GH dose, I don't think it can raise blood sugar.

Outline your diet and training.

What's your reason for using retatrutide?

 

[Manualtrt]

I have just started on Hgh so titrating up, I’ll test the waters above 4iu but aiming to be at that ballpark whilst I’m on this cycle.

Reta - fair challenge, the original intent was to manage insulin sensitivity and help ensure diet was 2/300 above maintenance. It’s probably not required now given blood sugar numbers and the fact that I’m looking to be above maintenance.

Diet is pretty much on point aiming for 2-2.5g of protein per kg.

Training is a bro split, but thinking of switching to PPL

 

[ToesOverKnees]

Hi, I need your advice on most appropriate protocol. I am wanting to do my first lean bulk cycle, however I want to manage and optimise my BP, lipids and glucose as I titrate up.

Current
M40

BP – average 123/77 last month (with 40mg telmisartan)

Goal – minimise increase whilst on cycle and long term reduction to 110/70

Lipids (LDL 104mg/dl) – no dedicated meds currently

Goal -reduce LDL level (<70mg/dl) and manage further HDL reduction

Low blood sugar (multiple low (<3.9) glucose events per day) – have had a CGM for the last 10days, trying to isolate potential causes – symptoms include headaches and fatigue


Current protocol

Test c – 160mg per week

HGH – 2.5iu per day (split AM and PM) - started 3 weeks ago

Reta – 2.5mg per week

Proposed cycle c.16 weeks
Test C/ sust - titrate to 375mg
Hgh - titrate to 4iu
Reta - 3.33mg or max where I can sustain a 200-300kcal surplus

Considering adding NPP or mast at c.150mg

Meds on hand - what should I incorporate to manage BP and lipids?

Telmisartan 40mg
Telmaheal trio — telmi 40mg, cilnidipine 10mg, chlorthalidone 6.25mg
Cilnep T- telmi 40mg, cilnidipine 10mg
Ezetimbe 10mg
Rosuvastatin 10
Pitavastatin1mg
View attachment 346452

Current thinking, is to keep at telmi 40mg until bp goes to >130/80, replace with Cilnep t, hopefully that will have a material impact. Replace with telmaheal trio if BP creeps up again past 130).

On lipids - start with pita at 1mg and reevaluate at 8-10weeks when I get updated bloods.

What do you think, what else would you recommend?

I am concerned about the low glucose events - wasn’t expecting the CGM to be reporting those given Reta and Hgh - what do you recommend I should do with this?

Many thanks!

Are you having caffeine in the morning on an empty stomach? That always caused a hypo on my CGM. No problems since I reduced this from 150mg to 50mg caffeine and made sure to eat 30 minutes later.
Using the CGM, what foods have you found spike and drop blood sugar? I had to drop whole rolled oats in milk, sent my blood sugar really high then plunged it. I now eat oat groats and they don't cause a problem.

 

[Manualtrt]

I have a morning coffee but always after some food (high protein, low carb).

My low glucose events (more than 15mins with low blood sugar) are all over night.

I haven’t seen a reading above 7mmol, so no major spikes. Do need to do a better job at tracking impact of food.

 

[adrenalytic]

Hi, I need your advice on most appropriate protocol. I am wanting to do my first lean bulk cycle, however I want to manage and optimise my BP, lipids and glucose as I titrate up.

Current
M40

BP – average 123/77 last month (with 40mg telmisartan)

Goal – minimise increase whilst on cycle and long term reduction to 110/70

Lipids (LDL 104mg/dl) – no dedicated meds currently

Goal -reduce LDL level (<70mg/dl) and manage further HDL reduction

Low blood sugar (multiple low (<3.9) glucose events per day) – have had a CGM for the last 10days, trying to isolate potential causes – symptoms include headaches and fatigue


Current protocol

Test c – 160mg per week

HGH – 2.5iu per day (split AM and PM) - started 3 weeks ago

Reta – 2.5mg per week

Proposed cycle c.16 weeks
Test C/ sust - titrate to 375mg
Hgh - titrate to 4iu
Reta - 3.33mg or max where I can sustain a 200-300kcal surplus

Considering adding NPP or mast at c.150mg

Meds on hand - what should I incorporate to manage BP and lipids?

