TRT Blood Pressure and Pulse Rate & Therapeutic Phlebotomy

Discussion in 'Men's Health Forum' started by james2012, Sep 9, 2010.

  1. #1
    james2012

    james2012 Member

    First it was Depo about two months ago. When my hemocrit levels raised when I went from 100mg to 125mg I was yanked off rather quickly - I have 25 stents and take Plavix so high hematocrit is off the table. I was on Testim in the past and never had an issue before I almost successfully completed a protocol to restart my own HPTA axis and did not follow through with another year of TRT before trying the protocol again - I have idiopathic hypogonadism and the testes, pituitary, and hypothalamus all responded to the protocol so they are working fine. But that is not what I am talking about here.

    I doubled my dose of Testim and my BP is about 145/95 and my cardiologist would like it no higher than about 125/85. I also noted my pulse rate is high - around 95, but both BP and pulse rate do drop during the day.

    The Depo was awesome at first, but then libido and erectile dysfunction hit and hit hard. I switched to Testim, got some arimidex (which I have yet to start at .25mg every third day), and do 250IU of hcg every three days. No real lab data on any of this yet.

    I know everyone is going to scream at me here for not starting the T, waiting, getting a measurement along with E2, then stepping up at the right time to arimidex (if necessary) and then on to HCG when everything is stabilized. I am going to do this when I return from my anniversary cruise. Right now, my libido and ED are normalizing to a point where I may be able to use a PDE5 inhibitor (Levitra is my choice).

    As my insurance does not cover Testim, when I return I am stopping everything and starting with 10g androgel, which it does cover and then taking the slow approach described above. I did not respond at all to 5g in the past, but on 5g of Testim I had morning numbers around 560 with one and only one measurement of 795 total T (I think this was an outlier). No gyno, no tender nipples, some water retention but not a great deal. Taking an HCTZ blood pressure pill (which is a diuretic) did not make that much of a difference. I am already on 10mg of Norvasc/day.

    I'm thinking cortisol caused by T being a little too high? Or maybe E2 being elevated but not enough to cause gyno, just enough to cause anxiety. My BP is tightly correlated to anxiety levels and I am on clonazepam to control this.

    I just want to make it through my anniversary cruise and be able to function sexually. After that, I have no problem with the slow methodical approach. I am just asking for some theories as to what the high BP, anxiety, and higher pulse rate MAY be caused by.
     
  2. #2
    james2012

    james2012 Member

    Sorry, forgot to mention that due to the Plavix I cannot give blood. Where does one get a therapeutic phlebotomy? I live in Austin.
     
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  3. #3
    Chris.N

    Chris.N Active Member

    testosterone therapy cause a slight increase in blood pressure, it is very common, but can be managed with proper dosing.
     
    mrmorris likes this.
  4. #4
    james2012

    james2012 Member

    Thanks Chris.
     
  5. #5
    Michael Scally MD

    Michael Scally MD Doctor of Medicine


    At almost any blood bank/donation center. The difference is a doctor's order.
     
  6. #6
    james2012

    james2012 Member

    Thanks Mr. Scally. It turns out I can give blood on Plavix, just not platelets, so I can just walk in now and without a precription.
     
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  7. #7
    zkt

    zkt Member

    You need to get your priorities straight.
    25 stents? You exaggerating a little?
    But none the less: you need to get your BP in a safer range.
    How many infarcts have you had? BP is the number one predictor of future events.
    You are also heading for a case of cardiomyopathy with the tachycardia.
    Tell your doctor you want to try metoprolol. HCTZ is often effective in lowering BP if hypervolumia is the root cause. Metoprolol will address the cardiomyopathy by lowering the rate and intensity of contractions.
    In addition, you appear to be a good canditate for an A2 receptor blocker, terazosin, for instance.
    T will definately raise BP and HCT. The last things you need. So will GCs.
    Get the aromitization under control and you wont need so much T.
     
  8. #8
    james2012

    james2012 Member

    No dude, I really have 25 stents in three arteries - LAD, CX, and RCA. Check out my site Lump on a Blog where I have all the procedures printed out in the my story section. I am 43 and had 43 heart attacks between the ages of 38-41. Turns out I was resistant to 75mg Plavix before switching to 150mg. No stents since then.
     
