TRT & Long term Health risks

[Luca_03]

Hi All,

I am 57 & been on TRT for about (12yrs) I get blood tests every 6 months and have been good on my dose (0.30ML 2x per week). My numbers (hematocrit, estrogen, prostate, etc...) are all fine and I feel well.

1. Will continuing to take TRT cause any problems down the road such as (heart attack, stroke, prostate issues, cancers, etc...) My primary care doctor was mouthing off about how he would never prescribe this since it may cause heart attack or stroke. My TRT doc, however, has not mentioned this. I will ask during my next appt. Have you ever had any health condition arise years after you used it or know someone who did? Should i be concerned about long term issues?

2. I dont plan on stopping my regimen, but suppose I do in the future and I wean off slowly, ive heard that once you slowly reduce it and go off, your levels go back to what they were before you started TRT. So if your initial level was lets say (250) or something low, your levels would return to that. Is this true or would the levels dip even lower for someone like me who has been on it so long.

3. If someone discontinues TRT and their levels go back to what they were before the person started their regimen, is there anyway to naturally increase testosterone? Ive heard men "claim" they did it with diet or supplements. Maybe if theyre young they could naturally increase it, but im skeptical.

Thanks All!

 

[Systemlord]

Will continuing to take TRT cause any problems down the road such as (heart attack, stroke, prostate issues, cancers, etc...)

My primary care doctor was mouthing off about how he would never prescribe this since it may cause heart attack or stroke.

It seems like the only doctor's spewing this crap are the ones that don't specialize in this area of medicine.

A junk study came in 2013 that showed heart attacks and strokes in men on TRT, but was a VA study with obvious calculation errors, bad data that was dubunked by doctors.

Testosterone and the Heart - PMC

Testosterone (T) has a number of important effects on the cardiovascular system. In men, T levels begin to decrease after age 40, and this decrease has been associated with an increase in all-cause mortality and cardiovascular (CV) risk. Low T ...

www.ncbi.nlm.nih.gov

Testosterone (T) has a number of important effects on the cardiovascular system. In men, T levels begin to decrease after age 40, and this decrease has been associated with an increase in all-cause mortality and cardiovascular (CV) risk. Low T levels in men may increase their risk of developing coronary artery disease (CAD), metabolic syndrome, and type 2 diabetes. Reduced T levels in men with congestive heart failure (CHF) portends a poor prognosis and is associated with increased mortality. Studies have reported a reduced CV risk with higher endogenous T concentration, improvement of known CV risk factors with T therapy, and reduced mortality in T-deficient men who underwent T replacement therapy versus untreated men.

 

[S1W]

Hi All,

I am 57 & been on TRT for about (12yrs) I get blood tests every 6 months and have been good on my dose (0.30ML 2x per week). My numbers (hematocrit, estrogen, prostate, etc...) are all fine and I feel well.

1. Will continuing to take TRT cause any problems down the road such as (heart attack, stroke, prostate issues, cancers, etc...) My primary care doctor was mouthing off about how he would never prescribe this since it may cause heart attack or stroke. My TRT doc, however, has not mentioned this. I will ask during my next appt. Have you ever had any health condition arise years after you used it or know someone who did? Should i be concerned about long term issues?

You're older than me and have been on TRT 3x longer than me - I take it as a positive sign that you're not experiencing any issues. Also, the specific issues your doctor mentioned sound like the typical knee jerk fears that uninformed doctors have regarding TRT.

2. I dont plan on stopping my regimen, but suppose I do in the future and I wean off slowly, ive heard that once you slowly reduce it and go off, your levels go back to what they were before you started TRT. So if your initial level was lets say (250) or something low, your levels would return to that. Is this true or would the levels dip even lower for someone like me who has been on it so long.

Some guys do go back to previous levels, some do not. Note that after 12 years and at the age of 57, your levels would very likely be lower than they were when you started anyway - even if you had never gone on TRT.

3. If someone discontinues TRT and their levels go back to what they were before the person started their regimen, is there anyway to naturally increase testosterone? Ive heard men "claim" they did it with diet or supplements. Maybe if theyre young they could naturally increase it, but im skeptical.

Thanks All!

Assuming no significant underlying health problems or general poor health (obesity, etc) I honestly don't believe there is a way to naturally increase levels. Before I committed to TRT, I spent a year eating very healthy, drinking minimally, and lifting weights regularly. I was fit and healthy before this, and even more so afterwards. My T levels didn't change at all.

