Here is my Coronary Calcium Score Test Results. Price was $99, took 5 minutes for the test

[PeterBond]

I believe Peter Bond recommends this test annually for people that actually use androgens (even a cycle or two yearly).

I do not.

Any recommendations on what we should be doing instead?

Measure the conventional risk factors that are relatively cheap and don't come with radiation exposure, such as cholesterol (total, LDL and HDL) and blood pressure. Although the use of HDL cholesterol is rather limited when measured on-cycle, as it's unclear what an AAS-induced decrease in HDL means in terms of cardiovascular disease risk: Anabolic Steroids, HDL Cholesterol and Cholesterol Efflux Capacity - MESO-Rx

On top of that I'd monitor hematocrit at least bianually, kidney function (preferably with cystatin C measurements) and damage (urine analysis [bi]annually), and if budget allows it annual echocardiography—on the assumption that you might actually quite AAS usage or severly decrease its dosage if a decrease in heart function or detrimental changes to its structure, are observed.

As a final note: if you happen to be in one of the select groups in which coronary CT angiography is useful, then by all means take it of course. But usually those groups shouldn't be using AAS in the first place...

 

[Type-IIx]

I do not.


Measure the conventional risk factors that are relatively cheap and don't come with radiation exposure, such as cholesterol (total, LDL and HDL) and blood pressure. Although the use of HDL cholesterol is rather limited when measured on-cycle, as it's unclear what an AAS-induced decrease in HDL means in terms of cardiovascular disease risk: Anabolic Steroids, HDL Cholesterol and Cholesterol Efflux Capacity - MESO-Rx

On top of that I'd monitor hematocrit at least bianually, kidney function (preferably with cystatin C measurements) and damage (urine analysis [bi]annually), and if budget allows it annual echocardiography—on the assumption that you might actually quite AAS usage or severly decrease its dosage if a decrease in heart function or detrimental changes to its structure, are observed.

As a final note: if you happen to be in one of the select groups in which coronary CT angiography is useful, then by all means take it of course. But usually those groups shouldn't be using AAS in the first place...

I'm surprised by this! Are older men one of the select groups in which coronary CT angiography is indicated? Or, alternatively, did you not find the increase in plaque volumes from Budoff, Matthew J., et al. “Testosterone treatment and coronary artery plaque volume in older men with low testosterone.” Jama 317.7 (2017): 708-716 particularly persuasive? (204 to 232 mm^3 in the TRT group, vs. from 317 to 325 mm^3 in the placebo group)

 

[PeterBond]

I'm surprised by this! Are older men one of the select groups in which coronary CT angiography is indicated? Or, alternatively, did you not find the increase in plaque volumes from Budoff, Matthew J., et al. “Testosterone treatment and coronary artery plaque volume in older men with low testosterone.” Jama 317.7 (2017): 708-716 particularly persuasive? (204 to 232 mm^3 in the TRT group, vs. from 317 to 325 mm^3 in the placebo group)

I'm not entirely clear on which groups are good candidates for it, but it generally encompasses situations in which coronary artery disease is suspected. There are certain probability equations for this, which include risk factors such as age, but also the clinical presentation such as angina-related symptoms. Depending on the "pre-test probability" a coronary CT angiography is warranted (both too high and too low it's unnecessary). It's also used as an alternative to ischaemia testing in certain groups. The important part is that it can affect cardiovascular disease management in these situations.

I'm well aware of that study. It's suitable in a research situation, but it doesn't guide clinical decision-making.

 

[PeterBond]

Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography - PubMed

These estimates derived from our simulation models suggest that use of 64-slice CTCA is associated with a nonnegligible LAR of cancer. This risk varies markedly and is considerably greater for women, younger patients, and for combined cardiac and aortic scans.

pubmed.ncbi.nlm.nih.gov

While the dose is a lot lower nowadays with modern equipment (which not all labs have), the radiation exposure should always be kept in mind with any medical imaging that requires radiation exposure. This is perhaps even more true in young populations. Additionally, if you're planning on doing this annually, there's a larger cumulative risk. Coronary CT angiography should be targeted and not used blindly. The decrease in radiation dose does widen its clinical reach, but it remains targeted nevertheless.

 

[Type-IIx]

I'm not entirely clear on which groups are good candidates for it, but it generally encompasses situations in which coronary artery disease is suspected. There are certain probability equations for this, which include risk factors such as age, but also the clinical presentation such as angina-related symptoms. Depending on the "pre-test probability" a coronary CT angiography is warranted (both too high and too low it's unnecessary). It's also used as an alternative to ischaemia testing in certain groups. The important part is that it can affect cardiovascular disease management in these situations.

I'm well aware of that study. It's suitable in a research situation, but it doesn't guide clinical decision-making.

That makes sense, thank you. Are you still waiting on the HAARLEM trial supplementary data on cardiac changes or have you seen all you need to to have a sense of AAS-induced cardiac changes? I just want to make sure my mental model of cardiac changes is correct, that it includes cardiac cell apoptosis, shifts in redox balance towards oxidative stress, but should it also include changes to the vascular endothelium (I've only seen data using absurd doses) and progression of noncalcified coronary artery plaque volume (not so absurd)?