  9. #9
    zkt

    zkt Member

    I didnt mean to seem disrespectful; I`m the most serious guy you will ever meet when it comes to this sort of thing. Been to the cath lab 6 times myself, renal not cardiac.
    I dont think there is room for 25 stents in the cardiac arteries. 25 and 25 angioplasticies I can see. Post a link to the site you mentioned. I really want to check this out.
    But back to the subject:
    First of all, why the fuck didnt your cardiologist perform grafts after say the first half dozen or so?
    Thats crazy.
    Secondly, controlling BP is a hell of a lot more important to you than libido. One major clot 10 minutes away from help and libido wont matter any more. What BP meds are you on?
    Surely your cardiologist knows that Plavix is more effective in conjunction with asprin.
    What lipid (LDL, HDL, VlDL, TG) control drugs are you taking? My HDL tested at 94 last time, might have some useful recomendations.
    I would really like to follow up on this with you.
    Please tell me all you can relating to your condition.


     
  10. #10
    james2012

    james2012 Member

    I did not take it that way and would not mind it even if someone were combative (I have very thick skin), so don't hesitate to call BS if you see it. It is the only way to learn as far as I am concerned.

    Here is the link: Heart Disease Blog. There is actually plenty of room for 25 stents and there is not theoretical limit to the number of stents one can have. My doctor's personal record is a patient with 72. You can have stents within stents within stents as they are very think mesh tubes. My LAD is a full-metal jacket (stem-to-stern) with no room left for bypass.

    My original issue seems to have cleared itself up when I switched to the Testim gel and got off the shot. I also added hcg and have done two .25mg Armidex every third day (250IU on the HCG). As my insurance does not cover Testim, I am now going to stop everything, switch to 10mg pump androgel and do this methodically - Androgel, then Arimdex (if needed) and then HCG. On the Testim/HCG my libido increased and my ED resolved within about seven days and the anxiety resolved as well. The arimidex made a small difference in my libido but it was nothing to write home about and I was already doing quite well. I metabolize drugs very quickly and often must dose them at much higher levels. The cardiology picture is stable - blood pressure is excellent and I burn about 1000 calories in 1 hour (I can literally blast away at full throttle when on T therapy). Interestingly,when I am on T I have 0 excercise induced angina - even on the shots. A little research turned up some anecdotal evidence that T acts like a calcium channel blocker and dialates arteries.
     
  11. #11
    OhNoYo

    OhNoYo Active Member

    Who told you this?
     
  12. #12
    zkt

    zkt Member

    That is an amazing story and you are an amazing individual.:) Not only have you not let this unfortunate situation ruin your life, you have used it to well educate youirself and have turned it around into somethg very positive. My hat is off to you Sir.
    A couple things stand out in your labs and might be imoroved upon.
    25 oh-D, actually its immediate derivative, has been found to help mediate the effect of adherins in cancer cells. Whether or not this "stickiness" effect is applicable to the process of cholesterol infiltrating the arterial endothelium is as yet unknown. The new recomendation for daily vitamin D will probably be increased to 5000units/d. Wal mart sells it and I take it. Lots of other new discoveries recently made re. vitamin D as well.
    Your HDL could be raised with the addition of Niacin, 2-3g/d in conjunction with Crestor and the fibrate.
    Zetia will help lower dietary cholesterol altho yours is well controlled as is.
    The combination of fish oil (3-4 g) , folic acid (1600mg), and b-12 (1000mcg) /d in divided doses with meals has been correlated with improved long term outcomes and fewer thrombotic events in our population.
    arimidex will negatively effect your lipid profile. One of the SERMS might be better if excess estrogen Sx are a problem.
    How prevalent has CAD and PVD been on your family Hx?
    The other commonly effected arteries are the carotid, renal and abdominal aortic, all of which have significant stenosis in myself.
    Have you had them checked?
    Keep in touch and keep up the fight man.



     
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  13. #13
    james2012

    james2012 Member

    My most recent labs (already added Niaspin prescription Niacin and vitamin D at 15g/day per ODs guidance) indicated an LDL of 16 (way too low and I am bringing this back up), total cholesterol of 89, and HDL of 50. My E2 came back at 80 (this was when I was on the shot). I have since switched to Testim. I am taking Arimidex .25mg every third day and will remeasure in 2 weeks. It took a long time for the E2 results to come back (about 3 weeks). Is this normal? Thanks for all the advice.

    Interestingly all my plaque is "squishy" and not calcified. If I had taken a calcium scanner test my calcium score would have indicated open arteries. The stress test or a 64-slice CT scan would have shown differently and my first stress test during my first heart attack did show significant blockage in the LAD. The angio with IVUS indicated a weak collateral growth from the PDA to the tip of the LAD that saved my life. I actually took my first nuclear stress test while having a heart attack that I had been having for over two weeks. Dr. Samuel DeMaio - a very prominent cardiologist - said I was one lucky guy. The heart muscle death reversed itself - something he said can happen in some patients but not in others (the mechanism is not well understood) and my heart muscle is 100% functional with no areas of muscle atrophy or death.
     
