Elevated BP and headaches.

[Fortunate]

The simplest thing to try is to stop using Allegra D with the pseudoephedrine stimulant in it - it can aggravate palpitations and high blood pressure. Its stronger cousin ephedrine is banned for that.

Get Allegra without the D.

Agreed! I didn't realise he was taking the D. For sure, stop this.

 

[Fortunate]

Update?

 

[Rykertest]

Update?

Well, it's been an interesting few days and this post will be long as I want to provide as much info as possible. My TRT Dr ordered a set of labs. The key numbers were;

RBC - 6.03 - Range of 4.14-5.80
Hemo - 17 - Range of 13-17.7
HemoCrit - 49.8 - Range of 37.5-51
Total T - 945 - This is down from 1500+ 6 weeks ago after a lowered dose
Free T - 19.6 - Down from 38 6 weeks ago after lowered dose. Range is 6.8-21
Cortisol is 8 - Range of 6.2 - 19.4
Estradiol - 24 - Down from 65.3 six Weeks ago when I started an AI that I stopped 2 weeks ago.
Iron - 81 - Range 38-169
Ferritin - 87 - Range 30-400

I did not donate blood yet/if at all. I wonder if I need to supplement with Iron.

All other labs were normal. My TRT clinic followed up and said he likes where my numbers are but he wants me to up my DHEA dose to 100 from 50. I'll go 75. This clinic is good but they seem too aggressive in their chase of a number. I'd rather need more than deal with too much.

Here is the interesting part. I was given an EKG at my TRT office and it was fine. To refresh, I came in with high BP and headaches related to that. I was also having a few random flutters in my heart beat. No pain, no radiating anywhere, just an odd sensation I didn't enjoy and was worse when sitting down. I have no cardiac issue history, my triglycerides have always been low, and my cholesterol has always been around 200, currently 208 with a decent ratio.

Well, the day after my TRT visit, a few hours after waking I had some serious heart beat fluttering that was happening too much and too hard for my comfort level. I was sitting there and my heart just did the samba. That experience rattled my cage if I'm honest. I called my dr and they said go to the ER so I did. I had heart attack enzyme tests done, 2 hours apart, all negative. Bloodwork showed I'm totally fine, BP was a little higher than normal but that's surely stress related. After I'd been there while it came down to close to my normal range of 120/80'ish. An ER EKG showed a normal rhythm. Then, as I sat there the Dr noticed the flutters and said I was having
"PVC's". He said it's very common, almost always benign when that's the only symptom but He wanted to to follow up with my Dr. I did and he ordered a treadmill stress test that's to be scheduled. A holter monitor is also a possibility as is medication. It all depends on how ofter I have them and for how long.

I read online that CBD can help with PVC's so I got some from a local dispensary and I have to say, it has helped a fair amount. I don't know where all this is gonna go but I need to see it thru.

I would prefer my total T be a little lower that maxed out, I'm fine with the middle of the range on both free and total T. I may lower my dose from .20 to .18 and see what my labs indicate in 6 weeks.

I quit all pill form of allergy meds and use Flonase. My TRT doc wants labs again in 6 weeks, my regular Dr scheduled me a stress test and I've eliminated any supplement that could be considered a stimulant. My coffee habit is 1-2 cups each morning, (down from 5 cups by lunchtime) none after 9AM. I use no pre workout, never have, and I'm gonna put weights on hold until after the stress test. I will just walk each day on the treadmill like I have been.

I want to also add that as I read my own writing, it makes me look like a bit of a head case. lol. I have never had anxiety, depression, panic attacks, etc. I don't normally overreact to things, or I like to think I don't. I'm not nor have I ever been on any SSRI's or the like. I felt lead to add this part because looking back, it seems a bit drastic of a response. All I can say is to go from never having any cardiac issues at all to have them dropped in your lap along with high BP and the associated headaches....at the age of 49 it threw my own mortality square in my face for the first time. That discussion is for a different thread.

I've only been on TRT for about 5.5-6 months. What I wonder is if this issue is due to the thicker blood from TRT or if I would have had this issue regardless. If anyone has any similar experiences or what I can do to eliminate this issue, I'm all ears. Thanks in advance for your help.

