High Blood Pressure on TRT

[otus]

I started TRT several months back. Started 100mg once a week but after first follow up went to 120mg split into twice weekly doses.

Everything has been great, with all my hypogonadal symptoms eliminated. But now I have elevated BP. For the first 10 weeks it was hovering at 140/100. (I’ve always been about 120/80 despite sometimes being way out of shape) But the in last two weeks I’ve been getting some 150/110 readings.

I could definitely clean up my diet and lose some weight, and was only a few days into my New Year’s diet when yesterday I woke up to 160/110 BP. This alarmed me so I made a same day appointment to see my GP. I sometimes get white coats in office and sure enough when I arrived my BP was 188/110! I was able to get a 170/108 reading at the end of the visit when I was a little more chill. But, wow! I was seriously freaked out.

My GP prescribed me lisinopril 10mg and after taking my first dose last night, my BP dropped to 129/85 within a few hours. He also ran a bunch of blood tests. My iron was “normal” but at the bottom of range and my Ferritin was low (15 with bottom range being 26). All the other important markers from hemocrit to minerals to RBC were in range.

My GP, who was pro-TRT, suggested I might want to stop TRT. My urologist is of the opinion that if I don’t mind being on ACE inhibitors then I should let them do their job and revisit the issue once I clean up my diet and reduce my BMI (29). He also thinks regular blood donations will help, but I’ve also read that those could further deplete ferritin.

I guess I’m just asking what should be my protocol? My GP saw 188/110 and didn’t even want me to exercise until the lisinopril kicked in for a few days. I’m now super dedicated to some diet and lifestyle changes I’d been putting off, and I have no problems being on meds if necessary… but I’m not sure if there is something else I should be doing, some other marker I should be looking at, if I should lower my dose, or break it up into more frequent shots… or what? My GP was alarmed and my urologist was unfazed. I’m not totally sure what to think.

This morning my BP was back to 150/100. I’ll take another lisinopril tonight and I’m sure it will take a few days to get into my system and keep my BP down all day. Should I be exercising while it’s still in this range?

Im confused and kinda scared. Totally ready to do the right thing but it just never seems clear what is best because when you read online you get so much info that eventually it conflicts. I can’t even really tell if this is a serious situation or just par for the TRT course. I don’t know if I should give blood or not. I don’t know if I should do cardio this week or not. I don’t know if I should stay on TRT or lower my dose or just keep at it. For example my GP said skip my second dose this week until BP stabilizes. Urologist felt I could stay on pinning schedule and just take the ACE inhibitor.

Any and all advice and perspective is much appreciated.

 

[Systemlord]

My iron was “normal” but at the bottom of range and my Ferritin was low (15 with bottom range being 26). All the other important markers from hemocrit to minerals to RBC were in range.

I was diagnosed with iron deficiency without anemia back in 2019, my MCV below range, iron saturation 12% (20-55%) ferritin 24 and iron 42. TRT was the cause and my endocrinologist recommended iron supplementation.

I had normal hemoglobin which is why doctors missed it, because they are taught to check ferritin when hemoglobin is abnormally low and I suffered for years.

My blood pressure was out of control and now is 113/65 with hematocrit and hemoglobin 53% and 18.4. I do take a low dose beta blocker.

You may not need the BP medicine once you correct the iron problem.

Iron deficiency without anaemia: a diagnosis that matters - PubMed

Iron deficiency anaemia (IDA) currently affects 1.2 billion people and iron deficiency without anaemia (IDWA) is at least twice as common. IDWA is poorly recognised by clinicians despite its high prevalence, probably because of suboptimal screening recommendations. Diagnosing IDWA relies on a...

pubmed.ncbi.nlm.nih.gov

Iron deficiency anaemia (IDA) currently affects 1.2 billion people and iron deficiency without anaemia (IDWA) is at least twice as common. IDWA is poorly recognised by clinicians despite its high prevalence, probably because of suboptimal screening recommendations. Diagnosing IDWA relies on a combination of tests, including haemoglobin and ferritin levels, as well as transferrin saturation. Although the causes of iron deficiency may sometimes be obvious, many tend to be overlooked.

 

[otus]

Thanks, Systemlord, your response means a lot. Would you recommend I skip my second dose of test cyp this week (GP's recommendation) or just keep at it and let the ACE do their job (urologist's recommendation).

Also, what do you think about donating blood when my ferritin is low? I've read the donation could both lower my BP but also crash out my ferritin (which may cause BP to rise?)

 

[Systemlord]

Thanks, Systemlord, your response means a lot. Would you recommend I skip my second dose of test cyp this week (GP's recommendation) or just keep at it and let the ACE do their job (urologist's recommendation).

Sure, glad I could help.

If your doctors aren’t concerned about your ferritin, that’s a pretty clear sign that they are operating outside their medical expertise. They aren’t taking action because of the normal hemoglobin, this is a mistake!

I was having problems even before my iron dropped below range, my issues started when near the bottom of the ranges and overtime the iron did drop below range.

At the very least you need to see a hematologist. You very well may require iron supplementation, otherwise your situation won’t improve or may get worse over time!

 

[Systemlord]

Also, what do you think about donating blood when my ferritin is low?

A stupid move! This would probably worsen your blood pressure.

 

[Fortunate]

I think your main priority is to get your blood pressure under control. I’d recommend continuation of your lisinopril and buy a high-quality blood pressure cuff. Check your pressure at least once a day. When you do, sit down. Uncross your legs. Make sure you don’t have to go to the bathroom. Relax. It’s reasonable to check it 2 to 3 times in one setting. Sometimes the number fluctuates. If possible, get one of the blood pressure monitors that automatically logs your pressure for you.

Exercise may not be possible for you right now per your physician, but you can start cleaning up your diet right away. Start with cutting out the obvious stuff like highly refined sugary stuff, soda, etc. Before embarking on a radical diet, I think it’s important to educate yourself thoroughly so you know what you can eat. There’s no one “perfect“ diet, but much of the literature seems to suggest that Mediterranean consistently performs well in studies. That said, I don’t follow Mediterranean. I am relatively low carb, and it is worked well for me. start with the low hanging fruit. If you drink soda, stop right away.

You may have to manipulate your TRT because of your blood pressure, but there are certainly other variables that you can manipulate as well, such as diet and exercise. Keep in mind, changes related to diet and exercise will occur gradually and not overnight. however, with your pressure is high as it’s been, you do need some relatively quick action and that’s why you need to follow the advice of your primary care physician and stay on your lisinopril and watch your pressure closely. you may have to temporary go on a combination of lisinopril and a diuretic, which is a pain. Whatever medication‘s you start, keep in mind, they can always be peeled back as you clean up your lifestyle.

 

[Belekas]

I had BP spikes after starting at just 125mg split E3.5D went down to 80mg, stayed there and it stabilised. Still a bit higher then initially but all in good range. But I started being very lean FWIW. Losing weight will help you tremendously as well. Anecdotally my pops had high BP he didn't even know about that went as high as 180/100 or something at 60+ yo. After following my guidance and dropping 5-10kg, when he went to get his BP measured the nurse freaked out as it was 117/70 and she said she never seen anyone at this age with such good BP. Healthy diet ofcourse, lots of water, good sleep. Works like a miracle even at that age

 

[Nelson Vergel]

Common Medications That Increase Blood Pressure - Alliance for Natural Health USA - Protecting Natural Health

anh-usa.org