 

[PeterBond]

That makes sense, thank you. Are you still waiting on the HAARLEM trial supplementary data on cardiac changes or have you seen all you need to to have a sense of AAS-induced cardiac changes? I just want to make sure my mental model of cardiac changes is correct, that it includes cardiac cell apoptosis, shifts in redox balance towards oxidative stress, but should it also include changes to the vascular endothelium (I've only seen data using absurd doses) and progression of noncalcified coronary artery plaque volume (not so absurd)?

All data is here: Anabolic Androgenic Steroids Induce Reversible Left Ventricular Hypertrophy and Cardiac Dysfunction. Echocardiography Results of the HAARLEM Study

Note that echocardiographic data can't tell anything about the mechanisms involved.

 

[malfeasance]

I do not.


Measure the conventional risk factors that are relatively cheap and don't come with radiation exposure, such as cholesterol (total, LDL and HDL) and blood pressure. Although the use of HDL cholesterol is rather limited when measured on-cycle, as it's unclear what an AAS-induced decrease in HDL means in terms of cardiovascular disease risk: Anabolic Steroids, HDL Cholesterol and Cholesterol Efflux Capacity - MESO-Rx

On top of that I'd monitor hematocrit at least bianually, kidney function (preferably with cystatin C measurements) and damage (urine analysis [bi]annually), and if budget allows it annual echocardiography—on the assumption that you might actually quite AAS usage or severly decrease its dosage if a decrease in heart function or detrimental changes to its structure, are observed.

As a final note: if you happen to be in one of the select groups in which coronary CT angiography is useful, then by all means take it of course. But usually those groups shouldn't be using AAS in the first place...

It looks like all of that is easy and cheap to do on your own except the echocardiogram. That appears to run $300-2000 depending upon where I look.

The $300 one has a review by a cardiologist and results within a few days.

It seems that one has to call around to get actual prices. No transparency with medical service pricing, apparently.

 

[PeterBond]

It looks like all of that is easy and cheap to do on your own except the echocardiogram. That appears to run $300-2000 depending upon where I look.

The $300 one has a review by a cardiologist and results within a few days.

It seems that one has to call around to get actual prices. No transparency with medical service pricing, apparently.

Yes, echocardiography is quite pricey. They offer it privately in my country (the Netherlands) in the price range of €500-1000 too. Prices are easy to acquire though, they're listed publically on the internet.

 

[kobefan]

Yes, echocardiography is quite pricey. They offer it privately in my country (the Netherlands) in the price range of €500-1000 too. Prices are easy to acquire though, they're listed publically on the internet.

what about cardiac fMRI to check if you have soft or calcified atherosclerotic plaque in coronary arteries ? less radiation induced DNA damage ?

 

[PeterBond]

what about cardiac fMRI to check if you have soft or calcified atherosclerotic plaque in coronary arteries ? less radiation induced DNA damage ?

I think you mean cardiac MRI instead of fMRI? It does not use ionizing radiation.

 

[Cherokee]

Could you fake chest pains... go to a hospital, or would your Dr Order an Echocardiogram under those circumstances? That way you don't have to pay out of the pocket.

 

[kobefan]

Could you fake chest pains... go to a hospital, or would your Dr Order an Echocardiogram under those circumstances? That way you don't have to pay out of the pocket.

usually if you do that they will do an EKG to check for ischemia. and they will do a troponin cardiac enzyme test.

 

[Cherokee]

Just for the record. I asked about the Coronary Artery Scan , and if people should be concerned about radiation. I asked the Anabolic Dr. He's a pretty bright guy. His comment was, do not worry at all about it. He said the dosage is extremely small. He commented that women get mammograms done yearly, and that isn't a problem. He highly recommended all men get one.

 

[PeterBond]

Just for the record. I asked about the Coronary Artery Scan , and if people should be concerned about radiation. I asked the Anabolic Dr. He's a pretty bright guy. His comment was, do not worry at all about it. He said the dosage is extremely small. He commented that women get mammograms done yearly, and that isn't a problem. He highly recommended all men get one.

No medical association on the planet recommends so, and rightfully so. And there's a big difference between women getting a mammogram in the ballpark age group 50-75 (which usually isn't even annually) for early detection of breast cancer (high incidence and established good reduction in mortality as a result of it) and coronary CT angiogram in a nontargeted population.

 

[Cherokee]

No medical association on the planet recommends so, and rightfully so. And there's a big difference between getting a mammogram women in the ballpark age group 50-75 (which usually isn't even annually) for early detection of breast cancer (high incidence and established good reduction in mortality as a result of it) and coronary CT angiogram in a nontargeted population.

Thank you for your input.

Using this formula, my insurance company will pay for the exam, if and only if the score falls between 5-19.9 ASCVD Risk Calculator: 10-Year Risk of First Cardiovascular Event Using Pooled Cohort Equations - ClinCalc.com

According to the American Cancer society, Women age 45 to 54 should get mammograms every year. Women 55 and older should switch to mammograms every 2 years.

