T Nation

TRT / Anemia - Ongoing Issues

@systemlord @dextermorgan I’ve read over numerous of these forums and y’all seem to have the most similar blood work to me as well as a good bit of knowledge and was hoping I could get some feedback.

Age:29
Medication: Test Cyp 120mg/week, Amlodipine/Day, Vit D3 5,000IU/Day, Crestor/day

Back Story: Last year started experiencing shortness of breath and poor workouts as well as poor muscle building. Summer of 2019 (June & July) I would get dizzy during softball games. August 23rd and October 4th I fainted. Cardiologist and neurologist ruled everything normal and was told I had anxiety however I have no history of this and I knew this wasn’t the issue. Researched a bunch and found low T could be a cause for the anxiety I was having (symptom not the cause), low libido, poor workouts, low energy, ect. Got checked and numbers were in fact low. Early January I started with 100mg/week test cyp injections for 3 months with improvement in libido but that was about it. Ended up increasing dose to 120mg/week which I have been on for an additional 3 months now and have not found any benefit. Since I still have the anxiety, brain fog, fast heart rate, high blood pressure, fatigue and just a general feeling of being off so I have done research and reviewed blood work over the year. During this time I actually found I was anemic as a child and decided to research that more and hence why I’m asking for y’alls input since y’all had similar issues.

This is a very short version of the story and I can answer as much as I can if needed. The main thing I would like from the two of you if possible is a review of my blood work and any suggestions on maybe Iron or b12.

Spreadsheet of Bloodwork

Thanks in Advance!

Dude, get screened for familial hypercholesterolemia. Do you have a familial history of CVD/premature death from myocardial infarction/stroke?

Don’t mess with iron without first getting a full iron panel done and ferritin.

B12 you can take regardless. Here’s the only one that works besides getting injections.
Sublingual Methylcobalamin 1000mcg

Get on 200mg/week TRT and thank me in 4 months when all those symptoms are gone and you start looking like you always wished you’d look.

He states his symptoms are fast HR, shortness of breath etc. Iron deficiency without anaemia can induce these symptoms, as can hypertension (heart palpitations in particular) and autonomic dysfunction, cardiac defects/conduction disorders. Prior to escalating dosage he needs to determine what is inducing his symptoms.

If autonomic dysfunction (something along the lines of IST/hyperadrenergic POTS/regular POTS) is the cause for his symptomatology, escalating the dosage will make things worse (absent of medication) due to testosterones effect on the CNS (effect on beta adrenergic receptor expression etc)

@dextermorgan

@seanmichael1990 no one can answer as to why you’re experiencing these symptoms. You’re best bet is to see a doc for a thorough evaluation (rule out autonomic abnormalities, cardiac defects etc). Not all cardiologists are well versed regarding POTS/autonomic dysfunction. If you’re cardiologist isn’t doing anything regarding you’re lipids… switch cardiologists…

Probably should add I’m 5’9” 180. BMI roughly 25. Grew up fishing, hunting, sports, played college lacrosse at ECU. Always been active.

@unreal24278 Yessir. Mom and dad both have high cholesterol. Paternal grandpa died at 40 from heart attack, and all 6 of his brothers died around the same age from the same age. I’m on a statin as of recently for the cholesterol. I’ve head ekg(s), echocardiogram and wore a holster monitor for 30 days, which luckily caught one the fainting episodes. Heart was ruled no issues and at the time I fainted the heart rate during that time wasn’t drastically high. It was in the 90s which I hover at around 90-110 throughout the day and 60s during sleep. Plus I don’t get dizzy or light headed from standing or standing for long period of times. Doesn’t seem like the trigger. Neurologist did MRI, EEG, Ambulatory EEG with no abnormal results.

@dextermorgan if you click on the “Spreadsheet of bloodwork” on the original post you can see all my labs which does include iron, ferritin, iron saturation, TIBC, UIBC hg and hmct.

