Anemic with very low BP's since starting trt gel

ratt57 · Mar 12, 2024

Hi. I'm new to the forum and happy to be here. I'm noticing a lot of posts are about trt gel, which I started 6 weeks ago; I joined a trt forum on Reddit and no one seemed to be taking my questions very seriously because I wasn't doing injections.

After about three days of starting Androgel 1.62% (two pumps), my insomnia, which I've been fighting for years, went away, which was a major improvement. Instead of tossing and turning for two hours I now sleep ten-fifteen minutes after my had hits the pillow. I also noticed after a couple of weeks of trt I felt calmer and had more of a sense of well-bring. All good.

But I'm also experiencing some negative symptoms that are getting worse. I've become very anemic and my systolic BP's drop to 70-90's when I stand up. My muscles also feel very weak, even from doing something like just making my bed. I had labs drawn last week and my RBC's, hematocrit and hemoglobin were all below normal. At first I thought I was dehydrated, but no matter how much water I drink, it doesn't seem to change anything. Strangely, I also mostly experience these symptoms more in the mornings than the afternoons or evenings.

I don't know what's going on, because the anemia and low-BP's seem to be the opposite of what I should be experiencing once I started trt. I'm thinking I may have to come off it, which I don't want to do.

Has anyone else experienced these symptoms or has any suggestions as to why they're happening? Thanks for any help.

Systemlord · Mar 12, 2024

ratt57 said:
I had labs drawn last week and my RBC's, hematocrit and hemoglobin were all below normal.

I'm starting to wonder if iron deficiency was your original issue that lead you to being placed on TRT.

TRT can cause ferritin levels to decline in some individuals. If you're on TRT, and you can't maintain normal ferritin, it’s because TRT increases EPO which increased erythroferrone, lowering hepcidin and ferroportin lets iron release from hepatocytes and therefore ferritin doesn't rise.

The obvious solution is to supplement iron.

I would check ferritin, MCV, MCH, MCHC and iron saturation.

ratt57 said:
Has anyone else experienced these symptoms or has any suggestions as to why they're happening?

I experienced the same symptoms for the first 2.5 years on TRT, at which point my ferritin levels were 24, stopped TRT for a couple of months at which point ferritin recovered, started TRT again and ferritin declined to 24 for a second time.

This is when my endocrinologist recommended iron supplementation.

Vince · Mar 12, 2024

ratt57 said:
Hi. I'm new to the forum and happy to be here. I'm noticing a lot of posts are about trt gel, which I started 6 weeks ago; I joined a trt forum on Reddit and no one seemed to be taking my questions very seriously because I wasn't doing injections.

After about three days of starting Androgel 1.62% (two pumps), my insomnia, which I've been fighting for years, went away, which was a major improvement. Instead of tossing and turning for two hours I now sleep ten-fifteen minutes after my had hits the pillow. I also noticed after a couple of weeks of trt I felt calmer and had more of a sense of well-bring. All good.

But I'm also experiencing some negative symptoms that are getting worse. I've become very anemic and my systolic BP's drop to 70-90's when I stand up. My muscles also feel very weak, even from doing something like just making my bed. I had labs drawn last week and my RBC's, hematocrit and hemoglobin were all below normal. At first I thought I was dehydrated, but no matter how much water I drink, it doesn't seem to change anything. Strangely, I also mostly experience these symptoms more in the mornings than the afternoons or evenings.

I don't know what's going on, because the anemia and low-BP's seem to be the opposite of what I should be experiencing once I started trt. I'm thinking I may have to come off it, which I don't want to do.

Has anyone else experienced these symptoms or has any suggestions as to why they're happening? Thanks for any help.

It sounds like you may be having some type of allergic reaction. With that much of a drop in blood pressure.

ratt57 · Mar 12, 2024

Systemlord said:
I'm starting to wonder if iron deficiency was your original issue that lead you to being placed on TRT.

TRT can cause ferritin levels to decline in some individuals. If you're on TRT, and you can't maintain normal ferritin, it’s because TRT increases EPO which increased erythroferrone, lowering hepcidin and ferroportin lets iron release from hepatocytes and therefore ferritin doesn't rise.

The obvious solution is to supplement iron.

I would check ferritin, MCV, MCH, MCHC and iron saturation.

