Testosterone therapy and the heart: New research finds no increased risk

https://www.wsj.com/articles/testosterone-therapy-can-be-safe-but-there-are-heart-risks-a544b8b5

by shaburn • 3 years ago

88 93 3 years ago

Vecr• 3 years ago

I wonder what the consensus view on trying to use exogenous testosterone for gaining muscle mass, I always thought it was somewhat risky.

Solvency• 3 years ago

Well there's a major difference between TRT and anabolic steroids. Everyone knows the latter is no bueno (for longevity and overall health). The verdict doesn't seem quite so resolved yet on TRT. Literally everything in the world has side effects, though. The men on TRT are likely OK with those (at least until they encounter them...then we'll see what happens a few generations in.)

Also this study means nothing to me. They're looking at a few overall risk factors. There are potentially thousands of factors to consider, all interrelated and deeply codependent. Such is human biology.

Science at large still doesn't truly know how hormones work and interact in their totality within the human body.

Meanwhile, many cardiologists and doctors still buy into the saturated fat myth and myopic "all cholesterol is bad and will lead to heart problems" myth perpetuated by the sugar industry decades ago. So I'm not taking anyone's word yet on any of this.

Ironically, bodybuilders tend to be an amazing source of bleeding edge anecdata on all of this stuff.

adrr6• 3 years ago

Testosterone therapy isn’t about gaining muscle, it is about getting testosterone levels to “normal” ranges. To gain muscles, the dose will be 10x of a therapeutic dose.

treeman79• 3 years ago

It’s not much fun. Get a shot. First couple of days. I FEEL AMAZING! I WANT TO PUNCH EVERYONE! Then you’re good for a couple days. Then your dragging worse then ever. Repeat every week.

Cream for skin is same thing but over the course of a day. Plus it’s crazy expensive.

Eventually decide it’s not worth it and start finding out why levels are low and try and fix underlying causes.

solumunus5• 3 years ago

Not quite true. As a natural your levels fluctuate massively throughout the day. Drink alcohol? Levels will go down. Bad sleep? Levels will go down. Sick? Levels will go down. Low body fat %? Levels will go down. When you’re on TRT you have consistent levels 24/7 no matter what environmental conditions are present. This has a significant effect. You will absolutely be able to more easily build and maintain a good physique on TRT.

coffeebeqn• 3 years ago

Getting into normal ranges can help muscle growth if you’re very low initially. Not bodybuilder levels but a better healthy baseline

leroy_masochist5• 3 years ago

Testosterone therapy isn’t about gaining muscle, it is about getting testosterone levels to “normal” ranges. To gain muscles, the dose will be 10x of a therapeutic dose.

Your math is way off. A TRT dose of testosterone is going to be something like 70-125mg/week. A bodybuilding dose is going to be ~250-350mg/week (often used in conjunction with other compounds like Deca-Durabolin, Trenbolone, Primobolan, Anavar, etc).

An extremely aggressive bodybuilding regimen for a highly experienced anabolic steroid user is rarely going to clear 10x the total milligrams of all AAS compounds injected/ingested when compared to low-dose TRT.

Also, in any human regardless of age and sex, adding a typical TRT dose of testosterone to your system is definitely going to add immediate and noticeable muscle mass.

PragmaticPulp5• 3 years ago

Using exogenous testosterone will shut down your endogenous production, or at least permanently reduce it. A lot of people will try to tell you it can be avoided with the right combination of SERMs and HCG, but there are a lot of people who thought they were doing the exact “right” protocols who end up on TRT because their testicles were permanently atrophied. It’s one of those topics where everybody thinks they’re the exception who will avoid the consequences, but do it long enough and it will happen.

There are also a lot of secondary effects that people underestimate. For example, the extra testosterone (beyond normal levels) will result in excess estrogen, which can grow excess breast tissue in males. There are medications that can interrupt this process, but getting the dosage right is difficult and many people fluctuate around ideal values. Fluctuation and low estrogen values will cause significant mental health effects. Again, these are theoretical avoidable under perfect conditions yet almost everyone ends up with some of it eventually. I had a friend who tried using testosterone all the “right” ways with excessive lab tests, HCG, cycling, SERMs, AIs, and everything else. It still ended up destabilizing his mental health and making him prone to anger and bouts of sadness/crying. He denied it for a long time because he thought it couldn’t possibly be his by-the-book protocol, but eventually we got him to admit it was a problem. Denial runs deep.

Basically: Don’t go down this path unless you accept that it’s going to have significant downsides and consequences, many of which are long lasting or permanent. And definitely don’t dabble in taking testosterone or steroids as an early step in a weightlifting career or as a trial to see if it gives you a boost. The consequences can/will be permanent for the rest of your life.

