T and Heart Disease

Don Schultz · Aug 6, 2015

Yet another question about TRT and heart disease. With TRT my level hovers high 800s, sometimes 900. My PCP says my T is too high and references increased risk of heart disease with a relatively high T as her concern. Should I be concerned?

James · Aug 7, 2015

Don Schultz said:
Yet another question about TRT and heart disease. With TRT my level hovers high 800s, sometimes 900. My PCP says my T is too high and references increased risk of heart disease with a relatively high T as her concern. Should I be concerned?

Are you experiencing any symptoms of heart disease (chest pain, shortness of breath), anything beyond this doc saying a total T in the high 800's is cause for concern? Have you had heart problems in the past, high blood pressure or a family history of heart disease? Absent any symptoms or a family history, I doubt you have much to be concerned about at that level. I've had high blood pressure my whole life, but once I went on TRT, my blood pressure is absolutely perfect every week. I have it checked every Monday. I'm off my blood pressure meds, although most everything you read says TRT can cause high blood pressure.

Don Schultz · Aug 7, 2015

I should have mentioned that. Yes, I have a history of heart disease. Everything is "normal" now but I had stents placed in 2012.

Nelson Vergel · Aug 7, 2015

Don

If your HDL, estradiol and hematocrit are normal, I would not worry much.

CoastWatcher · Aug 7, 2015

Don, A good friend, who had bypass surgery, is enjoying the benefits of TRT. He does see his cardiologist more frequently than he otherwise would, but he has been very pleased with the results of testosterone replacement. Everyone is different, but I'd check w/your cardiologist if your primary care physician is uneasy.

Don Schultz · Aug 7, 2015

Thanks! Good idea. The challenge is that the cardio is just guessing about wheather my heart disease is under control due to the measures we have taken or if it is progressing. Sometimes docs like to use a stress test but I always passed my stress tests in the years and months prior to my angina and stents. We assumed we had it under control for at least 6 years prior. The only way to know definitively if heart disease is progressing is with a coronary angiography (dye in blood) and thats a pretty advanced procedure and clearly not performed routinely. You would think with the prevalence of CHD that we could develop at definitive and simple test to know if the calcification is progressing. There are tests that can give a glimpse but they are not definitive. In my case, those tests showed reason for mild concern but nothing alarming. It was only when I developed angina and had the Coronary Angiogram that the real picture was completely clear. I was under direct treatment by a cardiologist for 6 years prior to 2012, I saw him August 1, 2012, in fact, and was given the all clear. I developed angina on August 15 and had 5 stents place on August 28. Like I said, they are guessing. I read most of Nelson's page on this topic and even the top docs in this area don't seem to be able to agree. Honestly, I'd like to hear Nelson's take on this because he has a great talent in reading, digesting, keeping current with and explaining current thought based upon quality studies and first hand knowledge.

Don Schultz · Aug 9, 2015

That's what I thought too, Nelson, keeping my HDL, E and Hematocrit in line is most important as a preventative. I looked at the EM page dedicated to T and Heart Disease. I see some docs (and studies) are claiming a connection and increased risk. Here's what I could not find: Are there any docs or studies that you know of that have connected a SPECIFIC T level for increased HD risk? All I could find was info stating the TRT is connected to increased HD risk but no mention of how high the T levels numbers were to create the risk. I guess my question would be, of those docs and studies claiming increased HD risk with TRT, are the also stating that lower T numbers (still under TRT) would be a lower the risk?

Nelson Vergel · Aug 9, 2015

Don

The three studies did not measure T levels after starting men on TRT (Yes, I know...crazy!). In fact, many men may have been underdosing which can make them hypogonadal. Hypogonadism has been proven to be tight to heart disease.

In my opinion, these flawed chart reviews failed not only to monitor men for T levels but also for hematocrit and estradiol.

Even the FDA admitted these studies were flawed.The FDA Determined Studies Linking Testosterone to Heart Attacks Were Flawed.

I think the most important factors that can increase heart disease on TRT are:

1- Low T levels due to underdosing.

2- High hematocrit that is not managed via phlebotomies

3- Low HDL caused by higher T doses

I do not even think high estradiol is a factor if T blood levels are also high enough to compensate for higher E2.

Anastrozole, by the way, can lower HDL in men.