Near Syncope

[Eldridge]

I ended up in the ER and was diagnose with Near Syncope. I started TRT 1/1/22. Hadn't done my 3 month lab result yet. My blood pressure was high as I hadnt been closely monitoring it since I started TRT. The few time I did check it, it was mostly good. The night this first started I had a cheat meal of pizza with extra meat/ high sodium. When I first had the dizzy spell my BP was 150/100. I ended up at the ER the next day because I almost fainted after trying to stand upright. Vomit all the water I had been drinking that morning and a half of grapefruit. I actually did my warm up walk and run for a mile before and got half way tru my weight routine before stopping. The bending over was making me feel faint.
My lab from the ER and were all normal. Hematocrit 49.3 % Hemoglobin 16.0. My protocol is .20 of 200 mg T. Cypionate every 3 days. I'm trying to follower up with my doctor or cardiologist but it seem like it will be a few week before I could get an appointment.
My question is could this be related to my TRT and should I stop until I can see a doctor. I took a dose yesterday, worked out and felt pretty good. This morning I woke up feeling kinda faint when I raise up and just now starting to feel a little better now. I'm not sure if this will last.

 

[ajax31]

Did they check your calcium level? Under Metabolic Profile

 

[Eldridge]

Did they check your calcium level? Under Metabolic Profile

yes 8.9 Range 8.5 - 10.1. Thinking I may have found a connection in the search menu. Testosterones have a drug contradiction with Loperamide Simethicone and can cause Syncope.

 

[Cataceous]

I see that interaction mentioned on this site:

Loperamide; Simethicone: (Moderate) The plasma concentration of loperamide, a P-glycoprotein (P-gp) substrate, may be increased when administered concurrently with testosterone, a P-gp inhibitor. If these drugs are used together, monitor for loperamide-associated adverse reactions, such as CNS effects and cardiac toxicities (i.e., syncope, ventricular tachycardia, QT prolongation, torsade de pointes, cardiac arrest).​

Testosterone Drug Interactions

TESTOSTERONE DRUG INTERACTIONS The interplay between medications and testosterone involves a complex network of biochemical interactions that can significantly affect a patient's health. Below is a detailed discussion of various medications and how they interact with testosterone. It is...

www.excelmale.com

You might consider checking testosterone levels sooner rather than later. Ideally get total testosterone, SHBG and free testosterone by equilibrium dialysis. Total testosterone and SHBG can be used to estimate free T if you don't want to spring for the free T test.

While your starting TRT dose isn't unreasonable, if you are a slower metabolizer then you could still have quite high serum levels. For example, at that dose I would have total testosterone averaging over 1,100 ng/dL, which is pushing double what I normally run.

Depending on your test results it seems as though the problem could be ameliorated through a dose reduction in one or both of the drugs.

 

[Eldridge]

Thanks, I will try and get those labs done soon, because I'm curious to know what my numbers are.

 

[Eldridge]

Thanks, I will try and get those labs done soon, because I'm curious to know what my numbers are.

A week later I am feeling better. Still get moments of lightheadedness but nothing as bad as what set me to the ER. I reduce my last 2, T dose to .15 ml 3 times a week at the advise of my provider. The didn't think the OTC meds for my stomach cause it. They thought the jump in my Hematocrit from 46.5 before starting , to the 49.3 at the ER was causing the lightheadedness. I have IBS-D and that is why I had been doing the OTC meds for my stomach. I also take Dicylomine for the IBS but the other meds seem to help more when I take them together.

 

[sammmy]

Many medications have warning against grapefruit, which can boost their concentrations with more side effects.
I would also go to a neurologist (check for dysautonomia, POTS) and a cardiologist (check for cardiac problems).

 

[Eldridge]

Many medications have warning against grapefruit, which can boost their concentrations with more side effects.
I would also go to a neurologist (check for dysautonomia, POTS) and a cardiologist (check for cardiac problems).

While in the ER did a lot of test on the conditions of my Heart. Chest X-ray, EKGs and labs all came back normal. So I'm thinking that rule out any heart problems

 

[sammmy]

Echo-cardiogram is the preferable test for heart functioning.

 

[Eldridge]

Echo-cardiogram is the preferable test for heart functioning.

Just left and appointment with my primary and he wanted to schedule me for and Echo and another test where I wear a device for 24 hours to monitor my heart. I'm a little ahead of him and got an appointment with a cardiologist for next week. Just took my 3 dose of Test for the week. I reduced it from .20 ml 3 time to 1.5 three time a week. The lightheadedness seem to get worst the day after my T shot and taper off the day before my dose. Also my stomach meds also seem to make it worst and reducing those too.

 

[sammmy]

The device monitoring heart rate is fine but better would be 24 hour monitoring of blood pressure. Dizziness is often the result of low blood pressure and it can't be measured at office, due to the "white coat effect".

If not, it is a good idea to get a blood pressure monitor and measure it at home in a relaxed state. I personally have "normal blood pressure" at doctor's office, but low at home, and it gets even lower after meals.