 

[opus11]

You're older than me and have been on TRT 3x longer than me - I take it as a positive sign that you're not experiencing any issues. Also, the specific issues your doctor mentioned sound like the typical knee jerk fears that uninformed doctors have regarding TRT.



Some guys do go back to previous levels, some do not. Note that after 12 years and at the age of 57, your levels would very likely be lower than they were when you started anyway - even if you had never gone on TRT.



Assuming no significant underlying health problems or general poor health (obesity, etc) I honestly don't believe there is a way to naturally increase levels. Before I committed to TRT, I spent a year eating very healthy, drinking minimally, and lifting weights regularly. I was fit and healthy before this, and even more so afterwards. My T levels didn't change at all.

At the age of 67, I tried to avoid starting TRT because of the same concern that once I stop TRT, my endogenous T will not come back.

Currently, I am using herbs to boost my TT to around 500, sometimes even 600; without the herbs it was 300.

In the future, if the herbs no longer work for me, I might start TRT.

 

[Jay-Jay]

I'm 79 and I've been on TRT for 11 yrs. My PCP has warned me about cardio risk and my urologist has reassured me that, for me, stopping TRT is a greater CV risk than continuing TRT. Doing my own research, the work of Dr. Abraham Morgentaler is very informative. He focuses on the health of the aging male and his work and the work of others indicate there is not an age-related reason to stop TRT. Several of his papers and videos are online.

 

[Dicky]

Well known member @readalot has a cautionary story about this. I am going from memory here. But as I recall: he had a reasonable TRT protocol. He wasn't using super high doses. After being on TRT for several years. He noticed a decrease in athletic performance. He got an echo-cardiogram done that showed left ventricle hypertrophy (enlarged heart). It's a cautionary story that TRT can be serious business.

@readalot I apologize if I have butchered your story. Feel free to set me straight.

 

[Systemlord]

He got an echo-cardiogram done that showed left ventricle hypertrophy (enlarged heart). It's a cautionary story that TRT can be serious business.

People not on TRT are diagnosed with an enlarged heart all the time.

How can you attribute this to TRT?

 

[madman]

Hi All,

I am 57 & been on TRT for about (12yrs) I get blood tests every 6 months and have been good on my dose (0.30ML 2x per week). My numbers (hematocrit, estrogen, prostate, etc...) are all fine and I feel well.

1. Will continuing to take TRT cause any problems down the road such as (heart attack, stroke, prostate issues, cancers, etc...) My primary care doctor was mouthing off about how he would never prescribe this since it may cause heart attack or stroke. My TRT doc, however, has not mentioned this. I will ask during my next appt. Have you ever had any health condition arise years after you used it or know someone who did? Should i be concerned about long term issues?

2. I dont plan on stopping my regimen, but suppose I do in the future and I wean off slowly, ive heard that once you slowly reduce it and go off, your levels go back to what they were before you started TRT. So if your initial level was lets say (250) or something low, your levels would return to that. Is this true or would the levels dip even lower for someone like me who has been on it so long.

3. If someone discontinues TRT and their levels go back to what they were before the person started their regimen, is there anyway to naturally increase testosterone? Ive heard men "claim" they did it with diet or supplements. Maybe if theyre young they could naturally increase it, but im skeptical.

Thanks All!

Testosterone Mythology Debunked

We live in a polemic world of clashing misinformation. Especially about hormones. Including testosterone. Too many men are taken off Testosterone (T) if they get a diagnosis of prostate cancer or heart disease even though the science shows otherwise. Today’s interview is with Dr. Abraham...

www.excelmale.com

Trt and heart disease

Can men with high blood pressure or heart disease still get testosterone prescriptions? Only looking for factual or personal experience answers no guesses or speculation please and thank you

www.excelmale.com

1. Will continuing to take TRT cause any problems down the road such as (heart attack, stroke, prostate issues, cancers, etc...) My primary care doctor was mouthing off about how he would never prescribe this since it may cause heart attack or stroke.

post #9/10/12/13

Low Testosterone in Men: Recommendations on the diagnosis, treatment and monitoring

ABSTRACT The relative proportional increase of the elderly population within many countries will become one of the most significant social transformations of the twenty-first century and, for the first time in history, persons aged 65 or above outnumbered children under five years of age...

www.excelmale.com

2. I dont plan on stopping my regimen, but suppose I do in the future and I wean off slowly, ive heard that once you slowly reduce it and go off, your levels go back to what they were before you started TRT. So if your initial level was lets say (250) or something low, your levels would return to that. Is this true or would the levels dip even lower for someone like me who has been on it so long.