I experienced the same symptoms for the first 2.5 years on TRT, at which point my ferritin levels were 24, stopped TRT for a couple of months at which point ferritin recovered, started TRT again and ferritin declined to 24 for a second time.

This is when my endocrinologist recommended iron supplementation.

ratt57 · Mar 12, 2024

I started taking 50mg iron tablets about five days ago, wondering if that was the issue. It may be too early, but I haven't seen any results so far. I'm going to ask my doc to run some more labs and specifically check my ferritin. How long did it take you to regain normal levels, and what dosage of iron do you take?

Seagal · Mar 13, 2024

ratt57 said:
Hi. I'm new to the forum and happy to be here. I'm noticing a lot of posts are about trt gel, which I started 6 weeks ago; I joined a trt forum on Reddit and no one seemed to be taking my questions very seriously because I wasn't doing injections.

After about three days of starting Androgel 1.62% (two pumps), my insomnia, which I've been fighting for years, went away, which was a major improvement. Instead of tossing and turning for two hours I now sleep ten-fifteen minutes after my had hits the pillow. I also noticed after a couple of weeks of trt I felt calmer and had more of a sense of well-bring. All good.

But I'm also experiencing some negative symptoms that are getting worse. I've become very anemic and my systolic BP's drop to 70-90's when I stand up. My muscles also feel very weak, even from doing something like just making my bed. I had labs drawn last week and my RBC's, hematocrit and hemoglobin were all below normal. At first I thought I was dehydrated, but no matter how much water I drink, it doesn't seem to change anything. Strangely, I also mostly experience these symptoms more in the mornings than the afternoons or evenings.

I don't know what's going on, because the anemia and low-BP's seem to be the opposite of what I should be experiencing once I started trt. I'm thinking I may have to come off it, which I don't want to do.

Has anyone else experienced these symptoms or has any suggestions as to why they're happening? Thanks for any help.

What was your T, hematocrit etc before starting T gel, and what is it currently?

ratt57 · Mar 13, 2024

Vince said:
It sounds like you may be having some type of allergic reaction. With that much of a drop in blood pressure

Seagal said:
What was your T, hematocrit etc before starting T gel, and what is it currently?

Hey, thanks for getting back to me. Testosterone has always strangely been normal, but free t and bioavailable have always been low. (33.1 and 62.2) Sex hormone binding globulin has been high at 92. We repeated the labs four times before he decided to try me out on trt. My endocrinologist says I have very unusual lab hormone levels and hasn't seen many males with similar results... mostly females (??). I'm a 67 year old man, lol...

Hematocrit and hemoglobin have always been a little low but I've never experienced the symptoms of anemia I'm experiencing now: shortness of breath, dizziness when standing, muscle weakness. Was difficult working out at the gym this today. I had cancer back in 2008 and after a lot of chemo and radiation it never really recovered from what it used to be. But it's now lower than it's ever been at 38.7, hemoglobin at 13.4. These symptoms all started about four days after starting trt, at the same time I started experiencing much better sleep and less anxiety, so I assumed they were all related. The iron tablets (50mg) I started six days seem to be helping a little, though, but the mornings are when I seem to experience the symptoms the most.

Systemlord · Mar 13, 2024

ratt57 said:
These symptoms all started about four days after starting trt, so I don't know what to think. The iron tablets (50mg) I started six days seem to be helping a little

If your ferritin is tanked, you’ll need quite a bit more iron than you’re currently taking.

Systemlord · Mar 13, 2024

ratt57 said:
How long did it take you to regain normal levels, and what dosage of iron do you take?

It took 3 months to get my ferritin above 100, taking 250 mg of chelated iron, then a maintenance dosage of 152 mg, which is better absorbing iron than iron tablets.

Melody68 · Mar 13, 2024

Illness can be sneaky . . . there's a chance your concerns are unrelated to TRT, or maybe the TRT triggers a problem that lies elsewhere. You should have a complete workup with your family doctor.

of574 · Mar 14, 2024

How often do you apply the gel? Only once in the morning? Have you had a morning reading yet?
I am asking since your symptoms are worse in the morning. Maybe the gel doesn't last you an entire day and you're running a lower T number than before.

When I was on androgel I noticed that taking a shower during the day or even at night would considerably change my T levels the next morning.

sammmy · Mar 14, 2024

Instead of spending months on theories, the easiest thing to do is to stop the Androgel and you will see if your symptoms go away.

