I put it in context that his point is TRT does not cause blood clots, strokes or heart disease. That is exactly what he stated. I was in the room with one hundred other doctors challenged to provide evidence it does. Nobody did. I have not found any.
Aside from the best available evidence in the literature are the desires and expectations of the patient and the experience of the clinician. He has decades of experience and patients that have been with him for those decades. He is not seeing heart disease in these patients. It’s difficult to move off of what you’ve personally seen in the world.
Possibly of interest, I do not ignore CBC results. Patients are treated individually and some undergo dosing changes, intermittent phlebotomy to regular phlebotomy to stopping TRT. No one size fits all approach. There are doctors that practice as such and pull patients off TRT if hct hits 51%.
Interestingly, I have two cardiologists who refer patients. They are younger docs. Started with two of my patients concurrently seeing one of them for hypertension and dyslipidemia management and one was also diabetic.
The perfect storm, overweight, out of shape old guys with low testosterone. Get them on TRT and within a year, low and behold, 30-40 lbs of visceral fat, gone. Lipids improved, insulin sensitivity improved. Blood pressure, yep, normal. Cardio is stunned, what the hell? They pretty much all say the worst thing for your heart is visceral fat. To his credit, we talk.
Long story short, I need to get going, we discuss all of this and hct and blood viscosity. The diabetic guy tends to run higher, 52-54%, 50% if he does hydrate well. The guy was not concerned, said the heart is a muscle and the increased oxygen is likely a good thing and patient is certainly better off with 53% hct and no dyslipidemia, normal glucose, normal BP and no meds. Not even close. He told a colleague and that guys sends patients.
On the other hand, take a guy whose BP is up, not feeling well, sluggish, hct 57%, that’s not going to fly. No one size fits all. Individual differences. That’s my position, for whatever it’s worth.