 

[Eldridge]

The device monitoring heart rate is fine but better would be 24 hour monitoring of blood pressure. Dizziness is often the result of low blood pressure and it can't be measured at office, due to the "white coat effect".

If not, it is a good idea to get a blood pressure monitor and measure it at home in a relaxed state. I personally have "normal blood pressure" at doctor's office, but low at home, and it gets even lower after meals.

I will mention this to the cardiologist on my visit next week. I test my BP regularly since that incident and it was around 150/100 when this first happen. Before I started TRT it stayed normal and about a month in I realize it had creep up. Got it back to normal all last week but one doctor visit they got a reading of 120/60. I was a little shocked but wrote it off as an error cause I never had that low number but I'm taking much more blood pressure meds since the incident. Crazy thing now my primary don't want to prescribe me the BP meds I told him I need. My prescribed BP meds got mix up because some visit I would tell them what I was taking and the wrong meds got stop ad it was the one I was taking.top Now my doctor don't want to change the BP meds ad want me to take only the one BP that had a water pill included. And I was never taking that one since I lost 25lbs. Maybe he's upset because I found a TRT clinic or just too lazy to redo the prescription I told him I want and it had been working for me all those years.

 

[Eldridge]

I see that interaction mentioned on this site:

Loperamide; Simethicone: (Moderate) The plasma concentration of loperamide, a P-glycoprotein (P-gp) substrate, may be increased when administered concurrently with testosterone, a P-gp inhibitor. If these drugs are used together, monitor for loperamide-associated adverse reactions, such as CNS effects and cardiac toxicities (i.e., syncope, ventricular tachycardia, QT prolongation, torsade de pointes, cardiac arrest).​

Testosterone Drug Interactions

TESTOSTERONE DRUG INTERACTIONS The interplay between medications and testosterone involves a complex network of biochemical interactions that can significantly affect a patient's health. Below is a detailed discussion of various medications and how they interact with testosterone. It is...

www.excelmale.com

You might consider checking testosterone levels sooner rather than later. Ideally get total testosterone, SHBG and free testosterone by equilibrium dialysis. Total testosterone and SHBG can be used to estimate free T if you don't want to spring for the free T test.

While your starting TRT dose isn't unreasonable, if you are a slower metabolizer then you could still have quite high serum levels. For example, at that dose I would have total testosterone averaging over 1,100 ng/dL, which is pushing double what I normally run.

Depending on your test results it seems as though the problem could be ameliorated through a dose reduction in one or both of the drugs.

 

[Eldridge]

Just got my lab back and I am shocked to RBC, Hemoglobin and Hematocrit all high.

RBC 6.09 (4.14 -5.80) HEMOGLOBIN 18.3 (13.0 -17.7) and HEMATOCRIT 56.6 (37.5 - 51.0)
TEST 928 (264-916) FREE TEST 20.1 (7.2-24.0)

Also wondering why my numbers wasn't high from the ER labs work. ER labs RBC 5.2 HEMO 16 HEMATO 49.3. I was drinking a lot of water that day and would that have cause those labs to be in range that day?
Hadn't did any more of my T treatment since my labs on April 1, and still notice I get a little dizzy sometimes when I lay down suddenly. Wondering how soon will my numbers drop to a more normal level without donating blood? Also maybe I need to try half that protocol to 60 ml 3 times a week? I think would be happy if my TT was around 600 and had no Hematocrit issues to deal with.

 

[Eldridge]

I see that interaction mentioned on this site:

Loperamide; Simethicone: (Moderate) The plasma concentration of loperamide, a P-glycoprotein (P-gp) substrate, may be increased when administered concurrently with testosterone, a P-gp inhibitor. If these drugs are used together, monitor for loperamide-associated adverse reactions, such as CNS effects and cardiac toxicities (i.e., syncope, ventricular tachycardia, QT prolongation, torsade de pointes, cardiac arrest).​

Testosterone Drug Interactions

TESTOSTERONE DRUG INTERACTIONS The interplay between medications and testosterone involves a complex network of biochemical interactions that can significantly affect a patient's health. Below is a detailed discussion of various medications and how they interact with testosterone. It is...

www.excelmale.com

You might consider checking testosterone levels sooner rather than later. Ideally get total testosterone, SHBG and free testosterone by equilibrium dialysis. Total testosterone and SHBG can be used to estimate free T if you don't want to spring for the free T test.

While your starting TRT dose isn't unreasonable, if you are a slower metabolizer then you could still have quite high serum levels. For example, at that dose I would have total testosterone averaging over 1,100 ng/dL, which is pushing double what I normally run.

Depending on your test results it seems as though the problem could be ameliorated through a dose reduction in one or both of the drugs.

Check out my last post. I just got my labs from Labs Corp. my SHBG WAS 27.6. I'm not familiar with what those number mean.

