I got this question from a friend of mine today who started testosterone replacement 3 weeks ago (injections of 100 mg per week):
"I've been gaining a lot of weight. Does this mean my estradiol is high? I don't have any nipple soreness or severe bloating but my ankles and wrist are swelling."
Here was my answer:
Testosterone is anabolic, and it will cause some nitrogen, sodium and water retention. Some men have water retention (edema) during the first few weeks of TRT which can be reflected as increased weight or ankle swelling. This edema may or may not be associated with high estradiol (only knowing your blood level of estradiol can tell this). Edema may be worsened in patients with preexisting cardiac, renal, or hepatic disease (watch for high liver enzymes and/or decreased creatinine clearance). Edema can be worsened by NSAIDs (Tylenol, Advil, etc), so they should be discontinued to see if it resolves. Sometimes switching from injections to testosterone creams is sufficient to decrease edema. Some physicians also prescribe a short round of diuretics.
If edema does not resolve after 4 weeks on therapy, referral to cardiology is suggested for vascular tests.
What Is Peripheral Arterial Disease?