TRT 1 Year Update

Pharma TRT
566

Official results from cardiac mri
@highpull anyone else
So it reads LV slightly enlarged. I mean I don’t keep my testosterone high.

I N T E R P R E T A T I O N
Impressions:
Non-ischemic, dilated cardiomyopathy.
No evidence of inflammation or edema. No delayed enhancement.
Findings:

  1. Mildly dilated left ventricle. Mild left ventricular global hypokinesis with mildly reduced
    systolic function(EF 45%).
  2. Normal right ventricular size. Mildly reduced right ventricular systolic function (EF 46%).
  3. Normal right and left atrial size.
  4. No evidence of inflammation or edema. No delayed enhancement.
567

So right now it is JUST the slightly reduced function? No other findings as of yet?

568

Hi Charlie, I think, for now, you continue with the planned follow-up evaluations. Also continue with a healthy lifestyle and working on cardio fitness. Of course, a heart condition is of concern. However, many are walking around with worse and doing fine. Sometimes, there is no explanation why someone with severe regurgitation, for example, is functioning beyond normal expectations and has zero symptoms. In all likelihood, this is what it is and will not progress.

1 Like
569

That’s it. Just had the Cadillac of cardiac imaging done.

@highpull @NH_Watts

If you like this stuff here’s the full report. The only thing am contemplating is starting a beta blocker???

P R O C E D U R E
Cardiac MRI

MRI CONTRAST AND MEDICATIONS
Contrast Agent Contrast Dosage Creatinine
Dotarem 0.15 Mmol/kg , 25ml

T E C H N I Q U E
The study was performed on a 3T scanner.SSFP Cine for Cardiac Function;Phase contrast for large
vessels;Phase contrast for valves;Delayed Enhancement with Gad 0.15;Pre-contrast T1 mapping;
Post-contrast T1 mapping;T2 mapping

I N T E R P R E T A T I O N
Impressions:
Non-ischemic, dilated cardiomyopathy.
No evidence of inflammation or edema. No delayed enhancement.
Findings:

  1. Mildly dilated left ventricle. Mild left ventricular global hypokinesis with mildly reduced
    systolic function(EF 45%).
  2. Normal right ventricular size. Mildly reduced right ventricular systolic function (EF 46%).
  3. Normal right and left atrial size.
  4. No evidence of inflammation or edema. No delayed enhancement.

A S S E S S M E N T
Left Ventricle:
The left ventricle is mildly dilated. There is no evidence of left ventricular hypertrophy.
There is no left ventricular regional hypertrophy. Left ventricular global systolic function is
mildly reduced. The ejection fraction is 45%. Left ventricular regional systolic function is
showing diffuse hypokinesis. Mild global hypokinesis.

Right Ventricle:
The right ventricle is normal in size. There is no evidence of right ventricular hypertrophy.
Right ventricular global systolic function is mildly reduced. The ejection fraction is 46%.

Left Atrium:
The left atrium is normal in size. Left atrium area in 4 chamber view is 22 cm2. Left atrium
volume is 97.10 ml. and Left atrium volume indexed with BSA is 46.68 ml/m2.
Right Atrium:
The right atrium is normal in size. Right atrium area in 4 chamber view is 16 cm2.

Aortic Valve:
The aortic valve is tri-leaflet. The aortic valve has no significant abnormalities noted.

Mitral Valve:
The mitral valve has no significant abnormalities noted.

Tricuspid Valve:
The tricuspid valve has no significant abnormalities noted.

Pulmonic Valve:
The pulmonic valve has no significant abnormalities noted.

Aorta:
There are no abnormalities in the visualized portions of the thoracic aorta.
Pulmonary Artery:
There are no abnormalities noted in the visualized portions of the pulmonary artery.
Pericardium:
There are no abnormalities in the pericardium.
Pericardial effusion:
There is no evidence of pericardial effusion.
Delayed Enhancement Imaging:
Normal LGE

Q U A N T I T A T I O N S
MEASUREMENT LEFT VENTRICLE RIGHT VENTRICLE
End Diastolic Volume 207 ml 197 ml
End Diastolic Volume indexed by BSA 100 ml/m2 95 ml/m2
End Systolic Volume 114 ml 107 ml
End Systolic Volume indexed by BSA 55 ml/m2 51 ml/m2
Ejection Fraction % 45% 46%
Myocardial Mass 142 g 38 g
Myocardial Mass indexed by BSA 68 g/m2 18 g/m2
Stroke Volume 94 ml 91 ml

1 Like
570

Hey bro your report says you do NOT have LVH. Hope you read that as a mistake!

Good news!

1 Like
571

So I went to a new cardio at another top hospital in my area. Hospital Number 20 in cardiology in the country according to newsweek ranking thing they do. My other Dr still at a great hospital nationally ranked.

