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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone and Men's Health Articles
Blood pressure responses to TRT are amplified by HCT levels in opioid-induced androgen deficiency
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<blockquote data-quote="madman" data-source="post: 274482" data-attributes="member: 13851"><p><em><strong>*Secondary hypogonadism is one of the most well-described hormonal side effects of opioid treatment and occurs in men with chronic opioid use due to the suppression of the hypothalamic-pituitary-gonadal axis, known as opioid-induced androgen deficiency (OPIAD) [2]. <u>Biochemically, OPIAD is characterized by low serum levels of testosterone and low levels of luteinizing hormone</u> [3]. <u>The magnitude of androgen deficiency depends on opioid treatment duration and dosage of opioids</u> [4]. <u>Furthermore, the severity of androgen deficiency in OPIAD appears to be accentuated in patients with comorbidities such as obesity, diabetes mellitus, hypertension, and hyperlipidemia [5]. Cardiovascular disease (CVD) and chronic pain often coexist [6,7] and the prevalence of hypertension in patients attending tertiary pain management clinics is up to 10 times higher compared to the general population</u> [8].</strong></em></p><p><em><strong></strong></em></p><p><em><strong>*<em>A recent large randomized study conducted among men with increased cardiovascular risk and total testosterone levels less than 10.4 nmol/investigated the effects of TRT with a follow-up period of 33 months [35]. <strong>Although there was no difference in the occurrence of major adverse cardiovascular events between the groups, the study reported a small yet significantly higher BP in the TRT group than in the placebo group. Furthermore, the occurrence of kidney disease and atrial fibrillation, both of which are strongly associated with hypertension, was higher among the participants in the TRT group. <u>These findings suggest a potential cautionary signal as the effects of TRT may not manifest as major cardiovascular events within a relatively short follow-up period</u>.</strong></em></strong></em></p><p><em><strong><em><strong></strong></em></strong></em></p><p><em><strong><em><strong><strong>*In this study, we found a significant positive interaction between baseline levels of red blood cell measurements and the association between TRT and daytime SBP, and that the degree of increase in both OSBP and daytime SBP was associated with an increase in both Hct and Hgb.</strong> In large population studies of healthy individuals, Hgb levels were positively associated with BP levels [16,17]. TRT, especially injectable administration, can lead to erythrocytosis, resulting in increased Hct and Hgb levels [36]. Consistent with our findings, a recent (nonplacebo controlled) study examining the effect of oral TRT on ambulatory BP found that an increase in BP was associated with an increase in Hct levels[31]. They found that men in the top quartile of changes in Hct (range, 6–14%) experienced the largest increase in mean ambulatory SBP of 8.3 mmHg. <strong><u>We found that a 10% change in Hct was associated with an increase in daytime SBP of 7.4 mmHg</u>. <u>This is in line with Poiseuille’s law, which states that an increase in viscosity causes an increase in resistance, subsequently leading to increased BP when cardiac output remains constant. To physiologically compensate for a 10% increase in Hct levels, a 20% increase in BP or 5% vasodilation is necessary to maintain adequate perfusion</u> [37].</strong></strong></em></strong></em></p></blockquote><p></p>
[QUOTE="madman, post: 274482, member: 13851"] [I][B]*Secondary hypogonadism is one of the most well-described hormonal side effects of opioid treatment and occurs in men with chronic opioid use due to the suppression of the hypothalamic-pituitary-gonadal axis, known as opioid-induced androgen deficiency (OPIAD) [2]. [U]Biochemically, OPIAD is characterized by low serum levels of testosterone and low levels of luteinizing hormone[/U] [3]. [U]The magnitude of androgen deficiency depends on opioid treatment duration and dosage of opioids[/U] [4]. [U]Furthermore, the severity of androgen deficiency in OPIAD appears to be accentuated in patients with comorbidities such as obesity, diabetes mellitus, hypertension, and hyperlipidemia [5]. Cardiovascular disease (CVD) and chronic pain often coexist [6,7] and the prevalence of hypertension in patients attending tertiary pain management clinics is up to 10 times higher compared to the general population[/U] [8]. *[I]A recent large randomized study conducted among men with increased cardiovascular risk and total testosterone levels less than 10.4 nmol/investigated the effects of TRT with a follow-up period of 33 months [35]. [B]Although there was no difference in the occurrence of major adverse cardiovascular events between the groups, the study reported a small yet significantly higher BP in the TRT group than in the placebo group. Furthermore, the occurrence of kidney disease and atrial fibrillation, both of which are strongly associated with hypertension, was higher among the participants in the TRT group. [U]These findings suggest a potential cautionary signal as the effects of TRT may not manifest as major cardiovascular events within a relatively short follow-up period[/U]. [B]*In this study, we found a significant positive interaction between baseline levels of red blood cell measurements and the association between TRT and daytime SBP, and that the degree of increase in both OSBP and daytime SBP was associated with an increase in both Hct and Hgb.[/B] In large population studies of healthy individuals, Hgb levels were positively associated with BP levels [16,17]. TRT, especially injectable administration, can lead to erythrocytosis, resulting in increased Hct and Hgb levels [36]. Consistent with our findings, a recent (nonplacebo controlled) study examining the effect of oral TRT on ambulatory BP found that an increase in BP was associated with an increase in Hct levels[31]. They found that men in the top quartile of changes in Hct (range, 6–14%) experienced the largest increase in mean ambulatory SBP of 8.3 mmHg. [B][U]We found that a 10% change in Hct was associated with an increase in daytime SBP of 7.4 mmHg[/U]. [U]This is in line with Poiseuille’s law, which states that an increase in viscosity causes an increase in resistance, subsequently leading to increased BP when cardiac output remains constant. To physiologically compensate for a 10% increase in Hct levels, a 20% increase in BP or 5% vasodilation is necessary to maintain adequate perfusion[/U] [37].[/B][/B][/I][/B][/I] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone and Men's Health Articles
Blood pressure responses to TRT are amplified by HCT levels in opioid-induced androgen deficiency
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