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Thread: TRT for 65+ with Heart Issues

  1. #1
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    Default TRT for 65+ with Heart Issues

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    Mr Rippetoe,
    I have a friend who is about to turn 66 and has in the past year started using TRT. He is on 200 mg/10 days from his PCP. He had an emergency quadruple bypass due to massive plague build ups a few years ago. In discussing his treatment he shared with me that his hematocrit and hemoglobin are testing high on his doctor's required panel but he didn't know the actual number just said it was high and it wasn't before starting TRT. He was advised to give blood at least monthly to manage this but he is uneligible to give blood to the red cross so he hasn't been.

    I'm wondering about the general trade offs of higher H&H vs the pros of using TRT if this dosing may be too high. His total test has gone from ~120 to ~700 I don't know his free test level. I'm thinking a lower dose could still get him most if not all the psychological pros at a lower level but drop that H&H to a lower risk level. I have read some studies around the natural levels of test created in the male body and think that from what I've seen about 7 mg per day should be the high end of a purely replacement (rather than sports optimization) dose as this appears to be the top end of what non-pubescent men's body create. If we factor in the ester cleave efficiency costs relative to weight (30%ish) I think that would land around 100 mg/10 days. Which I think as next step would be to advise 10 mg/day and just smooth everything out.

    I understand advising taking TRT to a lower level may be a difficult conversation but given my understanding of the heart risk with his specific background I am willing to have this hard conversation but I'm just operating on the best information I can get at this time and would GREATLY appreciate your advise given your expertise...what do you think?

  2. #2
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    What information do you have regarding the specific risks of TRT/CVD?

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    Quote Originally Posted by randomuser View Post
    Mr Rippetoe,
    I have a friend who is about to turn 66 and has in the past year started using TRT. He is on 200 mg/10 days from his PCP. He had an emergency quadruple bypass due to massive plague build ups a few years ago. In discussing his treatment he shared with me that his hematocrit and hemoglobin are testing high on his doctor's required panel but he didn't know the actual number just said it was high and it wasn't before starting TRT. He was advised to give blood at least monthly to manage this but he is uneligible to give blood to the red cross so he hasn't been.

    I'm wondering about the general trade offs of higher H&H vs the pros of using TRT if this dosing may be too high. His total test has gone from ~120 to ~700 I don't know his free test level. I'm thinking a lower dose could still get him most if not all the psychological pros at a lower level but drop that H&H to a lower risk level. I have read some studies around the natural levels of test created in the male body and think that from what I've seen about 7 mg per day should be the high end of a purely replacement (rather than sports optimization) dose as this appears to be the top end of what non-pubescent men's body create. If we factor in the ester cleave efficiency costs relative to weight (30%ish) I think that would land around 100 mg/10 days. Which I think as next step would be to advise 10 mg/day and just smooth everything out.

    I understand advising taking TRT to a lower level may be a difficult conversation but given my understanding of the heart risk with his specific background I am willing to have this hard conversation but I'm just operating on the best information I can get at this time and would GREATLY appreciate your advise given your expertise...what do you think?
    Why doesn't he donate blood somewhere else? The doc can also write him a script for therapeutic phlebotomy.

  4. #4
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    I haven't seen any adequately designed study that shows a causal relationship between TRT and CVD. I believe the relationship between TRT and higher H&H is established (right?) and appears to be inline with the timing of the changes in labs he is seeing for him specifically. So, I would think all the downstream concerns of a high H&H would apply which I believe include hypertension, more clotting potential, general blood flow issues? I'm just connecting the chain of the assumption TRT leads to higher H&H and higher H&H has long term CVD effects that may be of elevated risk in his scenario even though I haven't seen any good studies that show this...seems to be a general lack of adequate quality long term research just there from my investigation. I guess I'm also just supposing that TRT increasing H&H is dose dependent.

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    Did masks seem like a good idea for stopping the spread of the virus? Of course they did. Except for the fact that they don't, it was perfectly plausible.

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    I get what you're saying. I find this far more likely than I ever found masks stopping aerosol transmission. Which piece isn't right, TRT linked to higher H&H (dose dependent?) or H&H cardiovascular risks?

  7. #7
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    We will be doing a podcast with Keith Nichols MD about TRT very soon, and this will be the primary topic of discussion.

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    Quote Originally Posted by Mark Rippetoe View Post
    We will be doing a podcast with Keith Nichols MD about TRT very soon, and this will be the primary topic of discussion.
    Can you please ask him what the dangers of excessive testosterone are? And at what signs/symptoms/point do they kick in? For examples, if some is taking 500mg of test per week and their BP is fine, is there ANY downside? If so, what is that downside? We all know LDL/HDL fears are overblown; if you're an old man nobody cares about baldness and pimples; if your H&H is problematic, bleed it off (OP's friend should learn how to do it for himself); BP can be managed by being less fucking fat and a lower carb diet. So what exactly IS the problem?

    To put it another way, at what point (defined as medical complications, not mg/week or ng/dl) does TRT dosing become "STEROID ABUSE!!!!!" All these MDs refuse to answer that question.

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    We will axe him that question.

  10. #10
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    Quote Originally Posted by FatButWeak View Post
    Can you please ask him what the dangers of excessive testosterone are? And at what signs/symptoms/point do they kick in? For examples, if some is taking 500mg of test per week and their BP is fine, is there ANY downside? If so, what is that downside? We all know LDL/HDL fears are overblown; if you're an old man nobody cares about baldness and pimples; if your H&H is problematic, bleed it off (OP's friend should learn how to do it for himself); BP can be managed by being less fucking fat and a lower carb diet. So what exactly IS the problem?

    To put it another way, at what point (defined as medical complications, not mg/week or ng/dl) does TRT dosing become "STEROID ABUSE!!!!!" All these MDs refuse to answer that question.
    That's a great question. My guess is that it has something to do with what the DEA (not your doctor) believes to be a therapeutic dose.

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