High Blood Pressure on Testosterone ( TRT )

[Nelson Vergel]

High blood pressure or hypertension is a serious medical condition that can go undetected because it often has no symptoms. It’s referred to as “the silent killer” for this reason. High blood pressure can cause heart attacks, strokes, headaches, ruin your kidneys, erectile dysfunction and shrink your brain.

Before you start testosterone replacement TRT, it is very important to get your blood pressure under control. This is done through diet, stress management, lowering your salt intake or the use of blood pressure medications. TRT can increase water retention and blood pressure during the first weeks of treatment. It is a good idea to invest in a home-based blood pressure machine. One usually can be purchased at most pharmacy chains and cost under $ 50. Some, like the OMRON HEM-780, can measure blood pressure easily and keep track of changes with time. Take measurements twice a day until you gain control of your blood pressure again.

Testosterone increases extracellular water ECW. Testosterone acts directly on the kidney, because androgen receptors are expressed in renal tubules. There is evidence that androgens stimulate the expression of the angiotensinogen gene in the kidney, providing a potential mechanism of sodium and water retention by testosterone. This retention can increase weight and blood pressure during the first weeks of TRT. A high proportion of red blood cells (hematocrit) caused by TRT can also increase blood viscosity and blood pressure. High hematocrit can be managed by blood donations.

It is important to have your blood pressure measured during the first month of treatment to ensure that it does not increase with testosterone. The good news is that replacement doses are much less associated with this problem. More serious risks for hypertension are associated with the high testosterone doses associated with performance-enhancing use.

NOTE: Some natural ways to decrease blood pressure are decreasing your salt intake, exercising, keeping a normal body weight for your height, managing stress, and engaging in meditation and yoga. “Erection- friendlier” blood pressure medications like ACE (angiotensin-converting enzyme) inhibitors, renin inhibitors, ARB’s (angiotensin II receptor blockers), and combinations of them may be required for men who cannot maintain a blood pressure reading under 130/80 mm Hg. Diuretics, beta blockers, and calcium channel drugs used for hypertension may cause sexual dysfunction in men, but sometimes they cannot be avoided if your blood pressure cannot be controlled with ACE inhibitors or ARBs alone. Bu some studies show that blood pressure medications may be one of the main drug-induced reasons for erectile dysfunction. But managing ED with drugs (read the corresponding section on ED options) is a healthier choice than allowing high blood pressure to go untreated due to fears of ED-related side effects. Not only high blood pressure ensure that you have more cardiovascular risks, but it may also negatively affect your kidneys.

Monitoring Your Blood Tests While on Testosterone​

Testosterone Controversies: Lecture by Dr. Khera​

The post High Blood Pressure on Testosterone ( TRT ) appeared first on Testosterone Wisdom.

Continue reading...

 

[jacb]

Hi

My blood pressure has been slowly increasing over the years and now it needs intervention. (Yes I have tried diet and exercise etc).

So aged 62, I will tomorrow visit my GP and expect to be put on some form of medication. I get the impression from the forum that Losartan (Angiotensin II Receptor Antagonists - ARB) is a good starting point?

Any dissenting voices out there?

Target BP is < 140/80.

I am currently on 105mg of Test Cyp' (30mg, every other day).

My HCT is high at 53%. Blood donations have been impossible to arrange in the country where I live and when I went back to the UK to donate blood, they said the veins in my arms were too small! Donating blood is not an option.

@Nelson

 

[jacb]

Oh I forgot to ask, looking at the NICE (National Institute for Health and Care Excellence) flow chart for Hypertension, it seems to suggest that CCB's (Calcium Channel Blockers) are offered at the outset of treatment. Either by themselves or with Losartan (ARB's) etc.

I know nothing about CCB's .... should I simply ask for Losartan alone and see how it goes re the BP?

On page two the flow chart goes on to say that if blood potassium levels are below or equal to 4.5 mmol/l then a low does "Spironolactone" should be considered?

It also says that if blood potassium levels are above 4.5 mmol/l then an alpha-blocker or beta-blocker may be considered.

Oh boy!

 

[Golfboy307]

My own experience: after several years of trying "natural" BP control, I went on meds about 7 years ago (now age 55). I eat a client diet and am a long distance runner (and am on TRT). I have had the best luck with Lisinopril. The diuretic they started me on had lots of sides and negatively impacted erections.

Advice: start with one medicine and see how it works. You may not need much to bump down your BP.

 

[Belekas]

Also very interesting how many guys with good looking BP, living a healthy lifestyle, had an increase and to what level post starting and into their TRT treatments. It sucks if BP starts spiking once on TRT and one has to start taking meds after exhausting all other options.

 

[Graham]

Gels/creams are an option, it is primarily injections that cause this rise

 

[Belekas]

Hi

My blood pressure has been slowly increasing over the years and now it needs intervention. (Yes I have tried diet and exercise etc).

So aged 62, I will tomorrow visit my GP and expect to be put on some form of medication. I get the impression from the forum that Losartan (Angiotensin II Receptor Antagonists - ARB) is a good starting point?

Any dissenting voices out there?

Target BP is < 140/80.

I am currently on 105mg of Test Cyp' (30mg, every other day).

My HCT is high at 53%. Blood donations have been impossible to arrange in the country where I live and when I went back to the UK to donate blood, they said the veins in my arms were too small! Donating blood is not an option.