User232• 3 years ago

Using exogenous testosterone will shut down your endogenous production, or at least permanently reduce it

Can, not will. You're right though to point out that the body loves homeostasis and will downregulate endogenous testosterone production if serum levels are high from supplementation. Testicular atrophy from extended use is a real potential problem.

Unfortunately, TRT clinics are like the Internet Viagra doctors: they are drug dealers with an MD.

If you have low testosterone then see an endocrinologist or a urologist for treatment. There are certainly cases where exogenous testosterone injections are indicated, but depending on the kind of hypogonadism in question there can be better alternatives that don't involve injections or infertility.

It's worth noting that the secular testosterone decline is not a "new normal," but rather basically every man in the West is suffering from some kind of hypogonadism. We can speculate about the causes, but the precipitous drops in average population serum testosterone levels measured over the past decades is anything but natural or normal.

many of which are long lasting or permanent

True, but not all of the permanent effects are negative. Exogenous testosterone causes muscle cell nuclei to multiply, and there is a permanent anabolic effect as a result. It's nowhere near as dramatic as being on exogenous androgens, but it's still significant.

adrr6• 3 years ago

But there are still significant upsides including reduced mortality rates in long term observational studies.

https://www.nature.com/articles/s41366-019-0517-7

adastra222• 3 years ago

Are there ways of boosting endogenous production?

MagicMoonlight3• 3 years ago

It works. Every single athlete you have ever seen is on it. Any woman you see in a bodybuilding competition is on it (no a woman doesn’t have 2% bodyfat and 18 inch arms naturally). Every single celebrity is on it. No, Zac Efron doesn’t naturally have 20 inch arms.

It’s difficult to quantify risk because the people who die are always celebrity coke heads. They tend to die during binge sessions where they’ve slammed 5g of cocaine and had 12 shots.

Steroids increase BP so you need to manage that and you can’t be doing things like cocaine or drinking. The more you take, the worse your BP. That and the cocaine will be the killer.

I’m yet to see anything obviously harmful about testosterone. Some of the drugs that have branched off it have signs of harm but that might be due to increased strength or changed structure.

People are talking about your penis shrinking or whatever. Your testes do shrink but it’s not permanent. You need to make sure all traces of the drugs are out of your body before the system will start back up and that’s where people get stuck. Some drugs have metabolites that can last years. Testosterone isn’t the same but still takes time depending on the half life of the form.

Ironically women have the easiest time of it. Their hormone system doesn’t care about testosterone so they can go on and off whenever they want. The downside for women is the androgenisation. They start growing facial hair, deepening their voice and enlarging their clit. That’s a dealbreaker for most women for obvious reasons so a woman would need to be seriously committed to this.

For men, having a thicker beard and masculine features is a good thing so that’s fine. It will accelerate your rate of hair loss though.

It affects your personality. You are happier, braver, more focused and more aggressive. You feel like the leader of the pack no matter how pathetic you are. That confidence might be good or bad for you. You’ll be a lot more likely to approach women because you are continously aroused. You may be more of a cunt.

In summary, like all things it is a trade-off. You might die, but you’ll be the best you could ever be at physical sport. If you don’t care about sport then that’s not a great trade. Some people do drugs at weekends and kill themselves for parties. Lots of people make trades. This isn’t a casual trade to make, you need to think it through.

solumunus5• 3 years ago

The confidence thing is way overblown, very few people actually report that. The myth is perpetuated exclusively by people who have never taken steroids. Personally I feel exactly the same on almost any compound, the exception being tren which made me incredibly irritable. When I first tried them I thought I’d been sold fake gear because there was literally no difference in feeling compared to being natural. After being in the community for half a decade I can tell you that this is an extremely common experience.

leroy_masochist5• 3 years ago

Any woman you see in a bodybuilding competition is on it (no a woman doesn’t have 2% bodyfat and 18 inch arms naturally).

Not to nitpick, but this actually isn't true. A lot of these women don't run testosterone, but do run PEDs like Anavar (oxandralone) or SARMs like Ostarine that have a very high anabolic-androgenic ratio.

Their hormone system doesn’t care about testosterone so they can go on and off whenever they want.

Their hormone system does, in fact, care about testosterone. The difference, however, is that women naturally produce an infintesimally small amount amount of testosterone compared to men, so post-cycle effects and treatment protocols will be vastly different.

tedunangst6• 3 years ago

How about research into whether a 55 year old actually requires the T levels of a 25 year old or whether they can make do naturally?

indecisive_user2• 3 years ago

If I could choose between feeling like a 55 year old and a 25 year old, why would I pick the former?

If there are no major health consequences then what's there even to consider outside of cost?

