TRT & Cardiovascular Disease Conundrum

[TRTIslnd]

I'll keep it short but a lot here. Diagnosed with Low T back in 2016 with a number of symptoms. Started TRT late 2016 with one of the clinics referred to a lot here, but immediately started dealing with high hematocrit. Started blood donations and ferritin crashed. Adjusted dose and number of times I injected but it did not help. Tried for a few years, stopped for a few months and restarted 2X a week very low dose. Hematocrit continued to be a problem but I just donated even though my Ferritin levels were very low (half the low levels). BTW tried injecting everyday not for me. So I continued with 2x/week low dose. Felt better, not great but better but figured I could not go higher on dose so I kept going. I also noticed my hair definitely started thinning out and that maybe my prostate was also being impacted (changes in peeing stream pressures and flow). Not too concerned my PSA was not necessarily going up and well with my hair well I was accepting it.

Fast forward to late 2022 and while working out (I'm not in top shape and can definitely lose 40lbs to be where I want to be) I started having chest pains while running. Stopped went to do weights it went away. Went back to gym a few days later and same thing so now I'm freaked out. Went to cardiologist did a few test and looked like I had artery blockage and I was having Angina. Freaked out stopped TRT immediately because I knew I had thick blood to begin with. Did Angiogram ended up with two stents and bunch of medicines. Have not gotten back on TRT since and Dr thinks it is not a good idea at least for now. I know TRT did not cause my artery plaque buildup but thicker blood does not flow the same so maybe TRT contributed to the Angina.

Fast forward and I now have all the symptoms I had before in addition to now I also have low libido. I'm in my mid 50's so my dilemma is Low T is no good for your health, has a number of other health issues and I have low T with the symptoms. Obviously I want to live as long as I'm supposed to live but would rather do it with a good quality of life, which I was having when I was on TRT. But now that I have cardiovascular disease (CVD) and knowing my blood will thicken out, not sure path forward.

Any other out there in the same boat? What are you doing?
Should I try Clomid or Enclomiphene ? I'll take a small T boost if it does not impact hematocrit.
Any Doctors you would recommend in Houston that have plenty of experience with difficult TRT cases (high hematocrit) and CVD?

THX

 

[Nelson Vergel]

Dr Larry Lipshultz or Dr Mohit Khera in Houston.

 

[Fortunate]

I'll keep it short but a lot here. Diagnosed with Low T back in 2016 with a number of symptoms. Started TRT late 2016 with one of the clinics referred to a lot here, but immediately started dealing with high hematocrit. Started blood donations and ferritin crashed. Adjusted dose and number of times I injected but it did not help. Tried for a few years, stopped for a few months and restarted 2X a week very low dose. Hematocrit continued to be a problem but I just donated even though my Ferritin levels were very low (half the low levels). BTW tried injecting everyday not for me. So I continued with 2x/week low dose. Felt better, not great but better but figured I could not go higher on dose so I kept going. I also noticed my hair definitely started thinning out and that maybe my prostate was also being impacted (changes in peeing stream pressures and flow). Not too concerned my PSA was not necessarily going up and well with my hair well I was accepting it.

Fast forward to late 2022 and while working out (I'm not in top shape and can definitely lose 40lbs to be where I want to be) I started having chest pains while running. Stopped went to do weights it went away. Went back to gym a few days later and same thing so now I'm freaked out. Went to cardiologist did a few test and looked like I had artery blockage and I was having Angina. Freaked out stopped TRT immediately because I knew I had thick blood to begin with. Did Angiogram ended up with two stents and bunch of medicines. Have not gotten back on TRT since and Dr thinks it is not a good idea at least for now. I know TRT did not cause my artery plaque buildup but thicker blood does not flow the same so maybe TRT contributed to the Angina.

Fast forward and I now have all the symptoms I had before in addition to now I also have low libido. I'm in my mid 50's so my dilemma is Low T is no good for your health, has a number of other health issues and I have low T with the symptoms. Obviously I want to live as long as I'm supposed to live but would rather do it with a good quality of life, which I was having when I was on TRT. But now that I have cardiovascular disease (CVD) and knowing my blood will thicken out, not sure path forward.

Any other out there in the same boat? What are you doing?
Should I try Clomid or Enclomiphene ? I'll take a small T boost if it does not impact hematocrit.
Any Doctors you would recommend in Houston that have plenty of experience with difficult TRT cases (high hematocrit) and CVD?

THX

Consider transdermal or Natesto (Natesto likely to be safest option).