You will always go back to baseline (pre-trt levels) mind you no one can say for sure where your levels will end up post trt.

Even then why fret having a TT 250 ng/dl is horrible.


3. If someone discontinues TRT and their levels go back to what they were before the person started their regimen, is there anyway to naturally increase testosterone? Ive heard men "claim" they did it with diet or supplements. Maybe if theyre young they could naturally increase it, but im skeptical.

Following a healthy diet and maintaining healthy body weight, weight training/aerobics, getting quality sleep can have a positive impact on boosting T.

Forget relying on supplemental T-boosters.

Even then if there was a boost in T from the so-called T-boosters it would be transient and minimal at best!

Canadian Urology Guideline on Testosterone Replacement

Canadian Urological Association clinical practice guideline on testosterone deficiency in men: Evidence-based Q&A (2021) Ethan D. Grober, MD; Yonah Krakowsky, MD; Mohit Khera, MD; Daniel T. Holmes, MD; Jay C. Lee, MD; John E. Grantmyre, MD; Premal Patel, MD; Richard A. Bebb, MD; Ryan...

www.excelmale.com

19. What is the evidence for herbal or natural testosterone “boosters” in treating TD?

Current evidence-based reviews of the most common ingredients in testosterone boosters (T-boosters) on the market have found minimal to no evidence demonstrating their efficacy.40 Many of the ingredients within such compounds have never been tested for safety and/or efficacy in human trials. Among human trials, only 30% demonstrated an improvement in testosterone levels, 2% resulted in a decrease in testosterone, and 68% had either an indeterminant effect or no effect at all on testosterone levels.41 Concerningly, several case studies have demonstrated severe adverse events from T-boosters that contain banned/illicit substances, including steroids.42,43 Currently, T-boosters cannot be recommended by health practitioners and patients should be cautioned regarding the unknown efficacy and safety of T-boosters, along with the possibility for severe adverse events. Regulated, evidence-based treatments should be offered as an alternative in symptomatic hypogonadal men (moderate LE, strong recommendation).

T Boosters Intake in Athletes

Testosterone Boosters Intake in Athletes: Current Evidence and Further Directions Abstract “Testosterone boosters” (TB)—are supplements that are claimed to increase testosterone levels in the human body. While the consumption of TB may be popular among athletes, there is insufficient...

www.excelmale.com

*Based on the review, the authors conclude that at present TB cannot be recommended for use by athletes due to insufficient data on their efficacy and safety

 

[Nelson Vergel]

1. Will continuing to take TRT cause any problems down the road such as (heart attack, stroke, prostate issues, cancers, etc...) My primary care doctor was mouthing off about how he would never prescribe this since it may cause heart attack or stroke. My TRT doc, however, has not mentioned this. I will ask during my next appt. Have you ever had any health condition arise years after you used it or know someone who did? Should i be concerned about long term issues?

Does Testosterone Increase the Chance for a Heart Attack?

"Many healthcare providers hesitate to initiate men on testosterone replacement therapy (TRT) due to the belief that these treatments increase the risk of cardiovascular (CV) events. However, the data supporting this belief are conflicting. A systematic review and meta-analysis of 30 randomized...

www.excelmale.com

2. I dont plan on stopping my regimen, but suppose I do in the future and I wean off slowly, ive heard that once you slowly reduce it and go off, your levels go back to what they were before you started TRT. So if your initial level was lets say (250) or something low, your levels would return to that. Is this true or would the levels dip even lower for someone like me who has been on it so long.

No way to predict. Some small cohorts of young men had normalization of their baseline HPTA within 6 months. Some longer.
Read this thread: How long before T, LH and FSH endogenous production shut down after starting testosterone?

3. If someone discontinues TRT and their levels go back to what they were before the person started their regimen, is there anyway to naturally increase testosterone? Ive heard men "claim" they did it with diet or supplements. Maybe if theyre young they could naturally increase it, but im skeptical.

Weight loss if you are overweight may increase T by 20%. Better sleep may increase it also by 10-20%.