 

[Systemlord]

I had some serious heart beat fluttering that was happening too much and too hard for my comfort level. I was sitting there and my heart just did the samba. That experience rattled my cage if I'm honest. I called my dr and they said go to the ER so I did. I had heart attack enzyme tests done, 2 hours apart, all negative. Bloodwork showed I'm totally fine, BP was a little higher than normal but that's surely stress related. After I'd been there while it came down to close to my normal range of 120/80'ish. An ER EKG showed a normal rhythm. Then, as I sat there the Dr noticed the flutters and said I was having
"PVC's". He said it's very common, almost always benign when that's the only symptom but He wanted to to follow up with my Dr. I did and he ordered a treadmill stress test that's to be scheduled.

I remember my near constant heart flutters when I first started TRT, as if my heart was skipping beats, After my cardiac stress test on a treadmill, I thought I was going to dye! I could barely finish.

When I was done, I remember the tech looking at me strangely. It’s as if he was expecting to find a problem and shocked no problem was found.

I scheduled a consult with Dr. Saya and he said I had an iron problem. Months later I became iron deficient. The way I found out I’m supplementing enough iron is if I’m having heart flutters, because if I’m underdosing, I will get heart flutters when competing or intensity increase physically or mentally.

Maybe your serum iron is still subpar.

 

[Rykertest]

I remember my near constant heart flutters when I first started TRT, as if my heart was skipping beats, After my cardiac stress test on a treadmill, I thought I was going to dye! I could barely finish.

When I was done, I remember the tech looking at me strangely. It’s as if he was expecting to find a problem and shocked no problem was found.

I scheduled a consult with Dr. Saya and he said I had an iron problem. Months later I became iron deficient. The way I found out I’m supplementing enough iron is if I’m having heart flutters, because if I’m underdosing, I will get heart flutters when competing or intensity increase physically or mentally.

Maybe your serum iron is still subpar.

Is there a specific type/dose of iron I should consider? Will that supplementation have a downstream effect on RBC, hematocrit, etc?

I don’t quite know what to expect with the stress test. I loathe running and never do but I can walk all day long.

 

[Systemlord]

Is there a specific type/dose of iron I should consider?

I recently switched to the 25 mg gentle iron from The Vitamin Shoppe. You’re probably out far off from an optimal iron level. I would start out at 25 mg and see if that improves your symptoms.

Will that supplementation have a downstream effect on RBC, hematocrit, etc?

Yes, but how much is difficult to calculate. I don’t think if you went from an iron level of 86 to 128 is going to change things dramatically.

 

[Rykertest]

I recently switched to the 25 mg gentle iron from The Vitamin Shoppe. You’re probably out far off from an optimal iron level. I would start out at 25 mg and see if that improves your symptoms.

Yes, but how much is difficult to calculate. I don’t think if you went from an iron level of 86 to 128 is going to change things dramatically.

Sounds good. Another tidbit of info. My BP is only high NOW in the Diastolic (lower number) and the systolic is around 120. Last week it was both. Until a few weeks back, my diastolic was always. 66-72 or so.

 

[sammmy]

Your current T dose is still high: your lowest trough value before the next dose should be in the middle of the normal range, not at the top or above. As far as I know, the total and free T on TRT are proportional to the dose, so if you decrease your dose by 30%, that would put your lowest trough total T around 600. That dose reduction may reduce your symptoms if they are dose related.

Your Estradiol is probably still depressed from the AI, even after 2 weeks.

Allegedly, Flonase does not affect blood pressure but you never know. I personally use NasalCrom spray (Cromolyn) and it works very well against pollen allergy in the nose. I even spray it in the eyes since the antihistamine drops do not work well for me. NasalCrom may make you sneeze after spraying because it contains a slightly irritating preservative.

 

[Rykertest]

Your current T dose is still high: your lowest trough value before the next dose should be in the middle of the normal range, not at the top or above. As far as I know, the total and free T on TRT are proportional to the dose, so if you decrease your dose by 30%, that would put your lowest trough total T around 600. That dose reduction may reduce your symptoms if they are dose related.