What country do you live in? If you were residing in Australia with that lipid panel (esp due to trigs) on statins doctors would add a fibrate (closely monitored due to increased risk of myopathy/rhabdomyolysis) and/or PCSK-9 inhibitor.

What statin are you on and what dose do you use? 90-110 during the day is high. EEG is used to look at electrical activity within the brain. 90-110 during the day and 60 at sleep could indicate IST. If you have IST meds like beta-blockers, ivabradine etc can be tremendously therapeutic. Discuss this with your doctor though, all meds have risks.

I’d guess you probably have familial hypercholesterolemia given your familial history, but I’m not a doctor. Were you put on statins due to generalised dyslipidemia or do you have a diagnosis of FH. People with FH generally have more atherogenic subtractions of bad cholesterol, FH tends to be treated rather aggressively.

What were your labs prior to taking statins (or have you only started taking then very recently), I believe the desired result is typically a 50% reduction in LDL comparative to baseline. Even then, sometimes that’s not enough (esp with homozygous FH when LDL is like 600+)

Yeah I was checked for seizures as well thats why I did the EEG and as well as a 48hr EEG. Both with normal results.

@unreal24278 so my wife’s ironically a nurse on the ICU Cardio floor so she’s the one who made me take a statin. It’s Crestor 10mg/day.

The several EKGs I’ve had were all normal with a mild PVC and sinus tachycardia. BP runs around 135-140 / 85-95 while on amlodipine which is BP medication. Echocardiogram was normal. Heart monitor for 30 days was normal. I have tried a beta blocker (Propranolol 60mg extended release) which did lower my heart rate to about 85 but caused chest pains and worsens fatigue.

My dad has sleep apnea so I actually have a sleep study next week to check that out. Got a lot of good genes and apparently some shitty ones as well.

Oh and I’m the U.S.

Propranolol is a non-selective beta blocker. BB’s like atenolol (cardioselective/B1 adrenergic receptor selective) beta blockers are less likely to cause fatigue. Meds like ivabradine also tend to help with fast HR (with no discernible cause). All meds have risks, talk to your doc.

What’s your lipids like on Crestor? If those lipids on attached bloods are on Crestor, you need to be more aggressive with your treatment. LDL of 151 is pretty bad to begin with, an HDL of 32 makes it even worse (and you’ve got high trigs).

Yeah but we don’t know that do we. We know his current dose doesn’t make him feel ideal so unless 200mg will kill him in 8 weeks it make sense to try it since one possible outcome could be he feels amazing for a long time.

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I think with a RHR of 90-110 BPM throughout the day + checkups excluding cardiac pathology and a lack of symptomatology associated with POTS, IST could be diagnosed as other causative factors have been excluded.

That being said, I’m not a doctor. If he has IST with crippling symptomatology 200mg/wk will probably make him feel worse. He can try it if he wants though, it (probably) won’t kill him. It’ll def give a little bit of an anabolic boost.

Based on the fact that he tried 100mg & 120mg and didn’t feel great and since we can rule out car wrecks as the reason for not feeling great to me this is a classic case of NotEnoughTestosteronia and believe it’s very likely he’ll feel much better on a higher dose. The choices are feel not great like current or try 200mg with the possibility of either 1) feeling worse, stopping and going back to just feeling bad or 2) feeling amazing for long lengths of time and improvements in libido, etc.

For the record I felt all of these in the beginning of TRT and they resolved themselves on their own over time. It took longer than I would have liked but resolved nonetheless.

Yes, however this individual is what one would designate “high risk”. Generally speaking, most healthy adult men can tolerate supratherapeutic dosages of testosterone (200mg generally IS considered supraphysiologic, no man/very few men naturally produce 1600-2000ng/dl). However that being said, certain demographics are at risk. Look at this mans cholesterol in particular, and how his LDL shot up after initiating TRT. If someone is THAT sensitive to androgen induced lipid alteration, what will almost doubling the dosage entail? @highpull what do you suggest this guy does?