How to Boost Testosterone Naturally

How to Increase Testosterone Naturally By Nelson Vergel Author Testosterone: A Man's Guide There are several lifestyle, nutritional and other factors that can increase testosterone production by testicles in men. The degree of this increase has not been clearly quantified, but there is...

www.excelmale.com

 

[finkelet]

People not on TRT are diagnosed with an enlarged heart all the time.

How can you attribute this to TRT?

Exactly the point I was going to add. I bet he also drank water daily. Maybe it was because of that?

1 story without a lot of details is absolutely meaningless.

There are plenty of papers referenced on this forum that conclusively show that low T is a risk for CV disease, and now others are being released showing a strong correlation between low T and dementia. Many other disease processes are attributed to low T as well.

 

[madman]

Hi All,

I am 57 & been on TRT for about (12yrs) I get blood tests every 6 months and have been good on my dose (0.30ML 2x per week). My numbers (hematocrit, estrogen, prostate, etc...) are all fine and I feel well.

1. Will continuing to take TRT cause any problems down the road such as (heart attack, stroke, prostate issues, cancers, etc...) My primary care doctor was mouthing off about how he would never prescribe this since it may cause heart attack or stroke. My TRT doc, however, has not mentioned this. I will ask during my next appt. Have you ever had any health condition arise years after you used it or know someone who did? Should i be concerned about long term issues?

2. I dont plan on stopping my regimen, but suppose I do in the future and I wean off slowly, ive heard that once you slowly reduce it and go off, your levels go back to what they were before you started TRT. So if your initial level was lets say (250) or something low, your levels would return to that. Is this true or would the levels dip even lower for someone like me who has been on it so long.

3. If someone discontinues TRT and their levels go back to what they were before the person started their regimen, is there anyway to naturally increase testosterone? Ive heard men "claim" they did it with diet or supplements. Maybe if theyre young they could naturally increase it, but im skeptical.

Thanks All!

The History of Testosterone and the Evolution of its Therapeutic Potential

ABSTRACT Introduction: Testosterone therapy has been controversial since its synthesis from the 1930s to the present day. Testosterone’s history provides depth and context for current controversies. Aim: To review the history of testosterone therapy from its initial synthesis in the 1930s to...

www.excelmale.com

*Every clinician experienced with T therapy knows that one of the most important benefits of T therapy is what our patients tell us so often—they feel healthier, more vital, and with an improved sense of well-being

 

[Fernando Almaguer]

The only thing I can think of is that Testosterone makes guys want to build and optimize their muscle size. Building muscle you will look great, feel great but long term side effects of elevated mTor activity might mean shorter lifespans. Now one might attenuate that by fasting and driving up amPK, worry less about being a bodybuilder; around 45 years of age and onward. Just my two cents.

 

[tareload]

Age-predicted maximal heart rate revisited

OBJECTIVESWe sought to determine a generalized equation for predicting maximal heart rate (HRmax) in healthy adults.BACKGROUNDThe age-predicted HRmaxe…

www.sciencedirect.com

Mechanisms​

The mechanism underlying the age-related reduction in HRmax is not clear. It has been postulated that the primary mechanism is related to an age-related decline in intrinsic heart rate (i.e., independent of autonomic influences) 14, 15. In this context, it is interesting to note that the rate of decline in HRmax observed in the present study is very similar to that reported previously for intrinsic heart rate determined after cardiac autonomic blockade (−0.6 − 0.8 beats/min per year) 14, 15. Moreover, consistent with the present findings, gender (14)and habitual physical activity (16)do not appear to influence intrinsic heart rate in humans. These results collectively suggest that a decrease in HRmaxwith age may primarily be due to the reduction in intrinsic heart rate.

Conclusions​

The results of the present study fail to validate the traditional equation for predicting HRmax across the adult age range in healthy humans. Specifically, the traditional equation underestimates HRmaxpast age 40 years, markedly so in older adults. On the basis of the cross-confirmatory findings of our meta-analysis and complementary prospective study, we present a new equation for future use that should provide more precise results. These findings have important clinical implications related to exercise testing and prescription.

