Testosterone therapy

[runnertom]

Thank you for taking my question. I have posted before and am still looking to improve my chances of slowing or stopping my heart disease. Per previous posts, Feb 2003 I was found to have blockages in LAD and first diagonal that required CABG (age 54). It was a huge suprise since I have been 30 year runner/cyclist with benign family history and none of the classic risk factors. Consultation with cholesterol specialist revealed high homocycteine which is being treated with B viatmins. Pravachol has reduced total cholesterol of 210 (60 HDL) to 80 LDL, 60 HDL and 50 TG.
   I have further found by testing by my GP that my testosterone is at the very lower limit of the normal range (measured in the morning). I have been reading a lot of studies associating low testosterone with greater risk of CAD, although I don't think any prospective studies have shown this nor has supplementation been studied. My GP has offered to prescribe supplements based on other symptoms, but the lipid specialist would not, saying it would lower my HDL. Instead, he prespribed an SSRI for my anxiety/depression. That diagnosis was based soley on the fact that I am "obsessing" about my heart disease. The GP says I have every right to be very concerned (obsessed)considering the fact I would have been the last person he would have suspected of having heart disease.
  I would welcome your thoughts on the matter. Thank you.

[runnertom]

I have had my CRP checked within the last six months. I don't remember the exact number but my GP said is was good. My lp(a) was OK also.
  In your opinion, would it be worthwhile for me to visit the Prevention Clinic at CCF, or does it sound like my doctors and I have most of the bases covered? My exercise capacity is as good as ever as judged by my performance relative to my long standing running and cycling companions. A corotid ultrasound showed some stenosis which will be followed by serial followups.

[Cleveland Clinic]

tom,

thanks for the post.

Hormonal fluctuations can effect lipid levels.  Also, hormal levels fluctuate on a significant basis...so the low level you measured may be a facotr of when the sample was taken.

We do not routinely measure testosterone levels in our prevention clinic and would not think of supplementing it unless we were treating hypogonadism.  Your lipid profile is adequate. One thing we might consider is measuring your CRP. If elevated it would give a better idea of the activity of your disease. If high, we might consider a change to another statin such as atorvastatin.

Any supplementation of testosterone we would leave to an endocrinologist after evaluation of why the level was low.

It is somewhat normal to think 'why' does this happen to me.  But you are now revasculaized in a very durable way and need to think about getting back to enjoying life.

good luck