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Testosterone Replacement Therapy and Heart Disease

There I was 12 weeks into testosterone replacement therapy. By blood Pressure was low, my lipid panel looked like this

Cholesterol Range 110-200 mg/dL 126
Triglycerides 10-150 mg/dL 95
HDL 40-59 mg/dL 24
LDL (calc) 100-130 mg/dL 83
Non HDL cholesterol 102
Chol/HDL ratio 5.25

In others words I should live forever, but this was the day I had a heart attack. In a heart full of good arteries there was one that was 100% blocked. I lived, they say I will be 100% when all this is over. But now I am reading as much as I can about testosterone replacement therapy and heart disease. My heart surgeon is not at all worried about my using testosterone at replacement levels. Though he doesn’t want me self injecting during my recovery. He seems to think that my blood work indicates that TRT has done me nothing but good. No reason to change

But the studies on this subject are conflicting

The most prestigious studies on this makes one worry.

"Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men"

"Association of Testosterone Therapy With Mortality, Myocardial Infarction, and Stroke in Men With Low Testosterone Levels"

And we have one that shows a benefit to TRT therapy

"Testosterone supplementation reduces heart attack risk in men with heart disease"

Personally TRT has dramatically increased my energy level and libido. And that was what I was doing the night my heart said no more. I was engaging in a couple of hours of extremely vigorous activity that I would not have been interested in doing 12 weeks before. I believe that could be what the first two studies ran into. Patients using TRT have an increased energy level. They will do more than they would have without it. The TRT did not weaken the heart at all and may actually make it stronger. But it encourages us to push ourselves harder than our heart can take.

What have you guys seen on this subject?

And do you have an opinion on it?

First, I’m glad you are alright and going to make a full recovery.

We as humans are always looking for cause and effect. We want to be able to explain everything and assign blame when possible. It’s human nature. In this case, heart disease is so prevalent in this country and in men our age, that it’s virtually impossible to point to one thing as the cause for this episode. Clearly the blockage has been building for many years. So, it’s more likely that having low T contributed yo the blockage which is the proximate cause of the MI. However, I agree that increasing T levels can make middle aged men do stupid things! Lol


I’d also like to add that being on T therapy has been key in improving my health in many ways. I’ve fought HTN for 30 years. Now my BP is lower and more stable. I lost 30 lbs of fat and gained lean muscle mass. My lipid profile looks like an athletes. I exercise more vigorously and more often. My diet is completely cleaned up. I’m sleeping much better. Each one of these positive changes lead directly to better cardiac health. Now, I could drop dead tomorrow, but it won’t be because of TRT.

Exactly their is no way anything I did in the last 12 weeks had anything to do with that blockage. Your point about low T being a more likely cause is one I would agree with. It was not as if I only marginally low and that went on more than long enough to cause issues.

Olympic athletes have dropped dead. But no one blames their being in such good health for their deaths. Sometimes we are born with a ticking time bomb in our hearts

How old were you when you started TRT? What was your lifestyle like prior to starting?

Is it possible that you “made your bed” so to speak, over the years and that three months of TRT wasn’t enough to avoid having to lay in it?

I know that I felt so bad before I started TRT that I ended up living a very unhealthy lifestyle. It’ll probably takes just as many years of healthy living to recover completely.

Im sure that is what happened. I have always had low blood pressure and my my lipid panel panel always look ok if not as great as it looks now. But I let my weight get away from me. And working out stopped being any fun 10 years ago. Which was likely when my TRT levels hit bottom. I’m 59 now and was 59 when I started 12 or so weeks ago. And yes I have been eating a lot better, have lost a lot of wight and I am much stronger than I was pre TRT

Thanks for sharing your story, and I’m glad you’re okay. I noticed that your HDL cholesterol was very low at the time of your heart attack. Its nearly half the minimum value of the lab range. Low HDL, especially this low is very serious. Did your doc express any concern over this? Sometimes if your free testosterone gets too high, it can lower your HDL significantly.

It would be helpful if you shared your testosterone levels and RBCs too. High hematocrit could be a problem as it means your blood is thick and your heart has to pump harder.

I do not have the other blood work in front of me right now but from my memory. total testosterone is about 830 not unusually high nor was the free trt high. My hematocrit came in mid range the week before the heart attack not high at all. The total cholesterol level was prefect, Chol/HDL ratio looks great, No one said a low HDL was an issue. Oddly there was only sign of plaque in one place and only one place. An HDL issue would cause plaque but it is well in balance. Admittedly my blood work looked odd to me as well. But they liked it

There are all sorts of conflicting articles on this. Most trials are on older sedentary men that get a T boost, sometimes beyond normal protocol, and the they go out and jump into an active life…then drop dead. Surprised? Not me. My opinion is that the 30lbs Nash dropped and the exercise your are now doing outweigh the risks. Plus, you feel better so what’s that worth? Would you sack a couple years of life to feel good your duration? I don’t think that’s the case but if it were I would.

