Best meds to improve Ejection Fraction in TRT Users?

[IronKnight]

It turns out I had crazy high blood pressure (170/100), likely for months, too much caffeine, stress and I'm 125kg/275 pounds / 192cm/6'4, 44 years old.

Last week a cardiologist put me on Dipperam 5+160 (5mg Amlodipine + 160mg Valsartan), using this first once a day and after 2 days moved on to twice a day, which puts me around 127/78 after 1 week.
The maximum effect comes around 3-4 weeks, so I should soon be at 120 or below with that.

The cardiologist also sent me to have a ultrasound heart analysis by another doc, who found my heart Ejection Factor is only 48% (normal: 50-70) and I have some left ventricle hypertrophy (38mm). The doc commented that for my age (44 years old), 48% is way too low and this must be looked at.

I have been reading a lot on the topic and came to the conclusion that Nebivolol might be the best option to help with Ejection Factor, in general, this seems the beta blocker with the least negative side effects and potential positives (increase in NO, antioxidant profile, reduction of glucose, reduction of heart rate, etc.), a 10% increase seems likely with only 3 months at 5mg / day, and the left ventricle hypertrophy may also be reversed:
after 3 months of orally administered nebivolol (2.5 and 5 mg, n = 6)
[...]
Left ventricular function increased (ejection fraction 31.5 +/- 10.11 to 42.0 +/- 10.99%, P < or = 0.01) after 12 weeks of nebivolol. The left ventricular end-systolic diameter decreased in the nebivolol-group from 56.5 +/- 9.40 to 50.2 +/- 9.43 mm (P < or = 0.02).
From: Effect of nebivolol on left ventricular function in patients with chronic heart failure: a pilot study - PubMed

I also found this YouTube Video really interesting:

Coach Steve's Experience with Nebivolol; Heart Rate, Blood Pressure & Fat Loss. Vigorous PEDs​

Questions:

1. Is Nebivolol one of the best options to [ improve Ejection Factor + reduce left ventricle hypertrophy ] OR is there something better with low potential for negative side effects?
2. Should I just add Nebivolol to the already working "5mg Amlodipine + 160mg Valsartan" combo, or should I try to get rid of Amlodipine if blood pressure starts to go too low?
3. Depending on blood pressure numbers, would Nebivolol + Telmisartan be a good option once I lose some fat? (10kg/20lbs should result in a ~20 point blood pressure reduction in my case, but this will take at least 3 months, trying to minimize muscle loss)
4. Would Doxazosin be comparable to Nebivolol to improve Ejection Factor & reduce left ventricle hypertrophy?

Other clarifications for additional background:

Some life style notes: no coffee or caffeine in the last 2 weeks (lots of this before), magnesium: 500mg @ morning + 700mg @ night, citrulline malate here & there, trying to do hot baths (1h x 3 times / week after weight training) due to no sauna, 45min static bike x3 times a week, weight lifting 3 days / week.

My TRT protocol:
200mg weekly (real dose ~170mg or less due to ampule extraction, loss in injections, etc.)
2 injections: MF, 100mg each (likely ~80-90 max)
hCG in the same injection
Anastrozole 2mg / week, 1mg on injection day (This would be high for most people but seems to work well for me, otherwise my E2 goes too high)
Daily cialis: 10mg, now testing 5mg morning + 5mg evening
Common supplements: Creatine, Pregnenolone, DHEA, Boron, Vitamin D3+K2, desiccated beef organs

Recent labs:
Total T: 967.9
Free T: 32.41
E2: 42.6
Ferritin: 50ng/ml

 

[Jerajera]

I can't answer questions about the medications you listed, but I would drop my Test dose significantly if I were you.

If your trough Free T is 32ng/dL your peak is probably close to 45ng/dL, maybe higher. @readalot might have a model that predicts your peak value, or you could just get it tested around 24 hours post injection.

Either way, if I'd just been diagnosed with LVH and low ejection fraction, I would not want to stay at average Free T levels probably around 40ng/dL.

I don't understand dropping coffee but not your Test dose. That makes zero sense to me.

