Results from echo - time to put down the needle??

[Raiders789]

Hello everyone -

So for the past few months I've been dealing with orthostatic hypotension/venous pooling, which especially while lifting/cardio have been making me lightheaded and giving me bad brain fog. I've been trying to pinpoint whats been causing these issues for a while; first thought it was sodium/blood volume, then checked low iron, checked gi bleed/issues, and all were normal. No issues with electrolytes, lipids, ferritin/iron, thyroid, adrenals, kidneys, and cardiac strain(all verified by bloods).

A bit of context - I'm 20(about to be 21), and have been on testosterone for the last 8 months. First month was trt, and since then I've run two cycles/two cruises. Besides the AAS use, I'm very healthy and have been consistently eating clean + cardio every morning.

A week ago my doc put me in a 24hr blood pressure monitor that confirmed the orthostatic hypotension and referred me to a cardiologist. I got an echo done today, and everything came back within normal ranges although some measurements were "borderline-normal." My ejection fraction was 51% which is on the low side. My cardiologist said this is typical with athletes/athletes heart and likely what has been causing my orthostatic hypotension. My GLS and disatology were normal which he said was reassuring that my heart was healthy. LV wall thickness was 10mm which he said was on the high side but also typical with athletes and said I shouldn't worry, but to keep an eye on with future AAS use. My LV end-systolic and diastolic volume index were both high-normal which he said were both typical of athletes heart. My cardiologist said its nothing to really worry about too much, and since I told him I wouldn't be on supraphysiologic test for the near future he said it's likely my EF will come up a bit and will help with the OH symptoms. But I attached the full results here and was hoping you guys could tell me what y'all think.

So my plan now is to run actual trt - 125mg/week test cyp and 2-3IU GH a day for at least the next 3 months, and get another echo to see where I'm at. Ideally if there is a lot of recovery in my ejection fraction I could blast again but will just have to see. As much as I love blasting steroids, I value my health more and wouldn't even consider blasting unless I was in perfect condition to do so. Also I'm pretty young and have a lot of time to work with, so as much as it sucks now a few years of taking some time off AAS wound't be the end of the world. And if it doesn't recover, then it might be time to hang up the cleats.

But tl,dr - I want to optimize these next few months to try and regain as much ground as I can in raising my ejection fraction. Any tips? I'll be on true trt and plan to start running more, and use this as an opportunity to cut some fat off. But if there is anything else I can do to optimize progress these next few months please let me know!

Appreciate y'all!


Help - Low BP and high RHR on cycle??

 

[Raiders789]

ok so I've been doing a bit more researach on measures to improve ejection fraction/athletes heart and had some ideas/questions -

1) How effective is running/cardio for improving ef in my situation? Most science says that improved aerobic capacity can lower ejection fraction. But my cardiologist says I should keep training intensely and doing cardio every day. Chatgpt agrees and said daily cardio can improve stroke volume + vascular tone + autonomic control. My plan is to just do 30mins every morning on the elliptical at ~130bpm hr, do you guys think that is beneficial? Or should I just cut it out?

2) I've also seen that long valsalvas/holding my breath during hard reps is bad so I'll try to be better about slowly breathing out during the concentric.

3) Gonna still keep all vasodilators out for now, even preworkout. Also I'm going to cut back a lot on stims and only have 1-2 cups of coffee a day. I've been looking into other supplements too and I've heard good things about megadosing coq10. I already take 150mg just as general health supplement, but do you guys think it'd be worth it to bump that up? also I've heard good things about injectable carnitine for improving heart function do y'all think that would be worth adding in?

If y'all have any other suggestions on ways I can optimize this process please lmk! Appreciate you guys

 

[Elektrobot]

My ejection fraction was 51% which is on the low side

There is an epidemic of this going around here......

I'll be writing about my experience soon

The best suggestion I have right now is get your Vit D levels checked, and read this:

Effects of Vitamin D on Left Ventricular Ejection Fraction in Patients with Systolic Heart Failure: A Double-Blind Randomized Clinical Trial - PMC

Heart failure is a pathophysiologic state in which the cardiac output is not able to supply the body with enough oxygen and nutrients. The prevalence of heart failure has increased dramatically over the last decades. Vitamin D levels in patients ...

pmc.ncbi.nlm.nih.gov

 

[BigDadd7]

Ask your doctor about metropolol and entresto.

 

[sionnach]

There is an epidemic of this going around here......

Yooo, I know a dozen or more people who have complained about orthostatic hypotension in the last year, too...

 

[Raiders789]

There is an epidemic of this going around here......