Telmisartan 40mg
Telmaheal trio — telmi 40mg, cilnidipine 10mg, chlorthalidone 6.25mg
Cilnep T- telmi 40mg, cilnidipine 10mg
Ezetimbe 10mg
Rosuvastatin 10
Pitavastatin1mg
View attachment 346452

Current thinking, is to keep at telmi 40mg until bp goes to >130/80, replace with Cilnep t, hopefully that will have a material impact. Replace with telmaheal trio if BP creeps up again past 130).

On lipids - start with pita at 1mg and reevaluate at 8-10weeks when I get updated bloods.

What do you think, what else would you recommend?

I am concerned about the low glucose events - wasn’t expecting the CGM to be reporting those given Reta and Hgh - what do you recommend I should do with this?

Many thanks!

What is your height and weight? current body comp (bf%)? That LDL is pretty high for such a low dose of test. Is that genetic or is diet not as "on point" as you think? Your AST looks to be elevated as well. It's not concerningly high but should be a red flag. Did you have a strenuous workout the day before your blood draw? Could account for the elevation. Can't hurt to have some liver support either way.

I would get that LDL under control before adding/increasing anything. 4 grams of fish oil split into 2 g AM / 2 g PM should help. Consider 5 mg daily tadalafil for BP. Lowered my systolic by 10 points almost immediately.

Converting your E2, it looks to be about 43 pg/mL. Not out of range but again, kinda high for such a low dose of test. This makes me think you might be obese. Not a judgement, just an observation.

So, going back to what you're actually asking:

I want to manage and optimise my BP, lipids and glucose as I titrate up.

You have health markers that are signaling to you "please reduce this strain" but your mind is responding with "I'll reduce it as I add more strain". Does that make sense? Address these numbers before titrating anything up. If anything, titrate down (or come off completely) and check response.

If you are over 15% bf I would start the reta first and aim to drop down to 12% or less. Retest lipids and liver enzymes. Once in range, then you can blast your socks off.

 

[Photon]

My low glucose events (more than 15mins with low blood sugar) are all over night.

Have you done a blood prick to check glucose when u wake at night due to low bg?
Plenty of people get false low bg readings from cgms during sleep.

 

[Manualtrt]

What is your height and weight? current body comp (bf%)? That LDL is pretty high for such a low dose of test. Is that genetic or is diet not as "on point" as you think? Your AST looks to be elevated as well. It's not concerningly high but should be a red flag. Did you have a strenuous workout the day before your blood draw? Could account for the elevation. Can't hurt to have some liver support either way.

I would get that LDL under control before adding/increasing anything. 4 grams of fish oil split into 2 g AM / 2 g PM should help. Consider 5 mg daily tadalafil for BP. Lowered my systolic by 10 points almost immediately.

Converting your E2, it looks to be about 43 pg/mL. Not out of range but again, kinda high for such a low dose of test. This makes me think you might be obese. Not a judgement, just an observation.

So, going back to what you're actually asking:



You have health markers that are signaling to you "please reduce this strain" but your mind is responding with "I'll reduce it as I add more strain". Does that make sense? Address these numbers before titrating anything up. If anything, titrate down (or come off completely) and check response.

If you are over 15% bf I would start the reta first and aim to drop down to 12% or less. Retest lipids and liver enzymes. Once in range, then you can blast your socks off.

Thanks really appreciate the considered reply.

BF% - I had a dexa in march saying 9% I didn’t believe it at the time, I would say I’m leaner now. But would estimate 12-15%

LDL has come down from 112 to 104 since July (still too high)

Fair point on reducing the strain first, at the very least I’ll extend the titration schedule and knock the NPP on the head for now.

Have been convinced to start a statin: pitavastatin at 1mg. I already supplement with fish oils and nattokinase etc

will re do labs in 8 weeks to see where I am.

How quickly can I expect lipids to move at material amount if going with pita at 1mg?

I could also start Eze, @Ghoul i saw you recommend staggering the starting of this by a week to assess sides.

Thanks

 

[Photon]

How quickly can I expect lipids to move at material amount if going with pita at 1mg?

You know it takes less than a min to google for the answers for most of your questions..

LIVALO® (pitavastatin) | Clinical Trials Data

View LIVALO efficacy data from clinical trials for a range of lipid parameters and compared to commonly prescribed statins.

www.livalohcp.com

By week 12..