Your Estradiol is probably still depressed from the AI, even after 2 weeks.

Allegedly, Flonase does not affect blood pressure but you never know. I personally use NasalCrom spray (Cromolyn) and it works very well against pollen allergy in the nose. I even spray it in the eyes since the antihistamine drops do not work well for me. NasalCrom may make you sneeze after spraying because it contains a slightly irritating preservative.

I’m currently on a lowered dose of .20 of 200 mg/ml test Cyp twice each week, sub q. if I’m aiming for the middle of the range, is .15 too low? .18? I’m absolutely aiming for a therapeutic dose, nothing more.

How long does it typically take for the AI to wear off and let the E rise?

Are my ferratin levels too low to donate?

Thank you.

 

[sammmy]

Your new dose should be 70% of your last posted labs dose, assuming your tests were measured at trough, in the morning before the next injection.

Not sure how long it takes for Estradiol to settle after AI use but your latest test looked suspiciously suppressed from the previous value so I assume it is still influenced by AI.

I am not a specialist on ferritin but I would not donate blood or take iron before seeing the new levels after dose adjustment.

 

[unknownwhom]

Well, it's been an interesting few days and this post will be long as I want to provide as much info as possible. My TRT Dr ordered a set of labs. The key numbers were;

RBC - 6.03 - Range of 4.14-5.80
Hemo - 17 - Range of 13-17.7
HemoCrit - 49.8 - Range of 37.5-51
Total T - 945 - This is down from 1500+ 6 weeks ago after a lowered dose
Free T - 19.6 - Down from 38 6 weeks ago after lowered dose. Range is 6.8-21
Cortisol is 8 - Range of 6.2 - 19.4
Estradiol - 24 - Down from 65.3 six Weeks ago when I started an AI that I stopped 2 weeks ago.
Iron - 81 - Range 38-169
Ferritin - 87 - Range 30-400

I did not donate blood yet/if at all. I wonder if I need to supplement with Iron.

All other labs were normal. My TRT clinic followed up and said he likes where my numbers are but he wants me to up my DHEA dose to 100 from 50. I'll go 75. This clinic is good but they seem too aggressive in their chase of a number. I'd rather need more than deal with too much.

Here is the interesting part. I was given an EKG at my TRT office and it was fine. To refresh, I came in with high BP and headaches related to that. I was also having a few random flutters in my heart beat. No pain, no radiating anywhere, just an odd sensation I didn't enjoy and was worse when sitting down. I have no cardiac issue history, my triglycerides have always been low, and my cholesterol has always been around 200, currently 208 with a decent ratio.

Well, the day after my TRT visit, a few hours after waking I had some serious heart beat fluttering that was happening too much and too hard for my comfort level. I was sitting there and my heart just did the samba. That experience rattled my cage if I'm honest. I called my dr and they said go to the ER so I did. I had heart attack enzyme tests done, 2 hours apart, all negative. Bloodwork showed I'm totally fine, BP was a little higher than normal but that's surely stress related. After I'd been there while it came down to close to my normal range of 120/80'ish. An ER EKG showed a normal rhythm. Then, as I sat there the Dr noticed the flutters and said I was having
"PVC's". He said it's very common, almost always benign when that's the only symptom but He wanted to to follow up with my Dr. I did and he ordered a treadmill stress test that's to be scheduled. A holter monitor is also a possibility as is medication. It all depends on how ofter I have them and for how long.

I read online that CBD can help with PVC's so I got some from a local dispensary and I have to say, it has helped a fair amount. I don't know where all this is gonna go but I need to see it thru.

I would prefer my total T be a little lower that maxed out, I'm fine with the middle of the range on both free and total T. I may lower my dose from .20 to .18 and see what my labs indicate in 6 weeks.

