Water Retention While on TRT May Only Occur to Certain Men

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madman

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ABSTRACT

The human body can be viewed simplistically as being composed of fat-free and fat mass. With more sophisticated techniques, body composition can be broken down into fat mass, skeletal muscle mass, nonmuscle lean mass, visceral mass, and bone mineral content. Similarly, it is possible to obtain estimates of total body water and intracellular and extracellular water contents. Regardless of the model of body composition assessment, it is evident that androgens are important determinants of body composition; there is no body compartment that is not directly or indirectly affected by androgens. The effects of androgens on skeletal muscle mass have received the greatest attention in recent literature; however, a growing body of evidence suggests that androgens also regulate fat mass, bone mineral content, nonmuscle soft tissues, and body water.


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The effects of androgens on skeletal muscle mass have received the greatest attention in recent literature (Woodhouse et al, 2001); however, a growing body of evidence suggests that androgens also regulate fat mass, bone mineral content, non-muscle soft tissues, and body water.





TESTOSTERONE EFFECTS ON BODY WATER

The pioneers in the androgen field recognized that testosterone administration in androgen-deficient men and in healthy women was associated with significant retention of sodium, chloride, and potassium, sulfur, and phosphate (Knowlton et al, 1942; Wilson 1996). Knowlton et al. (1942) reported that much of the early weight gain could be accounted for by water retention in association with retained electrolytes and protein. When the administration of androgen is stopped, sodium, potassium, and water are lost quickly (Knowlton et al, 1942; Wilson 1996). Significant water retention resulting in edema is unusual in healthy, hypogonadal men, who are receiving replacement doses of testosterone. However, supraphysiologic doses of testosterone can result in edema and exacerbate heart failure when given to men with pre-existing heart or kidney disease. In clinical trials of testosterone replacement in older men (Snyder et al, 1999; Sih et al, 1997, Tenover 1998; Kenny et al, 2001), the frequency of edema and congestive heart failure in testosterone-treated men has been very low.
 

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Defy Medical TRT clinic doctor
All very true. I’ve never had water retention on any dose, even on 250 mg a week. Never took an AI and my last E2 test was 75.
 
This is really new information to me. I always thought estradiol caused the water retention. I'll have to do some research and look for those posts which Nelson alludes to. Thank you!
 
@JRoop


 
Swelling is one of TRT's most troublesome and hard to manage side effects. It occurs (in my estimate) to about 20 percent of users. The potential causes could be cortisol build up, increase sodium retention, in rare cases high estradiol, or cardiovascular issues. I am enclosing several posts on these issues.

Most cases of lower extremity (peripheral) edema has nothing to do with estradiol and a lot to do with cardiovascular issues. My number one suggestion if edema does not get better after a month on TRT is to get a full cardio work up by a cardiologist.

Some men report decreased edema after a short cycle of a diuretic like HTZ, so that is something to explore. Low sodium intake and plenty of water plus cardio may also help. Cardio exercise and sweating in a sauna have also been reported to help. But these are speculations that should not replace a good cardiovascular work up.

Pulmonary hypertension caused by sleep apnea has also been reported as a cause.

Obstructive Sleep Apnea Associated with Leg Edema

"A common but under-recognized cause of edema is pulmonary hypertension, which is often associated with sleep apnea. Venous insufficiency is treated with leg elevation, compressive stockings, and sometimes diuretics. The initial treatment of idiopathic edema is spironolactone. Patients who have findings consistent with sleep apnea, such as daytime somnolence, load snoring, or neck circumference >17 inches, should be evaluated for pulmonary hypertension with an echocardiogram."

edema[swelling] what is the cause


Ankle swelling after starting testosterone injections

How many of you are on Diuretics for water retention onTRT?


Here are excerpts from an interesting paper:

"This is the first controlled study demonstrating that testosterone increases extracellular water ECW. Previous data concerning the effects of testosterone on plasma volume (19, 20) and urinary sodium excretion (18, 21) are limited and conflicting. The underlying mechanism is unknown, but several possibilities exist. Testosterone could act directly on the kidney, because androgen receptors are expressed in renal tubules (31). There is evidence that androgens stimulate the expression of the angiotensinogen gene in the kidney (32, 33). Therefore, androgens could activate the local renal RAAS to stimulate sodium and water retention through an autocrine or paracrine mechanism (34). The epithelial sodium channel plays an important role in the sodium balance, as demonstrated by genetic abnormalities in its activity, such as in Liddle's syndrome (35). It has recently been reported that androgens increase mRNA expression of the α-subunit of the epithelial sodium channel in a human renal cell line (36), providing a potential mechanism of sodium and water retention by testosterone.