Most will see a drop by week 4..but I think doctors usually pull labs at 12w...
It really depends on which trials you're looking at..

 

[Manualtrt]

You know it takes less than a min to google for the answers for most of your questions..

LIVALO® (pitavastatin) | Clinical Trials Data

View LIVALO efficacy data from clinical trials for a range of lipid parameters and compared to commonly prescribed statins.

www.livalohcp.com

By week 12..
View attachment 346665

Most will see a drop by week 4..but I think doctors usually pull labs at 12w...
It really depends on which trials you're looking at..
View attachment 346666

Thanks.

Very helpful. I couldn’t find data on pita at 1mg, just at 2/4mg.

I will start at 1mg and re-assess from there, potentially going to 2mg if no sides (unlikely with pita)

 

[NotHuman]

Low dose statin
Ezetimibe
Empagliflozin/Dapagliflozin
Retatrutide
Telmisartan

That’s the whole fivesome for bodybuilders. It would be silly not to use most, if not all, when they have so much life saving potential.

 

[bigdaddyandfriends]

What @NotHuman said - that's your basic AAS defense pack

Blood pressure medicines will likely need to combined with increasing age and/or high dose cycles. I try to keep my BP as low as possible without symptoms ie orthostatic hypotension.

1. Start with Telmisartan, increase 40>80mg as needed
2. Next add Cilnidipine, increase 10>20mg as needed
3. Next add Chlorthalidone, increase 6.25>12.5mg as needed

There are combo pills with telmisartan or azilsartan plus cilnidipine, and triple combo pills with telmisartan, cilnidipine, and chlorthaldione.

Indapamide is another good diuretic that can be used instead of chlorthalidone. Hydrochlorothiazide is popular diuretic (both individually and in combo pills) but it can cause insulin sensitivity issues, so the other options are better.

ARBs like telmisartan, azilsartan, etc can raise serum potassium in some people. As can beta blockers, so generally they shouldn't be used together. CCBs like cilnidipine are potassium-neutral, and the diuretics I listed can reduce potassium. So telmisartan + chlorthalidone make a good combo, just need to make sure to stay hydrated with plenty of electrolytes.

If 80mg telmisartan, 20mg cilnidipine, and 12.5mg chlorthalidone is not adequately controlling BP, then it's time to reduce dosages ard/or reduce estrogen via AI.

 

[beorn777]

My bloods always look better when I'm doing consistent cardio and I stay leaner. Sometimes you do need some extra help to keep things in a good range but lot's of cardio, clean diet, and berberine kept me in a very good spot compared to when I didn't do those things.

 

[adrenalytic]

My bloods always look better when I'm doing consistent cardio and I stay leaner.

imo, daily cardio is non-negotiable for an enhanced bodybuilder. If you can't be bothered to do it, you reap what you sow.

 

[Manualtrt]

I thought I would provide a two week update on my lipid management protocol.

On Wednesday I had a NHS health check up looking at BP and lipids
On 4th sept my average BP was 123/77
As of 25/09 measured at the doctors as 117/77.
Taking Telmisartan 40mg

Lipids as below - big improvement in ldl from 104 to 70, in the context of increasing test dose from 160 to 370mg and adding 70mg mast (titrating up).

Taking pitavastatin 1mg (added Eze 3days before the test)

HDL still under pressure - need to work on that.

Goal is to reduce ldl further to <40. Will re test in 8 weeks, potentially increasing dose of pita to 2mg

Marker​	04 Sep 2025​	25 Sep 2025​	NCEP ATP III Interpretation​
Total Cholesterol	143 mg/dL	120 mg/dL	<200 mg/dL = Desirable ✅
LDL (bad cholesterol)	104 mg/dL	70 mg/dL	<100 = Optimal ✅; 100–129 = Near/Above Optimal → so improved to optimal
HDL (good cholesterol)	43 mg/dL	35 mg/dL	<40 = Low (risk factor) âŒ; ≥60 = Protective
Non-HDL Cholesterol	–	85 mg/dL	<130 mg/dL = Optimal ✅
Triglycerides	–	71 mg/dL	<150 mg/dL = Normal ✅
Chol/HDL Ratio	3.33	3.4

 

[bigdaddyandfriends]

Pitavastatin has a really good benefit/risk profile (superior to other statins)… maybe just jump to 4mg and that with the ezetimibe will drop your LDL < 50. That’s where it should be if maintaining supraphysiologic levels of androgens for any length of time. And with LDL that low. you can largely forget about HDL. The higher Pitavastatin dose will help it a bit too.

