[J M]

I’m making an assumption here based on the case presentation, to help you make an informed decision.

Peripheral edema and you’re on stimulants, It could be a sign of heart failure.

Do you take clen, t3, stimulants every time you diet?

Then you go off stimulants when not dieting and your heart has a chance to regain some global longitudinal strain and the edema goes away…

Bloodwork won’t help if this is the case.

You will need to ask for an echocardioediogram with speckle tracking and check your GLS.

A standard echocardiogram won’t tell much either. It will just allow you to see your EF, but you could have initial heart failure with preserved EF.

It’s an assumption, but that peripheral edema on a diet isn’t electrolyte imbalance or impaired sleep…

[J M]

Nebivolol primary use inst blood pressure control. It might in some people by making your kidney retain potassium – it’s a secondary effect.

Nebiovolol is a newer generation beta blocker – its primary use is lower the heart rate. Lower heart rate = less left ventricle hypertrophy and heart changes over time.

Nebivolol is a drug used in heart failure to reverse remodeling. It’s also a particularly interesting drug in bodybuilders because it will increase nitric oxide production and thus endothelial health.

Finerenone is a mineral corticoid receptor blocker. It modulates aldosterone a hormone that is over active particularly;arly in bodyhbuilders and will destroy your heart over time.

Without a doubt every enhanced athlete should be using a beta blocker to reduce the burden on the heart.

Aldosterone is already managed well with Telmisartan, imo no need for extra. Considering telmsaran already prevents LFH in real world scenario but also in research[/quote]

Kuba, respectfully I disagree.

Telmisartan reduction, slight suppression in aldosterone through the AT1 receptor is mild and indirect.

Finerenone directly blocks the mineralocorticoid receptor, preventing aldosterone from exerting its effects on the heart, kidneys, and blood vessels, regardless of how much aldosterone is circulating.

In heart failure for heart remodeling you will use a combination of an SGLT2 inhibitor (you guys like Jardiance right?), a beta blocker (Nebivolol being a better choice although proponolol more studied for this) , and ACE or ARB and until recently Spirolactone which now has a better substitute Finerenone.

Combination therapy would be the better choice. SGLT2, FInerenone, beta blocker and ARB. It would cover all the angles – and still it won;t “prevent” heart remodeling and cardio toxicity induced by AAS which is not only LVH, its apoptosis, calcium influx, diastolic disfunction, heart mass increase, mistrial valve dysfunction….

Lets not forget Cardio, specifically Zone 2, is extremely heart protective for bodybuilders – I can explain why but I dont think anyone is interested…

[J M]

Nebivolol primary use inst blood pressure control. It might in some people by making your kidney retain potassium – it’s a secondary effect.

Nebiovolol is a newer generation beta blocker – its primary use is lower the heart rate. Lower heart rate = less left ventricle hypertrophy and heart changes over time.

Nebivolol is a drug used in heart failure to reverse remodeling. It’s also a particularly interesting drug in bodybuilders because it will increase nitric oxide production and thus endothelial health.

Finerenone is a mineral corticoid receptor blocker. It modulates aldosterone a hormone that is over active particularly;arly in bodyhbuilders and will destroy your heart over time.

Without a doubt every enhanced athlete should be using a beta blocker to reduce the burden on the heart.

[J M]

1. Is your E2 controlled at this setup? If not add ai or change the setup to control e2 – for example for most people one of primo’s metabolites act as an aromitize inhibitor, whereas mast does not (even though it appears to modulate estrogen in certain tissues like the breast tissue).

2. Looks ok. Personally would just do testosteorne alone and an add anastrozole and have a healthier outcome. DHTs are particularly harsh in your lipids.

3. For your goals, thyroid medications are unecessary unless your bloodwork shows the need – hypothyroidism. Thyroid medication use is cardiotoxic – it will add unnecessary burden to your heart especially for your goals.

4. Yes. I would opt for a testosterone + ai and keep HCG on cycle.

Keep it simple. You can build a world class physique on testosterone alone. For a wedding? I wouldn’t even flinch on just using bio identical hormones only.

Anastrozole has over decades of FDA safety follow-up studies. Women are put on anastrozole for decades at a time after breast cancer. Its negative reputation in studies come from low estrogen levels itself, not particularly the drug. Anastrozle is predictable at lowering estrogen and can be used continually with high degree of margin of safety.

I would personally use testosterone and high growth hormone.

[J M]

10 mg and keep it at that so you have leeway to up the dose in case you run into heart failure.

Would add Fenerenone and nebivolol to that stack.