New Dr will review the cardiac mri I did. When I told him I had the CD he asked to hold on to it so his team can look. Good sign Dr is good. Waiting for his call to see if he sees anything concerning. My ekg normal.

This Dr actually answered my questions.
So he said right off the bat that trt is not causing what is happening. Amen.

My symptom that my hear rate takes hours to come down to resting after exercise is a problem and a symptom of my cardiomyopathy.

So he said the way to make my heart stronger is to start a beta blocker (stops the heart from listening to the hormone causing it to beat faster). He will titrate the BB. Also plan to add a ARB or ACE to the BB.

He also wants to put me on a 3 day heart patch monitor if my paps continue. Apparently less invasive than a traditional Holter monitor.

A few weeks ago I’ve upped my dose to 108mg a week divided in 2 injections. Cause of my lower free t reading.

I feel good. Am also Monitoring how the BB makes me feel. I actually stopped my cardio cause I just don’t want my heart to work hard after I exercise.

1 Like
572

Progress!

573

Whats interesting and puzzling is through the research I did heart failure ( am pre heart failure you can say) can cause low t.
Can also cause ed.

So what started what is still a mystery to me.

Also those acute symptoms I had back 2 years ago my BP was through the rough. For many years my Dr’s (pcp’s) wanted to give me BP meds and I always resisted. It’s possible over time cause my heart to get weak.

574

Was that BP symptom part of what’s going on now? An initial response symptom?

575

Idk. My blood pressure was through the rough for a short time over about a month. Before that it was just mild to moderate high.

Idk. But I feel confident my heart will not get weaker.

Concern was a blockage causing the low ejection fraction but my CT angio showed 0 plaque.

He also mentioned sometimes viruses can cause temporary cardiomyopathy.

Guys that’s why you must hunt for great Dr’s.

I believe the daily cialis I started last year has helped me stay symptom free.

Good news I can continue cialis with BB and arbs.

1 Like
576

Like what?

577

Viruses can do all sorts of things to the heart. A few years ago I started having pvcs and saw a cardiologist. One of the first questions he asked was had I been sick lately. I had just gotten over a bad case of strep. Good luck with everything, I know how concerning a heart issue can be.

2 Likes
578

@unreal24278
Hey man. When you have a Chance can you review my few recent post above?

I am hoping for you to comment on the BB I started and if you suggest an addition of an ACE or ARB. My Dr would like to add one of these to the BB.

Also for reference here’s my cardiac mri report.

Study Result

Narrative

CARDIAC MRI REPORT

I N D I C A T I O N S

Palpitations

P R O C E D U R E

Cardiac MRI

MRI CONTRAST AND MEDICATIONS

Contrast Agent Contrast Dosage Creatinine

Dotarem 0.15 Mmol/kg , 25ml

T E C H N I Q U E

The study was performed on a 3T scanner.SSFP Cine for Cardiac Function;Phase contrast for large

vessels;Phase contrast for valves;Delayed Enhancement with Gad 0.15;Pre-contrast T1 mapping;

Post-contrast T1 mapping;T2 mapping

I N T E R P R E T A T I O N

Impressions:

Non-ischemic, dilated cardiomyopathy.

No evidence of inflammation or edema. No delayed enhancement.

Findings:

  1. Mildly dilated left ventricle. Mild left ventricular global hypokinesis with mildly reduced

systolic function(EF 45%).

  1. Normal right ventricular size. Mildly reduced right ventricular systolic function (EF 46%).

  2. Normal right and left atrial size.

  3. No evidence of inflammation or edema. No delayed enhancement.

A S S E S S M E N T

Left Ventricle:

The left ventricle is mildly dilated. There is no evidence of left ventricular hypertrophy.

There is no left ventricular regional hypertrophy. Left ventricular global systolic function is

mildly reduced. The ejection fraction is 45%. Left ventricular regional systolic function is

showing diffuse hypokinesis. Mild global hypokinesis.

Right Ventricle:

The right ventricle is normal in size. There is no evidence of right ventricular hypertrophy.

Right ventricular global systolic function is mildly reduced. The ejection fraction is 46%.

Left Atrium:

The left atrium is normal in size. Left atrium area in 4 chamber view is 22 cm2. Left atrium

volume is 97.10 ml. and Left atrium volume indexed with BSA is 46.68 ml/m2.

Right Atrium:

The right atrium is normal in size. Right atrium area in 4 chamber view is 16 cm2.

Aortic Valve:

The aortic valve is tri-leaflet. The aortic valve has no significant abnormalities noted.

Mitral Valve:

The mitral valve has no significant abnormalities noted.

Tricuspid Valve:

The tricuspid valve has no significant abnormalities noted.

Pulmonic Valve:

The pulmonic valve has no significant abnormalities noted.

Aorta:

There are no abnormalities in the visualized portions of the thoracic aorta.