  14. #14
    james2012

    james2012 Member

    First, the cardiologist who did it. I have the reports of my PTCA interventions on my site Heart Disease Blog. Other cardiologists who looked at the videos of the surgeries to discern whether they could do a bypass to the tip of my LAD (it is fully jacketed with stents) also are aware of the number of stents and most are not surprised and say they see this but not that often and not at my age. However, they are well aware of the level of disease I have and some think the right approach was taken with me while others believe I should have went in for bypass. After my own lengthy research, I should have done beating heart open heart surgery with a LIMA artery bypass on the LAD and left the rest of the plaque alone and reversed the plaque by aggressive statin therapy, exercise, diet, and TRT. Hindsight is 20-20 and even the cardiologists are not aware of the benefits of T to the arteries. When I report that my exercise induced angina is gone, all the cardiologists that I see are surprised and one is now actively looking into the dilation effects of T on arteries. He is a research cardiologist.

    I also have the typical stent cards which indicate the serial number and location of each stent that I keep in a separate wallet in the event of an accident of sudden heart attack where I may find myself unable to communicate. I have 25 of these cards.

    I have Endeavor, Taxus, and Cypher stents so I am an experiment in all three stents as well. I have stents within stents, modified t-branch stents for septals (90 degree arteries that enter the heart chamber) and other off-label uses. The cardiologist that worked on me is a stent master and can do amazing things with stents. I was recommended to him by my endocrinologist, OD, and family physician. He has since moved away and if I need another stent I will be traveling to have him do it. However, I don't feel that is going to happen.
     
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  15. #15
    james2012

    james2012 Member

    Thanks for the words of encouragement. Keeping it positive is the way to go and helped me basically get to the point where I just live with it.

    I will watch for the Arimdex effects on my lipid profile. Given my previous post to your query, my lipids are actually very low right now - too low in fact. However, if I need to go a SERM I assume you are talking about clomid and tamoxifen. The former gave me the double vision so that's out. I have tried Tamoxifen when I was attempting a renormalization therapy for the HPTA axis. How much is the usual dosage and what is the frequency of dosage? Or better put - what is the usual staring dose and frequency?
     
  16. #16
    zkt

    zkt Member

    I`m really not in a position to advise you on SERMs doseage; all I have is a little personal experience and a bunch of anechdodal evidence. Dr. Scally would have the most informed advice around here on the subject. You seem to be well attended to, to say the least.
    According to Ornish and others you and I are in the HDL/LDL rangein which the convayance of cholesterol from the arterial walls back to the liver exceeds its depositation. I have a carotid doppler scheduled next week. It will be interesting to not the acceleration, or lack thereof, hopefully, but I`m not counting on it. I`ll post the results.
    You didnt mention your family history re. coronary and peripherial vascular disease. I would expect a very strong correlation abut wonder if cases such as yours dont arise spontaneously without previous genetic mutations. You know, the gene switch concept.
     
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  17. #17
    toolman

    toolman Active Member

    What other meds are you on. By chance does your cardiologist have you on a beta blocker?
     
  18. #18
    zkt

    zkt Member

    I believe he mentined a calcium channel blocker (Amlodipine).
    The two drugs are very similar in effect. The Ca blocker inhibits Ca from entering to smooth muscle and lessens the contractile force. The B blocker inhibits the action of the sympathetic neurotransmitters, epi, norepi, on the B2 receptors and lessens the contractile force of the cardiac smooth muscle and rate.
    If you have HT I would be happy to discuss it.
     
  19. #19
    OhNoYo

    OhNoYo Active Member

    What I highlighted in bold type was you stating you have had 43 heart attacks (myocardial infarctions) between the ages of 38-41. Who told you this, or was this a mistype, Sir?
     
  20. #20
    OhNoYo

    OhNoYo Active Member



    Ok, I just want to know if I'm reading this right or you there were some typos along the way...

    1) You have had 43 heart attacks.
    2) You had a nuclear stress test while you were having your first heart attack.
    3) Your first heart attack lasted over 2 weeks
    4) Your heart tissue muscle reversed itself and now there is no evidence of heart muscle loss or cell death.

    ...this is what you are claiming, Sir?
     

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