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  1. #1
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    Does Testosterone Replacement Therapy Increase Your Risk of Heart Attack?

    This has been a big issue in the news in the past year so I thought I would start here. There are only two studies that started this entire debacle and both were retrospective studies. This means they did not monitor the patients while they were on testosterone, they went into a database after the fact and made the determination with medical records.

    Since coming out many physicians, one in particular who is the foremost expert in the world on TRT, came out and said they have no ice how the study came to its conclusion. On top of this the patients already had pre existing conditions.

    Posted below are the many reviews of the literature since it came out contradicting the accusation that TRT increases your risk of heart attack. Feel free to respond to the thread and let us know what you think.


    [FONT=Tahoma]A review of literature published online in Mayo Clinic Proceedings (Jan. 26, 2015) has found no evidence that testosterone therapy increases cardiovascular risk, although one mens health expert cautions that thorough patient counseling is necessary and that only a well-controlled prospective study will definitively answer questions surrounding testosterone and cardiovascular risk.[/FONT]

    [FONT=Tahoma]The reviews lead author, Abraham Morgentaler, MD, of Mens Health Boston and Beth Israel Deaconess Medical Center, Boston, called it the most comprehensive and definitive review to date.[/FONT]

    http://urologytimes.modernmedicine.com/urology-times/RC/trt-review-finds-no-evidence-cardiovascular-risk



    [FONT=Tahoma]The public judgment of the overselling of testosterone therapy demands a response, stated the lead author, Martin Miner, MD, Clinical Associate Professor of Family Medicine and Urology, Warren Alpert Medical School of Brown University.[/FONT]

    As researchers and clinicians with extensive experience with testosterone deficiency and its treatment, we do not find any credible evidence that testosterone prescriptions increase health risks. We find the assertion that testosterone is prescribed to men who are simply reluctant to accept the fact that they are getting older is without foundation, and we object to comments that question the reality of testosterone deficiency, regardless of whether it is called hypogonadism or, as in advertisements, low T, Dr Miner stated.

    In addition, in our opinion, the idea that physicians prescribe testosterone due to pressure from drug companies is irresponsible and not supported by scientific evidence."

    Over-the-top comments tend to scare both patients and physicians.
    The FDA announcement that it is investigating the reports of increased cardiovascular risks has only added to the impression that a major study has determined serious problems with testosterone therapy, he stated.

    A case in point is a recent report1 published in PLoS ONE that investigated the risk of acute nonfatal myocardial infarction (MI) in a retrospective cohort study of a health-claims database. The authors compared the rates of MI within the first 90 days of an initial prescription for testosterone with the rates of MI for the 12 prior months in nearly 56 000 men. They also examined pre- and post-prescription incidence rates for nonfatal MI in another large cohort of more than 167 000 men for whom only phosphodiesterase-5 inhibitor (PDE5i) medications were prescribed, and after adjusting for potential confounders, compared these results to those of men who received testosterone prescriptions.

    The authors concluded that the risk of MI following testosterone prescription was substantially increased (at least twofold) in older men and younger men with preexisting, diagnosed heart disease.

    A close examination reveals that this study is too flawed to provide meaningful information on the cardiovascular risk of testosterone therapy, stated Dr Miner. First, the overall rate of nonfatal MI in the testosterone-treated group increased in all ages from 3.48 to 4.75 per 1,000 person-years. This amounts to just greater than one additional MI in 1,000 years of exposure to testosterone. It is misleading to characterize this increase as substantial based on relative risk when the absolute risk is so small and clinically meaningless.

    Also, the study duration (90 days) was short, and a true control group would have consisted of men with untreated testosterone deficiency, not those who received PDE5i medications. The overall risk was low, and the number of events in subgroups was remarkably few, he noted.

    More data from larger, longer term studies are needed to assess the potential effects of testosterone therapy on cardiovascular events in men. Based on the current evidence, he stated, "we can find no foundation for suggesting new restrictions on testosterone therapy in men with cardiac disease."