 

[tareload]

I'm 125kg/275 pounds / 192cm/6'4, 44 years old.

Waist circumference? Is your FFMI astounding or are you high bodyfat?

@Jerajera post of the week if not the month.

 

[SteveCleves]

This is like a smoker getting diagnosed with lung cancer and trying to figure out which inhaler they should try while they continue to smoke.

 

[IronKnight]

This thread is about how to improve Ejection Fraction and reduce LVH.

TRT does not directly cause LVH, in fact there are millions of average people, NOT on TRT who have LVH, even athletes, from Nelson himself:
"Most athletes that do not use testosterone or nandrolone have LVH. Anything that makes us use our hearts more would make LVH increase."

and from the Mayo Clinic:
"Uncontrolled high blood pressure is the most common cause of left ventricular hypertrophy"

Therefore, focusing on reducing the T dose makes no sense as the immediate course of action, while getting blood pressure under control does. I would encourage you to add your T dose commentary to the following thread, which proves that the upper natural range of Testosterone seems to be really around:
- Total Testosterone: 1400-1,593 ng/dL
- Free Testosterone: 42.5-54.7 pg/ml

As a side note, from a practical point of view, 200mg (~170mg real) is easier for me as here we have ampules (100mg each), and anything that is not a 100mg multiple is a mess to preload syringes, travel, etc. When I preload 2 months of shots, I often get at least 1 extra shot from the oil still present in the ampules, no vials here.

I am pretty sure I can even try 300mg / week (~250mg real) and still improve EF & reduce LVH, even without losing any fat, as long as my blood pressure & heart rate are in check. I may even do this + measure it for you, for entertaining purposes

With that out of the way, and going back into the topic, blood pressure is more about weight than body composition, but I'll answer the following:
/Waist circumference? Is your FFMI astounding or are you high bodyfat?/

Waist: 119cm / 46.85 inches
FFM: ~98kg / ~216lbs
Approx. Body Fat: 22% (from impedance scale), 25-27% (more likely guesstimate), 33% (from US army formula based on circumferences, less accurate for me)

My arm and leg veins are quite visible when its hot right now. When my waist is at 105cm / 41 inches lower abs are visible.

Bringing the thread more towards the topic, I found another post in this forum reporting success with the proposed ARB + BB approach (sorry, the link escapes me now, this is a slight modification):
/The doc gave me an ARB (some use an ACE instead of ARB) and a BB. ( Low dose candesartan and metoprolol)
After 3 months ejection fraction is up from 45% to 55% and my heart is stronger./

So, there it goes, 10% improvement after 3 months of ARB + BB (Beta Blocker) treatment, without any changes in the TRT dosage, exactly as in the study above.

For now, my plan is:
1. Get blood pressure under control via meds (= immediate progress)
2. Improve Ejection Fraction via meds (= immediate progress)
3. Slowly lose some body fat while preserving as much muscle as possible (will take a few months)
4. Consider other things depending on the new Echo-cardiogram after ~3 months
5. Try to eliminate some meds (i.e. Amlodipine seems to cause Edema sometimes) as my numbers improve

By the way, I discovered a few interesting blood pressure things today, this happened in the same day:
BP ~+= 10 with caffeine
BP ~+= 20 with cold
BP ~+= 30 with fast engaging activities that require a short reaction time (i.e. 1 min chess games, aka bullet)
BP ~-= 20 after a 17 min nap
BP ~-= 10-15 after deep breathing [ similar to this, I'm new to this ]