I'll be writing about my experience soon

The best suggestion I have right now is get your Vit D levels checked, and read this:

Effects of Vitamin D on Left Ventricular Ejection Fraction in Patients with Systolic Heart Failure: A Double-Blind Randomized Clinical Trial - PMC

Heart failure is a pathophysiologic state in which the cardiac output is not able to supply the body with enough oxygen and nutrients. The prevalence of heart failure has increased dramatically over the last decades. Vitamin D levels in patients ...

pmc.ncbi.nlm.nih.gov

Really appreciate the advice -

I'm planning to get a full vitamin panel when I get by bloods done in a few days along with other typical AAS user tests. I've never had my vitamin D tested but now I'm really curious. I've also had a history of low iron/relatively low hematocrit(43% on 600+mg cycles), I feel like that has to play a factor somewhere.

Also I used midodrine for the first time yesterday and that completely removed all of my symptoms, was actually crazy how much better I felt. Noticeably more mentally sharp, way higher energy, and felt great during my lift(ended up turning a light back day into a 2 hour intense session).

Looking forward to hearing your writeup!

 

[Elektrobot]

Also I used midodrine for the first time yesterday and that completely removed all of my symptoms, was actually crazy how much better I felt.

Thanks for mentioning that, I'm going to ask about it at my cardiology appointment tomorrow

 

[Raiders789]

Yooo, I know a dozen or more people who have complained about orthostatic hypotension in the last year, too...

Wild theory but maybe it has something to do with the covid vaccine?? I got double vaxxed(which did fuckall because I got covid twice) but I've done some surface level research, and although rare young men have been experiencing myocarditis following the second vaccine.

 

[Elektrobot]

Wild theory but maybe it has something to do with the covid vaccine?? I got double vaxxed(which did fuckall because I got covid twice) but I've done some surface level research, and although rare young men have been experiencing myocarditis following the second vaccine.

Myocarditis is also a symptom of covid. So hard to tell if its just correlation or not. Seems likely that there would be a certain percentage of people who had the vaccine but also had the virus, and suffered this as one of the potential symptoms of the virus.

Another perspective might be that the vaccine caused some covid like symptoms for people as a reaction, as some vaccines can. I had a pretty good fever for a day after my last booster. I wonder if its possible that some people reacted to the vaccine with myocarditis, just like others reacted with flue like symptoms or fevers. The science on that is way outside of anything I should speculate on though.

 

[Photon]

Ask your doctor about metropolol and entresto.

His BP is kinda on the low side..
Usually with jardiance + beta blocker + entresto, one can go from a very low EF back to ~65%, however with him already being hypotensive, it might be difficult to be on those meds.

(I'm no cardiologist, do whatever your cardiologist says)

 

[BigDadd7]

His BP is kinda on the low side..
Usually with jardiance + beta blocker + entresto, one can go from a very low EF back to ~65%, however with him already being hypotensive, it might be difficult to be on those meds.

(I'm no cardiologist, do whatever your cardiologist says)

Both of those can be low dosed to deal with low blood pressure .

 

[Raiders789]

Thanks for mentioning that, I'm going to ask about it at my cardiology appointment tomorrow

Yea so the two most common pharma drugs used for hypotension are fludrocortisone and midodrine. My doc had me try fludrocortisone first, which raises blood pressure by increasing sodium retention but that didn't do shit for my OH and just made me hold more water and look fat. Midodrine is much more effective because it actually constricts blood vessels. Also it has a shorter half life which I like better, since I can dose it an hour before my lifts/cardio when I need it, and not use it when I don't.

 

[Raiders789]

His BP is kinda on the low side..
Usually with jardiance + beta blocker + entresto, one can go from a very low EF back to ~65%, however with him already being hypotensive, it might be difficult to be on those meds.

(I'm no cardiologist, do whatever your cardiologist says)

Yeah, beta blocker probably isn't the move at least for now. I've been looking into Ivabradine as a possible way to lower my rhr(before starting midodrine it was ~85) but for at least my first day on midodrine my rhr has gone down to like 70. But I might buy some anyways just to have on hand and potentially try in the future.

 

[Raiders789]

Myocarditis is also a symptom of covid. So hard to tell if its just correlation or not. Seems likely that there would be a certain percentage of people who had the vaccine but also had the virus, and suffered this as one of the potential symptoms of the virus.

Another perspective might be that the vaccine caused some covid like symptoms for people as a reaction, as some vaccines can. I had a pretty good fever for a day after my last booster. I wonder if its possible that some people reacted to the vaccine with myocarditis, just like others reacted with flue like symptoms or fevers. The science on that is way outside of anything I should speculate on though.

