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    • Can Losartan decrease high hematocrit caused by testosterone replacement?

      Recently I had a really bad cold with a severe cough. It was so bad my doc put me on a bunch of stuff to reduce inflammation in my Bronchial and some cough trigger pills. He also had me stop using Lisinopril. It's one side affect in a drip and cough. I didn't take Lisinopril for BP, I toke it for migraines. So once my cold died and my cough settled he put me on Losartan(ARB). It's very similar to Lisinopril but the process in which it relaxes the blood vessels is a little different. Well today I went in for my 2 month blood donation. Well my hemoglobin was 15. It hasn't been that low since pre-TRT. I read that ARB's do lower your Hema and Hemo so I was wondering if I should skip donating for a while and then test again? This would be fantastic if this drugs keeps my migraines at bay and also keeps my Hemo and Hema at a good level without donating.

      This article was originally published in forum thread: Can Losartan decrease high hematocrit caused by testosterone replacement?
      Comments 32 Comments
      1. CoastWatcher's Avatar
        CoastWatcher -
        A citation that seems to back this up.

        http://www.ncbi.nlm.nih.gov/pubmed/11242510

        Ann Intern Med. 2001 Mar 6;134(5):426-7.

        Losartan Reduces Hematocrit in Patients With Chronic Obstructive Pulmonary Disease and Secondary Erythrocytosis

        For a man not dealing with elevated blood pressure, migraines, or copd, would it be safe? Perhaps others here have a sense of that.
      1. Nelson Vergel's Avatar
        Nelson Vergel -
        I take telmisartan since it may have metabolic benefits and also decrease fibrosis of the lymph system (may improve immune function). I had never heard about the effect on hematocrit caused by losartan.
      1. bigfred32's Avatar
        bigfred32 -
        I take hyzaar which is generic losartan for HBP. I still run at about 48-50 or so hema. I donate blood every two months, actually feels good in a weird way. Not because I want to do mankind a favor feel good kind of way... but like an oil change kinda way ...if that makes sense. I dont think losartan has anything to with it for me though. I hope that dosnt sound calous....
      1. CoastWatcher's Avatar
        CoastWatcher -
        Bigfred, what is your TRT protocol, if you don't mind? Have you run high on hematocrit since you achieved balanced levels?
      1. bigfred32's Avatar
        bigfred32 -
        I been on TRT for a year this month. I use a compounded TD that I respond to really we'll. For the most part, the only side issues I have had are hema. About 6 month mark hema was 52 and I started donating blood every 58 days. I get hema checked monthly and run about 48 but still donate. Not sure what it would be if I stopped but donations don't bother me. Also e2 runs in the 30-40 range with ultrasensitive test but I don't have any noticeable negative side effects. I am not on any AI but take zinc and DIM as part of daily regimen. The one other issue is high DHT in the 160 range but PSA is low and I get incredible results in the gym, So no complaint here
      1. Nelson Vergel's Avatar
        Nelson Vergel -
        Hematocrit may stabilize after long term testosterone replacement

        Although this study was done in mice, it may explain why hematocrit may eventually decrease and stabilize in men on TRT. I am one of those men who only went for therapeutic phlebotomy twice in the past 24 years. There seems to be an adaptive mechanism that makes red blood cells change form (get bigger) while hematocrit stabilizes.

        Guo W, Bachman E, Vogel J, Li M, Peng L, et al. The Effects of Short-Term and Long-Term Testosterone Supplementation on Blood Viscosity and Erythrocyte Deformability in Healthy Adult Mice. Endocrinology.http://press.endocrine.org/doi/abs/10.1210/en.2014-1784


        Testosterone treatment induces erythrocytosis that could potentially affect blood viscosity and cardiovascular risk. We thus investigated the effects of testosterone administration on blood viscosity and erythrocyte deformability using mouse models.


        Blood viscosity, erythrocyte deformability, and hematocrits were measured in normal male and female mice, as well as in females and castrated males after short-term (2-weeks) and long-term (5-7 months) testosterone intervention (50 mg/kg, weekly).


        Castrated males for long-term intervention were studied in parallel with the normal males to assess the effect of long-term testosterone deprivation. An additional short-term intervention study was conducted in females with a lower testosterone dose (5 mg/kg).


        Our results indicate no rheological difference among normal males, females, and castrated males at steady-state.


