Best Medications to improve Ejection Fraction in Testosterone Users?

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Thanks for sharing @IronKnight

I hope you stick around. I love people who are detailed in their sharing.

Good luck with doxazosin. It made me very tired.

Are you using some sort of continuous BP monitor? I have not come across one yet.

Have you had a calcium score test done? How about a stress test?

Also, remember that eGFR is more accurate when using Cystatin C in its formula. No interactions from high muscle mass or creatine supplementation.
 
Defy Medical TRT clinic doctor
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:

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

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:

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)

Will update this thread as I know more & my experiment results come :)
Just curious how everything worked out..
 
I am on 20mg of Nebivolol and find it to be very effective and do not notice any side effects while on it. I dropped my BP from 145-90ish HR 80 to 120-70 HR 55-70 now. I also take arginine-citrulline everyday along with Ultimate Prostate from Life Extension. I have great erection quality for age 61. I have found hydration is key for BP and RHR this also impacts sleep and almost everything else I really like LMNT in my water! I just upped my T Cypionate does up to 20mg a day even though it will probably be 1400TT. I am amazed at that dose what it does to my glucose levels! they just do not hardly budge up...I think keeping your BP-RHR in a good range has many benefits, I much rather be on a medication than have elevated BP.
 
Do you find Nebivolol interferes with weightloss or cardio?
it is hard for me to say! I am now 61 and ran hard in business for 35 years before walking away 5 years ago...I just do not have near the energy I had and cannot tell if Nebivolol has added to that or is it just age....either way I want to keep my RHR and BP in a comfortable zone. Sometimes I think we all are searching for fountain of youth and need to accept being 85% for the age you are at. Sorry I cannot give you clear answer but my cardiologist says it has the least issues. I know I have pretty decent nocturnal erections so that is good indication of impact on that.
 
As long as your blood pressure is controlled and you are doing cardiovascular exercise frequently, your ejection fraction will improve after a MI. My partner's went from 40 to 60+ in a year.

Here is a list of medications that may be more erection-friendly:

The ejection fraction (EF) is a measurement of the percentage of blood leaving the heart each time it contracts. It indicates the heart's ability to pump oxygen-rich blood out to the body. A normal heart's ejection fraction is between 55 and 70 percent, and a lower ejection fraction indicates a weaker pumping action, which can be a sign of heart failure or damage. On the other hand, an ejection fraction measurement higher than 75 percent could indicate a heart condition. Ejection fraction is typically measured using an echocardiogram, which is a type of heart ultrasound. Other tests such as a nuclear stress test or cardiac catheterization can also provide this measurement[1][3][4].

It is important to note that ejection fraction is just one of many tests used to assess heart function, and its interpretation should be done in the context of an individual's overall health and medical history.

Citations:
[1] Ejection Fraction: What It Is, Types and Normal Range
[2] Ejection fraction: An important heart test
[3] Ejection Fraction Heart Failure Measurement
[4] Measuring ejection fraction - Harvard Health
[5] Ejection Fraction: What Do the Numbers Mean? | Penn Medicine


After a myocardial infarction (MI), several measures can be taken to improve ejection fraction. These include lifestyle changes such as increasing physical activity, losing weight, taking prescribed medications for heart failure, diabetes, or high blood pressure, and managing underlying conditions like hypothyroidism, high blood pressure, or diabetes. Additionally, myocardial viability after acute myocardial infarction is a strong predictor of improvement in ejection fraction, and in some cases, low-dose dobutamine echocardiography can be used for early prediction of improvement in ejection fraction[1][2][3].

Citations:
[1] Low Heart Ejection Fraction | Aurora Health Care
[2] How Can I Improve My Low Ejection Fraction?
[3] Early prediction of improvement in ejection fraction after acute myocardial infarction using low dose dobutamine echocardiography
[4] Trajectories and determinants of left ventricular ejection fraction after the first myocardial infarction in the current era of primary coronary interventions
[5] 7 Ways to Improve Your Ejection Fraction (and What That Actually Means)

After a myocardial infarction (MI), several treatment options can help improve low ejection fraction (EF). These include:

1. **Medications**: Beta blockers or diuretics may be prescribed to improve heart function and control symptoms[1][2].

2. **Biventricular Pacemaker**: This special implanted pacemaker can help the lower chambers of the heart muscle pump together, leading to an increased heart EF[1].

3. **Healthy Lifestyle Changes**: Getting the appropriate amount and intensity of exercise, losing weight, quitting smoking, reducing salt or excess fluids, and eating a healthier diet are recommended for improving low EF[1][2].

4. **Heart Transplant**: In rare cases, a heart transplant may be considered[1].

5. **Managing Underlying Conditions**: Treating underlying conditions such as hypothyroidism, high blood pressure, or diabetes can also help improve ejection fraction[1][3].

It's important to consult a physician to determine the most suitable treatment plan based on individual circumstances.

