LA will never run out of testosterone clinics, and it’s probably because they’ve served a legitimate purpose – treating men with hormone deficiencies that have gone untreated for way too long. That said, clinics carry the risk of putting men on long-term hormonal therapy with little to no evaluation and even less monitoring. The men that Dr. Tehrani has treatment with her are on one end of the spectrum while the men on the other end have genuine heart issues that need a more defined answer. She helps both.

What the Research Shows

To say the least, men’s hearts are known to get in the way when discussing testosterone therapy because of the early termination of one of the first large studies. Around a decade ago, Eli Lilly & Company halted testing because heart problems began to surface in the study’s treatment group. After that, many other observational studies also began to show evidence for harm, resulting in more long-standing labeling that acknowledged the potential for cardiovascular risk.

That has since changed. In a large randomized controlled trial, testosterone therapy did not result in a worse case outcome of heart attacks, strokes or death.

Testosterone Therapy and Your Heart by David K. is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

This reassurance applies to a specific case: men diagnosed with low testosterone levels who are treated off-label with testosterone to increase their levels within normal physiological ranges, given medical supervision. It doesn’t apply to men with normal levels using testosterone for ‘bodybuilder’s high’ or for increasing energy levels. These cases haven’t been assessed in the same way, and the outcome cannot be generalized.

The same trial noted important findings that should not be dismissed when overall cardiac event rates provided some degree of reassurance. The treated group had an increased incidence of atrial fibrillation and pulmonary embolism, as well as of acute renal failure. It should be noted that these findings should not be used to dismiss the need for treatment. Rather, it illustrates the need for more careful monitoring and thoughtful prescribing.

Concerning findings include erythrocytosis, an increase in red blood cell concentration. Since testosterone increases red blood cell production, testosterone treatment can lead to an increase in hematocrit to the point of increasing blood viscosity and clotting risk. This risk is easily managed by monitoring routinely with lab tests and easily managed by dose adjustments.

There is good reason for concern if testosterone treatment is used in men with a diagnosis of congestive heart failure. Testosterone can increase blood pressure, where most formulations have a warning of that potential. Testosterone drug use can also cause fluid retention. This is of considerable concern for men with pathophysiological cardiac dysfunction and can cause sleep apnea. All of these issues can be easily managed if the drug use is monitored.

Supraphysiologic Dosing is Like Nothing Else

Substitution of a depleted hormone and the use of testosterone above the physiologic range are really quite different things. The latter falls within the realm of fitness culture and almost always co-occurs with additional drugs and is almost always done without medical supervision.

The adverse effects on the cardiovascular system are unmistakable. Long-term anabolic steroid use at supraphysiologic doses has been shown to result in hypertrophic cardiomyopathy, reduction in cardiac pump function, and the development of coronary artery disease at a age that others would deem premature.

Testosterone use at these levels should prompt a clinical evaluation. Sometimes symptoms of use will be evident, but often these structural alterations occur long before symptoms are evident.

Low Testosterone is Usually a symptoms Rather than a Diagnosis

Even in men in their 60s, the presence of low Testosterone is usually a symptom of co-morbidites. Weight gain, uncontrolled blood sugar and sleep apnea combined with other forms of chronic stress, welfare legacy drugs, and a host of illnesses can add to the stress that reduces testosterone.

All of these illnesses and co-morbidites will have an even more adverse effect on the circulatory system than low Testosterone (from a hormonal perspective). Correcting the hormone level without addressing the cause will leave the cardiovascular system in even worse shape than before. A man who feels better from Testosterone replacement, but still has untreated sleep apnea and an even worse blood sugar is no better protected from heart disease.

Thorough evaluation includes measuring total testosterone on two separate morning samples, assessing weight, blood pressure, lipids, glucose, and sleep quality. An afternoon blood draw that is immediately followed by a prescription is not an adequate evaluation.

Questions Worth Asking Before Starting

Determine if the diagnosis requires two morning samples and documented symptoms. Determine what your baseline hematocrit, blood pressure, and lipid panel were and how frequently they will be checked. Determine the target hematocrit level that the management or treatment will strive for, and if the dose will be impacted with a subsequent hematocrit value. Determine if you have been screened for sleep apnea. Determine what the plan will be if you decide to stop it, as there would be a need to manage if this treatment is being used for an extended amount of time.

No clinic that cannot answer the above would be considered a clinic that is practicing medicine.

When to See a Cardiac Specialist

Make an appointment with a cardiologist if you experience chest pain or pressure, shortness of breath when reclining or during physical exertion, a racing or irregular heartbeat, swelling in your legs, unexplained leg pain, leg swelling, which may be due to a blood clot, or unexplained leg swelling.

Due to coronary artery disease, heart attack history, heart failure, atrial fibrillation, blood clot history, uncontrolled hypertension, anabolic steroid use, or high doses in the past or present, even without symptoms, a cardiac evaluation is warranted for the men. Also, men who are currently on testosterone and have elevated blood pressure or hematocrit should be evaluated.

Dr. Tehrani offers cardiac evaluations to men undergoing hormone therapy in the Los Angeles area. Treatment with testosterone is safe for the heart when it is prescribed properly and monitored. The problems arise when this is not the case.

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Dr. Tehrani provides cardiac evaluation for men undergoing hormone therapy in the greater Los Angeles area. Testosterone is safe for the heart if it is prescribed appropriately and if it is monitored. The problems arise when it is neither.

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Maria Tehrani, MD
Cardiac Surgeon | Ronald Reagan UCLA Medical Center
Phone: 818-350-9899
Email: welcome@mariatehranimd.com
Address: 757 Westwood Plaza, Los Angeles, CA 90095
Hours: Monday–Friday, 9AM–5PM
Serving patients throughout Westwood, Brentwood, Beverly Hills, Santa Monica, Century City, Bel Air, Pacific Palisades, Marina del Rey, and Culver City.