AAS and Cardiovascular/Pulmonary Function

[hurricane]

[OA] Testosterone Treatment In Chronic Heart Failure

Mounting evidence suggests that hormonal deficiencies (HD) have an important role in chronic heart failure (CHF). In particular, androgen depletion is common in men with CHF and is associated with increased morbidity and mortality.

This review summarizes the current understanding of the complex relationship between CHF and testosterone, focusing on evidence derived from clinical trials that have investigated the role of testosterone in the treatment of CHF. A greater comprehension of this area will allow researchers and clinicians to plan future studies that improve current strategies to reduce mortality in this high-risk population.

Online databases PubMed (Medline), Web of Science, and Scopus were searched for manuscripts published prior to June 2018 using key words "heart failure" AND "testosterone" OR "anabolism" OR "hormone" OR "replacement treatment". Manuscripts were collated, studied and carried forward for discussion where appropriate.

In summary, findings from the literature demonstrate that testosterone treatment in CHF is a promising topic that requires further investigation.

D'Assante R, Piccioli L, Valente P, et al. Testosterone treatment in chronic heart failure. Review of literature and future perspectives. Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace 2018;88:976. Testosterone treatment in chronic heart failure. Review of literature and future perspectives | D'Assante | Monaldi Archives for Chest Disease

Brought this up with Dr. Marieb on Friday. My last blood work showed TT at 591. Hardly low but he actually said he'd consider using the testosterone cream.
Which I don't know much about but haven't heard anything good. Especially absorbtion rate. He mentioned it because I said my libido has really decreased.
But he said my weight may be a factor in that area. And he wouldn't even consider the cream until I drop 25lbs.
Can't take Viagra because of possible drop in BP with my other meds.
What do you think is clinically low test Doc?
It's ok if you don't want to answer that. Just curious.

 

[Michael Scally MD]

Brought this up with Dr. Marieb on Friday. My last blood work showed TT at 591. Hardly low but he actually said he'd consider using the testosterone cream.
Which I don't know much about but haven't heard anything good. Especially absorbtion rate. He mentioned it because I said my libido has really decreased.
But he said my weight may be a factor in that area. And he wouldn't even consider the cream until I drop 25lbs.
Can't take Viagra because of possible drop in BP with my other meds.
What do you think is clinically low test Doc?
It's ok if you don't want to answer that. Just curious.

The Free Testosterone is important.

 

[hurricane]

The Free Testosterone is important.

That was actually on the low side. I'll get the exact number from Marieb but I'm sure it was not much above "normal" range.
Thanks Doc. I'll get that answer tomorrow.

 

[Michael Scally MD]

Huang Y, Dai W, Li Y. Potential associations of testosterone/estradiol ratio, leukocyte hTERT expression and PBMC telomerase activity with aging and the presence of coronary artery disease in men. Experimental gerontology 2018. Potential associations of testosterone/estradiol ratio, leukocyte hTERT expression and PBMC telomerase activity with aging and the presence of coronary artery disease in men - ScienceDirect

Highlights
· Ratio of testosterone to estradiol was significantly lower in men with CAD than in men without CAD.
· Levels of hTERT mRNA and telomerase activity in peripheral blood mononuclear cells were lower in older men than younger men, and even lower in older men with CAD.
· Length of telomeres in peripheral blood mononuclear cells was similar between men with or without CAD.
· The balance of sex hormones is closely related to telomerase activity.

The present study aimed to examine associations of the testosterone/estradiol ratio, human leukocyte telomerase reverse transcriptase (hTERT) expression and telomerase activity of peripheral blood mononuclear cells (PBMCs) with aging and the presence of coronary artery disease (CAD).

Telomeres in leukocytes are shorter in individuals with CAD than in healthy individuals of the same age. Levels of sex hormones are related to aging, and the ratio of testosterone to estradiol has been linked to CAD in men.

Here we compared younger men (22 ± 2 yr, n = 26), middle-aged men (31 ± 5 yr, n = 35), older men without CAD (60 ± 10 yr, n = 30) and older men with CAD (63 ± 8 yr, n = 30) in terms of testosterone/estradiol ratio, leukocyte telomerase reverse transcriptase (hTERT) expression, activity of telomerase in peripheral blood mononuclear cells (PBMCs), and length of PBMC telomeres. Levels of hTERT mRNA of leukocyte and PBMC telomerase activity were significantly lower in older men than in younger or middle-aged men (p < 0.05).