If they don't, you have something else going on, not related to TRT or testosterone. Then you should definitely go see a general care doctor. Endocrinologists cannot figure out anything that is outside of their specialty.

ratt57 · Mar 14, 2024

Systemlord said:
If your ferritin is tanked, you’ll need quite a bit more iron than you’re currently taking.

How much would you recommend?

ratt57 · Mar 14, 2024

of574 said:
How often do you apply the gel? Only once in the morning? Have you had a morning reading yet?
I am asking since your symptoms are worse in the morning. Maybe the gel doesn't last you an entire day and you're running a lower T number than before.

When I was on androgel I noticed that taking a shower during the day or even at night would considerably change my T levels the next morning.

Once in the morning after showering, two pumps. I'm not scheduled to see my endo until 4/10.

ratt57 · Mar 14, 2024

Systemlord said:
It took 3 months to get my ferritin above 100, taking 250 mg of chelated iron, then a maintenance dosage of 152 mg, which is better absorbing iron than iron tablets.

That's a lot of iron, or maybe I'm not understanding iron dosages. I'm reading 45mgs. is the highest recommended dose. Can you recommend a brand, by any means?

ratt57 · Mar 14, 2024

Vince said:
It sounds like you may be having some type of allergic reaction. With that much of a drop in blood pressure.

It's looking like the drop in BP is from the anemia.

ratt57 · Mar 14, 2024

sammmy said:
Instead of spending months on theories, the easiest thing to do is to stop the Androgel and you will see if your symptoms go away.

If they don't, you have something else going on, not related to TRT or testosterone. Then you should definitely go see a general care doctor. Endocrinologists cannot figure out anything that is outside of their specialty.

I'm leaning toward doing that, although since I started taking the iron tablets it seems like it's improving.

Systemlord · Mar 14, 2024

ratt57 said:
That's a lot of iron, or maybe I'm not understanding iron dosages. I'm reading 45mgs. is the highest recommended dose. Can you recommend a brand, by any means?

If your ferritin is <30, the dosages I stated are standard for someone with iron deficiency.

Where are you getting your recommendations for iron dosing?

Individualized treatment for iron deficiency anemia in adults

Iron deficiency is one of the most common disorders affecting mankind, and iron deficiency anemia continues to represent a major public health problem worldwide. It is especially common among women of childbearing age due to pregnancy and menstrual blood ...

www.ncbi.nlm.nih.gov

A common generic approach for iron deficiency in adults consists of a daily dose of 150-200 mg of elemental iron.

The link below is highest absorption iron that I have used for years and is the only type of iron that works for me. Beware, gentle iron or GI friendly iron is low absorbing iron.

https://www.vitaminshoppe.com/p/iron-28-mg-300-capsules/vs-1203

ratt57 · Mar 14, 2024

Systemlord said:
I'm starting to wonder if iron deficiency was your original issue that lead you to being placed on TRT.

TRT can cause ferritin levels to decline in some individuals. If you're on TRT, and you can't maintain normal ferritin, it’s because TRT increases EPO which increased erythroferrone, lowering hepcidin and ferroportin lets iron release from hepatocytes and therefore ferritin doesn't rise.

The obvious solution is to supplement iron.

I would check ferritin, MCV, MCH, MCHC and iron saturation.

I experienced the same symptoms for the first 2.5 years on TRT, at which point my ferritin levels were 24, stopped TRT for a couple of months at which point ferritin recovered, started TRT again and ferritin declined to 24 for a second time.

This is when my endocrinologist recommended iron supplementation.

I just discovered a lot of the levels were drawn on March 5 with my CBC and I didn't pay any attention to them, I was mostly concerned with RBC's. My MCV, MCH, MPV and platelets are all normal. RBC's are low at 4.23. They didn't run MCHC or iron saturation labs. I'm seeing my GP in two hours, I'm going to ask him to run an iron sat level, but looking at the other labs it's probably going to be normal.

Systemlord · Mar 14, 2024

ratt57 said:
It's looking like the drop in BP is from the anemia.

No, it's the opposite. Iron is blood, so anemia would increase blood pressure. You have more issues going on than just low-T.

Anemic with very low BP's since starting trt gel

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