Plasma aldosterone Aldo levels fell significantly during testosterone treatment
, whereas a modest fall, which failed to reach significance, occurred during GH treatment. During combined treatments, a significant fall in Aldo was also observed. The uniform trend toward a fall in Aldo levels observed with single and combined treatments suggests an adaptive response to ECW expansion. The observation that the fall in Aldo was greater in the presence of testosterone suggests that additional androgen-mediated mechanisms are probably involved. Androgen receptors have been identified in human adrenocortical cells and appear to exert an inhibitory influence. In vitro studies have demonstrated that testosterone reduced the proliferation of human adrenal adenoma and adrenocortical cancer cell lines (38). It is possible that testosterone directly suppresses Aldo biosynthesis or secretion, but this remains to be demonstrated.
More on aldosterone

The effects of testosterone on the volume and distribution of ECW could theoretically occur secondary to aromatization to estrogen in peripheral tissues. Estrogen may cause fluid retention through reduction of the plasma antidiuretic hormone (arginine vasopressin)-plasma osmolality set point (39, 40) or stimulating the synthesis of hepatic angiotensinogen (41), enhancing the overall activity of RAAS and leading to sodium retention. However, this postulate is not supported by the observation that urinary sodium excretion is increased during oral contraceptive use (42) or that the plasma renin concentration is reduced in women receiving estrogen treatment (43). Moreover, estrogen reduces the plasma renin concentration, the activity of angiotensin-converting enzyme, and the Aldo response to angiotensin II (44, 45). These actions of estrogen putatively generated from aromatization of androgens could explain the slight reduction in plasma Aldo levels in response to testosterone in our study." Source

I notice that I hold more water when I eat higher sodium foods, drink alcohol, and skip the gym for more than 3 days. Higher simple carb intake also worsens water retention. I weigh myself every morning. If I am not careful, I can gain 3-4 pounds of water in 1 or 2 days. Not drinking enough water also makes the body retain water. My kidney function (eGFR) is good (80).

I think decreasing sodium and sweets intake, increasing water consumption, and doing some cardio are ways to control water weight. If it gets bad, the use of a diuretic only once can stabilize this issue during days where I go off the wagon at my family's parties.
 
He failed to mention why growth hormone (with no effect on estrogen) increases water retention, or why stanozolol or oxandrolone (DHT analogs, lower estrogen) can also cause water retention.
The effects of GH and androgens on RAAS is extremely pronounced even in the absence of estrogen.
The slide he used comes from a lecture about women and HRT risks (high estrogen and progesterone). Our estrogen and progesterone levels are much lower and our testosterone levels are much higher. Increased renal reabsorption of sodium is what is behind water retention, specially with androgens.

If estrogen was the main factor involved in water retention in men on TRT, then anastrozole would completely get rid off this issue. It does not. The only effective way to reduce water retention is:

1- Reduction of TRT dose/frequency
2- Lower comsumption of salt and sweets (which increase insulin and water retention)
3- Using diuretics

Here is the source of his main slide:

From post #9 above:

The effects of testosterone on the volume and distribution of ECW could theoretically occur secondary to aromatization to estrogen in peripheral tissues. Estrogen may cause fluid retention through reduction of the plasma antidiuretic hormone (arginine vasopressin)-plasma osmolality set point (39, 40) or stimulating the synthesis of hepatic angiotensinogen (41), enhancing the overall activity of RAAS and leading to sodium retention. However, this postulate is not supported by the observation that urinary sodium excretion is increased during oral contraceptive use (42) or that the plasma renin concentration is reduced in women receiving estrogen treatment (43). Moreover, estrogen reduces the plasma renin concentration, the activity of angiotensin-converting enzyme, and the Aldo response to angiotensin II (44, 45). These actions of estrogen putatively generated from aromatization of androgens could explain the slight reduction in plasma Aldo levels in response to testosterone in our study." Source
 
Last edited:
He failed to mention why growth hormone (with no effect on estrogen) increases water retention, or why stanozolol or oxandrolone (DHT analogs, lower estrogen) can also cause water retention.
The effects of GH and androgens on RAAS is extremely pronounced even in the absence of estrogen.
The slide he used comes from a lecture about women and HRT risks (high estrogen and progesterone). Our estrogen and progesterone levels are much lower and our testosterone levels are much higher. Increased renal reabsorption of sodium is what is behind water retention, specially with androgens.