These two parameters, as well as testosterone/estradiol ratio, were significantly lower in older men with CAD than in all the other groups (p < 0.05). The sex hormone ratio correlated significantly with age, hTERT mRNA levels, PBMC telomerase activity and telomere length (p < 0.05).

These results support the hypothesis that sex hormone balance is a biomarker of telomerase function, and that both of these parameters change as men age or develop CAD.

 

[hurricane]

The Free Testosterone is important.

Hey Doc. It was 5.7 ng/dl.
I know it's on the low side.
Should I be worried with that number?

 

[Michael Scally MD]

Hey Doc. It was 5.7 ng/dl.
I know it's on the low side.
Should I be worried with that number?

Many treat a low FT. It is critical to take into account all factors. IOW, CVD.

 

[Michael Scally MD]

[OA] Testosterone Replacement Therapy and Hospitalization Rates in Men with COPD

Testosterone deficiency is common in men with chronic obstructive pulmonary disease (COPD) and may exacerbate their condition. Research suggests that testosterone replacement therapy (TRT) may have a beneficial effect on respiratory outcomes in men with COPD. To date, however, no large-scale nationally representative studies have examined this association. The objective of the study was to assess whether TRT reduced the risk of respiratory hospitalizations in middle-aged and older men with COPD.

We conducted two retrospective cohort studies. First, using the Clinformatics Data Mart-a database of one of the largest commercially insured populations in the United States-we examined 450 men, aged 40-63 years, with COPD who initiated TRT between 2005 and 2014. Second, using the national 5% Medicare database, we examined 253 men, aged >/=66 years, with COPD who initiated TRT between 2008 and 2013. We used difference-in-differences (DID) statistical modeling to compare pre- versus post-respiratory hospitalization rates in TRT users versus matched TRT nonusers over a parallel time period.

DID analyses showed that TRT users had a greater relative decrease in respiratory hospitalizations compared with nonusers. Specifically, middle-aged TRT users had a 4.2% greater decrease in respiratory hospitalizations compared with nonusers (-2.4 decrease vs. 1.8 increase; p = 0.03); and older TRT users had a 9.1% greater decrease in respiratory hospitalizations compared with nonusers (-0.8 decrease vs. 8.3 increase; p = 0.04).

These findings suggest that TRT may slow disease progression in patients with COPD. Future studies should examine this association in larger cohorts of patients, with particular attention to specific biological pathways.

Baillargeon J, Urban RJ, Zhang W, et al. Testosterone replacement therapy and hospitalization rates in men with COPD. Chronic respiratory disease 2018:1479972318793004. SAGE Journals: Your gateway to world-class journal research

 

[hurricane]

Many treat a low FT. It is critical to take into account all factors. IOW, CVD.

Thanks Doc. Marieb has me headed back up to Brigham and Women's in Boston on Monday.
Harvard is going to do more genetic testing and he wants me examined again by their cardiology and EP departments.
He's unsure why my EF keeps dropping and rising on what seems like a monthly basis lately. I'll also consult with an endocrinologist to see if HRT may be appropriate.
I have to admit I'm a little worried about possible HRT. Jess and myself are worried it may cause more issues.
I guess I'll address that issue if it comes to it.
A couple afib bouts picked up by my linq recorder the last few days so haven't felt great. Started verapamil.
I'll update you next week after my Boston trip.
Again Doc thanks for everything. Very much appreciated coming from such a knowledgeable Doc as yourself.

 

[bob hughes]

Does LVH caused by aas abuse reverse after a period of time if the drugs are stopped, or reduced to TRT? As is the case with much of skeletal muscle hypertrophy?

 

[CensoredBoardsSuck]

Does LVH caused by aas abuse reverse after a period of time if the drugs are stopped, or reduced to TRT? As is the case with much of skeletal muscle hypertrophy?

I don't think anyone can give you a definitive answer on whether AAS even cause LVH, much less if it's reversible. I certainly don't claim to be an expert on the subject but from reading the studies Scally has generously posted in this thread, it appears it isn't totally reversible. But that's assuming AAS do induce cardiomegaly. It's also assuming I've interpreted the studies correctly.

 

[hurricane]

I don't think anyone can give you a definitive answer on whether AAS even cause LVH, much less if it's reversible. I certainly don't claim to be an expert on the subject but from reading the studies Scally has generously posted in this thread, it appears it isn't totally reversible. But that's assuming AAS do induce cardiomegaly. It's also assuming I've interpreted the studies correctly.

