To TRT, or not to TRT that is the question.

[mrgeeky]

Cant make up my mind. thinking of going back on TRT. great quality of life while on, but what are the dangers?  Well if the endo I saw was correct and going by wiki he is, then there are definite dangers of heart attack and stroke as we get older. 


Cant make up my mind if its worth the risk. "

"THE Food and Drug Administration (FDA) stated in 2015 that neither the benefits nor the safety of testosterone have been established for low testosterone levels due to ageing.^[18] The have required the label to increase information about the possibility of an increased risk of heart attacks and stroke.^[18]

On January 31, 2014, reports of strokes, heart attacks, and deaths in men taking testosterone-replacement led the FDA to announce that it would be investigating this issue.^[19]FDA's action followed three peer-reviewed studies of increased cardiovascular events and deaths.^[20] Also in November 2013, a study in the Journal of the American Medical Association reported an increase of 30% in deaths and heart attacks in older men.<sup>[21]"

http://en.wikipedia.org/wiki/Androgen_replacement_therapy#Diabetes_and_testosterone</sup>




 

 

[mrgeeky]

One has to wonder, for TRT to cause heart attacks, wouldn't one have to build up to it by using for a while? I mean, if you take and suddenly have a heart attack, isn't it more likey that the issue was already sitting there waiting to happen?

[jimmybro1]

Surely if you keep your cardiovascular system healthy you will be fine, I would imagine with age this risk increases for everyone as less cholesterol is converted to testosterone as you age.    

 

Thats my understanding anyway someone will correct me if i'm wrong. 

 

There maybe some increased risk of prostate cancer though due to prostate growth but you will need the cancerous cells for this to be the case and prostate cancer is a slow progressing cancer so may not even be an issue in your lifetime.

 

By keeping cholesterol and blood pressure in check you should be fine, just need to remember these things naturally increase with age hence why you hear about people in there 60s-80s having heart attacks and strokes. I would avoid stimulants also to reduce risk.  

 

This health issues are coming to all of us at some stage of your life might as well make life at the moment as enjoyable and comfortable as one day it's going to go to cake anyway. If hormone replacement therapy improves your quality of life I would have thought it was a no brainer.  

[atrollappears]

One has to wonder, for TRT to cause heart attacks, wouldn't one have to build up to it by using for a while? I mean, if you take and suddenly have a heart attack, isn't it more likey that the issue was already sitting there waiting to happen?

 

More likely if a lifetime smoker, or fat bastard with decades of poor dietary choices..

 

There is evidence to suggest some anabolic steroids increase blood pressure, and are responsible for fibrosis in cardiac tissue, this can be monitored and symptoms reduced with early use of ACE inhibitors or ARB's... 

[mrgeeky]

The endo I saw said, they did a study recently, where that many on TRT compared to the placebo group, started dying or having strokes that they had to stop the study.
My understanding these were people that had 10 years or more on me, but still scarey stuff. .

His idea was to just back off until more studies are done.  But how longs that going to take? I don't think its a no brainer Jimmybro. Imagine going back on TRT, having a stroke and going, oh f*ck why didn't I listen to the endo. But no doubt about it, life was better on.

Im just trying to nut out if its worth the risk and what the risks are.. Must see if I can find that study again and post it.



 

[mrgeeky]

ACE inhibitors or ARB's????? off for a google..

[atrollappears]

High blood pressure independent of AAS causes enlargement of the heart.  AAS gives a second hit.  The smooth muscle of the cardiovascular system is AR positive.  At high AAS concentration those muscle cells will hypertrophy. The job of the smooth muscle in the musculature is to pump rhythmically in a wave like form to assist the movement of blood.  With AAS induced hypertrophy of the smooth muscle that motion is compromised shifting more of the burden to the heart. Now I'm too old to play go fetch the pubmed abstracts but if you dig there you can find the support. It's an inconvenient truth but just be aware of it and try to limit super high dose use and control blood pressure.  One of the reasons that Diovan is so good for AAS users for blood pressure control is because it relaxes the smooth muscle of the vasculature opening the diameter and relieving some of the tension caused by hypertrophy.

 

there are old men in their 70's who are taking hormone replacement therapy because testosterone naturally declines.

it's safe for them if it's taken properly and without a prior genetic condition. i would say check if you have a family history of heart problems and also work on your diet to raise your hdl cholesterol.

http://www.ncbi.nlm.nih.gov/pubmed/22956867

"TRT was well tolerated in older patients, successfully increased testosterone level regardless of age, and did not significantly increase PSA levels in older men."

 

I don't want us to compare apples and oranges.  These guys were on a cream probably getting them to about 500 ng/dL on a normal range scale of 300-1100 ng/dL. So, we are really not looking here at anything close to what the plasma levels are here even for someone on 500 mg/w of Test C.  In that case the plasma levels would be 2000-2500 ng/dL. that would be double the top of normal range. There the results might be quite different in older men.  For instance old men are more likely to have erythrocytosis, which means really high red cells and that can place them at risk of cardiac stress and stroke.

 

Any medication that controls blood pressure (an inotrope) and to a lesser extent pulse rate (a chronotrope) while on AAS will reduce or prevent left ventricular hypertrophy (LVH) - this includes diuretics, beta blockers, alpha blockers, calcium channel blockers, ACE inhibitors as well as ARBs. But LVH in itself is not necessarily an issue. It often reflects the fact that bodybuilders have developed the significantly superior heart function and strength required to shift large weights and feed powerful muscles - what would be called an 'athletic' adaptation.