 

[madman]

I'll keep it short but a lot here. Diagnosed with Low T back in 2016 with a number of symptoms. Started TRT late 2016 with one of the clinics referred to a lot here, but immediately started dealing with high hematocrit. Started blood donations and ferritin crashed. Adjusted dose and number of times I injected but it did not help. Tried for a few years, stopped for a few months and restarted 2X a week very low dose. Hematocrit continued to be a problem but I just donated even though my Ferritin levels were very low (half the low levels). BTW tried injecting everyday not for me. So I continued with 2x/week low dose. Felt better, not great but better but figured I could not go higher on dose so I kept going. I also noticed my hair definitely started thinning out and that maybe my prostate was also being impacted (changes in peeing stream pressures and flow). Not too concerned my PSA was not necessarily going up and well with my hair well I was accepting it.

Fast forward to late 2022 and while working out (I'm not in top shape and can definitely lose 40lbs to be where I want to be) I started having chest pains while running. Stopped went to do weights it went away. Went back to gym a few days later and same thing so now I'm freaked out. Went to cardiologist did a few test and looked like I had artery blockage and I was having Angina. Freaked out stopped TRT immediately because I knew I had thick blood to begin with. Did Angiogram ended up with two stents and bunch of medicines. Have not gotten back on TRT since and Dr thinks it is not a good idea at least for now. I know TRT did not cause my artery plaque buildup but thicker blood does not flow the same so maybe TRT contributed to the Angina.

Fast forward and I now have all the symptoms I had before in addition to now I also have low libido. I'm in my mid 50's so my dilemma is Low T is no good for your health, has a number of other health issues and I have low T with the symptoms. Obviously I want to live as long as I'm supposed to live but would rather do it with a good quality of life, which I was having when I was on TRT. But now that I have cardiovascular disease (CVD) and knowing my blood will thicken out, not sure path forward.

Any other out there in the same boat? What are you doing?
Should I try Clomid or Enclomiphene ? I'll take a small T boost if it does not impact hematocrit.
Any Doctors you would recommend in Houston that have plenty of experience with difficult TRT cases (high hematocrit) and CVD?

THX

Welcome!

As Nelson stated Dr. Khera or Dr. Lipshultz!

TRT and Cardiovascular Disease

Testosterone replacement therapy and cardiovascular disease (2022) Jeremy M. Auerbach and Mohit Khera The use of testosterone therapy has a complex history of apprehension and questions regarding its safety. Despite an eventual consensus that testosterone therapy was safe and effective...

www.excelmale.com

Relationships between endogenous and exogenous T and CVD in men

Relationships between endogenous and exogenous testosterone and cardiovascular disease in men (2022) Arthi Thirumalai · Bradley D. Anawalt Abstract In this narrative review, we discuss the evidence about the controversy about the cardiovascular effects of endogenous and exogenous...

www.excelmale.com

Q&A 30:17-56:38

Testosterone and Cardiovascular Disease (Traverse Trial)

www.excelmale.com

Take home points this is huge!

Dr. Nasir Kurram 47:49-48:17

 

[madman]

Testosterone Therapy and the Risk of Cardiovascular Disease

Abstract The debate over the cardiovascular (CV) implications of testosterone therapy (TT) have resulted in diverging safety recommendations and clinical guidelines worldwide. This narrative review synthesizes and critically evaluates long-term studies examining the effects of TT within the...

www.excelmale.com

4. Conclusion

The therapeutic approach for TT for symptomatic hypogonadism and low testosterone levels associated with aging, obesity, and systemic illness presents challenges. These conditions are intricately linked with CVD outcomes and may confound the relationship between low testosterone and CVD. Although observational studies suggest an association between low testosterone and increased risk of CVD, results from testosterone supplementation are inconsistent. RCTs indicate that short-term TT at standard replacement is not associated with increased CVD risk. Nevertheless, the cardiovascular sub-study of T Trials observed increases in NCP and CAC, signaling the need for further investigation into potential long-term implications of TT.

The TRAVERSE trial, a landmark study unique in its capacity to evaluate CVD events, contributes valuable insights into the short-term safety of TT at lower physiological levels. However, the long-term effects and implications of mid to high physiological testosterone levels are not yet fully understood. The trials’ limitations — achievement of only low-normal testosterone levels, high discontinuation rates, brief follow-up period, and high loss to follow-up rate — suggest that the findings should be interpreted with caution. It is important to avoid generalizing the safety of TT based on these results alone and to approach the extrapolation of TRAVERSE’s conclusions to higher dosages or longer-term therapy with caution.

The decision to initiate TT requires a nuanced approach, which must account for current gaps in evidence regarding CV safety. A personalized assessment and management of CVD risk factors is essential for older men with known CVD. The CV effects of exogenous testosterone, when given to maintain physiological levels, remain to be fully explored. In this regard, an important question remains the identification of male patients with symptomatic hypogonadism who may benefit from TT. This topic continues to be the subject of ongoing debate. Hopefully, future trials will provide clarity on whether TT confers beneficial, neutral, or adverse cardiovascular effects in middle-aged and older men. Until definitive evidence surfaces, clinical practice should exercise caution and prioritize individualized care with informed discussions regarding the potential CV implications of TT.