Log:
129/85 (77 pulse) @ 5:30 - a few minutes after waking up
133/79 (86 pulse) @ 07:06 - 1h:24min after 600mg caffeine + 400mg theanine
141/77 (83 pulse) @ 08:23 - ~3h after 600mg caffeine + 400mg theanine
8:23 - 500mg magnesium
141/74 (84 pulse) @ 09:23 - ~4h after 600mg caffeine + 400mg theanine
150/90 (78 pulse) @ 11:27 - ~6h after 600mg caffeine + 400mg theanine [ 19ºC, shorts + no T-shirt on fasting day = adrenaline? vasoconstriction? ]
11:29 - 400mg theanine
162/90 (82 pulse) @ 12:51 - ~7.5h after 600mg caffeine + 400mg theanine [ 20ºC, more dressed, after 1h of bullet chess games ]
143/88 (79 pulse) @ 13:12 - ~8h after 600mg caffeine + 400mg theanine [ 20ºC, more dressed, after 17min nap ]
131/83 (80 pulse) @ 13:22 - ~8h after 600mg caffeine + 400mg theanine [ 20ºC, more dressed, after deep breathing exercise - 3 inhale + 3 hold + 8-12 breathe out, kind of like this

]

 

[tareload]

Just because you want something to be true doesn't mean it is true. Your writing reads as someone who is undergoing a fair amount of cognitive dissonance. I get it. For those interested.

Related. This post and whole thread is good primer.

Nandrolone for Mood | Feeling much Better..

Also, I haven't read the mouse study, but it occurs to me that in the early days of Low Carb, there was an attempt to show that (I think) olive oil was toxic using FMD as a measure. However I believe Volek subsequently showed that it was a short-term affect which disappeared after several weeks...

www.excelmale.com

Figure 2 | Androgen Effects on the Adrenergic System of the Vascular, Airway, and Cardiac Myocytes and Their Relevance in Pathological Processes

Figure 2: Androgen Effects on the Adrenergic System of the Vascular, Airway, and Cardiac Myocytes and Their Relevance in Pathological Processes

www.hindawi.com

Figure 4 | Androgen Effects on the Adrenergic System of the Vascular, Airway, and Cardiac Myocytes and Their Relevance in Pathological Processes

Figure 4: Androgen Effects on the Adrenergic System of the Vascular, Airway, and Cardiac Myocytes and Their Relevance in Pathological Processes

www.hindawi.com

Reference range for TT:

24 Hour TT Profiles in Young, Healthy Functional Men [1973-1983]

TLDR (great suggestion by @kazuya_mishima1): Danny and the TOT folks are mistaken to put it politely with respect to pharmacokinetics and dose response of injectable exogeneous testosterone. They act like it’s some mystery how you will respond to injectable testosterone. It really isn’t and...

forums.t-nation.com

Existence of 99.9999% tile+ endogenous (disease free) TT level does not mean it applies to your physiology. You would have to dig into math, statistics, the correlation between various TT assays, human physiology, etc to understand the error in your logic. An hour spent digging through my previous posts or @madman or @Cataceous would make this rather clear. T Nation has a bunch of my previous work as well. Some linked below.

Hello, 57 year old about to start TRT and have questions

Hello all, a little background.......I have been in a bad marriage for 37 years and have been through at least 5 traumatic family events & losses, so I assume I have been depressed for a while now but never dealt with it. I am now seperated and on depression, anxiety & insomnia meds started 2.5...

www.excelmale.com

RAAS:

Preferred Blasts on TRT?

What are folks’ preferred compounds for a blast on longterm TRT? For a bulk cycle and a cut cycle. Also, what other support do you use both during the blast and post-blast? I.e. liver support, etc…Anyone done a sarm blas…

forums.t-nation.com

TRT and Blasting. A Few Questions

Also check these out … Look how many times the embedded links have been clicked. What does that tell you? Topics E2 Aromatization as a f(BF level) Aldosterone BP RHR HRR Water retention RAAS CNS effects Beta adrenergic effects Get familiar with all these before you go there...

forums.t-nation.com

Best wishes and to your health.

In summary regardless of your BP meds experiments/polypharmacy in the short term,

1. drop the "TRT" dose
2. lower your total body mass (drop body fat and potentially some muscle mass if losing the fat does not cut it. Blood volume related to total lean mass).

Bigorexia has a penalty and muscular obesity hard on your heart just like fat obesity. Being overfat and lots of muscle even more work. Throw on top your mild Testosterone cruise and you are begging for trouble.