 

[Cataceous]

Based on total testosterone of 928 ng/dL and SHBG of 27.6 nMol/L your Vermeulen calculated free testosterone is about 24 ng/dL. That's on the high side considering that the average for healthy young men is more like 15 ng/dL. By the way, that SHBG is normal, close to the 30-35 we consider ideal. I'm confused about your dosing. Originally you were taking 40 mg every three days, or 93 mg per week, correct? Then you switched to 0.15 mL / 30 mg three times a week? But this is still 90 mg per week—hardly much of a change. The more frequent dosing could smooth out levels some, but overall I think it would be appropriate to drop to 60-65 mg per week, which would be more in line with your stated goal: "I think would be happy if my TT was around 600 and had no Hematocrit issues to deal with."

My understanding is that hydration issues can be identified by a skewing of the ratio of hematocrit to hemoglobin. But it looks as though your ratios are appropriate, at around 3.

 

[Eldridge]

Thanks, I'm new to this. The original dose prescribe was .2 ml three time a week but I did .2 ml every 3 days at the advice of someone saying this would be better. So I just assume that considered 120 mg a week also. Now I looking at the calendar when I started on Dec 31 it has only been once a week in each month that I had 3 shots a week. So that was like 9 weeks of 80ml each week and 3 weeks 120 ml and I sure how you would average that out. lol I'm more confused.
Ended up in the ER March 20. After that, week I only took 1.5ml shot 6days later. Still was having the syncope feeling so I stop for 2 weeks. Start feeling better and I took another .1mg last friday. So now my plan is to see how .1ml every 4 days will work out unless the bad syncope feeling coming on again. Redid lab for CBC and FT AND TT on Thursday and my clinic sent a order for Therapeutic phlebotomy. It look like that takes about 2 weeks to get that set up but I hoping if my CBC test look ok maybe I can skip that and countinue the .1ml every 3 days and see how that will work out. What do you think?

 

[Eldridge]

Based on total testosterone of 928 ng/dL and SHBG of 27.6 nMol/L your Vermeulen calculated free testosterone is about 24 ng/dL. That's on the high side considering that the average for healthy young men is more like 15 ng/dL. By the way, that SHBG is normal, close to the 30-35 we consider ideal. I'm confused about your dosing. Originally you were taking 40 mg every three days, or 93 mg per week, correct? Then you switched to 0.15 mL / 30 mg three times a week? But this is still 90 mg per week—hardly much of a change. The more frequent dosing could smooth out levels some, but overall I think it would be appropriate to drop to 60-65 mg per week, which would be more in line with your stated goal: "I think would be happy if my TT was around 600 and had no Hematocrit issues to deal with."

My understanding is that hydration issues can be identified by a skewing of the ratio of hematocrit to hemoglobin. But it looks as though your ratios are appropriate, at around 3.

Oh the free T was 20.1. Is that still consider high? I also try to drink a gallon of water each day. The last 2 labs I only drunk about 12 ounce of water before the test thinking its best to know what my level are if I might be a little dehydrated since the side effect happen so suddenly and I had been drinking my water as usual.

 

[Cataceous]

If your free testosterone wasn't measured by equilibrium dialysis or ultrafiltration then it should be ignored; standard immunoassay-based tests are too inaccurate. The next best thing is to calculate it from total testosterone and SHBG.

If you can handle more frequent injections then they are preferred because they smooth out your serum testosterone, perhaps reducing side effects. Ideally you'd inject three times a week or every other day. Based on your previous results I still think 60-65 mg testosterone cypionate per week total would be a reasonable next step. Taking 0.1 mL or 20 mg every three or four days is on the low side, especially for these longer injection cycles (47 and 35 mg per week). On twice weekly injections it's common for peak testosterone to be 50% higher than trough testosterone.

In conclusion, if I were you I would try either 0.08 mL (16 mg) or 0.1 mL (20 mg) three times a week. Give it time and see if it resolves the problems. Monitor free testosterone with either an accurate test or the calculators to ensure it stays reasonable.

 

[Eldridge]

If your free testosterone wasn't measured by equilibrium dialysis or ultrafiltration then it should be ignored; standard immunoassay-based tests are too inaccurate. The next best thing is to calculate it from total testosterone and SHBG.

If you can handle more frequent injections then they are preferred because they smooth out your serum testosterone, perhaps reducing side effects. Ideally you'd inject three times a week or every other day. Based on your previous results I still think 60-65 mg testosterone cypionate per week total would be a reasonable next step. Taking 0.1 mL or 20 mg every three or four days is on the low side, especially for these longer injection cycles (47 and 35 mg per week). On twice weekly injections it's common for peak testosterone to be 50% higher than trough testosterone.

In conclusion, if I were you I would try either 0.08 mL (16 mg) or 0.1 mL (20 mg) three times a week. Give it time and see if it resolves the problems. Monitor free testosterone with either an accurate test or the calculators to ensure it stays reasonable.

Thanks, I really appreciate all the information. After that last injection I notice a little brain fog but the dizziness and lightheadedness as if I might pass out hasn't started back up. Hopefully my updated CBC and Testosterone Test will be in this week and I will report back with those.