Why can testosterone increase water retention?

[Nelson Vergel]

J Clin Endocrinol Metab. 2005 Jul;90(7):3989-94. Epub 2005 Apr 12.

Independent and combined effects of testosterone and growth hormone on extracellular water in hypopituitary men.

Johannsson G1, Gibney J, Wolthers T, Leung KC, Ho KK.

Abstract
CONTEXT:
Symptoms of fluid retention in GH-deficient patients during GH replacement are greater in men than in women, suggesting that testosterone may augment or estradiol may attenuate the antinatriuretic actions of GH. The mechanisms underlying the sodium-retaining effects of GH are poorly understood.

AIM:
The aim of this study was to investigate the effects of GH and testosterone, alone and in combination, on extracellular water (ECW) and the hormonal mechanisms involved.

DESIGN:
Two separate, open-label, randomized, two-period, crossover studies were performed; the first compared the effects of GH alone with those of GH and testosterone, and the second compared the effects of testosterone alone with those of GH and testosterone.

PARTICIPANTS:
Twelve hypopituitary men with GH deficiency and hypogonadism were studied.

INTERVENTION:
During the weeks of intervention, GH (0.5 mg/d) and testosterone enanthate (250 mg) were administered by im injection.

OUTCOME MEASURES:
The outcome measures were ECW, IGF-I, plasma renin activity (PRA), aldosterone (Aldo), and atrial natriuretic peptide (ANP).

RESULTS:
GH treatment significantly increased (P < 0.05) both IGF-I and ECW, and these changes were enhanced by cotreatment with testosterone (P = 0.07 for both). PRA, Aldo, and ANP levels did not change. Testosterone treatment alone did not change the IGF-I concentration, whereas cotreatment with GH induced a marked increase. Testosterone alone increased (P < 0.05) ECW, and the effect was augmented (P < 0.01) by cotreatment with GH. Although PRA and ANP did not change, plasma Aldo decreased after single and combined treatments.

CONCLUSION:
GH and testosterone exerted independent and additive effects on ECW. The mechanisms of fluid retention for both hormones are likely to be exerted on the renal tubules. This is the first direct evidence that testosterone increases ECW.

 

[Nelson Vergel]

" Androgens have been shown to increase tubular sodium and water reabsorption and activate various vasoconstrictor systems in the kidney, such as the renin-angiotensin system and endothelin."

https://www.physiology.org/doi/full/10.1152/ajprenal.00034.2005

 

[Nelson Vergel]

"In conclusions, increases in α, β and γ-ENaC protein and mRNA levels in kidneys mainly in the distal tubules and collecting ducts under testosterone influence might lead to enhance Na+ reabsorption which subsequently might cause an increase in blood pressure."

Sub-chronic testosterone treatment increases the levels of epithelial sodium channel (ENaC)-α, β and γ in the kidney of orchidectomized adult male Sprague–Dawley rats

 

[Gman86]

Hey, more power to him. All I am saying is that I have been reading posts here and on Facebook for 10 years and rarely I see anyone saying that. In fact, most have normal or low estradiol when they test it while going through water retention. I took anastrozole whole having edema and it did nothing at all. So have a few guys I have coached.


Water retention during the first few weeks of TRT is one of TRT's most troublesome and hard to manage side effects. It occurs (in my estimate) to about 10-20 percent of users. The potential causes could be cortisol build up, increase sodium retention, in rare cases high estradiol, or cardiovascular issues. I am enclosing several posts on these issues.

Most cases of lower extremity (peripheral) edema have nothing to do with estradiol and a lot to do with cardiovascular issues. My number one suggestion if edema does not get better after a month on TRT is to get a full cardio workup by a cardiologist.

Some men report decreased edema after a short cycle of a diuretic like HTZ, so that is something to explore. Low sodium intake and plenty of water plus cardio may also help. Cardio exercise and sweating in a sauna have also been reported to help. But these are speculations that should not replace a good cardiovascular work up.

Pulmonary hypertension caused by sleep apnea has also been reported as a cause.

Thanks for the reply Nelson, appreciate you taking the time. But ya you’re definitely right about lower extremity edema, it absolutely has more to do with cardiovascular issues, than hormones, most of the time. I’m a nurse, and have been in the health field for over 10 years. I would guess though that most of the guys complaining about water retention, while on HRT, are more so complaining of water retention/ bloating in their face, abdominal region and fingers. Probably a good way to distinguish cardiovascular edema, vs edema from hormones/ electrolytes imbalances, is whether you have edema in your lower extremities along with retention in other places, or lower extremity edema just by itself. Just by itself, would most likely be cardiovascular related, and if it’s paired with retention in those other areas, it could be of different etiology. But of course, I’ve had patients with chronic heart failure that had fluid retention in multiple areas, so this doesn’t always hold true all of the time. But it’s pretty easy to rule out cardiovascular issues being the cause. If you’ve never had any cardiovascular issue prior to HRT, and if you’re asymptomatic of any other cardiovascular/ heart problems other than the fluid retention, you can most likely rule out it being related to any cardiovascular problems.

You say an increase in cortisol could be a cause, when beginning TRT, but I thought TRT lowers cortisol. I’ve read many threads where guys have borderline low cortisol after initiating TRT. I myself, have a borderline low cortisol level while on TRT. Also, lowering salt usually isn’t the answer. Increasing potassium is a better solution. They work together in balance to maintain proper fluid levels within the body. That’s of course assuming they are using natural salt, and not processed/ refined salt. That alone will make all the difference. Here’s a video on salt that will blow your mind, I know it did mine lol. But I agree with everything else you said, and I also agree that we should not be strictly looking at E2 every time water retention/ bloating occurs. There’s just too many things that can lead to water retention/ bloating, in a short period of time.

 

[maxadvance]

Actually within that same podcast 2 of the Docs specifically state bloat is almost always from T

 

[mazrim]

I don't understand why some people say that the bloat is caused from aldosterone increasing and therefore increasing sodium retention when test appears to lower aldosterone from the study first posted and the others I have looked at so far.