Just diagnosed with low testosterone after heart surgery

[ChristmasElf]

Good day, I'm 64 yr old male visually impaired with some residual sight (and a guide dog) who had a triple bypass open heart surgery April 2014. I recovered quickly from the bypass and cardio rehab. My cardiologist says I have made an outstanding recovery.i weigh 127lb and body fat approx 15%. I now do 30 min of high intensity interval training 3 to 5 days a week and started strength training with a trainer 5 days a week for a hour. in January.

Lab results on 02/06/15 showed total T 193 (ref 300-890), T Free calc 27.9 (47-244), SHBG 50 (13-71), %T Free calc 1.4 (1.6-2.9). My lipid panel was good tot chol 113 (130-195). Trig 58 (10-190), HDL 51, LDL direct 52, TSH 3.5 (.34-4.82) psa 1.1.

I have discussed the blood work results with my new primary care doctor and we will have a detailed discussion 16 March during my physical. He wants me to discuss this with my cardiologist during a previously scheduled appointment 10 March. He appears to be ready to prescribed testosterone gel replacement therapy if the cardiologist has no strong objections. From my reading of the studies posted in this for him it seems the benefits for someone in my position far outweigh any possible side effects. Interested in your view of testosterone therapy benefits for somebody with cardiovascular disease but otherwise in very good shape. Also interested in whether starting with testosterone gel is the best route. With my visual impairment it is likely that testosterone injections would require me to go to the doctors office every week or two which is sub optimal.

in addition to the bloodwork test testerone levels I have several of the other low-T signs but not all. Glad to have this for him to bounce ideas off of and see what issues other people on testosterone therapy are having

 

[Nelson Vergel]

ChistmasElf

Welcome to our team!

Congrats on your recovery. Your lipids look good. Obviously, your total testosterone is low.

Tell us what cardiac meds you are taking, please.

I would talk to your doc about starting with a 2 percent compounded testosterone cream (empowerrxpharmacy.com has a good and cheap one, your doc needs to send fax). 1 ml per day dose then recheck at week 4 to see if you need to increase dose to bring you to the 600-900 ng/dL total T range. Your hematocrit should be kept under 52 with blood donations if needed. Check estradiol by ultrasensitive test at week 4 also to ensure it is in the 20-50 pg/mL range. Your blood pressure should also be closely monitored. Your PSA should never approach 4 or increase more than 50 percent during the first month. Also, watch for any urination issues.

You may want to read this:

Thread: Does Testosterone Increase the Chance for a Heart Attack?

 

[CoastWatcher]

I have three friends who are on TRT and each of them deals with coronary artery disease. One of them, like you, is a successful bypass patient. All of them are carefully followed, and all of them report excellent results from the hormone therapy.

Good luck!

 

[ChristmasElf]

Thanks Nelson, forgot the meds. On 25 mg of Metoporol er (which may be dropped when I see my heart doc on 10 Mar (he said it might happen this time when I saw him last Aug) 40 mg Lipitor which explains the good lipid results and a low dose aspirin.

Will discuss uss the compounding cream with primary care doc but not sure about his response. He is a gp and indicated he had 15 other patients he was treating for low T. Hoping to stay with him at least to get some testosterone therapy started. He obviously is not a specialist in low t but hopefully a good start.

 

[Nelson Vergel]

So, no blood thinner? I am sure you are taking aspirin at least.

Let us know what transpires after your next doctor's visit.

Over 50% of patients in cardiac rehab have erectile dysfunction and also low mood.


[h=2]Sexual Dysfunction before and after Cardiac Rehabilitation[/b]

 

[ChristmasElf]

Yes Nelson I am taking a low dose "baby" aspirin as a blood thinner. But that's it.

 

[Vettester Chris]

Elf, welcome to EM, glad you joined!! The other guys have made some excellent comments regarding your situation, I don't have really anything to add at the moment. Will look forward to the continued progress of your program!

 

[ChristmasElf]

Saw my cardiologist yesterday. 11 months after my triple bypass open heart surgery he said I was doing so well he did not need to see me for a year. That progress pleases me. My primary care doc also wanted his input on me starting testosterone replacement therapy. I was pleasantly surprised that he had absolutely no problems with with my starting testosterone replacement therapy. He did not see an increased risk for someone with my cardiovascular history. During my physical next week my primary care doc and I will finalize the details of my therapy protocol. He has already told me that he believes I would benefit from the testosterone therapy. Looks like I will be starting with the generic version of the 2% FORTESTA gel as that is the covered Tricare starting gel. He does not use compounding pharmacies. I think he will be amenable to working as a team with me and I believe he will take my recommendations for follow-up blood tests which Nelson indicated above and in his book. I'll report how it goes. Reading Nelsons testosterone replacement therapy book cover to cover has been a real help for increasing my depth of knowledge and ability to converse with the doctor intelligently. Nelson thank you for writing it.

 

[CoastWatcher]

Great news - all the best!

 

[ChristmasElf]

My pcp started me on "Testosterone Gel" the generic 2% T gel for Fortesta last weekend. It was pre-authorized by my insurance TRICARE. He started me on four pumps. Each pump is 10 mg of testosterone. That is the "normal" starting dosage recommended. He will reevaluate the dosage in six weeks.

The following are lab results from 18Mar15 just before starting T or in addition to the lab results from mid February above.. FSH 26.2 mIU/mL (ref 0.9-15) HIGH, prolactin 4.5 ng/ml (ref 2.1-17.1); LH 15.1 mIU/mL (ref 1.3-12.9) HIGH, Testosterone total 120 NG/DL (ref 292-701) LOW, Free test calc 1.6 NG/DL (ref 4.8-25) LOW, SHBG 55.0 NMOL/L (ref 17-66)

I would appreciate any comments on the additional labs above. The total testosterone was down to 120 from the 193 mid February. The sample mid February was taken at approximately 11:30 AM in the sample taken last week was it 3:30 PM. Later in the day may account for some of the difference but that does seem like a significant lowering without any change in medication. I have not yet had a chance to talk about these results with the doctor so any questions I should direct towards him would also be appreciated. When he reevaluate the dosage in six weeks I will ask him to add estradiol levels to his lab work. I have the feeling that it may take significantly more than four pumps the day to bring my testosterone up to a reasonable level. But I have finally started the journey.

 

[GettingAnswers]

From a numbers standpoint based on the elevated levels of LH and FSH it appears you have primary hypogonadism, ie failure at the testicular level. TRT seems like a wise choice. Will let someone chime in if those numbers could indicate something that should be looked at.

Good luck on the trt!!

 

[CoastWatcher]

I am glad to hear from you again, and congratulate you on starting TRT. While everyone responds differently, I found that topical medication did nothing, not one thing, in regard to my testosterone level. I started treatment with a total testosterone of 165, slightly higher than yours, and after eight weeks, and two rounds of testing, found a new doctor and was switched to injections. So, as many here on the forum can attest, progress may take a bit of time: don't lose heart of the dialing-in takes a bit longer than you would hope.

 

[ChristmasElf]

Getting answers...yes I believe primary hypogonadism would also be consistent with one significant indicator of one of my testicles being much smaller than the other.