Testosterone Study Shows NoHeart Risk

[+ Lucky]

From wapo.com:

Millions of aging men have been prescribed testosterone replacement therapy to boost their sex drive and overall vitality. Now, a much-anticipated study shows the controversial treatment doesn’t increase the risk of “major” cardiac events such as heart attacks or heart-related deaths, nor does it protect the heart against them.

The finding is likely to ease concerns that supplemental testosterone poses a potential cardiovascular threat, but the study’s scientists also warned that men should not misinterpret the results and take testosterone as a way to restore youthful vigor.

“Men should not use testosterone for anti-aging,” said the study’s senior author, Steven E. Nissen, chief academic officer of the Heart, Vascular & Thoracic Institute at the Cleveland Clinic. “I don’t want our study to be misused by physicians to prescribe it to men who simply want to feel younger.” (OP note: Heaven forbid!")

It found that testosterone-replacement therapy did not produce a higher rate of “major adverse cardiac events” — including heart attacks and heart-related deaths — in middle-aged and older men with low testosterone (hypogonadism) who had preexisting heart disease or a high risk of developing it.

https://www.washingtonpost.com/wellness/2023/06/16/testosterone-therapy-heart-health/

OP Note: The article uses this photo:

It s not a photo of the OP as he looks today. But I sure like those curves!

Edited June 16, 2023 by Lucky

[+ nycman]

Just to reiterate……

Despite what the above picture implies, this study was done in middle aged men (not 20 year olds) with documented low testosterone levels, using transdermal gel (not injections), to get them back to "normal levels" (not the massively super-therapeutic doses that body builders use). 

It’s a little bit like saying pissing in an empty gallon jug won’t stain your carpet. No shit Sherlock.

 

[+ Lucky]

4 hours ago, nycman said:

Just to reiterate……

Despite what the above picture implies, this study was done in middle aged men (not 20 year olds) with documented low testosterone levels, using transdermal gel (not injections), to get them back to "normal levels" (not the massively super-therapeutic doses that body builders use). 

It’s a little bit like saying pissing in an empty gallon jug won’t stain your carpet. No shit Sherlock.

 

Would you rather the article had used  a picture of a middle-aged man with low testosterone? He probably couldn't have gotten up for the photo session!

[+ Pensant]

Thank God low T was never a problem for me. Of course, it did lead to some hair loss later in life!

[Guest]

Many had assumed that testosterone replacement might carry even greater cardiac risk than estrogen replacement therapy. It's great to hear that this is probably not the case. It definitely improves the lives of a lot of men (both older and some younger). 

[+ bashful]

Over the years, I've had low testosterone symptoms (fatigue, depression, weight gain, etc.).  I once (about 15 years ago) asked my prior doctor about a testosterone test, and I inferred from his response that replacement therapy could cause more serious problems, so I never thought about it any more.  

Recently, I got an email from Quest, they were having a sale on medical tests.  I ordered a STD panel, and noticed the Testosterone test was only $55, so added it onto my tests.  Got back results, no STDs, but testosterone was 186.  Been reading stuff on internet that replacement therapy may not be so bad.  I've made an appointment with my current doctor to discuss.  

 

[Guest]

1 hour ago, bashful said:

Over the years, I've had low testosterone symptoms (fatigue, depression, weight gain, etc.).  I once (about 15 years ago) asked my prior doctor about a testosterone test, and I inferred from his response that replacement therapy could cause more serious problems, so I never thought about it any more.  

Recently, I got an email from Quest, they were having a sale on medical tests.  I ordered a STD panel, and noticed the Testosterone test was only $55, so added it onto my tests.  Got back results, no STDs, but testosterone was 186.  Been reading stuff on internet that replacement therapy may not be so bad.  I've made an appointment with my current doctor to discuss.  

 

Hopefully, you had your free testosterone level checked, not total. Assuming you did, you can look up the relative risks and benefits of hormone replacement and decide if a trial is right for you. This new study adds to our understanding of the risks. There's very little risk in just trying it for a month to see if it improves your mood and energy levels. Don't expect much weight loss. There are other risks and benefits, but it's greatest benefit could be your feeling better. My advice would be to at least try it out. 

[+ nycman]

6 hours ago, bashful said:

I've made an appointment with my current doctor to discuss. 

God, I love smart people!

[Rudynate]

On 6/20/2023 at 10:36 PM, bashful said:

Over the years, I've had low testosterone symptoms (fatigue, depression, weight gain, etc.).  I once (about 15 years ago) asked my prior doctor about a testosterone test, and I inferred from his response that replacement therapy could cause more serious problems, so I never thought about it any more.  