 

[t_spacemonkey]

all BP meds are awful for your general wellbeing. i have mild BP elevation and refuse to take any of this shit. currently working on weight loss/diet/exercise program to get it down naturally. IMHO BP meds are ok short-term if you are really high, but you need to get it down naturally and get off

 

[tareload]

Also here for implications of TRT vs natural endogenous T production on AUC:

Hello, 57 year old about to start TRT and have questions

I had 100mg im shot on Monday @11.30 and have not felt anything different so far. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3188848/ Results Effects on sexual interest appear after 3 weeks plateauing at 6 weeks, with no further increments expected beyond. Changes in erections/ejaculations...

www.excelmale.com

 

[Vince]

It turns out I had crazy high blood pressure (170/100), likely for months, too much caffeine, stress and I'm 125kg/275 pounds / 192cm/6'4, 44 years old.

Last week a cardiologist put me on Dipperam 5+160 (5mg Amlodipine + 160mg Valsartan), using this first once a day and after 2 days moved on to twice a day, which puts me around 127/78 after 1 week.
The maximum effect comes around 3-4 weeks, so I should soon be at 120 or below with that.

The cardiologist also sent me to have a ultrasound heart analysis by another doc, who found my heart Ejection Factor is only 48% (normal: 50-70) and I have some left ventricle hypertrophy (38mm). The doc commented that for my age (44 years old), 48% is way too low and this must be looked at.

I have been reading a lot on the topic and came to the conclusion that Nebivolol might be the best option to help with Ejection Factor, in general, this seems the beta blocker with the least negative side effects and potential positives (increase in NO, antioxidant profile, reduction of glucose, reduction of heart rate, etc.), a 10% increase seems likely with only 3 months at 5mg / day, and the left ventricle hypertrophy may also be reversed:
after 3 months of orally administered nebivolol (2.5 and 5 mg, n = 6)
[...]
Left ventricular function increased (ejection fraction 31.5 +/- 10.11 to 42.0 +/- 10.99%, P < or = 0.01) after 12 weeks of nebivolol. The left ventricular end-systolic diameter decreased in the nebivolol-group from 56.5 +/- 9.40 to 50.2 +/- 9.43 mm (P < or = 0.02).
From: Effect of nebivolol on left ventricular function in patients with chronic heart failure: a pilot study - PubMed

I also found this YouTube Video really interesting:

Coach Steve's Experience with Nebivolol; Heart Rate, Blood Pressure & Fat Loss. Vigorous PEDs​

Questions:

1. Is Nebivolol one of the best options to [ improve Ejection Factor + reduce left ventricle hypertrophy ] OR is there something better with low potential for negative side effects?
2. Should I just add Nebivolol to the already working "5mg Amlodipine + 160mg Valsartan" combo, or should I try to get rid of Amlodipine if blood pressure starts to go too low?
3. Depending on blood pressure numbers, would Nebivolol + Telmisartan be a good option once I lose some fat? (10kg/20lbs should result in a ~20 point blood pressure reduction in my case, but this will take at least 3 months, trying to minimize muscle loss)
4. Would Doxazosin be comparable to Nebivolol to improve Ejection Factor & reduce left ventricle hypertrophy?

Other clarifications for additional background:

Some life style notes: no coffee or caffeine in the last 2 weeks (lots of this before), magnesium: 500mg @ morning + 700mg @ night, citrulline malate here & there, trying to do hot baths (1h x 3 times / week after weight training) due to no sauna, 45min static bike x3 times a week, weight lifting 3 days / week.

My TRT protocol:
200mg weekly (real dose ~170mg or less due to ampule extraction, loss in injections, etc.)
2 injections: MF, 100mg each (likely ~80-90 max)
hCG in the same injection
Anastrozole 2mg / week, 1mg on injection day (This would be high for most people but seems to work well for me, otherwise my E2 goes too high)
Daily cialis: 10mg, now testing 5mg morning + 5mg evening
Common supplements: Creatine, Pregnenolone, DHEA, Boron, Vitamin D3+K2, desiccated beef organs

Recent labs:
Total T: 967.9
Free T: 32.41
E2: 42.6
Ferritin: 50ng/ml

The best thing I know to improve ef is CoQ10. Also you can get your levels checked. EF of 48% I would not consider low.

