What I wonder is, at what point does it become detrimental to heart function. Is there a set point for everyone, like X level causes slow deterioration in cardiac function or is it genetically individual, like Tim acquires dialated cardiomyopathy on 200mg/wk and derp acquires it on 10,000mg/wk. Currently we have no idea as to what the set point is for testosterone and cardiovascular complications, what we do know though is (like you stated) there is a trend towards higher testosterone levels (within reason, say 300-1200ng/do) being associated with lower rates of cardiovascular disease. However men do tend to have higher LV mass and rates of cardiovascular disease in general when compared to women, yet less incidence of cerebrovascular disease and osteoporosis (esp after menopause for women). I believe these differences ARE sex hormone linked to some extent, as cardiac myocytes contain androgen receptors, men have bigger muscles than women on average, they also have bigger hearts, both contain androgen receptors (and a ton of other receptors), coincidence? I think not.
The incidence of increased cardiovascular disease in men can be explained by A: men generally taking more chances than women when it comes to diet or lifestyle decisions (rec drug use etc), also potentially androgen mediated and the decreased level of osteoporosis in middle aged men compared to middle aged women is likely androgen mediated (menopause=low estrogen and testosterone, estrogen and androgens help maintain and increase BMD, thus men still have androgens (albeit not as much) and a woman’s estrogen production plummets to damn near zero with menopause). Androgens in physiologic concentrations may also play a neuroprotective effect, leading to lower rates of cerebrovascular disease.
With all the fear mongering surrounding this class of medication (androgens/anabolic agents), we probably won’t ever have a definitive conclusion as to at what point health risks outweigh benefits. I think it’s a fair point to assume that doses like 500mg/wk in a normal individual over time will pose health risks long term (the extent of these risks are largely unknown, however I don’t buy that it’s extremely deadly, I def believe it increases the chance of SCD and cardiovascular abnormalities however I believe the risks are slightly blown out of proportion, for a healthy young male (not me) acute exposure to supraphysiologic doses of testosterone is relatively harmless as can be seen in various pieces of literature (although most studies lack follow ups, so that’s an issue lol)