AngryData• 3 years ago

Is a temporary boost worth developing a reliance on such medication? From what ive seen your body quickly adapts to the testosterone, and while it feels good initially eventually you are back to the same baseline, except now if you stop taking it you will feel even worse as the levels drop below what your initial baseline was to start with. And many people will resort to taking even higher and higher doses, chasing the "high" that they got from it initially.

mbg721• 3 years ago

For what purpose, living forever? Like suddenly being 25 is going to vanish into thin air with no consequences?

hulitu• 3 years ago

If I could choose between feeling like a 55 year old and a 25 year old, why would I pick the former?

Theoretically, you are wiser at 55. /s

itairall2• 3 years ago

I am 100% pro TRT but if a person starts in their 40s, I just highly doubt it will be a free lunch if you are on TRT for 40 years.

On the other hand, there is no way to know at the individual level all the healthy habits that would come with TRT. This discussion is always from the point as if everyone is optimally healthy when reality is the opposite. Even just getting bloodwork done so much more than you would without TRT is a huge factor. No one is taking TRT and then playing video games and eating pizza all day.

The real downside to me though is having to get a supply of testosterone for decades. We are just so irrational on this subject that who knows what will happen in 10 years. The proposed hoops to have to jump through that are being debated right now are completely insane. Having to see a doctor in person once a month would be utterly ridiculous.

rblatz• 3 years ago

Of course they can, but they feel better at elevated T levels.

PragmaticPulp5• 3 years ago

TRT is tricky because patients will feel an initial boost in their early treatment. They assume this feeling is their new normal, but then things level out and they go back to a more normal-ish feeling.

Severe testosterone deficiencies respond very well to treatment. Going from 55 year old to 25 year old levels isn’t as dramatic.

TRT forums are full of people with normal or low-normal who thought TRT was going to solve all of their problems and make them feel young again, only to be disappointed that they don’t really feel much of anything after a while. However, now they’re stuck on it for life because their endogenous production has dropped off.

adrr6• 3 years ago

You can just dose on HCG for a month and your natural levels will come back.

eljimmy• 3 years ago

"Sure, you can overclock that CPU, but why?"

I dislike questions that challenge pushing the limits of our existence.

tedunangst6• 3 years ago

Do you also dislike questioning whether pushing the limits of existence accomplishes anything? What questions do you think should be permitted?

archo• 3 years ago

https://archive.is/eu1eH

steele• 3 years ago

Gender affirming care for everyone

m00x• 3 years ago

Going from man to very man.

MagicMoonlight3• 3 years ago

If a woman can get testosterone because she feels like feeling like a man then men should be able to get their own hormones.

Women are allowed testosterone for menopause as well which is really bullshit. They can get it over the counter while a man faces deep scrutiny if his hormone levels have dropped with age.

leroy_masochist5• 3 years ago

Seeing a lot of conflation of a) TRT dosages of T, b) bodybuilding dosages of TRT, and c) T-related PEDs in these comments.

I think the key things to remember here are:

*Monitoring your own response to the therapy is key, whether you're a middle-aged man getting shots of Sustanon at your doctor's office or a professional bodybuilder running over a gram of androgens every week. There is no substitute for regular bloodwork. Some people's livers handle this shit better than others'.

*Contra some of the posts on this thread, not all PEDs are going to permanently shut down your HPTA. In fact, basically nothing is. People decide that they're "permanently damaged" because they expect PCT to fully take care of the shutdown and then can't ride out a few weeks of cold turkey. The testes restart, but they're like a diesel engine; it takes a while to get them going again.

*On a similar note, not all PEDs are going to automatically kill you. Some, like methenolone, are if anything beneficial to overall health and longevity. Others, like halotestin, are probably going to take years off your life. Do your own research and, again, get bloodwork done regularly.

*Finally, it's interesting to hear comments from people saying the "wanted to punch everyone", etc, when they started TRT. At TRT doses, most men experience a sense of calm and confidence, rather than irascibility.

mgarfias• 3 years ago

*Finally, it's interesting to hear comments from people saying the "wanted to punch everyone", etc, when they started TRT. At TRT doses, most men experience a sense of calm and confidence, rather than irascibility.

Yup. When off the stuff I’m super irritable. On it I’m calm. Too bad it turned my blood into 140w gear oil. I’ve been waiting 6mps to get into an endo who up and quit and now I’m waiting more.

sfjailbird• 3 years ago

it's interesting to hear comments from people saying the "wanted to punch everyone", etc, when they started TRT. At TRT doses, most men experience a sense of calm and confidence, rather than irascibility.

