orthostatic hypotension and TRT

[James Cole]

Hello guys…

Been on TRT for about six months now an was perfect at the beginning but now I am getting a lot of delayed orthostatic hypotension that only goes away if I stop the T shots…

My labs are ok only DHEA was low so I supplemented it but sides are still the same…

Has anyone dealt with DOH succesfully?

Thanks!
JC

 

[sammmy]

Orthostatic hypotension gets worse when the blood vessels expand, for example in hot weather.

I checked if testosterone can have a vasodilation effect, and it does:

The vasodilatory action of testosterone: a potassium-channel opening or a calcium antagonistic action? - PMC

www.ncbi.nlm.nih.gov

 

[Systemlord]

TRT has an affect similar to calcium channel blockers. I got dangerously low blood pressure while sleeping when injecting too frequently.

That’s why, after over four years I gave up on injections, Jatenzo doesn’t have that effect on me.

I believe it has to do with the 6 hour half-life.

 

[James Cole]

Thanks guys! What solutions you propose? I do ethanate btw…

 

[Systemlord]

Thanks guys! What solutions you propose? I do ethanate btw…

Maybe, maybe you need a shorter ester, like Jatenzo, new oral T gel capsules, 6 hour half-life and very expensive ($1250-$3400) if not covered by insurance. I got my insurance to cover it 100 percent by getting a medical exception from my doctor after 4 years of treatment failure on every other delivery method.

 

[James Cole]

Hello Guys… I can get Nebido which is testosterone undecanoate as well… could this work?

Can you guys explain to me why one might work while ethanate wont?

Btw… I do have naturally low blood pressure… is there maybe a way to raise it a bit?

 

[Systemlord]

I can get Nebido which is testosterone undecanoate as well… could this work?

Probably not, Nebido creates very flat steady hormone profile, like injecting cypionate 1-2 times daily.

Nebido has the longest half-life (30 days) or any TRT option. If you went the Nebido route and had problems, you’d be stuck with it in your system for many weeks.

 

[Systemlord]

Can you guys explain to me why one might work while ethanate wont?

Nobody can give you definitive answers, it’ll either work or it won’t.

 

[sammmy]

Nebido is not likely to work - it has a very long life when injected.

The most logical thing to do it lower your T doses as low as you can tolerate to reduce the vasodilation caused by it.

Treatments for low blood pressure are seldom prescribed because they may have side effects, so you will treat a side effect of T with a drug that brings on other side effects.

See page 1466 in this article for possible treatments:

 

[James Cole]

Nebido is not likely to work - it has a very long life when injected.

The most logical thing to do it lower your T doses as low as you can tolerate to reduce the vasodilation caused by it.

Treatments for low blood pressure are seldom prescribed because they may have side effects, so you will treat a side effect of T with a drug that brings on other side effects.

See page 1466 in this article for possible treatments:

I am doing 50mg divided into Monday and Thursday… 25/25 Im not sure I can go lower than that… or what else do you guys suggest…?

 

[sammmy]

I would try an abdominal binder or pyridostigmine from the article. Pyridostigmine may give you a slight diarrhea since it stimulates intestinal peristalsis. If you have constipation, it will make you "more regular".

If that doesn't work, see where your trough levels of T and free T sit. I would adjust the dose to the lower end of normal and even slightly below. It may be possible that this is achieved with lower than your current doses. You may need to do such a dose reduction only during the warmer months, which exacerbate orthostatic hypotension.

 

[sammmy]

Preventing and treating orthostatic hypotension: As easy as A, B, C - PMC

Orthostatic hypotension is a chronic, debilitating illness that is difficult to treat. The therapeutic goal is to improve postural symptoms, standing time, and function rather than to achieve upright normotension, which can lead to supine ...

www.ncbi.nlm.nih.gov

 

[James Cole]

I will look into all this info! Thanks all for your help!