High blood pressure from Hematocrit and Hemoglobin

Melody68 said:

I have searched the forum but haven't found a lot of information, or concern, for the high blood pressure that can result from the thicker blood that higher hct and hemoglobin can give to you.

I've been on Trt for about 6 months now (currently 84 mg/week) and my hct and hemo are climbing; I suspect my next blood test will show hct of .53-.54 and hemo of 179-181 (ref 135-175). Before Trt my hct was around .48 and hemo of 170; my blood pressure was always excellent, about 120/80 and even 110/70.

But the last few times I've tested my blood pressure it has been higher, almost always 144/80, which from what I read is considered high blood pressure. Surely others deal with the same issue . . . or not? What BP limits do you guys feel comfortable with?

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Melody68 said:

I have searched the forum but haven't found a lot of information, or concern, for the high blood pressure that can result from the thicker blood that higher hct and hemoglobin can give to you.

I've been on Trt for about 6 months now (currently 84 mg/week) and my hct and hemo are climbing; I suspect my next blood test will show hct of .53-.54 and hemo of 179-181 (ref 135-175). Before Trt my hct was around .48 and hemo of 170; my blood pressure was always excellent, about 120/80 and even 110/70.

But the last few times I've tested my blood pressure it has been higher, almost always 144/80, which from what I read is considered high blood pressure. Surely others deal with the same issue . . . or not? What BP limits do you guys feel comfortable with?

Click to expand...

Seagal said:

No, not the same here.
It appears like a correlation with HCT, and high BP is indeed a potential risk of elevated/high HCT. I would consistently monitor my BP over longer period of time in order to have more data than 'the last few times'.
Without any other changes since starting TRT, I would see this BP as big red flag. I would try to donate blood, check HCT and keep monitoring BP. You can figure out if/how your BP relates to HCT.

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Melody68 said:

Well, it's a bummer topic, but I have to deal with it.

Monitoring it on a daily basis and then averaging is a good idea. Do you use a home kit of some sort to take your blood pressure? If so, when would be the best times of the day to do so?

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Melody68 said:

I looked at the wrist monitors, $30-40, not a lot of money. Do they work OK? Do you find yours as accurate as conventional medical equipment?

I'm looking at the whole situation closer now. I DO drink a lot of coffee, and I DON'T drink a lot of water. I've also been reading that circumin reduces blood iron and hematocrit. I'll have to come up with a plan . . .

I'm still in my first year of TRT, and it was supposed to be an experimental year to test whether I go on T permanently. My T wasn't way low, but lower at around 11.0. It certainly hasn't solved a number of initial concerns that I had, but it really has helped with one issue, my body composition. At the age of 68 I had lost a lot of upper body muscle, and the waist was getting out of line. In earlier years I was consistently 6'3 and 240 lbs, people would say well built. Despite not exercising much, the shoulders and arms are coming back quickly and the waist is leaning out. Really, I like the effect, so does my wife, so I guess I'll stay on T and thus have to figure out all these other pesky sides . . .

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Melody68 said:

I've had to go to the doctor a few times, for different issues, the last while - they always test your blood. I've been surprised by the higher figure. I also tested myself at the pharmacy yesterday, same kind of reading. But I'm curious as to what the result might be when I test myself in the relaxed setting of my home. I'm checking Amazon right now and will get one of these monitors. Are you saying your Sanitas was accurate compared to professional equipment?

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Melody68 said:

I have searched the forum but haven't found a lot of information, or concern, for the high blood pressure that can result from the thicker blood that higher hct and hemoglobin can give to you.

I've been on Trt for about 6 months now (currently 84 mg/week) and my hct and hemo are climbing; I suspect my next blood test will show hct of .53-.54 and hemo of 179-181 (ref 135-175). Before Trt my hct was around .48 and hemo of 170; my blood pressure was always excellent, about 120/80 and even 110/70.

But the last few times I've tested my blood pressure it has been higher, almost always 144/80, which from what I read is considered high blood pressure. Surely others deal with the same issue . . . or not? What BP limits do you guys feel comfortable with?

Click to expand...

Does Patient-Applied TRT Pose Risk for Blood Pressure Elevation?

