HRT and high blood pressure

[Lost78]

I'm not on HRT yet, but I have a concern. I've been reading up on the benefits and side effects of HRT and the apparent risk of death it has... I'm currently 37 male and by dr standards morbidly obese at a bulky 280 lbs... And am taking LISINOPRIL for high blood pressure. I don't know when I'll be able to start HRT as I'm seeking a therapist first to talk me through my process and mental struggles, but I'm just researching and trying to be as well educated in this as the glorious Internet allows. But is there an ideal weight to start? Is there a higher risk at death based on family history, like heart disease, cancer and what not? I mean I know I could get hit by a car crossing the street but I'm just trying to prevent any unneeded trips to a morgue.

[Rachel]

Hi Lost,

when you stated therapist did you mean gender therapist?

I have seen girls who are very heavy and on hrt. Only your Doctor can answer what he/she will prescribe and at what dose. They may prescribe low dose.

E loves fat and T loves muscle. Being on E reduces muscle and reduces your metabolism so losing weight while waiting to go on hrt is advisable. I know that last statement was not needed.

I was 327 pounds (now 206). I went from 260 to 140 to 327 to 180 an now 206 (I gained 26 pounds in 2 years on hrt). I exercise, run and have a trainer. Losing weight requires more commitment when on hrt for a while.

Spiro is a heart med and your doctor will need to know you are on a heart med.

Good luck.

[Lost78]

I tried googling "gender therapist" but all I found was transgender therapist, not sure if that's a therapist for after the fact or prior, guess I'll know when I go. 

[Marly]

Hi Lost,

when you stated therapist did you mean gender therapist?

I have seen girls who are very heavy and on hrt. Only your Doctor can answer what he/she will prescribe and at what dose. They may prescribe low dose.

E loves fat and T loves muscle. Being on E reduces muscle and reduces your metabolism so losing weight while waiting to go on hrt is advisable. I know that last statement was not needed.

I was 327 pounds (now 206). I went from 260 to 140 to 327 to 180 an now 206 (I gained 26 pounds in 2 years on hrt). I exercise, run and have a trainer. Losing weight requires more commitment when on hrt for a while.

Spiro is a heart med and your doctor will need to know you are on a heart med.

Good luck.

I can't really say either. But I am on Metropolol and a 5mg Lisinopril, so have a similar concern. I am not yet on HRT. I was about 260 last year and have been on a low-carb diet since (now 195) ...at 6' tall. I'm planning to get down to 160 to 170 before I start HRT (since it does tend to replace muscle with fat) Quoting someone, I read this "get as light as possible before starting" of course, you don't need to hear it from me, but being lighter has helped my blood pressure a lot and I may soon be off Metropolol. I have no plans to gamble with my life either

[Dee Marshall]

OK, I've actually been on it. Quite a while ago my PVP moved me from lisinopril/HCTZ to losartan/HCTZ. My endo put me on spironolactone, which is also a BP med and estrogen. My blood pressure, before HRT was always low borderline. After a few weeks of HRT it was low to low normal and my PCP took me off of the losartan/HCTZ. Basically, if your endo puts you on spiro, which is likely in the US, make sure you know the signs of low blood pressure and inform your PCP immediately if they turn up. Make sure they know you take the spiro for reasons other than BP and you want to continue it. My last BP reading, two days ago, was 112/78 on just spiro and E.

[DrummerGirl]

I was on lisinopril before I started HRT since my BP was really high.  After a month on estrodiol and spiro, my BP dropped into the low-normal range and my GP started taking me off of it.  After 3 months of HRT I wasn't on any meds besides the E and S.  My BP has been normal ever since I was fully off the lisinopril.  I've also lost almost 45 lbs. since starting HRT so that probably helped as well.

Spiro is a diuretic that is primarily used as a BP medicine, and I remember reading a study a while back where they suggested that estrodiol has some BP lowering effects.  I think it said it acted as a calcium channel blocker, but I could be remembering that wrong.

[Valwen]

Story time, I am 33 and when I first saw a doctor about 6 months ago I was about 270lb, my  blood pressure was deadly high 180/115 when calm sometimes it hit as high as 200/120. I made it clear my first appointment that I wanted to start hrt as soon as I could. (I go to the fenway health center in Boston there fantastic for LGBT patients)

The first few visits where all about my blood pressure first I was put on lisinopril, then after it dropped a bit we swapped to a combo pill with lisinop/HCTZ and a few weeks later when I went back my blood pressure was still high but showing signs of continued improvement, I had also lost a few pounds and so I started spiro and estradiol lowish doses. A month later we uped the hormones and a few weeks later added a progesterone after I mentioned that I had bought a treadmill to lose weight and was concerned it might negatively impact my development.

I have sense averaged a loss of about 2lb each week, the irony being that it wasn't until I started hormones that make it harder to lose weight that I could muster the motivation to actually start walking regularly the last time I checked I was down to 241lb and about 3 months on hormones 4-5 on blood pressure meds. Last BP check 125/88. Still a bit high but dramatically better, up side spiro also helps bp so it's a win win drug.

So it's totally doable I was very close to where you are.

--Serena

[KayXo]

E loves fat

In some regions, usually gluteofemoral, breast tissue and face, for instance BUT from what I understand from science, fat deposition is actually inhibited at the waistline in the presence of E. The mechanism behind this is not metabolism but lipoprotein lipase and how it reacts to hormones.

Spiro is a heart med

It reduces blood pressure and is anti-androgenic, as a side-effect.

being lighter has helped my blood pressure a lot

A result of less carbs because carbs by way of raising insulin increase blood pressure. This is a very well known effect of dropping carbs.

Estradiol (not to be confused with premarin or birth control pills) increases vasodilation of arteries so should reduce blood pressure and it has been many times asserted that this is why women are less prone to heart disease than men, especially before menopause. Progesterone (not to be confused with medroxyprogesterone) also has been shown to reduce blood pressure in hypertensive individuals and increase vasodilation of arteries.

Spiro, being a diuretic, might result in some weight loss due to water loss similar to when one drops carbs but cutting carbs seems to also have a dramatic effect on fat deposition, reducing this.

I'm not a doctor; just reporting what I read. As always, do your own research and discuss this with your physicians.

[iKate]

I can also echo what others here have said.

I was on Lotrel (amlodipine-benazepril) and my doctor just switched that to amlodipine and added the spiro. She also added HCTZ. My BP was regularly 140 and above even with medication. Now I lost some weight and I have the E, my blood pressure is anywhere from 110/75 to 130/85, usually smack dab on 120/80 but getting lower as I progress.

I have heard the opposite about E that it's supposed to raise blood pressure but in my case whatever I've been taking has been working.

Regarding weight, lose it if you can before you start. This is because once you start E you may have difficulty losing weight.

[KayXo]

I have heard the opposite about E that it's supposed to raise blood pressure

Find out if the E they were taking about was bio-identical or not.