Recently, I got an email from Quest, they were having a sale on medical tests.  I ordered a STD panel, and noticed the Testosterone test was only $55, so added it onto my tests.  Got back results, no STDs, but testosterone was 186.  Been reading stuff on internet that replacement therapy may not be so bad.  I've made an appointment with my current doctor to discuss.  

 

Be forewarned though.  Your doc may say, "Oh, that's normal for your age, you don't need TRT" (emphasis added).  But of course, the whole point of TRT is to have more energy, better libido, sharper mind, etc., not to feel like an 80 year old. So you may have to push back a little. 

[Guest]

24 minutes ago, Rudynate said:

Be forewarned though.  Your doc may say, "Oh, that's normal for your age, you don't need TRT" (emphasis added).  But of course, the whole point of TRT is to have more energy, better libido, sharper mind, etc., not to feel like an 80 year old. So you may have to push back a little. 

I agree that if your Free Testosterone level is not in the reference range, and you have symptoms of low testosterone, you should have the right to decide on trying hormone replacement. By the way, topical treatments are generic now, so no need for injections of testosterone cypionate, as hinted in the OP.

[EZEtoGRU]

Good news with this study. However TRT still does come with other risks. Testosterone is considered a super-food for prostate cancer. If there is a history of prostate cancer in your family, be very wary. 

Edited June 23, 2023 by EZEtoGRU

[+ bashful]

On 6/21/2023 at 2:41 AM, Unicorn said:

Hopefully, you had your free testosterone level checked, not total. Assuming you did, you can look up the relative risks and benefits of hormone replacement and decide if a trial is right for you. This new study adds to our understanding of the risks. There's very little risk in just trying it for a month to see if it improves your mood and energy levels. Don't expect much weight loss. There are other risks and benefits, but it's greatest benefit could be your feeling better. My advice would be to at least try it out. 

I think it's total.  Another thing to put on the list when I speak with doc.  Thanks

[+ bashful]

On 6/23/2023 at 6:56 AM, EZEtoGRU said:

Good news with this study. However TRT still does come with other risks. Testosterone is considered a super-food for prostate cancer. If there is a history of prostate cancer in your family, be very wary. 

Prostate cancer was the prior doctor's biggest reason to not test.  Fortunately, no history in my family.

Edited June 26, 2023 by bashful

[Guest]

4 hours ago, bashful said:

I think it's total.  Another thing to put on the list when I speak with doc.  Thanks

A bit frightening, if true. If there's a reason to test a total testosterone level, I don't know of any. 

[Guest]

4 hours ago, bashful said:

Prostate cancer was the prior doctor's biggest reason to not test.  Fortunately, no history in my family.

Well, autopsy studies on men who've died for other reasons have shown that if X is the age of death the man has an X% chance of having a prostate cancer on autopsy. So everyone has a family history. What's more important is whether there's a family history of death due to prostate cancer. If your relatives get their PSA checked in the absence of symptoms (screening), one will almost always test positive, and procedures are usually done in those cases. In the overwhelming majority of those who get prostate-removing procedures due to rise in PSA, that prostate cancer would have never affected their lives.

That being said, if one is concerned about prostate cancer, it's certainly easy to screen for. If the PSA rises too quickly (particularly with low amounts of free PSA), one can always stop the testosterone. It's hardly a reason to not start it to being with. Also, testosterone replacement doesn't appear to increase the risk of getting prostate cancer--though if you have prostate cancer, testosterone will likely make it grown more quickly. 

[+ bashful]

On 6/26/2023 at 12:42 AM, Unicorn said:

A bit frightening, if true. If there's a reason to test a total testosterone level, I don't know of any. 

When I ordered the test online, it listed one, no differentiation.  I’ll look at the remarks and read it again.  It had very small paragraph, but the word total was in the text.

[+ bashful]

On 6/26/2023 at 12:57 AM, Unicorn said:

Well, autopsy studies on men who've died for other reasons have shown that if X is the age of death the man has an X% chance of having a prostate cancer on autopsy. So everyone has a family history. What's more important is whether there's a family history of death due to prostate cancer. If your relatives get their PSA checked in the absence of symptoms (screening), one will almost always test positive, and procedures are usually done in those cases. In the overwhelming majority of those who get prostate-removing procedures due to rise in PSA, that prostate cancer would have never affected their lives.

That being said, if one is concerned about prostate cancer, it's certainly easy to screen for. If the PSA rises too quickly (particularly with low amounts of free PSA), one can always stop the testosterone. It's hardly a reason to not start it to being with. Also, testosterone replacement doesn't appear to increase the risk of getting prostate cancer--though if you have prostate cancer, testosterone will likely make it grown more quickly. 