Does Patient-Applied Testosterone Replacement Therapy Pose Risk for Blood Pressure Elevation? Circadian Medicine Perspectives (2022) Michael H. Smolensky, Ramon C. Hermida, Linda Sackett-Lundeen, *Ramon G. Hermida-Ayala, and Yong-Jian Geng ABSTRACT We reviewed medication package inserts, US...

www.excelmale.com

Water Retention With Fine E2 Labs

My most recent labs on 8mg daily test cyp. Total Testosterone 675 ng/dL 250-1100 Free Testosterone 162 pg/mL 35-155 Ultrasensitive Estradiol 32 pg/mL

www.excelmale.com

madman said:

48 h ambulatory BP monitoring would be needed to see the true impact on BP.

Would not get too caught up on just elevated hematocrit when it comes to use of exogenous T and BP.

Although many tend to blame estradiol when it comes to bloat/water retention keep in mind that androgens increase sodium/water.

Androgens increase the retention of electrolytes.

The use of exogenous androgens will result in the retention of sodium, chloride, water, potassium, calcium, and inorganic phosphates.

Bloating/edema can be common in some and to what degree depends on many factors.

This can easily drive up ones blood pressure.

Inhibition of corticosteroid 11β-hydroxysteroid dehydrogenase enzymes plays a role.

Most of the initial increases in weight gain on trt are water-related whether extracellular/intracellular.

Many men on trt can gain 5-15 lbs of water weight within the first month.

The majority of gains when first starting trt are due to extracellular water (between the muscle and skin) which shows up as bloat/puffiness and intracellular water (inside the muscle cell) which will make the muscle look fuller and harder due to increased glycogen stores.

Even then once the body adjusts or measures have been taken to minimize the bloat/puffiness you are always going to hold more water when using androgens as the muscle cells will retain more water (intracellular).

When coming off androgens, especially high doses you are always going to be pissing out the water weight (extra/intracellular).

Part of the reason why men who abuse androgens mainly the so-called wet compounds deflate when they come off is because they are holding a shit load of excess water weight which is always going to be pissed away.

Does Patient-Applied TRT Pose Risk for Blood Pressure Elevation?

Does Patient-Applied Testosterone Replacement Therapy Pose Risk for Blood Pressure Elevation? Circadian Medicine Perspectives (2022) Michael H. Smolensky, Ramon C. Hermida, Linda Sackett-Lundeen, *Ramon G. Hermida-Ayala, and Yong-Jian Geng ABSTRACT We reviewed medication package inserts, US...

www.excelmale.com

Some take home points here!

• Complications of TRTs are elevated blood pressure (BP) and hypertension. Further investigation is required to determine if these and other adverse effects, like altered lipids and hematocrit and risk of major acute cardiovascular events (MACE), result from the produced T nonphysiologic 24 h patterning

• Determination of the true risk of elevated BP per unique TRT requires 48 h ambulatory BP monitoring and the correct choice of outcome measures, that is, asleep systolic BP mean and amount of asleep systolic BP dipping, most indicative of risk for MACE




Testosterone Replacement Therapy and Blood Pressure

Elevation of BP and new-onset and worsened HTN are adverse effects of TRTs; they are of major concern because they are predisposing to MACE, especially when accompanied by a treatment-induced increase of low-density lipoprotein cholesterol, a decrease of high-density lipoprotein cholesterol, and polycythemia. The package insert of each PA-TRT reports by type and frequency of the likely medication-caused adverse effects recorded in company-sponsored safety trials. There is a great disparity between the 10 unique PA-TRTs in the reported effects upon BP. BP safety trials conducted prior to 2018 entailed only daytime OBPM; nonetheless, in most package inserts the actual mean numerical change in diastolic (D) and systolic (S) BP (DBP, SBP) from baseline and scheduled clinical patient visits during treatment is not specified. Furthermore, the exact incidence of new-onset and progressed HTN is not always conveyed; instead, their incidence is categorized along with other adverse effects as proportions, for example, less than 1% or less than 3%, of trialed participants so affected. With these limitations in mind, the incidence based on OBPM of new-onset HTN of five of the six gel and solution PA-TRTs, that is, of Axiron® (https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/ 022504s013lbl.pdf),Fortesta®(https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/021463s020lbl.pdf), Natesto® (https://www.accessdata.fda.gov/drugsatfda_docs/label/ 2014/205488s000lbl.pdf), Testim® (https://www.accessdata .fda.gov/drug/satfda_docs/label/2009/021454s008lbl.pdf) [and its biosimilar Vogelxo® (https://www.accessdata.fda .gov/drugsatfda_docs/label/2019/204399s010lbl.pdf)], and Striant® (https://www.accessdata.fda.gov/drugsatfda_docs/ label/2004/21543s002lbl.pdf), is reported to be less than 1%. Even though the package insert of the other PA-TRTs warns of BP elevation and HTN as adverse effects, as later discussed few list specific incidences.

