Question is now how to find a good heart specialist that will be a good fit. e.g. someone who has experience with hormone treatment or what should I look for?
You should look for someone that has good reviews, and is not inclined to shove a plant-based diet and statins down your throat. I found a low-carb friendly doc that is also testosterone friendly from an anabolic doc video, just so happened to practice 20 minutes away from me:
They're talking about how Anabolic Doc managed to reverse his elevated calcium score in that video - you may find it interesting.
At the end of the day, the function of the cardiologist is to order diagnostics for you and prescribe medication. Assuming you do not have any significant cardiovascular complications to begin with, and are looking for preventive medicine, what they believe and their level of expertise is not necessarily important so long as they fulfill those functions.
The easy and inexpensive diagnostics that you want to detect and quantify plaque are the coronary calcium scan (for calcified plaque) and the carotid intima-media thickness (CIMT) ultrasound scan (for soft plaque). A CT coronary angiogram is basically the ultimate test to visualize all types of plaque in the coronary arteries, but this is a bigger deal in terms of expense, so they aren't likely to order this for a 37 year old with no symptoms.
What is reversible? Everything about atherosclerosis appears to be reversible given the right conditions, but the conditions occur rarely, so regression is rare. There were several participants in the recent Keto CTA study that showed regression of plaque despite very high LDL / ApoB on a keto diet, likely due to exceptional metabolic health combined with exceptionally low inflammation. It is also possible to see regression by reducing your LDL / ApoB to very low (child-like) levels. Or, you could do both as I have recently decided to do.
I am largely a cholesterol skeptic and favor metabolic and inflammatory theories for CVD, which seem more accurate to me, and are necessary to explain the many cases of heart disease that exist in the presence of low cholesterol. I've decided to crush my ApoB into the ground anyway, so long as I can do it without significant side effects or without worsening my metabolic health (like statins would). So far, so good with that.
They call that hedging your bets, and that's what I like to do when I find very intelligent people on both sides of a debate, because neither side is likely to be 100% wrong. Or to put it another way, I'm not willing to bet my life on ApoB being 100% wrong as a causal factor in CVD. And if you're on the same page, then you'll need some better tolerated non-statin drugs, like PCSK9 inhibitors, bempedoic acid, and ezetimibe, in addition to supplements like delta-tocotrienols and berberine. That's where the cardiologist comes in.
Where am I starting, and is what I'm doing working? Those are the questions you are going to answer with baseline and then serial follow-up plaque scans. You should have a zero calcium score at your age - if you don't, you have big problems, and would be in the top maybe 5% for degree of atherosclerosis for men your age. How long can you keep it at zero though?
The carotid IMT is likely to be more immediately useful and interesting, because you almost certainly will not be perfect on this test, and you'll know exactly how not perfect you are, and how much better or worse you are next year, after spending a year doing whatever you are going to do with lifestyle and TRT and interventions. If the next test is the same, or better, congratulations and keep up the good work. If it's worse, something you're doing isn't working, and more changes need to be made.