The problem is when this coincides with fibrosis in cardiovascular tissues. In this instance fibrosis is the deposition of less flexible collagen not just in the heart but in arteries and veins across the body. This seems to occur directly and indirectly as a result of AAS use, and some AAS are worse than others - eg Deca is notoriously bad. This extra collagen makes the cardiovascular tissues a bit 'stiffer' and increases the pressure (force) required by the heart to pump blood through the body (increases the 'load').

As a result, a rather less healthy (and structurally maladaptive) deposition of new muscle (LVH) will occur in an attempt to overcome the strain of the increasing load, and once past a certain size, it begins to reduce the efficiency of the heart as a pump. But the fibrosis also affects things like the passage of nerve impulses across the heart (often resulting in atrial fibrillation or heart block, for example), and interferes with the essential growth of new blood vessels (angiogenesis) to the new cardiac muscle, potentially starving these tissues of oxygen, resulting in pain (angina), necrosis and scarring. And the scarring makes the heart even more inflexible, and is thus basically a very unwelcome positive feedback loop.

All these outcomes are incredibly unhealthy for the heart, and probably explain why some powerlifters/bodybuilders (anecdotally, and I suppose relative to their otherwise incredibly healthy looking bodies) seem to suffer disproportionately from heart attacks, afib etc etc. ARBs are unusual in their ability to reverse tissue fibrosis, and as a bonus can also reduce blood pressure, which is a major trigger for unhealthy LVH. N-acetylcysteine has potentially been shown to have benefits in reducing fibrosis, but these unfortunately cancel out those of the ARB!

 

To clarify, fibrosis can be reversed, though it's unlikely to be fully, and not in everyone. And the damage to other tissues such as heart valves (due to fibrotic stiffness and years of elevated BP and raised PCV) is unlikely to be reversed.

Prevention is logically going to be a safer course of action. Unfortunately, though some compounds are thought to be harsher, there is scant human research (for obvious reasons).

BP medication should still be in everyone's arsenal though: even beyond the fibrosis aspect, controlling elevated blood pressure and the effects of raised haematocrit (PCV) should be universally important for all AAS using bodybuilders.

This means giving blood on a regular basis would also be wise (or doing it yourself via vacuum tubes if you've the balls lol).

And as for pre-workout stimulants dramatically aggravating all of the effects we've just been discussing.... LOL.

Losartan is the most heavily researched of the ARBs with regards to reversing fibrosis. Angiotensin receptor blockers (ARBs) are generally suffixed with ~sartan.

However one of the most efficacious of the ~sartans, at least in research, is Olmesartan, closely followed by Irbesartan. But really, most of this will simply come down to what you can get your hands on and at what price.

In the absence of any of the ARBs, you could try any of the other blood pressure medications (ACE inhibitors are probably the next choice, though personally I'd avoid diuretics), with a fairly high dose of N-acetylcysteine (iirc it was about 2g daily). The NAC approach is not as effective but it does offer something I suppose.

FWIW both ACE-inhibitors and ARBs are slightly less effective for people of West African origin (blacks) with regards to blood pressure reduction (due to differences in the renin system); the anti-fibrotic effect should remain however.

[jimmybro1]

The endo I saw said, they did a study recently, where that many on TRT compared to the placebo group, started dying or having strokes that they had to stop the study.

My understanding these were people that had 10 years or more on me, but still scarey stuff. .

His idea was to just back off until more studies are done.  But how longs that going to take? I don't think its a no brainer Jimmybro. Imagine going back on TRT, having a stroke and going, oh f*ck why didn't I listen to the endo. But no doubt about it, life was better on.

Im just trying to nut out if its worth the risk and what the risks are.. Must see if I can find that study again and post it.

 

Your endo isn't going to want to take any risk at all so of course he is going to suggest otherwise. 

 

Your just going to have to weigh up the pros and cons yourself and make a decision. If I had low levels that was affecting my lifestyle I know what my decision would be. 

 

Your only supplementing to have normal levels of testosterone not ridiculously high levels.... I would just keep an eye on health markers... having low testosterone can also cause lots of health issues...   

[atrollappears]

ACE inhibitors or ARB's????? off for a google..

 

Angiotensin II raises blood pressure, ACE inhibitor blocks enzymatic conversion...

 

ARB's block the receptor.... (much better as they dont blunt skeletal muscle hypertophy)....

[mrgeeky]

cheers guys, some great reading..

[mrgeeky]

http://www.peoplespharmacy.com/2013/05/31/popular-blood-pressure-pills-under-cancer-cloud/

Is Cartia  the low dose  blood thinning disprin / asprin come under the list of ACE - inhibitors, or ARB's list?


 

[maccaz]

daz, what would you recommend for someone who has bp naturally on the high side

 

losing a lot of fat/weight has improved it a little but only to a point and doctor basically said "some people have naturally slightly higher bp, dont worry"  but if i wanted to take preventative action for when I'm older, what would be best?

 

even when i was very fit, 75 odd kg and quite lean, generally healthy, my bp was up a little, so i tend to believe that it is just naturally a little high.

[atrollappears]

http://www.peoplespharmacy.com/2013/05/31/popular-blood-pressure-pills-under-cancer-cloud/

Is Cartia  the low dose  blood thinning disprin / asprin come under the list of ACE - inhibitors, or ARB's list?

 

 

Nope.... Cartia is a Calcium channel blocker.... Aspirin is an anti-platelet and has nothing to do with lowering BP...

[atrollappears]

daz, what would you recommend for someone who has bp naturally on the high side

 

losing a lot of fat/weight has improved it a little but only to a point and doctor basically said "some people have naturally slightly higher bp, dont worry"  but if i wanted to take preventative action for when I'm older, what would be best?

 

even when i was very fit, 75 odd kg and quite lean, generally healthy, my bp was up a little, so i tend to believe that it is just naturally a little high.

 

What do you call high..?

 

Are you natural or enhanced..?