        Short-term high dose testosterone increased hematocrit and whole blood viscosity in both females and castrated males. This effect diminished after long-term treatment, in association with increased erythrocyte deformability in the testosterone-treated mice, suggesting the presence of adaptive mechanism.


        Considering that cardiovascular events in human trials are seen early after intervention, rheological changes as potential mediator of vascular events warrant further investigation.
      1. Bambi's Avatar
        Bambi -
        I have been on Benicar HCT for several years and without blood draws, my hematocrit would be way over normal.
      1. Marco N Cognito's Avatar
        Marco N Cognito -
        Quote Originally Posted by Nelson Vergel View Post
        I take telmisartan since it may have metabolic benefits and also decrease fibrosis of the lymph system (may improve immune function). I had never heard about the effect on hematocrit caused by losartan.
        I have been on losartan 50mg b.i.d. and after researching the other ARBs, am thinking of switching. While telmisartan shows some metabolic benefits, Olmesartan seems to trump it :
        http://www.ncbi.nlm.nih.gov/pubmed/23303198
        http://www.ncbi.nlm.nih.gov/pubmed/18360012
        http://www.nature.com/hr/journal/v31...r2008303a.html

        Only thing about losartan is that it is the only ARB that exhibits a decrease serum uric acid, while the others increase it:
        http://link.springer.com/article/10....75-2840-12-159

        Confused. What do you think?
      1. Nelson Vergel's Avatar
        Nelson Vergel -
        Marco

        Be careful if you decide to go for Olmesartan

        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3956379/
      1. Marco N Cognito's Avatar
        Marco N Cognito -
        Quote Originally Posted by Nelson Vergel View Post
        Marco

        Be careful if you decide to go for Olmesartan

        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3956379/

        Thanks for the heads up on this, Nelson! Are we sure the other ARBs don't exhibit this same side effect?
      1. Steelballs's Avatar
        Steelballs -
        I have an update. After 4+ weeks on Losartin my energy is up and holy cow the morning wood is unreal. I have no idea why but wow I love it. It gets so intense it wakes me. Oh ya and bye bye cough.
      1. Marco N Cognito's Avatar
        Marco N Cognito -
        Quote Originally Posted by Steelballs View Post
        I have an update. After 4+ weeks on Losartin my energy is up and holy cow the morning wood is unreal. I have no idea why but wow I love it. It gets so intense it wakes me. Oh ya and bye bye cough.
        What is your dose?

        Losartan, an angiotensin receptor blocker (ARB), may have, via it its metabolites, effects on NO/vasodilation which would account for increased blood flow:

        http://www.researchgate.net/publicat...cts_of_EXP3179
      1. Steelballs's Avatar
        Steelballs -
        Marco, great link. Thank you. I take 50mg every nite
      1. Marco N Cognito's Avatar
        Marco N Cognito -
        Quote Originally Posted by Steelballs View Post
        Recently I had a really bad cold with a severe cough. It was so bad my doc put me on a bunch of stuff to reduce inflammation in my Bronchial and some cough trigger pills. He also had me stop using Lisinopril. It's one side affect in a drip and cough. I didn't take Lisinopril for BP, I toke it for migraines. So once my cold died and my cough settled he put me on Losartan(ARB). It's very similar to Lisinopril but the process in which it relaxes the blood vessels is a little different. Well today I went in for my 2 month blood donation. Well my hemoglobin was 15. It hasn't been that low since pre-TRT. I read that ARB's do lower your Hema and Hemo so I was wondering if I should skip donating for a while and then test again? This would be fantastic if this drugs keeps my migraines at bay and also keeps my Hemo and Hema at a good level without donating.
        Found this obscure study:http://www.ncbi.nlm.nih.gov/pubmed/9621296



        J Am Soc Nephrol. 1998 Jun;9(6):1104-8.

        Losartan, an angiotensin II type 1 receptor antagonist, lowers hematocrit in posttransplant erythrocytosis.

        Julian BA1, Brantley RR Jr, Barker CV, Stopka T, Gaston RS, Curtis JJ, Lee JY, Prchal JT.