 

[Vince]

It turns out I had crazy high blood pressure (170/100), likely for months, too much caffeine, stress and I'm 125kg/275 pounds / 192cm/6'4, 44 years old.

Last week a cardiologist put me on Dipperam 5+160 (5mg Amlodipine + 160mg Valsartan), using this first once a day and after 2 days moved on to twice a day, which puts me around 127/78 after 1 week.
The maximum effect comes around 3-4 weeks, so I should soon be at 120 or below with that.

The cardiologist also sent me to have a ultrasound heart analysis by another doc, who found my heart Ejection Factor is only 48% (normal: 50-70) and I have some left ventricle hypertrophy (38mm). The doc commented that for my age (44 years old), 48% is way too low and this must be looked at.

I have been reading a lot on the topic and came to the conclusion that Nebivolol might be the best option to help with Ejection Factor, in general, this seems the beta blocker with the least negative side effects and potential positives (increase in NO, antioxidant profile, reduction of glucose, reduction of heart rate, etc.), a 10% increase seems likely with only 3 months at 5mg / day, and the left ventricle hypertrophy may also be reversed:
after 3 months of orally administered nebivolol (2.5 and 5 mg, n = 6)
[...]
Left ventricular function increased (ejection fraction 31.5 +/- 10.11 to 42.0 +/- 10.99%, P < or = 0.01) after 12 weeks of nebivolol. The left ventricular end-systolic diameter decreased in the nebivolol-group from 56.5 +/- 9.40 to 50.2 +/- 9.43 mm (P < or = 0.02).
From: Effect of nebivolol on left ventricular function in patients with chronic heart failure: a pilot study - PubMed

I also found this YouTube Video really interesting:

Coach Steve's Experience with Nebivolol; Heart Rate, Blood Pressure & Fat Loss. Vigorous PEDs​

Questions:

1. Is Nebivolol one of the best options to [ improve Ejection Factor + reduce left ventricle hypertrophy ] OR is there something better with low potential for negative side effects?
2. Should I just add Nebivolol to the already working "5mg Amlodipine + 160mg Valsartan" combo, or should I try to get rid of Amlodipine if blood pressure starts to go too low?
3. Depending on blood pressure numbers, would Nebivolol + Telmisartan be a good option once I lose some fat? (10kg/20lbs should result in a ~20 point blood pressure reduction in my case, but this will take at least 3 months, trying to minimize muscle loss)
4. Would Doxazosin be comparable to Nebivolol to improve Ejection Factor & reduce left ventricle hypertrophy?

Other clarifications for additional background:

Some life style notes: no coffee or caffeine in the last 2 weeks (lots of this before), magnesium: 500mg @ morning + 700mg @ night, citrulline malate here & there, trying to do hot baths (1h x 3 times / week after weight training) due to no sauna, 45min static bike x3 times a week, weight lifting 3 days / week.

My TRT protocol:
200mg weekly (real dose ~170mg or less due to ampule extraction, loss in injections, etc.)
2 injections: MF, 100mg each (likely ~80-90 max)
hCG in the same injection
Anastrozole 2mg / week, 1mg on injection day (This would be high for most people but seems to work well for me, otherwise my E2 goes too high)
Daily cialis: 10mg, now testing 5mg morning + 5mg evening
Common supplements: Creatine, Pregnenolone, DHEA, Boron, Vitamin D3+K2, desiccated beef organs

Recent labs:
Total T: 967.9
Free T: 32.41
E2: 42.6
Ferritin: 50ng/ml

I'm sure your doctor explain to you, level is too high. Will also kill you. It's common in young athletes when they have levels above 80%. They pump all the blood out of there heart and then the heart is not primed. And of course instant death.