I'd agree. Firstly we don't know if my AAS use caused my LVH. Maybe but maybe not.
Secondly my LVH hasn't reduced since stopping AAS almost 2 years ago.
I know I'm just one individual so not the best sample size.

 

[bob hughes]

I don't think anyone can give you a definitive answer on whether AAS even cause LVH, much less if it's reversible. I certainly don't claim to be an expert on the subject but from reading the studies Scally has generously posted in this thread, it appears it isn't totally reversible. But that's assuming AAS do induce cardiomegaly. It's also assuming I've interpreted the studies correctly.

Right ex or current steroid users aren’t the most studied population and There’s no definitive answers on a lot of this stuff. It was just a question that ive thought about and I wanted to put it out there to see what people thought. I thought it was at least generally excepted that AAS Does in some cases cause LVH. And I get the sense from what I’ve read, that it does not reverse, At least to the extent that skeletal muscle growth does. But I’ve never seen it directly addressed

 

[bob hughes]

I'd agree. Firstly we don't know if my AAS use caused my LVH. Maybe but maybe not.
Secondly my LVH hasn't reduced since stopping AAS almost 2 years ago.
I know I'm just one individual so not the best sample size.

I know that with LVH caused by blood pressure, it is possible to reverse. Not sure about other causes.. Have you talked to your doctor about possible treatments to reverse it?

 

[hurricane]

I know that with LVH caused by blood pressure, it is possible to reverse. Not sure about other causes.. Have you talked to your doctor about possible treatments to reverse it?

We've discussed it and the consensus between my cardiologist and EP is that it won't.
I have multiple conditions such as dialated cardiomyopathy, atrial flutter and fibrillation, inappropriate sinus tachycardia, and more.
My heart is under alot of stress so it would be extremely difficult in my case.
But in a otherwise healthy AAS user I would think the chances might be better.
Basically my heart is fukd. lol.

 

[bob hughes]

We've discussed it and the consensus between my cardiologist and EP is that it won't.
I have multiple conditions such as dialated cardiomyopathy, atrial flutter and fibrillation, inappropriate sinus tachycardia, and more.
My heart is under alot of stress so it would be extremely difficult in my case.
But in a otherwise healthy AAS user I would think the chances might be better.
Basically my heart is fukd. lol.

Wow. I’m assuming you probably got dealt a bad hand genetically Then. Sounds like you’re doing what you can to be healthy, I commend you for that

 

[hurricane]

Wow. I’m assuming you probably got dealt a bad hand genetically Then. Sounds like you’re doing what you can to be healthy, I commend you for that

No doubt genetics plays a part in it. I was just up in Boston to have additional genetic testing done.
But like you said I play the hand I've been dealt. No complaints.
That's why I try to urge people to stay safe. Crazy doses may not have immediate consequences but down the road they may bite you in the ass.
Stay safe bud. You seem very responsible with your use of AAS.

 

[Dr JIM]

Brought this up with Dr. Marieb on Friday. My last blood work showed TT at 591. Hardly low but he actually said he'd consider using the testosterone cream.
Which I don't know much about but haven't heard anything good. Especially absorbtion rate. He mentioned it because I said my libido has really decreased.
But he said my weight may be a factor in that area. And he wouldn't even consider the cream until I drop 25lbs.
Can't take Viagra because of possible drop in BP with my other meds.
What do you think is clinically low test Doc?
It's ok if you don't want to answer that. Just curious.

A TT of 591 strongly suggests another cause of your suppressed
Libido HC!

IMO the last thing you need is another drug to complicate your already complicated medical history.

 

[hurricane]

A TT of 591 strongly suggests another cause of your suppressed
Libido HC!

I know Doc. I was waiting for you to tear into me. lol. I'm sure stress and my weight play a significant role.
Not to mention worrying about the new addition to the household.
I need you around to slap some sense into me.

 

[Dr JIM]

I know that with LVH caused by blood pressure, it is possible to reverse. Not sure about other causes.. Have you talked to your doctor about possible treatments to reverse it?

Folk must avoid the notion androgen associated LVH is reversible per se primarily bc many become complacent and fail to take the proper steps to diagnose this condition until its to late for meaningful cardiac recovery.

 

[jhb]

After reading through this, I am now kinda of worried. My doc put me on trt a few years ago, said he would keep me at the top of my reference range which is 1000 to 1100, which comes out to be 200mg every 7 days, so I try to stay in that ball park year round. Is there any thing for me to worry about for long term at that amount?