Slowing down as we age: aging of the cardiac pacemaker’s neural control - GeroScience

The cardiac pacemaker ignites and coordinates the contraction of the whole heart, uninterruptedly, throughout our entire life. Pacemaker rate is constantly tuned by the autonomous nervous system to maintain body homeostasis. Sympathetic and parasympathetic terminals act over the pacemaker cells...

link.springer.com

 

[tareload]

Mechanisms of atrial fibrillation in athletes: what we know and what we do not know - PMC

Exercise is an emerging cause of atrial fibrillation (AF) in young individuals without coexisting cardiovascular risk factors. The causes of exercise-induced atrial fibrillation remain largely unknown, and conclusions are jeopardised by apparently ...

www.ncbi.nlm.nih.gov

Figure - PMC

Exercise is an emerging cause of atrial fibrillation (AF) in young individuals without coexisting cardiovascular risk factors. The causes of exercise-induced atrial fibrillation remain largely unknown, and conclusions are jeopardised by apparently ...

www.ncbi.nlm.nih.gov

 

[Fortunate]

@readalot, I came across a 2020 review of testosterone's affect on the beta adrenergic system, titled "Androgen Effects on the Adrenergic System of the Vascular, Airway, and Cardiac Myocytes and Their Relevance in Pathological Processes". I'm embarrassed to admit it, but I don't know how some guys are able to post external pdf's. Do you insert them as an image? You can search for this article and download a pdf if interested.

I skimmed it. Still need to read in further detail, but I think the review proposes a few mechanisms for hypertension with exogenous T, including affects on peripheral vascular tone and affects on cardiac muscle. Again, I have to read closer, but I thought of your situation.

Like you, I notice a more forceful heart beat even with really small doses of T. A separate, long term observation is that I get headaches with most forms of TRT (except Natesto). I am starting to lean towards blaming the headaches on hypertension. Even if BP elevation is transient, I suspect it could trigger a headache in someone prone to headaches (me).

Now, I am struggling with what to do about it. Calcium channel blockers and beta blockers are commonly used to prevent migraines. I have been on a calcium channel blocker for years for migraine prevention, but I wonder if a beta blocker would be more effective blunting T's affect on beta adrenergic receptors? I could go back to Natesto or attempt to stay on an injection regimen and try adding a beta blocker. But, do I really want to rely on a beta blocker just so that I can continue TRT?

Mixed feelings. TRT helps in many ways, but headaches are a problem. Natesto is the path of least resistance, but it is clearly less convenient than periodic injections. Just thinking out loud, and hoping stimulate a little more discussion on CV concerns.

 

[tareload]

@readalot, I came across a 2020 review of testosterone's affect on the beta adrenergic system, titled "Androgen Effects on the Adrenergic System of the Vascular, Airway, and Cardiac Myocytes and Their Relevance in Pathological Processes". I'm embarrassed to admit it, but I don't know how some guys are able to post external pdf's. Do you insert them as an image? You can search for this article and download a pdf if interested.

I skimmed it. Still need to read in further detail, but I think the review proposes a few mechanisms for hypertension with exogenous T, including affects on peripheral vascular tone and affects on cardiac muscle. Again, I have to read closer, but I thought of your situation.

Like you, I notice a more forceful heart beat even with really small doses of T. A separate, long term observation is that I get headaches with most forms of TRT (except Natesto). I am starting to lean towards blaming the headaches on hypertension. Even if BP elevation is transient, I suspect it could trigger a headache in someone prone to headaches (me).

Now, I am struggling with what to do about it. Calcium channel blockers and beta blockers are commonly used to prevent migraines. I have been on a calcium channel blocker for years for migraine prevention, but I wonder if a beta blocker would be more effective blunting T's affect on beta adrenergic receptors? I could go back to Natesto or attempt to stay on an injection regimen and try adding a beta blocker. But, do I really want to rely on a beta blocker just so that I can continue TRT?

Mixed feelings. TRT helps in many ways, but headaches are a problem. Natesto is the path of least resistance, but it is clearly less convenient than periodic injections. Just thinking out loud, and hoping stimulate a little more discussion on CV concerns.

Thanks very much for the reference. Nice lit review. Here's the link:

Androgen Effects on the Adrenergic System of the Vascular, Airway, and Cardiac Myocytes and Their Relevance in Pathological Processes

<i>Introduction</i>. Androgen signaling comprises nongenomic and genomic pathways. Nongenomic actions are not related to the binding of the androgen receptor (AR) and occur rapidly. The genomic effects implicate the binding to a cytosolic AR, leading to protein synthesis. Both events are...

www.hindawi.com

You can either attach a pdf or post images of select pages with the functionality on this forum. I'll give your thoughts and questions some reflection. Thank you.