 

[Vince]

Cardiac Imaging In Athletes

Athletic heart syndrome refers to the physiological and morphological changes that occur in a human heart after repetitive strenuous physical exercise. Examples of exercise-induced changes in the heart include increases in heart cavity dimensions, augmentation ...

www.ncbi.nlm.nih.gov

 

[tareload]

Cardiac Imaging In Athletes

Athletic heart syndrome refers to the physiological and morphological changes that occur in a human heart after repetitive strenuous physical exercise. Examples of exercise-induced changes in the heart include increases in heart cavity dimensions, augmentation ...

www.ncbi.nlm.nih.gov

There is nothing about OP's BP or RHR that indicates elite athlete or even athletic. Quite the opposite. Resting EF on its own could lead that way but his RHR/BP strongly indicate his heart is working too hard at rest.

RHR is lousy and so is BP in context of athlete.

The basics:

Summer Blast and Coming Off 2 Years of Tren

Yes i know. But my question stands.

forums.t-nation.com

 

[Vince]

There is nothing about OP's BP or RHR that indicates elite athlete or even athletic. Quite the opposite. Resting EF on its own could lead that way but his RHR/BP strongly indicate his heart is working too hard at rest.

RHR is lousy and so is BP in context of athlete.

The basics:

Summer Blast and Coming Off 2 Years of Tren

Yes i know. But my question stands.

forums.t-nation.com

Yes, It talks about the heart muscle becoming stronger and thicker, making the chamber smaller. Even though my understanding is when the chamber becomes smaller, the EF increases.

 

[Belekas]

I know it's not what you want to hear and not directly related to your question but I agree with everything that our experienced guys posted above. Personally I think this one is a no-brainer FWIW. Drop the weight, get lean, ditch all the stimulants and most of the other crap you are taking, and I bet your BP will come down by a lot. If like you say your BP has been 170/100 for months and you haven't felt it then it might have been that high actually for years? Cuz most folks spend decades with high BP before they even know it. And the damage might have been already done. At this point the last thing I would stress about are the "gainz". And to me getting healthy is a number one priority and that means staying OFF as much meds/drugs as possible yet alone not running 200mg test per week. Sure you can do 400mg, who gives af right, but if shit hits the fan, you won't be able to turn back the time. It's a tough one to swallow but IIWII. Hope that doesn't go over your head.

Just my 0.02 cents.

 

[IronKnight]

Thanks for all the links & tips

Quick update: The cardiologist put me on torsemide 10mg (a diuretic) on Monday, his reasoning being to "aim to have a daily average blood pressure of 120/80", he refused to provide a prescription for Nebivolol 5mg as it would "only drop BP by 6 points, which is too little", I tried torsemide before my workout on Tuesday and was a disaster:

Headaches, feeling poorly all day (unable to train or work properly), couldn't lift numbers that would have normally been easy for me, almost passed out while overhead pressing, etc.

On Monday, I'll meet the cardiologist again and tell him to:
1. provide a prescription for Nebivolol 5mg
2. No more diuretics (possible long term kidney damage, electrolyte trouble, bad training/work performance, etc.)
3. Will shoot for a 10kg/20lbs fat loss instead, which should drop BP by 20 more points.

So, if he accepts, that will leave the BP lowering protocol as follows:
Meds:
1. Dipperam 5+160 x twice a day (320mg Valsartan + 10mg Amlodipine daily)
2. Nebivolol 5mg (interested on this due to reduction in heart rate + possible stress management help, see video above)

With the weight loss, I'm hoping to eliminate Amlodipine first, which is causing some edema (swollen ankles), and would reduce the BP treatment to only 2 meds: 320mg Valsartan + 5mg Nebivolol daily.

Remember, when I say 200mg / week, it's really ~170mg (unable to extract 100% of the oil from the ampule + losses on each injection), which would be laughed at on any PED forum if called "cruising" . Ampules are messy, you guys are lucky to have vials.

I also forgot to say that my Hematocrit was 51, so I also donated blood last month (hadn't donated blood in 3 years), but saw no (measurable) difference in BP as a result.

I agree most BP meds are problematic, the *sartans (ARBs) & Nebivolol (@ 5mg) seem to be among the very few that might be reasonably OK long term from my reading so far.

On the supplement front, I'm adding some Omega 3 at night to make blood a bit thinner, which should theoretically also help in the meantime. I get nosebleeds if I go too high on these, so will try to stay below that threshold.