Citations:
[1] Low Ejection Fraction Symptoms & Treatment | Baptist Health
[2] Low Heart Ejection Fraction | Aurora Health Care
[3] How Can I Improve My Low Ejection Fraction?
[4] The Treatment of Heart Failure with Reduced Ejection Fraction
[5] 7 Ways to Improve Your Ejection Fraction (and What That Actually Means)


The best exercises to improve ejection fraction after a myocardial infarction (MI) include:

1. **Aerobic Exercise**: Engaging in aerobic activities such as walking, cycling, or swimming can be beneficial for improving ejection fraction. Research has shown that structured, individually tailored exercise training can significantly improve left ventricular ejection fraction (LVEF) in post-event coronary artery disease (CAD) patients[2].

2. **Resistance Training**: Some people with heart failure benefit from resistance or weight training, which can also contribute to improving ejection fraction[4].

3. **Cardiac Rehabilitation**: Participating in exercise-based cardiac rehabilitation programs, which typically include a combination of aerobic and resistance training, has been shown to have a positive impact on ejection fraction. A 12-week early, structured exercise training program has been found to significantly improve LVEF in post-event CAD patients[2].

It's important to consult with a healthcare professional before starting any exercise program, especially after a myocardial infarction, to ensure that the chosen exercises are safe and appropriate for individual circumstances.

Citations:
[1] https://www.ahajournals.org/doi/full/10.1161/01.cir.94.5.978
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3221192/
[3] https://pubmed.ncbi.nlm.nih.gov/8790035/
[4] How Can I Improve My Low Ejection Fraction?
[5] https://www.pennmedicine.org/update...5/july/5-tips-for-exercise-with-heart-failure
 
I have an ejection fraction of 42, by mri, so it is precise. I have suffered a major MI nearly 6 years ago. Was just recently in hospitals for echo, angiogram and mri of heart. Echo showed 30-35! It is a very subjective test, mri is the gold standard.
I have significant dead heart muscle. They put me on Entresto to help improve EF. I take cardiverol, 3.125 mg 2 a day. I have no side effects from that.
48 EF by echo is nothing to worry about. This forum will throw you under the buss if you take any BP meds. Ignore the bro science and follow your Dr
 
This forum will throw you under the buss if you take any BP meds. Ignore the bro science
Your comment is based on no evidence. This forum is dedicated to discussions about blood pressure medications and management. I wish you a swift recovery and ongoing health, but remarks of this nature are not tolerated here unless you are making them as a constructive remark based on proof.

 
Just curious how everything worked out..
Sorry for the huge delay updating this thread.
My EF is now perfect: EF - 63.8% 2024-03-19

This is using the protocol, where I accepted readalot's challenge and I've been at > 250mg / week for > 1 year.

TOT Protocol:
Testosterone Enanthate @ ~250mg / week, injecting ~80-90mg x 3 / week TTS [ ~250mg/week is the real injected amount, based on my math on ampule loss, injection loss, the fact I get at least 2 extra shots when I preload syringes, etc. ]
HCG @ ~390 IU x 3 week TTS [ Lowered from x3 week previously, due to water retention and +20 increase in BP during refeeds on weekends ]
Anastrozol @ 2mg/week TT [ because my E2 runs too high otherwise, even at lower 140mg/week doses, my bone density is off the charts due to weight training ]

Current Supplements & Meds:
- 1/day x Temilsartan 80mg [ for BP, HCT, lipids, etc. stay tuned for blood work :) ]
- 2/day x Nebivolol 5mg [ for BP & HR, NO gastric reflux ]
- 1/day x Doxazosin 4mg [ for BP, 1 dose, evening only ~18:30 ]
- 2/day x Cialis 5mg [ for many reasons ]
- 2/day x TUDCA 1200 mg [ -30 points in Liver markers ALT, ASP ]
- 2/day x Aava Labs Omega3 (1xam/1xpm) [ 2 = 1000mg EPA + 500mg DHA ] [ for "general health" ]
- 1/day x 100mg DHEA [ because DHEA was low in blood work ]

Other things:

Citrulline Malate [ for NO ]
Electrolites [ for fasting days ]
MCT C8 Oil [ for first 2 fasting days / week, to ease the transition to Keto ]

Other things Before bed:

1 x B complex [ always ]
1 x 50mg pregnenolone [ always ]
1 x 3mg boron [ always ]
~3h before bed: 900mg Magnesium Citrate
 
Last edited:
r BP-RHR in a good range has many benefits, I much rather be on a medication than have elevated BP.
Agreed.


High blood pressure, or hypertension, poses significant risks to aging men, impacting various aspects of their health. Here are the key risks and factors associated with high blood pressure in this demographic:

Cardiovascular Risks​

  1. Heart Disease: High blood pressure can lead to coronary artery disease, heart failure, and myocardial infarction (heart attack). The increased pressure can cause the heart to work harder, leading to hypertrophy (enlargement) and eventually heart failure.
  2. Stroke: Hypertension is a major risk factor for both ischemic and hemorrhagic strokes. The elevated pressure can damage blood vessels in the brain, leading to blockages or ruptures.
  3. Aneurysms: Persistent high blood pressure can cause blood vessels to weaken and bulge, forming aneurysms. These can rupture, leading to life-threatening internal bleeding.

Renal Risks​

  1. Chronic Kidney Disease: High blood pressure can damage the blood vessels in the kidneys, reducing their ability to filter waste from the blood. This can lead to chronic kidney disease and eventually kidney failure.