    The researchers reported their results2 in the April 8, 2014 issue of Journal of Men's Health.


    http://www.consultantlive.com/mens-health/evidence-testosterone-therapy-does-not-support-cardiac-risk


    [FONT=Tahoma]Abstract[/FONT]
    [FONT=Tahoma]Although numerous randomized studies have shown that testosterone replacement therapy (TRT) improves intermediate outcomes in patients at risk and in those with proven cardiovascular disease (CVD), results derived mainly from registries and observational studies have suggested an increased cardiovascular risk in elderly men receiving often supra-therapeutic doses of testosterone. Recent meta-analyses have shown that when testosterone has been used in patients with pre-existing cardiovascular conditions, the effect on the disease has been either beneficial or neutral. Similar results have been reported in hypo- and eugonadal men. Contrasting results have been reported by two trials of testosterone treatment in frail elderly men.[/FONT] Reports from poorly analyzed databases have reported an increased risk of cardiovascular events with testosterone use. More recently, a population-based study showed no increased cardiovascular risk of testosterone replacement in hypogonadal men. Available data from controlled clinical trials suggest that the use of testosterone in elderly men does not increase cardiovascular risk nor the risk of events. Studies in men with CVD, angina, or heart failure report a benefit from testosterone replacement in men with or without hypogonadism. Therefore, at present, the cardiovascular benefits of TRT in elderly men outweigh the risks. This is particularly evident in those men with pre-existing CVD.

    http://link.springer.com/article/10.1007/s12020-015-0561-6



    [FONT=Tahoma]A newly published review suggests that age-related testosterone deficiency treatment with intramuscular injections of testosterone replacement therapy (TRT) offers health benefits and lower cardiovascular risk compared to testosterone replacement by patch or gel.[/FONT]
    [FONT=Tahoma]While TRT can result in increased muscle mass and strength, decreased fat mass, and increased bone mineral density, the therapy has known risks. These include the development of polycythemia, decreases in high-density lipoprotein cholesterol, breast tenderness and enlargement, and prostate issues.[/FONT]

    The authors point out, however, that TRT does not increase prostate cancer risk. And whether TRT hurts, helps, or has no effect on cardiovascular risk remains controversial in the literature.

    The University of Florida, Gainesville, researchers who conducted this latest review were among the authors of a previously published study suggesting that oral TRT increases cardiovascular risk, but no significant cardiovascular effects were noted with injected or transdermal TRT (BMC Med 2014; 12:211).
    [FONT=Tahoma]For the current study, which was published online in the American Journal of Physiology Endocrinology and Metabolism (April 21, 2015), study authors Stephen E. Borst, PhD, and Joshua F. Yarrow, PhD, reviewed literature indicating that intramuscular injected TRT produces greater musculoskeletal benefits and lower cardiovascular risk compared to transdermal TRT We also review the literature discussing the use of 5-reductase inhibitors as a promising means of improving the safety profile of TRT.[/FONT]
    [FONT=Tahoma]According to the authors, for older hypogonadal men, administering TRT by injection, versus orally or transdermally, offers greater musculoskeletal benefits because doses are higher by injection. But while doses are higher when injected, intramuscular TRT might be less likely to result in cardiovascular risks than transdermal TRT. This could be because transdermal testosterone results in greater serum dihydrotestosterone (DHT) elevation, due to significant expression of 5-reductase in skin not muscle.[/FONT]



    http://www.steroidology.com/forum/testosterone-replacement-therapy/676385-trt-review-finds-no-evidence-cardiovascular-risk-jan-30-2015-a.html


    And finally below is our take on the issue that we actually published before any of these studies came out.



    [FONT=Tahoma]TOTAL MEN IN THE STUDY: 8,709[/FONT]
    [FONT=Tahoma]MEN ON TESTOSTERONE: 1,223[/FONT]
    [FONT=Tahoma]67 deaths, 23 MIs and 33 strokes for a total of 123 = 10%[/FONT]

    [FONT=Tahoma]MEN NOT ON TESTOSTERONE: 7,486[/FONT]
    [FONT=Tahoma]681 deaths, 420 MIs and 486 strokes for a total of 1,587 = 20%[/FONT]

    Im not great a math but I am failing to see the correlation. It seems to me the testosterone actually helped.

    Nowhere in the study does it say what form of testosterone or how much they were given. No one has a clue what these patients were actually taking since they were not being controlled, the study of the data was done long after the men were placed on testosterone.

    The study honestly sounds more like a lawyer wrote it than researchers because it links numerous other studies to it in order to come to its conclusion, in my humble opinion its no more than very biased school report
    .