Any suggestions for blood work? kidney, liver & potassium come to mind to monitor changes from introducing these meds

Potassium, eGFR, ALAT, ASPAT?

 

[Michael D]

I have been trying every blood pressure med under the sun to try to find one that works, without serious side effect. I've found a number of them that will get my BP into a safe zone, but I play tennis and most of them make it impossible for me to be competitive. I am constantly gasping for breath and leaning on my knees. Another serious side effect is erectile dysfunction. I never had a problem with that (since I started TRT) before I started to treat my very high BP. For me, Nebivolol has been the best compromise, along with the lisinopril my Doc insists I take (and he's right, my BP cannot be controlled with just one drug). I still huff and puff when I exercise, but I just have to accept that my high performance athletic days are over. If I don't control my BP I won't live as long...my kidneys are already damaged.

I have to agree with the majority here...you're taking too much T for simply compensating for what your body is not making naturally.

 

[SteveCleves]

Just curious, does your cardiologist know about your TRT?

 

[Systemlord]

I have been trying every blood pressure med under the sun to try to find one that works, without serious side effect.

I had the same problem, beta blockers give me zero side effects.

 

[tareload]

Just curious, does your cardiologist know about your TRT?

What's the wager?

Every cardiologist I know would be trying to castrate me with those BP numbers.

TT mean above 1200 ng/dl and FT mean sitting at 40 ng/dl. What's there for a Cardiologist not to love? .

Elevated Hct plus bad plasma viscosity even more work on the Ole ticker.

Get Big or die Tryin. I am not far from those at 120 mg/week TC.

 

[IronKnight]

I'm slowly making some progress:
7 days into a prolonged fast, I've dropped ~10kg (mostly water, yes), and morning BP is consistently around 120/70 (last 3 days).
Waist is 114cm from 120cm before, and I'm using a bit of cold (not moving much, but minimally dressed) to speed up the fat loss process a bit, upper and middle abs visible (but not very defined yet) when flexing.

I am trying to reverse as much damage as possible via autophagy + will have another Echocardiogram at the end of the month to see where things are. Aiming for EF > 52, ~60 should be ideal, as >75 is also bad. Nebivolol alone should increase EF by 10%, but in 3 months:

Effect of nebivolol on left ventricular function in patients with chronic heart failure: a pilot study - PubMed

These data indicate that nebivolol might improve cardiac function in patients with reduced left ventricular function.

pubmed.ncbi.nlm.nih.gov

Prolonged fasting is also supposed to help with blood pressure and other things:

The Effects of Prolonged Water-Only Fasting and Refeeding on Markers of Cardiometabolic Risk

(1) Background: Cardiometabolic disease, including insulin resistance, hyperlipidemia, and hypertension, are major contributors to adverse health outcomes. Fasting has gained interest as a nonpharmacological therapeutic adjunct for these disorders. (2) ...

www.ncbi.nlm.nih.gov

Safety, health improvement and well-being during a 4 to 21-day fasting period in an observational study including 1422 subjects

Only few studies document longer periods of fasting in large cohorts including non-obese participants. The aim of this study was to document prospectively the safety and any changes in basic health and well-being indicators during Buchinger periodic fasting ...

www.ncbi.nlm.nih.gov

re Prolonged Fasting:
In my case, I'm using only ~3L water + 1 cup of bone broth / day (for electrolytes + easier transition into refeeding later)

BP Meds now: 2 x Dipperam 160+5 (160mg Valsartan + 5mg Amlodipine) + 2 x 5mg Nebivolol

After a lot of reading, I came accross this:

How To Maintain Cardiovascular Health While Bodybuilding

Maintaining cardiovascular health while bodybuilding should be one of your top priorities. The main cause of death among bodybuilders is heart disease.

moreplatesmoredates.com

Some interesting notes from there:
1) resting heart rate:
"A lot of guys are walking around with borderline tachycardia (resting heart rates over 100), which is super unhealthy.
Many argue that heart rate is not important as long as you are under 100 beats per minute, but the reality is that the lower your resting heart rate is, the better indicator it is of your health."
=> In this regard, 2 x 5mg Nebivolol is helping, half life is 12h, so I'm taking 5mg in the morning + 5mg 12 hours later.
My resting heart rate is now 60-70, whereas before it was 80-90, just watching TV on the couch.