If estrogen was the main factor involved in water retention in men on TRT, then anastrozole would completely get rid off this issue. It does not. The only effective way to reduce water retention is:

1- Reduction of TRT dose/frequency
2- Lower comsumption of salt and sweets (which increase insulin and water retention)
3- Using diuretics

Here is the source of his main slide:

From post #9 above:

The effects of testosterone on the volume and distribution of ECW could theoretically occur secondary to aromatization to estrogen in peripheral tissues. Estrogen may cause fluid retention through reduction of the plasma antidiuretic hormone (arginine vasopressin)-plasma osmolality set point (39, 40) or stimulating the synthesis of hepatic angiotensinogen (41), enhancing the overall activity of RAAS and leading to sodium retention. However, this postulate is not supported by the observation that urinary sodium excretion is increased during oral contraceptive use (42) or that the plasma renin concentration is reduced in women receiving estrogen treatment (43). Moreover, estrogen reduces the plasma renin concentration, the activity of angiotensin-converting enzyme, and the Aldo response to angiotensin II (44, 45). These actions of estrogen putatively generated from aromatization of androgens could explain the slight reduction in plasma Aldo levels in response to testosterone in our study." Source

stanozolol and oxandrolone cause water retention? I’ve never heard this. I’ve always heard that DHT derivatives decrease water retention in most men. Never once heard that they increased or caused water retention
 
stanozolol and oxandrolone cause water retention? I’ve never heard this. I’ve always heard that DHT derivatives decrease water retention in most men. Never once heard that they increased or caused water retention
They can, specially at higher doses. So does Anadrol (Oxymethalone)

Types of anabolic steroids.jpg
 
I'm curious to know if there is a correlation between hematocrit and LVEF level for the TRT folks that experienced edema?
There is a strong correlation between long term exposure of high blood pressure and left ventricular hypertrophy. I have not seen data on long term hypertension and ejection fraction but I assume there is an effect. As we know, high hematocrit can cause high blood pressure.
 
Here’s a great 10 min video where Victor black goes over the mechanisms behind water retention. At least the mechanisms that are relevant to us

 
It was posted above and I had comments on it. He bases a whole conclusion on a single slide he got from a women’s lecture to make an extrapolation for men on TRT that are exposed to a small relative amount of estrogen. Read post 12 and 13.
 
Beyond Testosterone Book by Nelson Vergel
It was posted above and I had comments on it. He bases a whole conclusion on a single slide he got from a women’s lecture to make an extrapolation for men on TRT that are exposed to a small relative amount of estrogen. Read post 12 and 13.

He references the slide in this quick video, but he’s been researching this stuff for 35+ years, he’s very knowledgeable on subjects like these. I think u’d really like and agree with a lot of his views if u ever listened to his stuff. He’s a huge proponent of E2, and it’s vast benefits, just like u, if not more. He’s all about taking the symptoms that people blame on E2, or even things that might actually be caused by E2, and addressing them in the healthiest ways possible. He’s extremely against ai use.

But there’s no denying that E2 can increase water retention. Thousands and thousands of bodybuilders have taken an ai to shed water, and it works everytime. Same with many on HRT, including myself. If E2 is high, and u take an ai, u will lose water weight fairly quickly. How much obv depends on the dose of ai, how much water weight the person has to lose, and how high their E2 was to begin with. But there’s just no denying that E2 has the capability of increasing water retention, just like many things do. What he explains, and what I agree with him on, is that taking an ai to decrease the water weight from too high of E2 is the incorrect way to go about it

Oh I didn’t even see that this vid was already posted, whoops. Sorry about that
 
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