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    Last edited by Kayce; 06-03-2016 at 12:55 AM.



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  2. #2
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    Re: Does Testosterone Replacement Therapy Increase Your Risk of Heart Attack?

    Look up Dr. Jeffrey Life and he has a great deal of information on the misnomers of TRT in the medical community. He's in his 70s and jacked as shit.


    Joe Pietaro
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  3. #3
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    Re: Does Testosterone Replacement Therapy Increase Your Risk of Heart Attack?

    Say what you want to say, but my friend was on steroids for a quite a long time, when he finished using them, he had such a heart problem that he had a surgery on it, and now he is on medical treatment in England. I would be the one to say no, wait, let's look at his health results from the past, but they were all alright




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    Re: Does Testosterone Replacement Therapy Increase Your Risk of Heart Attack?

    There is a difference between TRT (where you try to put your test level in the middle of the normal range) and blasting (where you try to put your test level way, way above the normal range). Studies have shown that men with Low T actually have a higher rate of heart problems then the general population. This means that raising them up into the normal range (the goal of TRT) actually REDUCES the risk of heart issues.

    I am not sure if there are any studies about long term effects of routinely keeping your test level in the several thousand range. I cannot image it would be good for you. Short bursts, sure, but routinely...




  5. #5
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    Re: Does Testosterone Replacement Therapy Increase Your Risk of Heart Attack?

    Here is another study that not only show the importance of testosterone as we age but IGF-1 and DHEA:


    [FONT=&quot]Marcello Maggio ∑ Fulvio Lauretani ∑ Gian Paolo Ceda ∑ Luigi Ferrucci. [/FONT][FONT=&quot]Relationship Between Low Levels of Anabolic Hormones and 6-Year Mortality in Older Men.[/FONT][FONT=&quot][/FONT][FONT=&quot]Archives of Internal Medicine 167(20):2249-54 ∑ November 2007[/FONT]

    [FONT=&quot]Abstract[/FONT]
    [FONT=&quot]Aging in men is characterized by a progressive decline in levels of anabolic hormones, such as testosterone, insulinlike growth factor 1 (IGF-1), and dehydroepiandrosterone sulfate (DHEA-S). We hypothesized that in older men a parallel age-associated decline in bioavailable testosterone, IGF-1, and DHEA-S secretion is associated with higher mortality independent of potential confounders. Testosterone, IGF-1, DHEA-S, and demographic features were evaluated in a representative sample of 410 men 65 years and older enrolled in the Aging in the Chianti Area (InCHIANTI) study. A total of 126 men died during the 6-year follow-up. Thresholds for lowest-quartile definitions were 70 ng/dL (to convert to nanomoles per liter, multiply by 0.0347) for bioavailable testosterone, 63.9 ng/mL (to convert to nanomoles per liter, multiply by 0.131) for total IGF-1, and 50 microg/dL (to convert to micromoles per liter, multiply by 0.027) for DHEA-S. Men were divided into 4 groups: no hormone in the lowest quartile (reference) and 1, 2, and 3 hormones in the lowest quartiles. Kaplan-Meier survival and Cox proportional hazards models adjusted for confounders were used in the analysis. Compared with men with levels of all 3 hormones above the lowest quartiles, having 1, 2, and 3 dysregulated hormones was associated with hazard ratios for mortality of 1.47 (95% confidence interval [CI], 0.88-2.44), 1.85 (95% CI, 1.04-3.30), and 2.29 (95% CI, 1.12-4.68), respectively (test for trend, P <.001). In the fully adjusted analysis, only men with 3 anabolic hormone deficiencies had a significant increase in mortality (hazard ratio, 2.44; 95% CI, 1.09-5.46 (test for trend, P <.001). Age-associated decline in anabolic hormone levels is a strong independent predictor of mortality in older men. Having multiple hormonal deficiencies rather than a deficiency in a single anabolic hormone is a robust biomarker of health status in older persons. [/FONT]

    [FONT=&quot]In this study, researchers found that independent of age and multiple potential confounders, low circulating levels of multiple anabolic hormones, including testosterone, IGF-1, and DHEA-S (in the lowest quartiles of the population), were an independent predictor of mortality during 6 years of follow-up of 410 men 65 years and older. Researchers pointed out that there is a synergistic effect between the three hormones in that DHEA-S can be converted to testosterone in peripheral tissues, and some of the peripheral actions of both DHEA-S and testosterone may be mediated via tissue-generated IGF-1.[/FONT]




  6. #6
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    Re: Does Testosterone Replacement Therapy Increase Your Risk of Heart Attack?