 

[Manualtrt]

Hi,​

I have just got the results back from my latest bloods.

I ran an 8 week trt+ protocol of 300mg test c, 30mg mast and 70mg primo and anadrol on workout days

Stopped about 2-3 weeks ago due to injury so back to a 150mg test dose (last bolus 4 days before bloods)

Some disappointing results so would welcome your views:

LDL not as low as I was hoping for, currently on 1mg pita, ezetimibe.

I am now thinking to go to 4mg pita and add Bemp?

HDL - trending lower

Due to joint pain was considering a TRT protocol of 140mg test c with 70mg deca. But concerned about haematocrit levels creeping up further (not able to donate for 6weeks).

Limited blood panel as it’s the one required by my TRT provider, I am due to get a fuller panel in c.3-4 weeks.

Should I hold fire on deca until new results?

Any other red flags I should consider?

LIPID PANEL (With Trends & NCEP ATP III Classification)​

All lipid values shown in US units (mg/dL) for consistency.

Marker​	04 Sep 2025​	25 Sep 2025​	11 Nov 2025​	Trend​	Reference / NCEP ATP III Interpretation​
Total Cholesterol	143	120	121	↓ then stable	<200 mg/dL = Desirable
LDL-C	104	70	78	↓ then ↑	<100 = Optimal (100–129 = Near Optimal)
HDL-C	43	35	28	Falling	<40 = Low (≥60 = Protective)
Non-HDL-C	—	85	93	Slight ↑	<130 = Optimal
Triglycerides	—	71	Not provided	—	<150 = Normal
Chol/HDL Ratio	3.33	3.4	4.37	↑	Ideal <4.0

---

​

​

B. FULL BLOOD WORK (Latest Values from 11/11, With UK/US Units + Reference Ranges)​

Hormones, Liver/Kidney, Blood Count & Metabolic Markers​

Test​	Result​	UK Units (SI)​	US Units​	Reference Range (UK/US)​
Total Cholesterol	3.14	mmol/L	121 mg/dL	<5.0 mmol/L / <200 mg/dL
HDL Cholesterol	0.72	mmol/L	28 mg/dL	>1.0 mmol/L / >40 mg/dL
LDL Cholesterol	2.03	mmol/L	78 mg/dL	<3.0 mmol/L / <116 mg/dL
Chol/HDL Ratio	4.37	Ratio	Ratio	Ideal <4.0
Urea (BUN equiv.)	11.44	mmol/L	~32 mg/dL	2.5–7.8 mmol/L / 7–20 mg/dL BUN
Creatinine	93	µmol/L	1.05 mg/dL	60–110 µmol/L / 0.7–1.3 mg/dL
eGFR	96	mL/min/1.73 m²	Same	>90 normal
Haematocrit	0.517	Fraction	51.7%	40–50%
Haemoglobin	171	g/L	17.1 g/dL	13–17 g/dL
RBC Count	5.45	×10¹²/L	5.45 million/µL	4.4–5.8
MCV	99.8	fL	fL	80–100
WBC	4.0	×10⁹/L	4,000/µL	4–11 ×10⁹/L
Platelets	158	×10⁹/L	158k/µL	150–450
ALT	26	U/L	U/L	<41 (men)
AST	30	U/L	U/L	<40
GGT	15	U/L	U/L	10–70
TSH	1.26	mIU/L	µIU/mL	0.4–4.0
Free T4	11.9	pmol/L	0.93 ng/dL	10–22 pmol/L
Total Testosterone	21.48	nmol/L	619 ng/dL	300–1000 ng/dL
Free Testosterone	0.752	nmol/L	21.7 ng/dL	5–18 ng/dL (varies)
SHBG	2.56	nmol/L	—	10–70 nmol/L
Oestradiol (E2)	187	pmol/L	51 pg/mL	<150 pmol/L men
PSA	0.98	µg/L	0.98 ng/mL	<1.4 (age 40–49)
HbA1c	33	mmol/mol	5.2%	<42 mmol/mol / <5.7%