        Abstract

        The mechanism by which angiotensin-converting enzyme inhibitors reduce red cell mass in renal transplant recipients with erythrocytosis is unclear. To examine the role of angiotensin II in this disorder, losartan (a competitive antagonist of the angiotensin II type 1 [AT1] receptor) was administered to 23 patients with erythrocytosis. Fourteen patients took 25 mg/d for 8 wk; nine others were treated with 50 mg/d for 8 wk. Hematocrit decreased from 0.527 +/- 0.027 to 0.487 +/- 0.045 after 8 wk (P < 0.01)--by at least 0.04 in 19 patients. Decrement in hematocrit in the initial 8 wk of therapy was significantly greater in patients administered 50 mg/d than in patients on 25 mg/d. Twelve of 14 patients initially treated with 25 mg/d showed a small change in hematocrit; the dose was increased to 50 mg/d for 8 more wk. Hematocrit decreased from 0.528 +/- 0.030 before losartan treatment to 0.483 +/- 0.055 after 16 wk (P < 0.01). After therapy, serum erythropoietin significantly decreased in eight patients with elevated baseline levels, but not in 15 patients with normal baseline levels; however, hematocrit significantly decreased in both groups. Losartan was withdrawn in 16 patients; hematocrit increased from 0.440 +/- 0.057 to 0.495 +/- 0.049 after 8.9 +/- 7.5 wk (P < 0.001), without change in serum erythropoietin. Thus, specific blockade of AT1 receptors inhibited erythropoiesis, suggesting a pathogenic role for angiotensin II in posttransplant erythrocytosis.
      1. Steelballs's Avatar
        Steelballs -
        Macro, thanks for that link. Btw, I waited over 3 months this time before giving blood. It did go up a little. So it looks like I'm in a steady spot. I am pretty sure Losartin isn't a replacement for giving blood but it does help reduce my hemo. And my lebido is still up. So it helps there too. So if any of you are taking Lisinopril I strongly recommend trying it.
      1. Marco N Cognito's Avatar
        Marco N Cognito -
        Quote Originally Posted by Nelson Vergel View Post
        I take telmisartan since it may have metabolic benefits and also decrease fibrosis of the lymph system (may improve immune function). I had never heard about the effect on hematocrit caused by losartan.
        Since I recalled you are or were taking telmisartan, I just came across this from some research and thought I should bring to your attention in case you already didn't see this conflicting data regarding ARBs (i.e. telmisartan, losartan, etc.) and cancer :
        http://www.wsj.com/articles/SB100014...15172395384146
        http://www.reuters.com/article/us-bl...65C2C120100613
        http://www.peoplespharmacy.com/2013/...-cancer-cloud/
        "Barely three weeks later (June 20, 2011), however, a study from Taiwan published in the Journal of Clinical Oncology revealed that patients with diabetes taking ARBs such as candesartan (Atacand) and telmisartan (Micardis) experienced an increased risk of cancer."


        http://jco.ascopubs.org/content/29/22/3001.full

        "Among the individual ARBs, losartan decreased the risk (OR, 0.78; 95% CI, 0.63 to 0.97) and candesartan (OR, 1.79; 95% CI, 1.05 to 3.06) and telmisartan (OR, 1.54; 95% CI, 0.97 to 2.43) possibly increased the risk of occurrence of malignancy."

        http://www.ncbi.nlm.nih.gov/pubmed/21358417
        http://www.fda.gov/Drugs/DrugSafety/ucm257516.htm
        http://www.sciencedaily.com/releases...1001115646.htm
        http://www.ncbi.nlm.nih.gov/pubmed/26550179

        And so, as is the case with many meds, we have a lot of opposing data & controversy. I am on Losartan, so am concerned as well.

        Thoughts??
      1. Steelballs's Avatar
        Steelballs -
        Marco. Holy cow. Never knew about these studies. Thanks for sharing this. It seems like every drug has some risk. Unless I read it wrong if you are not diabetic or borderline and taking losartin you are fine.
      1. Marco N Cognito's Avatar
        Marco N Cognito -
        Quote Originally Posted by Steelballs View Post
        Marco. Holy cow. Never knew about these studies. Thanks for sharing this. It seems like every drug has some risk. Unless I read it wrong if you are not diabetic or borderline and taking losartin you are fine.

        No, not diabetic, and taking losartan only. Here's an interesting perspective on the controversy from a physician:
        http://www.drdalepeterson.com/Do-ARBs-Cause-Cancer.blog
      1. Markee's Avatar
        Markee -
        My PCP has me on 4mg of Doxazosin for borderline HBP I also always have high Hematocrit 53.3 levels
        I've been donating blood constantly for many years
        Wonder would it be a good idea to ask my PCP to switch me over to Losartan instead ?
        The 4mgs of Doxazosin don't seem to be working to great and really lowering my BP
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