Accurate determination of the actual effect of the individual PA-TRTs on BP and induced incidence of HTN in hypogonadal men is difficult because of the inherent limitations of OBPM to ascertain representative DBP and SBP values, even though it is the recommended method of assessing BP and diagnosing HTN.




Discussion

Reports of animal model and human studies concerning the mechanisms mediating T-induced effects on BP are inconsistent (30, 37, 58, 72, 80, 82, 83, 90, 121, 157, 158, 178). According to Dubey et al. (37), T acts as a pro-hypertension hormone by stimulating catecholamine synthesis, modulating the renin-angiotensin-aldosterone system, altering endothelin-1 level, inducing endothelial damage to further atherosclerosis, and injuring glomerular endothelial cells to negatively affect renal function. Although some of the cited reports assert T constricts blood vessels and raises BP, some others assert T dilates blood vessels and lessens arterial stiffness and thus reduces BP.

The major focus of this article has been to compare the PK and achieved 24 h patterning of T concentration in relation to the adverse effects of BP elevation and HTN, known risk factors for MACE, of the different FDA-approved nonbiosimilar PA-TRTs. Serum TT, FT, and DHT concentrations in young adult men exhibit pronounced predictable-in-time 24 h variation. However, in men with an androgen hormone deficiency, these T concentrations are not only abnormally low but lack prominent circadian patterning. Accordingly, we characterized each PA-TRT according to its ability to simulate the normal TT circadian rhythm (Figure 1A). We developed five criteria for this purpose: (i) elevated and near peak TT level during nighttime sleep, (ii) peak TT level around the time of morning awakening, (iii) moderately elevated TT level during the initial hours of wakefulness, (iv) reduced TT level in the late afternoon, and (v) lowest TT level in the evening. Because at this time it is unknown whether any one of these criteria, for example, circadian time of highest or lowest TT level, is of greater biological importance than the others, we weighted each one of them equally.

Water Retention With Fine E2 Labs

My most recent labs on 8mg daily test cyp. Total Testosterone 675 ng/dL 250-1100 Free Testosterone 162 pg/mL 35-155 Ultrasensitive Estradiol 32 pg/mL

www.excelmale.com

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Melody68 said:

Madman, an excellent write-up as always, thanks.

Yes, it's easier for the layperson to comprehend the simple notion that blood is "thicker" and therefore harder to pump through the body, thus causing an elevation in BP. It seems there is always more to it than meets the eye.

Today is exactly two months since I was taking 60 mg/week and then had a blood test and started the higher dose of 84 mg week. I'd like to test my blood in another month - I know I shouldn't change the protocol too much, otherwise I won't be able to discern anything from my then three month experience. I'd like, however, to do a few things . . . 1. buy a BP monitor and log the results 2. cut down dramatically on my coffee consumption and 3. increase my water intake. No need to reduce salt, we don't add salt to any of our foods. I'll keep the injection periods the same until the test at least.

I presume that a blood phlebotomy would also be premature before the three month test . . .

Click to expand...

Melody68 said:

Madman, an excellent write-up as always, thanks.

Yes, it's easier for the layperson to comprehend the simple notion that blood is "thicker" and therefore harder to pump through the body, thus causing an elevation in BP. It seems there is always more to it than meets the eye.

Today is exactly two months since I was taking 60 mg/week and then had a blood test and started the higher dose of 84 mg week. I'd like to test my blood in another month - I know I shouldn't change the protocol too much, otherwise I won't be able to discern anything from my then three month experience. I'd like, however, to do a few things . . . 1. buy a BP monitor and log the results 2. cut down dramatically on my coffee consumption and 3. increase my water intake. No need to reduce salt, we don't add salt to any of our foods. I'll keep the injection periods the same until the test at least.

I presume that a blood phlebotomy would also be premature before the three month test . . .

Click to expand...

Melody68 said:

Madman, an excellent write-up as always, thanks.

Yes, it's easier for the layperson to comprehend the simple notion that blood is "thicker" and therefore harder to pump through the body, thus causing an elevation in BP. It seems there is always more to it than meets the eye.

Today is exactly two months since I was taking 60 mg/week and then had a blood test and started the higher dose of 84 mg week. I'd like to test my blood in another month - I know I shouldn't change the protocol too much, otherwise I won't be able to discern anything from my then three month experience. I'd like, however, to do a few things . . . 1. buy a BP monitor and log the results 2. cut down dramatically on my coffee consumption and 3. increase my water intake. No need to reduce salt, we don't add salt to any of our foods. I'll keep the injection periods the same until the test at least.

I presume that a blood phlebotomy would also be premature before the three month test . . .

Click to expand...

Hi, new guy (40) on TRT from the Netherlands

Welcome to Nelson's domain! Was your blood work done in the early AM in a fasted state? We always want to test at peak (highest point). Although a TT 13.9 nmol/L (400.9 ng/dL) is far from stellar it is not a given that your FT is low. Need to know where your SHBG sits. You are missing the...

www.excelmale.com

Creatine and rbc H&h ?

So my question is basically does one on trt who has an elevated H&H hematocrit and hemoglobin around 54 and 18 and habitually works out with weights 4/5 days a week want to use creatine without causing any side effects . I know creatine does a lot of wonderful things like increase atp and...

www.excelmale.com

Workout with mask: hematocrit

Did anyone experienced slightly higher hematocrit levels after starting to workout with masks?

www.excelmale.com

Melody68 said:

I've had to go to the doctor a few times, for different issues, the last while - they always test your blood. I've been surprised by the higher figure. I also tested myself at the pharmacy yesterday, same kind of reading. But I'm curious as to what the result might be when I test myself in the relaxed setting of my home. I'm checking Amazon right now and will get one of these monitors. Are you saying your Sanitas was accurate compared to professional equipment?

Click to expand...

Belekas said:

Sorry you going through this. I had a similar issue with TRT a year or so ago but my HC and HGB were perfect and barely went higher while on. Mind you I was very lean when starting, no drinking, no coffees, great, smart nutrition, perfect hydration, etc, etc. And still my great BP started spiking and I started getting all kinds of different issues which I covered in my thread, if its still here somewhere. My cardio was always great in the last 20 years or so, even upped it, added proper supps, tried manipulations with salt, electrolites, etc, etc tried different T doses, frequencies and still no bueno. Got off TRT and now probably like a year later my BP is 105/65, 110/70 or so on a good day. I don't mind anything up to 120/80 and feel the best. I worked fucking hard to get that BP down, keep it down and the most important find what works FOR ME. And I found it with lots of trial and error but thats absolutely not what Docs recommend. Now I'm cool, calm and collected with a beautiful BP and HR, not always hot, no red face, no headaches at all, no spiking BP, heart feels more mildly beating, then while on TRT it was beating a lot harder and making me feel it which absolutely didn't sit well with me. Lost some weight as well and got even leaner as been doing some detoxes and other protocols fwiw. Brain feels a lot better, cognitive functions better. Can actually read and remember what I've read as it was bad enough while on TRT. Less flight or fight respons, more calm, less moody and overall feeling better. Ofc I miss TRT for other reasons like erection quality, more libido (at least for me), better gym performace, fuller muscles, better recovery, etc, buuuuuuut there is no point having all that if it comes with the price of high BP. That shit is a silent killer and will do truck loads of damage with time if untreated and yet many people walk with 180/100 and have no idea that its that high on their way to get Starbucks 150g sugar induced Latte for breakfast Given all that I know now and how I manage to control my BP I think I will give TRT(or HRT) another go in the future just not sure when as I still have more then 20ml of Sustanon, 20ml of Deca, 10ml of Prop and 10ml of Primobolan left in my cupboard

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