This guy has a RHR of 90-110 BPM day round, imagine having a heart rate of 110 sitting down. Tachycardia induced cardiomyopathy is a potential risk alone stemming from such a high RHR, his body is theoretically running a marathon at rest. The effect testosterone generally has on beta adrenergic receptors/the central nervous system to begin with will likely amplify his HR issues. He has hypertension/extensive dyslipidemia, supratherapeutic dosages of test WILL transiently increase blood pressure due to it’s effect on the renin angiotensin aldosterone system (hypertension is an independent risk factor for myocardial infarction, stroke, retinopathy etc). His lipids and familial history indicate he probably has familial hypercholesterolemia. His LDL isn’t terrible, but it’s pretty high and his HDL is very low (and his trigs are high). It’s the perfect atherogenic storm…

99% of the time I’d agree with you, increase the dose. But this guy is what one would consider really “high risk”, if he’s going to increase the dose he needs to be on meds to address his HR issues, cholesterol and blood pressure.

Look at how elevated this dudes VLDL is, it’s like double the ref range, no wonder his trigs are so high.

He has to get his dyslipidemia and hypertension under control and I think that should include an extremely strict diet. At that time, I would agree to an increase, but to150mg, at least at first.

Hindsight is 20/20, but given his blood pressure, heart rate, lipids, family history with his symptoms and age, I don’t think I would have started him on TRT until these issues are addressed and under control.

@highpull @unreal24278 Also, I wear a garmin watch that tracks sleep and very often shows that my oxygen gets down into 80s which could be sleep apnea so I have a sleep study Wednesday which I believe can contribute to some of these symptoms.

Also, the cholesterol seems to be an issue which I never thought it was since last year during my physical I was told my numbers weren’t too bad by my PCP however the Endo I recently saw is the one who said my cholesterol numbers were alarmingly bad is the one who prescribed the Crestor.

Been a wild year in the health department boys lol. New doctor is also setting me up with kidney specialist FYI.

I appreciate everyone’s concerns and I’m well aware of the family history and have always known I’m going to go out with a heart attack just didn’t know when.

@unreal24278 I have only been on Crestor (statin) for a month. I started after the last blood labs I had done. Technically my resting heart rate is low 60s when I sleep. But I agree my day heart rate is high but I’m not sure that’s from the anxiety from all this. It’s like my brain fog causes me to not feel sharp and trying to function like that gives me anxiety. But I’m not sure. I’m not increasing my trt dose.

Dad is on cholesterol medication, CPAP, beta blocker and was on TRT until he was recently told to stop due to his blood levels getting to high despite blood donations.

@dextermorgan I have started the B12 this morning. I’m not going to adjust TRT dosage at this moment bc I’m not convinced that was the issue. I ask you bc I’ve read a few of your post where you mention you didn’t see benefits of TRT until anemia was addressed.

Pre TRT:

Hemoglobin: 38.8
Hematocrit: 13.4

Didn’t have iron levels tested until after trt with ongoing issues. Values are:

Ferritin: 87
Iron: 88
TIBC: 416
UIBC: 328
Iron Saturation: 21%
B12: 338

These numbers are identical to what yours were and wanted to ask if you think it was really the Iron and B12 that helped.

I’ve tested everything from adrenal function, thyroid, Pheochromocytoma, Lyme, heart, brain and every doctor said since my numbers were within range that anemia was not the cause however according to Red Cross my numbers are anemic and I can check of quite a few symptoms of iron and b12 defiency even though numbers are low normal.

@systemlord Any suggestions? What was your iron an blood levels when you decided to treat anemia? Symptoms?

My iron was 44 (59-158) and ferritin 24 (25-336) and Iron Saturation 12% (!) (20-50). I had potassium, vitamin C and vitamin D deficiencies at the same time so is difficult to single out my symptoms and assign them to the iron deficiency.

I really didn’t get much benefit until I lost 20 lbs. TRT improved my anemia (and was one reason I was put on) and supplementing Iron helped but I don’t use it anymore. Pre-TRT my HCT was very low and TRT raised it a good 10 points. I eat a shit load of red meat daily.