I quit all pill form of allergy meds and use Flonase. My TRT doc wants labs again in 6 weeks, my regular Dr scheduled me a stress test and I've eliminated any supplement that could be considered a stimulant. My coffee habit is 1-2 cups each morning, (down from 5 cups by lunchtime) none after 9AM. I use no pre workout, never have, and I'm gonna put weights on hold until after the stress test. I will just walk each day on the treadmill like I have been.

I want to also add that as I read my own writing, it makes me look like a bit of a head case. lol. I have never had anxiety, depression, panic attacks, etc. I don't normally overreact to things, or I like to think I don't. I'm not nor have I ever been on any SSRI's or the like. I felt lead to add this part because looking back, it seems a bit drastic of a response. All I can say is to go from never having any cardiac issues at all to have them dropped in your lap along with high BP and the associated headaches....at the age of 49 it threw my own mortality square in my face for the first time. That discussion is for a different thread.

I've only been on TRT for about 5.5-6 months. What I wonder is if this issue is due to the thicker blood from TRT or if I would have had this issue regardless. If anyone has any similar experiences or what I can do to eliminate this issue, I'm all ears. Thanks in advance for your help.

Wow. Reading this feels like my story too. Literally same situation. TRT for several months. High Total T and Free T on labs(but nothing crazy), took some AI, and here came all these issues with palpitations/anxiety.

Posted here about it: Need some guidance. Palpitations / Anxiety.

I abused PEDs in my 20s. I didn't have issues like palps/anxiety when my Total T values where much higher than my posted amount and when I didn't try to manipulate e2.

Your labs:
Total T - 945
Estradiol - 24

Your e2 isn't all THAT low.

Mine recently was:
Total T - 1155ng/dl - lab range 250-1100 ng/dL
e2 - 10pg/ml - lab range < OR = 29 pg/mL

I am really starting to believe it is due to a disproportionate T/E ratio in the body brought on by AIs.

And i say this because you could probably have 24 e2 levels without TRT, but never have the same palpitation symptoms. On the other side, you had 1500+ total T with 63 e2 and no palps until e2 was lowered by the AI.

 

[Fortunate]

I agree with @sammmy. I’m pretty confident that if you lower your dose, your symptoms will subside eventually. I doubt it’s related to iron.

 

[Rykertest]

Wow. Reading this feels like my story too. Literally same situation. TRT for several months. High Total T and Free T on labs(but nothing crazy), took some AI, and here came all these issues with palpitations/anxiety.

Posted here about it: Need some guidance. Palpitations / Anxiety.

I abused PEDs in my 20s. I didn't have issues like palps/anxiety when my Total T values where much higher than my posted amount and when I didn't try to manipulate e2.

Your labs:
Total T - 945
Estradiol - 24

Your e2 isn't all THAT low.

Mine recently was:
Total T - 1155ng/dl - lab range 250-1100 ng/dL
e2 - 10pg/ml - lab range < OR = 29 pg/mL

I am really starting to believe it is due to a disproportionate T/E ratio in the body brought on by AIs.

And i say this because you could probably have 24 e2 levels without TRT, but never have the same palpitation symptoms. On the other side, you had 1500+ total T with 63 e2 and no palps until e2 was lowered by the AI.

I just read your thread and you’re right, there are a lot of similarities. How are your palpitations As of today?

 

[unknownwhom]

I just read your thread and you’re right, there are a lot of similarities. How are your palpitations As of today?

Well my readings were:

Total T - 1155ng/dl - lab range 250-1100 ng/dL
e2 - 10pg/ml - lab range < OR = 29 pg/mL

As of 5/19/23. AND, i didnt really feel bad when those labs were taken only after (around 5/21). So, my guess is my e2 went further down than that (crashing) and I am bouncing back.

Palps are getting better. They are heavier at night. I have some xanax I am taking in the evening (.25mg just to calm me down). I have a halter monitor and an echo to just confirm everything is in order.

I, like you, lowered my dose. I am currently on 120mg/week split e3.5d. I started that Monday. So, after 4-6 weeks im going to get bloods in my trough and go from there. After about 6 weeks, if everything lines up in the middle of the reference ranges and I have good in my trough im going to remain at 120mg. If they are still high, Ill slowly decrease again.

What about you?