Pacemaker and TRT

[Dwig]

I had heart failure 3 weeks ago which resulted in pacemaker installation. They withdrew TRT at that time so feeling pretty down. Has anyone started back with TRT after pacemaker. I am 78 and was in decent shape before failure. One week in ICU and lost muscle and motivation.

 

[Vince]

I had heart failure 3 weeks ago which resulted in pacemaker installation. They withdrew TRT at that time so feeling pretty down. Has anyone started back with TRT after pacemaker. I am 78 and was in decent shape before failure. One week in ICU and lost muscle and motivation.

My understanding is the issue blood clots. If you have no history of blood clots TRT should be okay. That's my two cents, I'm no doctor though.

 

[Nelson Vergel]

I did a search to see if there was any data.

I found important information about testosterone replacement therapy (TRT) in men with cardiovascular disease, but there's no specific published data about TRT use in men who have recently received pacemakers. However, here's what the current evidence shows that's relevant:

Key Findings​

General Cardiovascular Safety: The landmark TRAVERSE trial (2023) found that testosterone replacement therapy did not increase major cardiovascular events like heart attacks, strokes, or cardiovascular death in men with existing heart disease or high cardiovascular risk New England Journal of Medicine PubMed.


Important Cautions: However, the study did find a higher incidence of atrial fibrillation, pulmonary embolism, and acute kidney injury in the testosterone group American College of Cardiology. The increased arrhythmia risk has implications for treatment decisions in men with testosterone deficiency Houston Methodist.


ACC/AHA Guidelines: Current ACC guidelines recommend avoiding TRT in patients with recent myocardial infarction, revascularization, advanced or severe heart failure, and stroke within the last six months PubMed Central.

The Pacemaker Gap​

While the studies excluded men with pacemakers from some ECG analyses, there's no specific guidance on when TRT can be safely initiated after pacemaker implantation. The key concerns would likely be:

1. Arrhythmia risk - Given the increased atrial fibrillation risk with TRT
2. Timing after cardiac procedure - Similar to the 6-month waiting period recommended for other cardiac interventions
3. Individual risk assessment - The reason for the pacemaker (bradycardia vs. heart failure with biventricular pacing) would matter

Bottom line: This appears to be an understudied area. Given the ACC guidelines' caution about recent cardiac procedures and the arrhythmia concerns, a cardiologist would need to weigh the individual patient's circumstances, including why they needed the pacemaker and how long ago it was implanted.