Pulmonary Artery:

There are no abnormalities noted in the visualized portions of the pulmonary artery.

Pericardium:

There are no abnormalities in the pericardium.

Pericardial effusion:

There is no evidence of pericardial effusion.

Delayed Enhancement Imaging:

Normal LGE

Q U A N T I T A T I O N S

MEASUREMENT LEFT VENTRICLE RIGHT VENTRICLE

End Diastolic Volume 207 ml 197 ml

End Diastolic Volume indexed by BSA 100 ml/m2 95 ml/m2

End Systolic Volume 114 ml 107 ml

End Systolic Volume indexed by BSA 55 ml/m2 51 ml/m2

Ejection Fraction % 45% 46%

Myocardial Mass 142 g 38 g

Myocardial Mass indexed by BSA 68 g/m2 18 g/m2

Stroke Volume 94 ml 91 mL

579

I’ll reply to this ASAP, currently I’m under a lot of stress and not happy in general (don’t wish to talk about this, but a bit lost at the moment), however I’ll weigh in soon. Remember though I’m not a medical professional.

1 Like
580

From what I recall you have no familial history of heart disease and/or cardiomyopathy. You ARE however symptomatic (heart palpitations, tachycardia, frequent ectopic beats and whatnot). If you exercise frequently (esp endurance exercise) may I suggest a stress test? Athletes heart can frequent present with enlarged (concentrically or dilated) left ventricles (right ventricle too for endurance athletes, enlargement potentially boardering on pro-arrythmiac). A stress test (if athletes heart is present rather than a cardiomyopathy associated with a weakened heart) will demonstrate ejection fractions returning to normal when exposed to exercise stimuli. That being said from what I recall you’re RHR is around 80, making athletes heart seem unlikely (unless you’re HR is elevated due to other reasons such as high sensitivity to catecholamine release, medication etc), hypokinesis indicates you’re myocardium isn’t contracting with the strength that of a normal individual does (however many elite endurance athletes have mild hypokinesis)

I can’t recommend medications due to the fact I am not a medical professional, however ACE inhibitors have a proven track record with regard to lowering overall mortality rates in those with cardiomyopathy and left ventricular dysfunction, furthermore ace inhibitors (and beta blockers) will (probably) lead to a decrease in ventricular diameters and improved ejection fractions, I could go into depth as to how they work (mechanisms) but it’s not particularly interesting and I don’t wish to bore you.

ARB’s are also effective with regard to treating heart failure, improving cardiac response to exercise stimulus. ARB and ACE meds have similar actions, the one blocks conversion from angiotensin I to angiotensin II the other simply prevents angiotensin II from binding to receptors of which it has affinity for. Angiotensin II causes profound vasoconstriction and increases in BP, hence blockade of this hormone be it on a receptor level or via converting enzymes will reduce BP, relax blood vessels and reduce cardiac workload (good for a weakened heart)

Either or should be fine, monitor electrolyte balance @charlie12

581

Thank you for your insight. Not sure if u researched specific meds but with ARB’s I read a couple of studies with Losartan being effective with few sides.

Not sure about specific ACE meds.

BTW cardiologist thought no point in stress echo because I do not have CAD. But I do see the value in confirming what happens to my EF under stress. Am no athlete by any stretch of the imagination. I just do cardio 2-3 x a week for about 15-20 minutes at a time. And some loose weights a couple times a week, and push ups.

@unreal24278

582

@dbossa @enackers
Can either of you please ask one of the Dr’s if trt would affect and perhaps has caused my recent dx of non ischemic dilated cardiomyopathy. I’ve been in trt for 2 years. My cardiac mri report is a few posts up.

I would appreciate this as I worry about this.

583

@charlie12 I can reply on their behalf on this issue as it has already come up in conversation. Both testosterone and estradiol are cardioprotective. There is zero evidence of exogenous testosterone causing cardiomyopathy. However, synthetic testosterone derivatives (anabolic steroids) is a different subject entirely on this matter. If you are taking synthetic derivatives, all bets are off.

584

I asked a couple months ago when you were posting about your problems. I was curious and I noticed your e2 and free t were on the lower end.

They said increase dose for protective benefits and reap the rewards. If that doesn’t fix you over the course of several months (get better) it’s something else.

585

OK. Thx.
My cardiologist also said trt did not cause this.

He has since started me on a BB and ARB. That should make heart stronger and then redo echo. Eventually MAY Take me off 1 or both drugs.

I still feel very good with energy, strength, libido etc.

I did increase my t dose slightly. It’s not like my t and e2 was low and caused this. My t and e2 readings overall over the 2 years was good. Those last readings u saw was when I started metformin (which I stopped a month ago). It did make me lose a few pounds. Not sure if the drug affected my t levels.

I do plan on restarting metformin after I adj to the heart meds.

@enackers @dbossa