Neurological Risks​

  1. Cognitive Decline and Dementia: Hypertension is associated with an increased risk of cognitive decline and vascular dementia. The condition can damage the blood vessels in the brain, affecting cognitive functions.

Other Health Risks​

  1. Vision Problems: High blood pressure can damage the blood vessels in the eyes, leading to retinopathy, which can cause vision loss or blindness.
  2. Peripheral Artery Disease: Hypertension can lead to the narrowing of arteries in the limbs, causing pain and increasing the risk of infections and amputations.
 
Hey @IronKnight

Thanks for sharing your protocol.

How are your hematocrit, HDL, and blood pressure now?
I have not checked my blood pressure in a while, but the day I was at the cardiologist he said it was 140, so it's likely ~<=130 in normal circumstances. I don't measure my blood pressure anymore because it was taking too long to do this every day, but I learned a lot while I was doing it.
Additionally, if my EF is perfect, this suggests, my blood pressure is OK too.

However, what I have I give to you, my latest most comprehensive labs from 2023-10-17. I have NOT donated blood in > 1 year and my HCT is fine. [ likely via Telmisartan? ]
Any markers you would like me to check in 2024?


By the way, I noticed huge improvements in reactivity via amygdala reset / vagus nerve training [ basically, I'm literally NOT angry anymore when unexpected things happen, people say/do stupid things, etc. -> MUCH MORE calm, relaxed and "present" ] with this protocol, showering like this most mornings:
20 seconds all the way cold
10 seconds all the way hot
repeat for 5 minutes
At the end: > 30 seconds of cold only, following the "finish with cold" principle.

Other things I do that help blood pressure / blood flow:
- Hiking on mountains with various groups (usually >= 13km walks)
- Usually > 10k steps / day [ often > 1 hour of walking / day ]
- Earthing:
"Earthing or grounding increased zeta potentials in all samples by an average of 2.70 and significantly reduced RBC aggregation. Conclusions: Grounding increases the surface charge on RBCs and thereby reduces blood viscosity and clumping."
- BJJ
- Boxing
- Pomegranate juice (750ml) on training day shakes

According to my BJJ buddies I have "incredible veins", my vascularity is way above average ;)

Anyway, I hope this helps someone trying to test the limits and walk the fine line of the max that is humanly possible, without dying in the process, like me :)
 

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Sorry for the huge delay updating this thread.
My EF is now perfect: EF - 63.8% 2024-03-19

This is using the protocol, where I accepted readalot's challenge and I've been at > 250mg / week for > 1 year.

TOT Protocol:
Testosterone Enanthate @ ~250mg / week, injecting ~80-90mg x 3 / week TTS [ ~250mg/week is the real injected amount, based on my math on ampule loss, injection loss, the fact I get at least 2 extra shots when I preload syringes, etc. ]
HCG @ ~390 IU x 3 week TTS [ Lowered from x3 week previously, due to water retention and +20 increase in BP during refeeds on weekends ]
Anastrozol @ 2mg/week TT [ because my E2 runs too high otherwise, even at lower 140mg/week doses, my bone density is off the charts due to weight training ]

Current Supplements & Meds:
- 1/day x Temilsartan 80mg [ for BP, HCT, lipids, etc. stay tuned for blood work :) ]
- 2/day x Nebivolol 5mg [ for BP & HR, NO gastric reflux ]
- 1/day x Doxazosin 4mg [ for BP, 1 dose, evening only ~18:30 ]
- 2/day x Cialis 5mg [ for many reasons ]
- 2/day x TUDCA 1200 mg [ -30 points in Liver markers ALT, ASP ]
- 2/day x Aava Labs Omega3 (1xam/1xpm) [ 2 = 1000mg EPA + 500mg DHA ] [ for "general health" ]
- 1/day x 100mg DHEA [ because DHEA was low in blood work ]

Other things:

Citrulline Malate [ for NO ]
Electrolites [ for fasting days ]
MCT C8 Oil [ for first 2 fasting days / week, to ease the transition to Keto ]

Other things Before bed:

1 x B complex [ always ]
1 x 50mg pregnenolone [ always ]
1 x 3mg boron [ always ]
~3h before bed: 900mg Magnesium Citrate
Curious.. why the boron?
 
Curious.. why the boron?
I read something about Boron lowering SHBG, but I am not buying it anymore, just "finishing it off" (I still have a couple of bottles) as I want to simplify my protocol.

You can lower SHBG with occassional carb refeeds around training anyway.
(SHBG goes up on keto, fasting, etc. but down with carbs)
 
I read something about Boron lowering SHBG, but I am not buying it anymore, just "finishing it off" (I still have a couple of bottles) as I want to simplify my protocol.

You can lower SHBG with occassional carb refeeds around training anyway.
(SHBG goes up on keto, fasting, etc. but down with carbs)
Ah.. I've read some recent research that boron can mitigate cardiac fibrosis. I was curious if it was related to your prior EF issue. I've been cutting a lot of stuff from my protocol too. It gets to be too much some times... thanks for the reply!
 
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