2) better to avoid peaks above 120/80:
"You want your blood pressure to be no higher than 120/80 at all times, year-round.[...]
Most bodybuilders will brush off blood pressure readings slightly above 120/80 that aren't considered hypertensive, when they shouldn't."
=> Given the +15 BP daily increases vs. "first BP in the morning", I would have to wake up around 105/70 to accomplish this.
I was so happy my BP was finally 120/70 in the morning man, still lots of work to do

3) Astragalus supplementation
"has the ability to reduce blood pressure.[...]
It also reduces hardening of the arteries, cholesterol absorption and plaque build up.
[...]
It is also possible that it improves cardiac contractions, generally strengthening your heart and its ability to pump.
The reason I use it is because Astragalus is virtually the only compound that research shows can regenerate Kidneys, as well as greatly lower creatinine and raise GFR"
=> This was very interesting to me because I've read a lot about BP meds lowering GFR, whereas some people like Peter Attia suggest you should aim your GFR to be 105 in your 40s so you are OK in your 90s.
Additionally, I had a recent 95 GFR reading and subsequent 73 a couple of weeks after meds, so the kidneys seem to be getting a hit.

Some small clarifications to some previous comments:
- re body fat: I finally measured this properly via DEXA: 24% body fat
- re Free T: 32.41 pg/ml is my "through -1", the real through is lower. I also have only measured this once, should check it more.
- re does your cardiologist know about your TRT? => yes, I told him the first day, he didn't ask anything (although I showed him all my labs on the 1st visit, and he checked them but didn't comment on anything). He's not very cooperative and clearly unfamiliar with weightlifting fans, so I'll meet another one later this month.
- re HCT: I hadn't donated blood in 3 years and it was still at 51, I don't seem to have a problem with that. Also, donating didn't lower BP for me, at least not in a measurable way. Additionally, the *sartans seem to help in this regard.
- re exercise performance: I just want to beat my humble PRs in the gym, and any med that gets in the way will be ruled out
- re Ubiquinol supplementation: I strongly believe taking organic freeze-dried beef heart powder should be superior, as all the building blocks for the heart should be there, not just Ubiquinol. Time will tell

re BP supplements, I'm currently thinking in the direction of:
Magnessium, Citrulline malate
Omega 3, Astralagus (to improve GFR, but also lowers BP), Garlic (mainly for BP)

re BP Meds:
I would like to ditch Amlodipine as it seems to be giving me some stomach acid sides, and in general, CCBs are not great.
A decent exercise-compatible combo would be: 80mg Telmisartan + 2 x 5mg Nebivolol + ? mg Doxazosin
However, I'm not sure I'll be able to keep my BP < 120/80 like that, including daily peaks.
If that fails, a close 2nd would be:
2 x 160mg Valsartan + 2 x 5mg Nebivolol + ? mg Doxazosin
I'll discuss this proposed approach with the 2nd cardiologist and see what he says (I'll ask him to do the Echocardiogram first + share what has been tried so far later, so I'm not suggesting him for anything in particular)

Doxazosin should also help with EF on its own:
Doxazosin was associated with a significantly higher level of voluntary submaximal exercise and a favorable trend on left ventricular ejection fraction (increase of 9.8% of the baseline value vs 2.7% with placebo; p = NS)

Doxazosin for the treatment of chronic congestive heart failure: results of a randomized double-blind and placebo-controlled study - PubMed

In this study we evaluated the effects of once-daily administration of oral doxazosin in patients with chronic congestive heart failure (CHF). After a stabilization period of at least 2 weeks with digitalis and diuretics, 73 patients with chronic CHF were randomized to receive additionally...

pubmed.ncbi.nlm.nih.gov

Will update this thread as I know more & my experiment results come