My yearly PSA tests generally run low.  There was a recent rise, but still in the normal range, along with higher WBC.  Doc diagnosed it as Prostatitis rather than UTI.  
 

Not sure how my acquired Hypothyroidism being treated with 25 mcg Synthroid will fit into the mix.  I’m glad doc will take time explaining it.  I’ll sent the test result to him in advance.  
 

Thanks for all the good info.
 
To be honest, I’m hoping TRT will help with my overall well being.

Edited June 28, 2023 by bashful

[Guest]

25 mcg is a tiny dose, usually given to start people (especially older adults) slowly. Rarely is less than 50 mcg needed (for true hypothyroidism, not for subclinical hypothyroidism, the treatment for which is controversial). A typical dose is 100 mcg. This would not relate to the prostate problem. If the PSA is between 4 and 10, getting the free PSA is helpful. Higher levels suggest non-cancerous sources, such as prostatitis or BPH (simple enlargement). 

[+ bashful]

I have an appointment with my PCP in a couple weeks to discuss current test, (total vs. free), and get any insight on what I should look for in a provider (Urologist, or Endocrinologist) going forward, and whether to get re-tested.

And, since I had already decided to change Urologists for my yearly bladder cancer follow ups, I made an appointment with a new Urologist at another hospital group for October (the earliest available date for him).  He was about to only one who listed most my conditions (Low T, and BPH),  It didn't actually list bladder cancer, but it was first time I saw a doctor list "Genitourinary Survivorship" (I had to google it). 

If my PCP says he can treat Low T, I don't have a problem with that, but I will still be moving on to another Urologist, and I want to keep PCP in loop, and see if he has any other recommendations. 

Regarding the Synthroid, PCP started me on that when my TSH levels began trending higher than normal about two years ago, and I had no energy, and my  depression was worsening (thought meds pooped out).  I do remember at that time, one of the doctors refer to it as subclinical hypothyroidism, but somehow in the follow up info, and notes, it's being termed as acquired hypothyroidism.  Never thought there was a distinction, but I felt better after I went on it, but the low energy is back, that made physical therapy after surgery became more and more difficult, and I've gained weight, and mood's not so great.

Edited July 9, 2023 by bashful

[+ purplekow]

On 6/28/2023 at 4:51 PM, Unicorn said:

25 mcg is a tiny dose, usually given to start people (especially older adults) slowly. Rarely is less than 50 mcg needed (for true hypothyroidism, not for subclinical hypothyroidism, the treatment for which is controversial). A typical dose is 100 mcg. This would not relate to the prostate problem. If the PSA is between 4 and 10, getting the free PSA is helpful. Higher levels suggest non-cancerous sources, such as prostatitis or BPH (simple enlargement). 

25 mcg as an ongoing dose is next to useless. If you needed supplementation of your thyroid hormone, a second level should have been obtained within a few weeks of the first starting of the Synthroid.  At that point, an increase to 50 mcg  would be reasonable.  If you are younger than 50, starting at 50 mcg or even 75 mcg, which is the does most of my patient's wind up needing if not more, would be reasonable.  

As far as free testosterone, that total testosterone is low enough that I doubt the free testosterone will be anything but low, but that would have been the test to order.  I did not know that labs were now doing lab tests on demand for patients.  I assume they do not try to charge the insurance company for such tests.   

[+ sf westcoaster]

Has anyone had experience using a Testosterone Gel ? Is it effective and are the results different than using injections?

[+ Notor]

3 hours ago, sf westcoaster said:

Has anyone had experience using a Testosterone Gel ? Is it effective and are the results different than using injections?

Injections worked better for me, but it seems that everyone gets different results. I think you need to do your own trial.

[Guest]

21 hours ago, sf westcoaster said:

Has anyone had experience using a Testosterone Gel ? Is it effective and are the results different than using injections?

The gel provides a smoother level over the week, assuming you have normal skin. Of course, if you use the gel, you need to make sure you don't hug or caress someone for a good hour afterward (usually it's dosed after the morning shower, getting dressed afterward). If one doses it as instructed and doesn't have rashes or other skin problems, gels are easier and minimize the high/low effect of the injections. 

[EZEtoGRU]

On 7/10/2023 at 2:24 PM, sf westcoaster said:

Has anyone had experience using a Testosterone Gel ? Is it effective and are the results different than using injections?

I used Androgel (roll-on) some 8-9 years ago.  It provided minimal benefit for me.

[+ bashful]

On 7/10/2023 at 10:05 AM, purplekow said:

I did not know that labs were now doing lab tests on demand for patients.  I assume they do not try to charge the insurance company for such tests.   

Quest did the test.  Paid with credit card online.