On TRT: How to check the state of cardiovascular system & how to find heart specialist

Currently I (37m) am taking 20mg testosterone propionate and 150 IU hcg per day. doing that since a couple of months.

I asked the doc if he can check my carotis intima and so on to see if there is soft plaque etc....

He said I need to go to cardiologist.

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?

which diagnostics should I ask him for ideally? I want to get as much good information as possible. so maybe if I know what to say before then he will make more extensive diagnostics?

do you people know what things are reversible regarding blood vessels?

 

This is a huge topic but here are a few things to start with. I recently heard the results of a large sample of data correlated with heart events, and the number one risk factor was A1C, which should be under 5.5 or hopefully lower. This makes sense since elevated blood sugar can damage the lining of the blood vessels. Triglycerides should be under 90. Fasting insulin under 6, Homocystiene under 10. CRP under 1. You can get ultrasound scans as well as the CAC scans, however the problem with those is that 1) plaque, especially calcified plaque is a fairly advanced state of CVD, so even if you don't have much you could still be in the early states of disease, 2) you need a series of them to determine trend, then it is still hard to tie the trend to a specific factor and 3) the action no matter the result is generally to do everything you reasonably can to be as healthy as possible, although in cases of extreme blockage you might be motivated to take more extreme measures. To me a good cardiologist is consistent with Dr. Kendrick's book and does not use statins, however I have no idea how to find a good cardiologist. You might check with holistic/integrative medical practices and see what they recommend. I would assume that almost any condition can be reversed and I have heard of extreme blockages being reveres with, for example the addition of vitamin K2, and I have heard a lot abut Nattokinase recently as well.

 

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.

 

You might also check Lp(a). There isn't AFAIK a perfect fix if it's elevated although Oxandrolone apparently will help, but you could be at greater risk if it's elevated and hence might want to take more extreme measures

 

This is a huge topic but here are a few things to start with. I recently heard the results of a large sample of data correlated with heart events, and the number one risk factor was A1C, which should be under 5.5 or hopefully lower. This makes sense since elevated blood sugar can damage the lining of the blood vessels. Triglycerides should be under 90. Fasting insulin under 6, Homocystiene under 10. CRP under 1. You can get ultrasound scans as well as the CAC scans, however the problem with those is that 1) plaque, especially calcified plaque is a fairly advanced state of CVD, so even if you don't have much you could still be in the early states of disease, 2) you need a series of them to determine trend, then it is still hard to tie the trend to a specific factor and 3) the action no matter the result is generally to do everything you reasonably can to be as healthy as possible, although in cases of extreme blockage you might be motivated to take more extreme measures. To me a good cardiologist is consistent with Dr. Kendrick's book and does not use statins, however I have no idea how to find a good cardiologist. You might check with holistic/integrative medical practices and see what they recommend. I would assume that almost any condition can be reversed and I have heard of extreme blockages being reveres with, for example the addition of vitamin K2, and I have heard a lot abut Nattokinase recently as well.

do you know what dosage of k2?

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.

- do you know on what dosage of testosterone the doc is himself?
- so you dont take any statin at all?
- how would the statin worsen the metabolic health? (I might be able to switch out the 5mg rosuvastatine + 5mg ezetimibe with bempedoic acid 180mg + 5mg ezetimibe). Pcsk9 would be to expensive here in Germany
- any delta-tocotrienols and berberine products you can recommend so I know what to look for?

You might also check Lp(a). There isn't AFAIK a perfect fix if it's elevated although Oxandrolone apparently will help, but you could be at greater risk if it's elevated and hence might want to take more extreme measures

yeah my lpa is slightly elevated. Was measured first with 127,3 nmol/l then 6 months later with 93,7 nmol/l.

 

Currently I (37m) am taking 20mg testosterone propionate and 150 IU hcg per day. doing that since a couple of months.

I asked the doc if he can check my carotis intima and so on to see if there is soft plaque etc....

He said I need to go to cardiologist.

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?

which diagnostics should I ask him for ideally? I want to get as much good information as possible. so maybe if I know what to say before then he will make more extensive diagnostics?

do you people know what things are reversible regarding blood vessels?

Have you ever had a Heart CT calcium score, checking for plaque? It's normally out of pocket and cost about $120

 

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?

which diagnostics should I ask him for ideally? I want to get as much good information as possible. so maybe if I know what to say before then he will make more extensive diagnostics?

do you people know what things are reversible regarding blood vessels?

Many cardiologists are not TRT friendly since they believe TRT screws up lipids and causes high blood pressure. If I were you, I would find a hormone friendly urologist and ask him or her who he/she refers patients to. That's how I found mine.

Younger cardiologists tend to have more education about testosterone.

If your insurance pays, ask the doctor to run these blood tests:
CBC
CMP
Lipid Panel or Cardio IQ
D-Dimer
High Sensitivity CRP
Homocysteine


Cardiologists get a full family history, EKG, calcium score (sometimes), and depending on several markers, they may request an electrocardiogram.

The most amazing medication for lipid management right now is Repatha. It does not cause issues with high CPK like statins can cause.

Blood pressure meds are commonly prescribed. ARBs, and ACE inhibitors are the most erection friendly.

I had left ventricular hypertrophy LVH for years due to my high BP. I had a lot of side effects from BP meds until I started losartan plus nevilolol. My LVH dissappeared after a year of good BP control.

I had arrythmia a few months ago (PVC's) that were completely resolved by a simple ablation.

Most young men with optimized TRT and normal blood pressure do not usually have heart issues unless your family CVD history is very strong, your LDL is high for a long time, and you are not obese.

 

do you know what dosage of k2?



- do you know on what dosage of testosterone the doc is himself?
- so you dont take any statin at all?
- how would the statin worsen the metabolic health? (I might be able to switch out the 5mg rosuvastatine + 5mg ezetimibe with bempedoic acid 180mg + 5mg ezetimibe). Pcsk9 would be to expensive here in Germany
- any delta-tocotrienols and berberine products you can recommend so I know what to look for?


yeah my lpa is slightly elevated. Was measured first with 127,3 nmol/l then 6 months later with 93,7 nmol/l.

For K2, I take either 2-3 MK-4 capsules with 100mcg each per day, or 100mcg Mk-7, however I suspect a higher dose of MK-4 would be fine. Some people APOE4's I think can build up too much K2 so I stay at moderate doses since I don't know if I'm in that category.

For Lp(a), the best advice I've heard in my opinion is to optimize the other big cardio issues, specifically avoid excess psychological stress, and keep HbA1c below 5.5, fasting insulin below 6, CRP below 1, and Triglycerides below 90, while keeping Vitamin D above 50 and taking 1-2 grams of vitamin c per day, as well as Vitamin K2 and magnesium. And keep blood pressure in healthy ranges. The problem with all the studies that showed Lp(a) to be an issue is that they were done with populations that were violating the basics in this list. Most doctors don't even test fasting insulin or CRP for example. Homocysteine may be worth checking as well and AFAIK should be below 10 or so.