The recommendation is that if you are a woman from age 40 on, you should have a mammogram every year, even if your doctor forgets to mention it,” says Dr. Zeb.

6 Mammogram Myths

Annual mammograms can be a lifesaving screening exam for women. But common mammogram myths you may believe could have a serious impact on your health.

www.hopkinsmedicine.org

Correct me if I'm wrong... Coronary Calcium Scan is not full blown coronary CT angiogram, the later which uses a higher and longer dose or radiation.

I asked the Anabolic Dr if he thought anyone using AAS should get a Calcium Score test, and he said everyone who does steroids should. I told him about your opinion, and he laughed. He stated the amount of radiation is extremely small.

The Anabolic Dr just referenced mammogram testing, and said women get them every year, and the radiation is not a big concern.

Would you not consider Steroid users a targeted population?

So, once again.... this leaves people with less knowledge on the subject (such as me) getting conflicting views from people who obviously are more knowledgeable than I am!

 

[PeterBond]

USPSTF recommends biennial screening for women aged 50 to 74 years, American Cancer Society indeed does recommend annually, but only for 45 to 54. The European Commission Initiative on Breast Cancer recommends mammogram screening every 2 to 3 years for 45-49 year olds, every 2 years for 50-69 year olds, and every 3 years for 70-74 year olds. My country also screens every 2 to 3 years in women aged 50 to 75. Annual is not the norm, and even the American Cancer Society recommends it only during a relatively narrow window of a women's lifetime.

But the most important part here is that a mammogram has a HUGE benefit in this context. Breast cancer incidence is high, about 10% of women develop breast cancer in the screening age group. Early detection as a result of screening decreases mortality (from breast cancer) by about 30 to 35%. That's HUGE and undoubtedly outweighs the risk associated with radiation.

What benefit does this CT scan yield for steroid users in general who are not in the eligible groups on top of risk factors that do not confer radiation risk or are invasive in other ways besides the drawing of blood or measuring blood pressure, etc.? Any benefit is unknown and likely marginal at best. He can laugh at my opinion, but if there's anything to laugh about, it's about this comparison. The comparison to breast cancer screening is appalling.

 

[PeterBond]

Also, your test notes:

The DLP was 116.35 mGy-cm.

If you apply a conversion factor of 0.014 mSv/Mgy*cm to get the effective dose, it boils down to 1.6 mSv. The total dose of the average mammogram is 0.4 mSv. So this is 4 times the radiation exposure of a mammogram, too.

 

[Cherokee]

USPSTF recommends biennial screening for women aged 50 to 74 years, American Cancer Society indeed does recommend annually, but only for 45 to 54. The European Commission Initiative on Breast Cancer recommending mammogram screening every 2 to 3 years for 45-49 year olds, every 2 years for 50-69 year olds, and every 3 years for 70-74 year olds. My country also screens every 2 to 3 years in women aged 50 to 75. Annual is not the norm, and even the American Cancer Society recommends it only during a relatively narrow window of a women's lifetime.

But the most important part here is that a mammogram has a HUGE benefit in this context. Breast cancer incidence is high, about 10% of women develop breast cancer in the screening age group. Early detection decreases mortality by about 30 to 35%. That's HUGE and undoubtedly outweighs the risk associated with radiation.

What benefit does this CT scan yield for steroid users in general who are not in the eligible groups on top of risk factors that do not confer radiation risk or are invasive in other ways besides the drawing of blood or measuring blood pressure, etc.? Any benefit is unknown and likely marginal at best. He can laugh at my opinion, but if there's anything to laugh about, it's about this comparison. The comparison to breast cancer screening is appalling.

He just compared the exposure of the radiation, and said people are not getting cancer from Mammograms. He was not saying the procedure is as beneficial as Breast cancer screening. Just comparing the risks.

For most cancers, the risk was highest for those exposed as children to radiation, and was lower as the age at exposure increased. Depending on the body part getting radiation affects the percentage increase risk of getting cancer.

So they even have a hard time quantifying the risk of radiation dosage.

Which made me wonder... I wonder how this dosage compares to cell phone usage over months and years! If they can measure the dosage in mgy-cm from a CT Scan/xray etc. How much are we getting from Cell Phones?

"The FCC limit for the head (SAR of 1.6 W/kg) is just two-and-a-half times lower than the level that caused behavioral changes in animals (SAR of 4 W/kg). "Thus, the brain receives a high exposure, even though the brain may well be one of the most sensitive parts of human body ... and should have more protection."

I'm getting nervous, I'm going to go put my Tin Hat on.

 

[PeterBond]

He just compared the exposure of the radiation, and said people are not getting cancer from Mammograms. He was not saying the procedure is as beneficial as Breast cancer screening. Just comparing the risks.

They do, but the risk of dying from that is far lower than from dying from breast cancer as a result of not screening: https://www.acpjournals.org/doi/10.7326/M15-1241

Annual screening of 100 000 women aged 40 to 74 years was projected to induce 125 breast cancer cases (95% CI, 88 to 178) leading to 16 deaths (CI, 11 to 23), relative to 968 breast cancer deaths averted by early detection from screening.