Adding testosterone also raises estrogen (estradiol) which causes irritability. It is hard to find a balance where both are in check.

leroy_masochist5• 3 years ago

That's why you get your blood work done and titrate anastrozole, which a good TRT-prescribing office is going to do without you asking. I would disagree with your contention that it is hard to dial in estradiol. It is, in fact, a very straightforward process based off of blood labs.

ajcp2• 3 years ago

It's not hard at all if you do initial bloodwork to establish baseline estradiol. After that and depending on the results the TRT regime should include an estrogen blocker to negate a rise.

temporallobe• 3 years ago

I had to go on TRT about six years ago because of brain tumor (prolactinoma) that effectively destroyed my ability to produce testosterone. My prescribing doctor was and is an endocrinologist, and he told me from the very beginning that there was no direct increased risk for cardiac events, but it does increase RBC, so hypertension becomes a risk, with all of the obvious negatives that comes with. If you’re on TRT or plan on doing it in the future, regularly check your BP. I believe regular blood tests is the standard protocol as well.

My experience is that I have a slightly better mood, BUT, I have increased libido that does a crazy spike about halfway through the cycle (where I feel a raging insatiable teenager), followed by a significant drop in both mood and libido. It’s rather annoying, but better than the alternative.

rhinoceraptor3• 3 years ago

Do you have to go in to an office to get it? If not you can just split your dose in half and double the frequency. The reduced fluid volume also means you can do subcutaneous instead of intramuscular so it's less of a hassle.

Llamamoe2• 3 years ago

This is why I added a low dose SARM to my feminizing HRT. I wish I realized earlier how much it was contributing to my already problematically low BP.

solumunus5• 3 years ago

Sounds like he has you on a terrible prescription. Undecanoate every few months? With a proper dosing schedule you won’t have these peaks and crashes. Unfortunately, in most places the common prescriptions for these things make absolutely no sense!

backtoyoujim• 3 years ago

Glad to see gender therapy is doing fine for CIS males, I suppose.

thesaintlives6• 3 years ago

My experience:

1.Taking PED's is amazing.

2.Permanently shutting off your own test production is complete nonsense.

3.PCT did nothing for me. When you come off expect to feel low. Bridge with HGH.

4.Arimidex etc. is not always necessary. I never bothered and had no problems.

5.Microdosing is complete bollocks.

5.Be sensible. Unless you are going for peak athletic performance look for other ways to increase your testosterone levels etc.

6.Start slowly and build up your dose and the compounds as you require.

7.Tren is the absolute last thing to try.

8.There is no magic bullet. Results take work and dedication.

Questions? Details? Disagree? Comment..

jychang2• 3 years ago

What do you mean by bridge with HGH? How does that affect mood/“feeling low”?

thesaintlives6• 3 years ago

It makes you feel a little better mentally and helps you keep up a slightly different training routine (more aerobic based, not as heavy). It also allows your own system to come back online. I know this from doing it and it is also suggested by one the guys I really like listening to with regards to what and how to use these drugs - Broderick Chavez...

willio58• 3 years ago

1.Taking PED's is amazing.

I feel like we need more research on the negative effects long term of specific PEDs. I’m not willing to sacrifice any years on the backend of my life for the appearance of myself now, but if I had guarantees that managed properly I wouldn’t change my lifespan negatively I would consider it.

The other whole aspect is how these affect you mentally. Like the classic “roid rage”, is that avoidable if you take a manageable dose or is something like that inevitable with taking drugs that manipulate your hormones?

thesaintlives6• 3 years ago

Yes. For sure. I love sex and I am an older guy. Many women love a jacked guy. For me the risk reward ratio was totally worth it. I did it from 16 to 19 years of age (not sensible) and then from 49 onwards (sensible). 250mg a week and under you get virtually no side effects. Most certainly not roid rage. Only positive mental attitude adjustments. 500mg and over you know about it. Many side effects, not positive. I weigh about 95kg naturally. Base how much you need for what you want to get on how big you are and how big you want to become..

credit_guy• 3 years ago

look for other ways to increase your testosterone levels

Can you point to anything? The market and the internet are full of "increase your testosterone naturally" scams. It's very difficult to separate signal from noise.

ajcp2• 3 years ago

Minimize alcohol intake, maximize sleep efficiency, stabilize and simplify diet, and engage in physical exercise. As unmagical these things sound they have been shown to help keep your natural testosterone production at its best.

thesaintlives6• 3 years ago

Exercise. Eat meat. Don't eat junk food or food from plastic. See what your levels actually are. Look at the water you are drinking. Make sure nothing is adversely affecting your endocrine system and you are not getting extra estrogen from somewhere. A fit young man should be oozing testosterone!

thesaintlives6• 3 years ago

Oh.. I will just throw this in - more than likely all those pills and potions are complete bunk. Just like protein powder - complete bunk. Eat food and drink full fat milk if you want to get more calories..

Testosterone therapy and the heart: New research finds no increased risk

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