My timeline with getting covid was a bit weird - got covid in late 2019(I think) and had it pretty bad, completely lost taste and smell and was sick for a week. Still haven't fully recovered my sense of smell but I guess that just happens to a small fraction of the population. Then I got the two vaccines, and then I got covid again sometime in like 2022 but it wasn't that bad. I've had my troponin/BNP tested a few times on cycle and has always been at the bottom of the range but that doesnt rule out residual scarring/fibrosis. So I'm gonna try to get a cardiac MRI sometime soon to see for sure

 

[Raiders789]

Wanted to share an update/some research I've been doing -

So I've been looking into how covid could possibly play into this. Although it's not talked about much, a fraction of the people that get covid will experience symptoms long after they are cured, also known as long covid. Personally I had covid pretty bad in 2020; completely lost my taste and smell. To this day I haven't fully recovered my sense of smell. But since then I've been triple vaxxed. Started to get bad orthostatic intolerance symptoms this year.

There are a lot of ways that covid can disrupt the autonomic nervous system and cause POTS/OH. It can fuck up nerves that control vessel squeeze, HR reflex, and things like that which results in weaker vasoconstriction when you stand/change posture and lead to venous pooling and a resulting racing HR to compensate. Some people with long covid have autoantibodies that interfere with receptors used to constrict veins/modulate HR and again contribute to poor vascular tone and HR. Long covid can also fuck with your blood volume by blunting your RAAS and cause hypovolemia, which both lead to low bp/orthostatic issues. I'm meeting with my cardiologist next week, and if the cardiac MRI doesn't show fibrosis/scarring or anything else abnormal I'm gonna ask if he can order me an upright norepinephrinetest and an upright renin + aldosterone test. But regardless I really want to know the root of these OH issues. My suspicion is that especially considering the fact I have long covid due to never regaining my smell it's also causing my POTS/OH.

 

[Raiders789]

Ok just thought I'd share another update in case someone from the future reads this thread and happens to be dealing with the same thing as me -

So I got diagnosed with long covid/hypovolemic POTS. Upright renin and aldosterone were very low from my last blood test. But I feel that I've learned to manage the symptoms pretty well. Some things that work for me:


- Always being on top of getting electrolytes in. I've been using the WHO formula for their oral rehydration solution, which is so effective I almost don't need to use midodrine at all throughout the day. I'll do 5g salt and 15g dextrose per liter of water and usually will drink about 2-4L of this per day. On bad days all of my fluid intake will be from the ORS formula.

- Glycerol has been huge for me too. Not sure why this isnt more popular?? If you take it right it gives absolutely diabolical pumps. it is a sugar alcohol that temporarily expands blood volume and hyper hydrates you for a few hours. Marathon runners use it, and some pre workouts have it like GorillaMode - although not nearly enough to be effective. The studies have people doing .5g/kg to 1g/kg mixed in 22ml/kg of water. To get the best effects from it, I'll drink a 1.5L ORS with 7.5g salt 25g dextrose and 70g glycerine(extremely cheaper if you just buy the pure vegetable glycerine liquid on amazon its the same things as glycerol, and it tastes good) and sip that 2 hours before my lift. Gives me diabolical pumps and I haven't had any lightheadedness when lifting using this(in combo with midodrine). For guys without any autonomic issues I would 100% recommend trying this before a lift, the pumps are crazy. Only thing is that some people say they get GI issues when they go above 1g/kg, but I haven't experienced that at all.

- Midodrine and Pyridogistimine have been huge too. they both raise bp through different mechanisms, but ill take 10mg midodrine and 30mg Pyridogistimine preworkout and that gets rid of my lightheadedness and keeps my bp ~110/70 when it would otherwise be 80/50(vasodialaiton from pumps drops my bp like crazy). Although now with the ORS and glycerine I've never had to use either of these meds throughout the day, and have been able to take less midodrine preworkout without lightheadedness.

- Stimulantmaxxing ive noticed helps too. I take 200mg modafinil every day and caffeine is 200-400mg. I don't get an increase or decrease in bp/rhr with either of these, and have gone up to 400 modafinil without any bp/hr change. Caffeine is great too but it dehydrates me so usually I'll only have a few cups of coffee. If anything they help with lightheadedness a bit. But those two are great because I essentially get to take side effect free stimulants, which has been huge for my focus when studying.

- I've been on trt for the past few months getting this sorted out, but started a mini cycle this week. Doing 500 test, 150npp, 200mast, 30 anavar preworkout and 6iu gh, and im gonna run this for 4 weeks to get a bit leaner and to see how my POTS responds to the gear. I'm gonna get another echo after this mini cycle to see if anything changes - however I was dehydrated when I got the one above, and now that I'm a lot more in tune with my hydration I anticipate that my next one will have more normal results. 4 days into the cycle and my morning bp has increased a little - from ~90/60 to ~95-100/60. I've put on like 7lbs of water which has noticeably helped with my hypovoluemic symptoms, although I look 4% bf fatter than I did a week ago.

Assuming this mini cycle goes well and my next echo comes back looking better, I'm gonna try running some compounds that really drive up blood pressure like high nandrolone + anadrol to see how that affects my basal bp +POTS symptoms.