@Nelson

Did you have BP issues before starting TRT? If not then I would consider lowering the dose or try a different injection frequence fwiw. Before all this I have to ask you how does your body composition look and do you workout? I see that you said that "you have tried" healthy diet and excercise etc. Not sure theres anything to try except to start doing whats needed and never look back. Most benefits will come with time doing exactly what needs to be done, no shortcuts and no free lunches. And if you haven't exhaused all other options before and now look to take a tablet to do the work for you well thats not the best way to approach the issue fwiw. Sorry if you already doing all this but without context these questions in isolation make not much sense.

 

[jacb]

Did you have BP issues before starting TRT? If not then I would consider lowering the dose or try a different injection frequence fwiw. Before all this I have to ask you how does your body composition look and do you workout? I see that you said that "you have tried" healthy diet and excercise etc. Not sure theres anything to try except to start doing whats needed and never look back. Most benefits will come with time doing exactly what needs to be done, no shortcuts and no free lunches. And if you haven't exhaused all other options before and now look to take a tablet to do the work for you well thats not the best way to approach the issue fwiw. Sorry if you already doing all this but without context these questions in isolation make not much sense.

I was aircrew until about five years ago and had regular medicals. I was told that the BP was starting to rise and was getting to the upper end of acceptable 140/90. The trend was established before TRT. Maybe (hard to know) TRT increased the BP, it did increase my HCT and they can go hand in hand.

Re diet and exercise…. You do what you can but the BP has got to a point where it is now foolish not to medically intervene or risk doing damage that could have been avoided. Eating properly and exercise won’t now stop.

 

[Fernando Almaguer]

My own experience: after several years of trying "natural" BP control, I went on meds about 7 years ago (now age 55). I eat a client diet and am a long distance runner (and am on TRT). I have had the best luck with Lisinopril. The diuretic they started me on had lots of sides and negatively impacted erections.

Advice: start with one medicine and see how it works. You may not need much to bump down your BP.

I take 10 mg daily sometimes 20 when i feel like it. How much lisinopril (mg) do you take?

 

[jacb]

Met the GP this AM.

He asked for blood tests (Creatinine, Glomerular filtration rate and Electrolytes) tomorrow and 7 days after starting Losartan. Initially 25mg each AM, adjusted as my Blood Pressure response dictates.

He also asked that I keep AM/PM BP records for a week prior to starting medication in order to establish a BP baseline. I asked if he thought it should be possible to get below 140/90 and he said, most certainly. So, there is the target.

Let's see how it goes.

 

[Golfboy307]

I am on 30 mg Lisinopril per day. 10mg in the morning and 20mg before bed. Dosage ranges from 10 mg - 80 mg. Seems to really do the trick, along with other NO boosting supplements I take.

 

[jacb]

I am on 30 mg Lisinopril per day. 10mg in the morning and 20mg before bed. Dosage ranges from 10 mg - 80 mg. Seems to really do the trick, along with other NO boosting supplements I take.

Thanks, Golfboy307

Evidently Lisinopril is an angiotensin-converting enzyme inhibitor or "ACE" blood pressure medication, somewhat similar to Ramipril which will soon be available where I am. The currently available BP Medication in NZ can be seen here.

I have noted what you have said but will start with Losartan, 25mg every morning and see how it goes.

Thanks again

 

[Golfboy307]

As mentioned, Losartan seems to be a popular choice and well tolerated. Keep us posted. Absolutely have to get the BP under control. The term "silent killer" is very apt.

 

[jacb]

As mentioned, Losartan seems to be a popular choice and well tolerated. Keep us posted. Absolutely have to get the BP under control. The term "silent killer" is very apt.

Thanks, Golfboy307

I will keep the forum posted. I have just been reading an interesting page about the pros and cons of ACE & ARB's, from a prescribing point of view. It can be found HERE.

 

[Rabbit91476]

Was on b/pads before trt but was 5”’8. 220. Dropped to 160#. Had to stop taking them due to orthostatic hypotension. But I was unhealthy lean. Got back up to 170 and was borderline needing them so I restarted losartan 100mg. With trt and gym therapy I put on 10# muscle and eventually 10# fat. Eventually averaging 185#. sbp120-140 as long as I don’t drink to much.
I read a lot about telemesartan and all it’s benifits so I started 80mg 3 days ago and have dropped down to 183 and am doing a slow poor job of trying to work my weight to 175.

I know more than you asked for

 

[mooseman109]

I have been on TRT for nine years. Never had BP issues before and not first few year. Has a heart attack almost 4 years ago. My BP will be high now if no meds. I take low dose losartan and cardiverol. Today at dr office i was high at 136/73. Typically low 120 over 70. So I don’t think trt did it, but the heart attack changed things

 

[jacb]

Interesting ... I am on 105mg per week (inject every other day) of Depo (TC) and I wish I had a low weight problem, 6' 1" and 246 Lbs.

How long did the Losartan take to have a mensurable effect on your BP? After 48 hours I cant see any real difference at 25mg per 24 hrs.

 

[Rabbit91476]

Losartan take 2-3 hours to take effect. If it’s your first time on blood pressure meds it can take 3-5 days for the full compounding effect.

Losartan is a weak blood pressure medication. I started at 50 mg. 100mg is the max dose. What was your average blood pressure before starting.

 

[Nelson Vergel]

I am now talking Losartan plus Norvasc. Good combo, no ED or fatigue side effects so far.

 

[jacb]

What was your average blood pressure before starting.

I was alarmed to see that the last few years hadn’t been kind to me, 171/100

I have only been on Losartan for less than a week, I notice that my Systolic pressure has reduced a little, but so far my Diastolic pressure has remained much the same. is that normal?