I'm looking for a little advice on where to get started. First, a little background to give you an idea of where I'm at. I'm 44 years old and look 24. I've always been a really, really skinny guy. I've been on testosterone for about four years. Since then, I've gained about 30 to 40 pounds putting me at about 160 now. I worked out with my home gym but I have laid off for over a year because of some health issues, which I think I have pretty much resolved now. I was running at least three times a week, but had to stop because of foot problems. Major heart attacks run in my family. My mother has had a major one, and every male on her side has died of their second, if not third heart attack. I've had high blood pressure for at least 17 years.

I've got a decent amount of equipment in my home gym. I've got a new smith machine, elliptical, 80 pound bag, some free weights (curl barls, dumbbells), and a pull-up bar that I can do multiple exercises on, and a dip station. I don't have the money or time to go to a gym in town. The closest is about 15 miles from home and there's more steroids than toilet paper used in their bathroom.

I've got a little beer gut that I need to work on getting rid of. I want to put on weight and muscle but still be able to run two or 3 miles (even if it hurts). I'm a canine handler and need to be able to do long tracks without killing myself.

I guess what I'm looking for, is advice on how to balance lifting, cardio, and running. I really don't know enough about all of this to get a good balance and not defeat the purpose of putting on muscle when I'm also doing cardio or some running. I can't feasibly be that guy that spends two or three hours in the gym every day. I work 10 hours a day and have two little girls to take care of. My plan is to start being a morning person and make myself get up to do it before work-which on my schedule is going to be a bitch but the only way I'll have uninterrupted time to work out.

Diet is a another separate issue that I need to work on. I eat like crap, but I'll do some research on that and maybe even getting into meal prepping. It's just hard to do with picky girls and a wife that doesn't like to cook.

I guess I have a few questions before any advice or suggestions. When you say you have some medical conditions that you think are resolved that prevented you from lifting for the past year, what are they? Or rather, why did they prevent you from lifting? Is buying a smith machine instead of a rack and barbell related to this medical issue?

One other thing, nutrition is not a separate issue. You need to have both in sync if you actually want to hit your goals. If not even just for body composition, but having the right building blocks to recover from yesterday's training so you can keep grinding tomorrow.

Dunno if you have seen my thread but check it out, there may be some insight there for you.
Im skinny fat kind of guy. From what I can tell there is only a few things you can do:

1. Eat like crazy (dirty bulk) and lift the heaviest you can and put on muscle. you will get fatter and it will still take time even with noob gains in effect to really change much.

2. "tone" up. What I mean by this is not really aim to pack on tons of muscle or tons of fat. Think athletic look, beach body type. To me this kind of lines up with a body recomp. Where you slowly alter your body to look more like what you are happy with.

I would ask yourself what your goals are. If you want to try and change your body type completely, going from paperweight to heavy weight you may as well just eat and go heavy for 2 years and see where you are and either keep going or maintain.

If you would rather make it a long term lifestyle kind of thing id say just eat like you have some common sense and put in a good well balanced workout. Progressive loads on the big lifts (bench, squat, deadlift, overhead press) and add in some cardio work to keep your conditioning and body fat in check and keep at it for many years.  

Personally I much prefer long term lifestyle approach vs just eating a ton of food. I like all different types of workloads, sometimes I just want to do heavy squats and other times i just chase a pump. I try and match my calorie needs to the day. Just remember the whole thing is a journey dont expect things to change real drastically overnight. If you cut right out of the gate you will just hit bottom and youll have to go up again so its best to just go ahead and go up. Now, with that said if you have a good amount of body fat it may not hurt to cut for a short time. I usually try and keep body fat in check and not let it get too out of hand. If I jiggle when brushing my teeth thats a sign.

As for the medical issues: I've got 3 or 4 pinched nerves, arterial stenosis, blown discs (2 are severe), arthritis, and bone spurs in my c-spine. I've had this problem forever but it has been at its worst over the last few months. I finally had a steroid injection last week and it really helped me feel almost back to normal. Foot problem=plantar fasciitis. My knees sound like rice crispies from previous injuries and surgeries.