    In my opinion, the main reason that it is assumed that trt will increase the risk for a heart attack is primarily due to the increase that is seen in the hematocrit levels. If you work smart and monitor your CBC as well as your hormone levels then there are ways to alleviate problems as they arise. Just like any other medication, trt can have side effects. Some Good, Some Bad. Low dose asa is effective at thinning the blood and so is therapeutic blood donation's so the elevated hematocrit becomes irrelative if monitored.




  7. #7
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    Re: Does Testosterone Replacement Therapy Increase Your Risk of Heart Attack?

    Quote Originally Posted by Push50 View Post
    In my opinion, the main reason that it is assumed that trt will increase the risk for a heart attack is primarily due to the increase that is seen in the hematocrit levels. If you work smart and monitor your CBC as well as your hormone levels then there are ways to alleviate problems as they arise. Just like any other medication, trt can have side effects. Some Good, Some Bad. Low dose asa is effective at thinning the blood and so is therapeutic blood donation's so the elevated hematocrit becomes irrelative if monitored.
    Just gotta be careful.


    The musclemecca bodybuilding news guy


  8. #8
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    Re: Does Testosterone Replacement Therapy Increase Your Risk of Heart Attack?

    Quote Originally Posted by lmilic View Post
    Say what you want to say, but my friend was on steroids for a quite a long time, when he finished using them, he had such a heart problem that he had a surgery on it, and now he is on medical treatment in England. I would be the one to say no, wait, let's look at his health results from the past, but they were all alright
    Big difference between TRT and AAS. TRT dosages typically will not rise much over 200mg/wk. The heart is a muscle and AAS gives us the ability to create hypertrophy in muscles. The exact amount of hypertrophic that the heart receives is going to very just st like gains from bro to bro.




  9. #9
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    Re: Does Testosterone Replacement Therapy Increase Your Risk of Heart Attack?

    The FDA is a little worried about testosterone. But you know who isnít worried about testosterone at all? The Journal of the American Heart Association (AHA)!
    Itís a basic fact of testosterone science that some people have higher levels of an enzyme called aromatase that converts testosterone to estrogen. Every man needs some estrogen for sperm maturation and a healthy libido, but if the levels of estrogen get too high, it can potentially lead to heart attack and stroke.
    Thatís why any responsible TRT doctor will, if necessary, prescribe medications (anti-aromatases) to regulate estrogen levels that are out of whack.
    Similarly, if testosterone is over-dosed and not monitored, it can potentially lead to the production of more red blood cells, which makes the blood thicker and harder to pump, which in itself can lead to heart attack or stroke.
    A meta-study in the Journal of the American Heart Association (meta-study link) looked at over 100 testosterone studies and they saw that higher levels of testosterone were essential to heart health.
    A meta-study in the Journal of the American Heart Association looked at over 100 testosterone studies and they saw that higher levels of testosterone were essential to heart health.
    They reported that low testosterone is associated with abnormal EKG readings and that men with higher levels were 25% less likely to suffer from sudden cardiac arrest.
    In fact, the journal reported that low testosterone was associated with a higher rate of mortality in general, along with higher rates of cardiovascular mortality, obesity, and diabetes!
    The bottom line is that low levels of testosterone have potentially dire consequences for men, but if you do decide to undertake the great journey that is TRT, you must do so with the aid of a competent, concerned physician whoíll monitor your before and after testosterone levels, check your estrogen levels and red blood cell count, and take corrective steps if any are out of healthy ranges.
    GD




  10. #10
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    Re: Does Testosterone Replacement Therapy Increase Your Risk of Heart Attack?

    You could try a alternative for raising testosterone levels as well, being more natural. Some of these natural alternatives would be to lose weight and eat a nutrient-rich, whole foods diet - this diet includes lots of protein, zinc, magnesium and healthy fats, which are good for maintaining optimal testosterone levels.






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