My personal story lines up with the idea of a already existing problem showing up after TRT therapy. Not due to the therapy, but due to being so much healthier, that I was pushing my heart to its limit. Without knowing that was dangerous.

I had a 100% blockage, yet I felt great until it all fell apart. Nothing I did in the last few months had anything to do with that. It is a lot like the Viagra ad. “Ask your doctor if you are healthy enough to have sex”. Viagra doesn’t cause heart attacks, But it might make an old guy chase younger tail and die in the throngs of passion. No sex and you live 10 more years, but is that really living? TRT is much like that. Actually it is exactly like that, I no longer need any ED meds. TRT lets you live a more vigorous and passionate life. How many years of your life is that worth? And from what I read so far, TRT may be adding life not taking it.

I had some health issues 3/2 years ago everybody is all of a sudden a freaking cardiologist or my case a pulmonologist trt is probably better for you then no trt . don’t pay attention to all those commercials linking trt to heart disease, ambulance chasers . especially if your quality of life is better

Ambulance chasers are a blight on the land

Q: What does a lawyer get when you give him Viagra?
A: Taller

Q: What’s the difference between a lawyer and a prostitute?
A: A prostitute will stop screwing you when you’re dead.

Q: Why does the law society prohibit sex between lawyers and their clients?
A: To prevent clients from being billed twice for essentially the same service.

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You need to be checking CRP and homocysteine.

I will check all the blood panels and see if I find that. Off the top your head you wouldn’t know which one I’m looking at would you? I have a lot of them right now I will check them all

I looked up a homocysteine test was. it was not tested but vitamin B12 and folic acid was tested instead they both came in the high range. As far as abnormalities my iron levels were low and my ferritin was high now I just need find out what crb is

CRP or C-reactive protein was not tested for before the heart attack and the results would have been high afterwards, so it was not done. I assume that it would have been good information ahead of time as one artery was very inflamed. Oddly and fortunately it is only one.

Other factors:
thyroid function, iodine and selenium
co-Q10 ubiquinol form
insulin sensitivity
EFA’s nuts, flax seed oil/meal, fish oil
health fats
high normal T, FT
E2 near 22pg/ml, elevated estrogen is bad for the arteries
Test Vit-D25 and take Vit-D3
natural source Vit-E, Vit-C and other antioxidants
high potency B-complex multi-vits with trace elements, iodine+selenium, no iron!

Low cholesterol conveys increased all-cause mortality. Some with low cholesterol have hear attacks and many with high cholesterol do not. The drug companies spun the lie very well. There is a lot more to arterial endothelial health. Research that at lef.com

Serum iron levels are very changeable. Better to rely on CBC, hematocrit and ferritin.

E2 was high 37pg/ml for a short time but i adjusted my meds. Not sure were it is now but it is down to the point of symptom free

I took your advice and took my temps and the morning was only 97.1 warming up to 98.5 I started iodine and selenium and now my morning temp is 98.4. It was very effective. I eat unusually well (but too much) so your food suggestions are already there. I had unfortunately cut back on seafood (cost) and made the iodine issue worse with sea salt.

I will need to take another Lipid Panel when all is said and done and see where I really am. I was coming off of 4 days without any food. It felt like a flue to me. Historically my Lipid Panel comes in the low end of normal but not freakishly low like it was thing time.

Test Vit-D25 got it will do … take Vit-D3 …I started that the last time you suggested it.

My guess is that I should have got on these issues 10 years ago. Now I find myself highly motivated

Hematocrit came in a bit low. I had just given blood. Before that it had come in at 44.5 range 37.5 - 51 Which I was told was fine and I did not actually need to give blood yet. Do you agree with that?

I’m going in to get my cardiologist to say. Yep you can go back to normal now. As to how this all relates to the Testosterone replacement therapy, I had started about 8 weeks for the heat attack. All the doctors I have been to, they all seem to think it was a good thing I was on it and said to stay on it during recovery. Just stay out of the weight room until they give the OK. It seems testosterone expands the blood vessels in the heart. Considering what sort of heart attack I had. That may have saved my life and it is good for my recovery.

Things I learned about the beta blockers and statin drugs they give you. They lower testosterone levels badly. Fortunately it was easy for me to compensate.

Laying around taking it easy for three mouths makes mess out of you psychically

That is it. Now I am going to be doing some serous rehabilitation