Pain, but mostly time, has prevented me from working out. The smith machine hasn't hardly been used yet so it hasn't caused me any issues. I know some people say they're junk, but I feel safer since I'll be using it by myself without a spotter and it is the only way I can have so many machines in one small area.

I'd post a picture to give you guys an idea of my build, but I'm afraid the ladies would save it for their personal pleasure.

Solace22-what do you mean by "cut?"

Balance cardio and lifting.

Lift weights faster.

A good way to start would be to pick a beginner program that you enjoy, plenty of them here. Establish a goal and then move towards it.

Sounds to me like you would be better off gaining some muscle first, it's a nice confidence boost, you can get rid of the beer gut after a couple months.

You need to figure out your total daily energy expenditure. This will give you an idea.

While you are lifting, you need to eat slightly above that number each week to have surplus calories for gaining muscle, you also want lots of protein and fats in your diet.

My Fitness Pal on your phone (it's free) will help you track everything.

How much time do you think you will be able to dedicate to a workout, and how many days each week?

cut = cut body fat.
my knees sound real bad too but they dont hurt.

It's better to look at it as compromising, not balancing.  Strength and endurance are antagonistic, so pick one to prioritize, make it the focus, and do minimal work on the others.  As a guy, a few years older than you, I would recommend prioritizing strength work because that's what age takes from you first.  I say that as a lifelong bicycle racer/triathlete/runner, who switched priorities about 4 years ago, when I was about your age.

If strength is the priority, lift heavy 3-4 days/week for 45-60 minutes, sprint 1-2 days per week and walk or easy jog 2-3 days per week.

If you're time crunched, lift 2 days/week heavy, sprint 1-2 days per week, and take a couple long walks with your kids 1-2 days per week.

If you choose to prioritize the endurance work, figure out what activity you want to do - running is easy, cheap, and very time efficient and do that 4-5 times per week (1 long, 1 hard, and the rest easy).  Lift 2 times per week, once heavy (4-6 reps) and once lighter/high reps (8-12 and not to failure).

BTW - this is all for naught if you don't fix the diet...

You have to decide which is the priority because you can't get both, especially in your 40s.

I'm half drunk so we'll keep it to links tonight, somebody else can explain they whys.

Routine:
Starting Strength

You want to gain some size and some strength, the quickest way is a linear progression program of compound lifts.  The best way to learn those lifts without a coach is this book.

Diet:
Renaissance

Diet is 80% of equation.  Want to gain weight?  Eat surplus.  Want to lose weight?  Eat a deficit.  It is really that easy, up until a point.  This book will explain the basics so you can work on a diet that's right for you.

Equipment:
Squat Rack

Find a 300lbs Olympic set locally, play it again sports, dicks, or garage sale.  Unless you want to buy once, cry once, look into Rogue.

They equipment you have will work, just not as well.  You want to lift safely by yourself, you need a squat or power rack.  You want to use compound movements like squats, presses and deadlifts, you need an Olympic weightlifting bar with plates or bumpers.

Want more info, here's a start.
https://www.youtube.com/user/CWSmith52

Starting strength. It's only 3 days a week. Realistically it takes up to 90 minutes with rests between sets but i bang it out in under an hour pretty frequently by just powering through all the warm up sets with minimal rest between them.

With your fucked up back and knees i would probably go mostly bike for some cardio. Keep it short and sweet. Warm up for 5 minutes, moderate pace for 10-15 then go as fast as you can as long as you can, back to a moderate pace till you can talk again then sprint again, repeat a couple times. Done in a half hour. You don't need to jog 3 miles every day to be able to run 3 miles. Some high intensity intervals will get your heart and lungs in real good shape and you can focus a bit more on strength and building muscle.

Diet and proper rest play a big role.

Thanks for all of the input. I've been working on a workout schedule. I'll take a links as soon as I get some quite time.

Other people have given reasonable advice, so I'll ask, just to be safe, you are watching your RBC very carefully, right?  Regular bloodwork?  And giving blood on a regular basis?

TRT for some people can lead to higher than safe RBC levels, and if I had a family history of heart attacks and high blood pressure, I'd be monitoring that very, very regularly.

I have it checked about every three months. It's ok as far as I know. I haven't been told otherwise.

I should have posted these earlier, but this is what we're dealing with: