Another water retention issue

[CB46]

I am 55 and in good shape but had a 358 ng/dl T level and a FT of .46 ng/dl. I started TRT in January. I was prescribed .5cc Cypionate per week and quickly felt much better. However, over the first 4 months, I gained about 13 lbs, my pants were tight, and my ankles swelled substantially. I then started having kidney aches, which I believe to be from dehydration. At that point, I had not read about TRT and edema issues so had not kept properly hydrated. BTW- I did have VERY sore nipples with noticeable puffiness around my nipples and 102 estradiol level but felt really good. One-1mg pill of Anastrozole eliminated the soreness in less than one day but my libido has never felt as good. I am only now reading about estradiol levels and ratios.

Due to the substantial edema, my doctor had me stop TRT and the swelling went away. He had me restart with .25cc injections to see if the lower dose would help but after two injections, I see my ankles swelling again.

I have read the relevant posts and see the recommendation to check for circulation issues. I asked the PA I am working with about an ankle brachial test and he checked with the cardiologist at the practice, who I have seen. They say that without any other symptoms, they did not believe circulation was an issue.

Any suggestions? I eat well, work out, do plenty of cardio/sweating, and have kept hydrated. The edema did not seem to slow over the first 4 months but is this something that will decrease over time? Are there people that just cannot stay on TRT due to this issue? Would a cream be better?

I see that the practice does not have enough experience treating this issue but they are working with me to find an answer. Insurance has covered me at this practice but I wonder if a more knowledgeable practice, even if I have to pay, is the answer??

Any help would be greatly appreciated,

Thanks,

CB

 

[madman]

I am 55 and in good shape but had a 358 ng/dl T level and a FT of .46 ng/dl. I started TRT in January. I was prescribed .5cc Cypionate per week and quickly felt much better. However, over the first 4 months, I gained about 13 lbs, my pants were tight, and my ankles swelled substantially. I then started having kidney aches, which I believe to be from dehydration. At that point, I had not read about TRT and edema issues so had not kept properly hydrated. BTW- I did have VERY sore nipples with noticeable puffiness around my nipples and 102 estradiol level but felt really good. One-1mg pill of Anastrozole eliminated the soreness in less than one day but my libido has never felt as good. I am only now reading about estradiol levels and ratios.

Due to the substantial edema, my doctor had me stop TRT and the swelling went away. He had me restart with .25cc injections to see if the lower dose would help but after two injections, I see my ankles swelling again.

I have read the relevant posts and see the recommendation to check for circulation issues. I asked the PA I am working with about an ankle brachial test and he checked with the cardiologist at the practice, who I have seen. They say that without any other symptoms, they did not believe circulation was an issue.

Any suggestions? I eat well, work out, do plenty of cardio/sweating, and have kept hydrated. The edema did not seem to slow over the first 4 months but is this something that will decrease over time? Are there people that just cannot stay on TRT due to this issue? Would a cream be better?

I see that the practice does not have enough experience treating this issue but they are working with me to find an answer. Insurance has covered me at this practice but I wonder if a more knowledgeable practice, even if I have to pay, is the answer??

Any help would be greatly appreciated,

Thanks,

CB

post #3

Edema on TRT

I take 100 mg Test Cyp once a week. I seem to get edema around day 5 thru 7. Then when I take my next shot it goes away. I would have thought edema would be worse when test levels are higher but seems to be just the opposite for me. Any ideas why or anyone else experience this? Thanks

www.excelmale.com

Your doctor started you on .5 mL /week which would be 100 mg T if the strength of your testosterone is 200 mg/mL (most common).

Post labs from your previous and current protocol.....TT, FT, estradiol, SHBG, DHT, prolactin, and CBC which would include critical blood markers such as RBCs/hemoglobin/hematocrit.

Hopefully, your blood work was done at true trough (7 days post-injection) as we want to see where your levels sit at the lowest point just before your next injection.

Although excess e2 can play a role in bloat/puffiness it is not solely to blame.

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.

Most of the initial increases in weight gain on trt are water-related whether extra-cellular/intra-cellular.

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 extra-cellular water (between the muscle and skin) which shows up as bloat/puffiness and intra-cellular water (inside the muscle cell) which will make the muscle look fuller and harder due to increased glycogen stores.

Building up new muscle tissue (actin/myosin) which would be considered dry gains (new proteins) takes time and a proper diet/training protocol is needed.

Most on trt claiming to have packed on a significant amount of muscle within the first 4 weeks of starting are holding a fair amount of water (extra-cellular/intra-cellular) not dry gains.

When I first started trt on 100 mg/week T cyp injected strictly sub-q I gained 15 lbs at the 4-week mark and a good portion was water weight.

A good portion was bloat but my muscles were also holding more water/glycogen as they were much fuller/harder due to my high carb diet as I consume 650 grams/day!

Top it off that I was also consuming a fair amount of Himalayan sea salt.

 

[sammmy]

Ankle swelling is a very concerning sign (most typically showing venous insufficiency) and it is NOT what people call 'water retention' on TRT. Although it is rather strange to be triggered by TRT.

If your doctors "do not believe its circulation issue" but are not actively doing anything to diagnose, you must fire them immediately and find better doctors that would do kidney and venous studies.

 

[sammmy]

Testosterone: This medicine may cause blood clotting problems. Tell your doctor right away if you have pain, redness, or swelling in the arm or leg, sharp pains in the chest, or trouble breathing.

 

[CB46]

I really appreciate the comments. I prepared a table with lab results.

 

[madman]

I really appreciate the comments. I prepared a table with lab results.

View attachment 14515

What day of the week were you injecting and how many days after was blood work done?

As you can see 2 months after injecting 100 mg/week your TT went from a sub-par 358 ng/dL--->to a high-end 925 ng/dL and your FT went from 0.46 ng/dL--->2.48 ng/dL (most likely not tested using an accurate assay ED or UF) and your estradiol went from 28.1 pmol/L--->102 pmol/L (most likely not tested using an accurate assay LC/MS-MS).

Keep in mind if these are your true trough (7 days post-injection) levels then peak TT/FT/estradiol levels will be much higher.

Your SHBG was driven down from 43.3 nmol/L--->34 nmol/L.

With a high-end TT 925 ng/dL and SHBG 34 nmol/L, it would be a given that your FT let alone estradiol will be high.

Hematocrit went from 44.5--->48.7.

Missing full CBC panel which would include markers hemoglobin/RBCs?

Keep in mind that although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

The only way to know where your FT level truly sits is to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best).

Critical to know where your FT level truly sits!

Next time you have blood work done make sure to use the most accurate assays for TT/FT/DHT/estradiol (LC/MS-MS) and FT (Equilibrium Dialysis or Ultrafiltration).

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You stopped injections on April 16 and as you can see TT/FT started to decline and as of May 27 are absurdly low (hypogonadal).

Estradiol also dropped off!

Hematocrit still hovering around the same as it would take much longer to decline.

As of May 21, you started back on trt using half the dose of .25 mL (50 mg T/week) and it is doubtful that such dose injected once weekly will have your trough TT/FT levels in a healthy range.

 

[CB46]

Lab work was done the morning before my Friday injections while fasting. I will try the other lab for a more accurate analysis.

I was told to try a half dose for a while to hopefully control the water retention and then slowly build back to the 100 mg. Do you think the lower dose will make a difference with regard to water retention? Am I wasting my time with the lower dose? Did I just not wait long enough before my body acclimated to the higher T level and everything that went along with it? In other words, will the water retention issue get better over time?

 

[madman]

Lab work was done the morning before my Friday injections while fasting. I will try the other lab for a more accurate analysis.

I was told to try a half dose for a while to hopefully control the water retention and then slowly build back to the 100 mg. Do you think the lower dose will make a difference with regard to water retention? Am I wasting my time with the lower dose? Did I just not wait long enough before my body acclimated to the higher T level and everything that went along with it? In other words, will the water retention issue get better over time?

That says it all!

You were basically hitting a very high-end trough TT 925 ng/dL (7 days post-injection) and seeing as your SHBG was only 34 nmol/L then it would be a given that your trough FT level would be very high.

The shit kicker here is your peak TT/FT let alone estradiol will be much higher 8-24 hrs post-injection/during the first few days of the week.

The downfall of injecting larger doses of T once weekly is that not only will there be a significant difference in peak-->trough but blood levels will not be as stable throughout the week which can wreak havoc on one's mood/energy/libido/erections and recovery.

Although some men do feel well when injecting once weekly most are splitting up their weekly dose and injecting twice weekly (every 3.5 days) let alone many with low SHBG inject smaller doses of T daily or EOD.

SHBG is critical to know as not only will it have a significant impact on FT but can also dictate what injection frequency may suit you best.

The benefit of injecting lower doses of T more frequently is that you will be clipping the peak--->trough let alone maintain more stable levels throughout the week.

An FT of 5-10 ng/dL would be considered low.

FT 16-31 ng/dL is considered healthy.

Most men on trt will do well having FT in the 20-30 ng/dL range and some may run slightly higher levels.

With a trough TT 925 ng/dL and SHBG 34 nmol/L your FT is most likely over 30 ng/dL and again your peak levels earlier in the week will be much higher.

You would most likely do much better starting off on 80 mg/week and splitting the dose into twice-weekly injections (40 mg every 3.5 days).

Most men on trt are injecting 100-200 mg/week.

Many men would never need the high-end dose of 200 mg/week and can easily achieve a healthy FT level on 100-150 mg/week let alone high or in some cases absurdly high FT on such dose.

Believe it or not, some men can achieve high levels on <100 mg/week.

Where your TT/SHBG sits is going to play a big role.

Unfortunately many are running absurdly high FT levels at a trough well above what would be needed to experience the beneficial effects of trt.

Let alone have no clue where their FT level truly sits as they are not testing using the most accurate assays.

Too many get caught up in the more T is better mentality.

Most commonly prescribed esterified T injections are enanthate or cypionate.

When starting trt or tweaking a protocol Increasing/decreasing dose of T) you need to wait 4-6 weeks until blood levels stabilize due to the ester/PK before having blood work done.....testing at the true trough (lowest point) to see where said protocol (dose T/injection frequency) has your TT/FT/estradiol/SHBG and in some cases DHT/prolactin let alone important blood markers such as RBCs/hemoglobin/hematocrit.

 

[madman]

Variance in Peak and Trough T Levels in Men Using Intramuscular T Injections

MP85-14 VARIANCE IN PEAK AND TROUGH TESTOSTERONE LEVELS IN MEN USING INTRAMUSCULAR TESTOSTERONE Bruno Nascimento*, Helen L Bernie, Elizabeth Schofield, John P. Mulhall, New York, NY INTRODUCTION AND OBJECTIVES In men using intramuscular testosterone (IM T), clinical experience shows us that...

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[madman]

Effect of Weight on Serum T with Sub-Q TE in Men with TD

Effect of Weight on Serum Testosterone with Subcutaneous Testosterone Enanthate in Men with Testosterone Deficiency (2020) SAT-037 Background: In men, obesity is often associated with low testosterone (T) levels, but the information is limited as to how body weight affects the pharmacokinetic...

www.excelmale.com

Regarding testosterone levels.

The average young healthy male produces 5-7 mg/day.

When using exogenous T many factors can come into play when it comes to what dose of T is needed to achieve a healthy FT level.

The dose T, SHBG level, injection frequency, metabolism, the sensitivity of the AR, polymorphism of the AR, and CAG repeat length (long/short), bodyweight.

 

[CB46]

Madman,

You have given me a lot of great information. I really appreciate you taking the time out of your day to respond.

CB

 

[Systemlord]

Are there people that just cannot stay on TRT due to this issue?

All you need is a doctor that's not clueless. Your starting protocol wasn't the best choice, smaller injections can greatly reduce side effects and at the very least a diuretic be prescribed for the ancle swelling once proper steps had been taken to remedy the sides.

This problem most often is poorly trained doctors because TRT is rarely done correctly in the sick care setting.

Between your 50mg weekly dosage and the ridiculous 1mg AI I think it's time you find a capable doctor to manage your TRT.

You need to closely watch your salt intake.