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Left ventricular hypertrophy and testosterone replacement therapy

I was morbidly obese @ 320 pounds, depressed with no sex drive. I managed through working out drop to about 250 pounds in six months. But it was a real struggle doing 3 hours of cardio per day with 30 minutes of strength training 5-6 days a week.
But the low sex drive pressured but my wife to get my testosterone checked.

It was <20ng/dl with the normal range being 240-850. Virtually undetectable.
So about 8 months ago, I was prescribed testosterone replacement, initially @ 100mg every 2 weeks which brought my test levels close to 200, still low. So it was upped to 100mg/week.

Since that time my left ventricular wall thickness has increased from 1.1 cm to thickened at 1.8 cm. I have also gained about 30 pounds of muscle to be about 260 pounds. I look like a pro football player and I was very muscular having lifted from age 15-25 years so I chaulked it up to regaining my muscle memory.
What I did not like is that my heart has thickened. I dont know if it is because of getting an athletic heart from weightlifting. My weighttraining is not much 8 sets per bodypart once a week with loads of cardio.
Blood pressure is labile, meaning somedays particulary after cardio days can be as low as 90/60 with bp meds and I get lightheaded and cant work out. Then if I stop my bp meds it can be 150/90. Drives me nuts.
My dose is now adjusted from 40mg of lisinopril to 20mg and my hctz is cut in half to 12.5mg daily.

But because I was skipping my bp meds due to the severe lightheadedness almost falling a few times. That it may have contributed to the left ventricular hypertrophy.
I did a stress echo and although it showed a thick left ventricle, my exercise capacity was superior having gone 17 minutes on a bruce protocol on the treadmill.
Right now, I dont know what to do really.
I want to keep my blood pressure low and hope to reverse the thickening but I dont want to have sudden cardiac death in an athlete in the meantime.
I am wondering what I can do as far as anti-arrythmics, a betablocker, bystolic or even coreg to slow my heart function down to help reverse this.
Cardiologist doesnt know as he thinks its from the testosterone, working out and blood pressure issue. Which all makes sense. So I go from super depressed obese guy to looking fit and muscular (a bit too much for my liking) and also having a meatball for a heart. My goal was to not get diabetes when I started working out hard but now worried about sudden cardiac death from the hypertrophy.
I cant go off the testosterone as I cant function and I dont want to quit working out and go back to being obese.
Any suggestions and yes, I am definitely trying to keep my blood pressure under 120/80 with the ace inhibitor, just wondering about the betablockers.
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367994 tn?1304953593
A thick heart wall can be the result of high blood pressure and/or an athlete's heart syndrome/symptom. If an athlete's heart is a high risk for a heart attack, it is not substantiated by a large number of athletes keeling over with a heart attack.

Sport's medicine concludes with most trained athletes the cardiac consequences of their activity would appear to be adaptive, benign and probably reversible. However, intensive athletic training is associated with a small but finite risk of sudden death, which may be a consequence of the cellular electrical changes of mild-to-moderate cardiac hypertrophy. An enlarged heart can distort the pathway of electrical impulses and that appears to be a low risk.  Physiologically, heart cell configuration (side by side increase) is different with pathological enlargement and an athletes' cells gain elongation and has elasticity attributes) and may return to normal with reduced exertion.

I had an enlarged left ventricle (dilated, wall size normal) due to high blood pressure, and medication reversed the chamber size to normal (reversed remodeling medical term).  Reduce the workload of the heart by decreasing the high resistance of narrowed vessels by relaxing vessels with medication.

A beta blocker helps lower blood pressure and can help prevent any arrhythmias associated with an enlarged heart.  

Hope this gives you a perspective, and thanks for the question.  Take care.
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Avatar universal
hey man all these things you have suggested are correct regarding the causes. hypertension affects many actually all body systems in a negative fashion. I myself have been in strength training and bodybuilding for several years I was a lightweight when I started and gained close to 50 lbs of muscle after a few yrs of hard training and nutrition. it's a lifestyle for me and so when strength and size became harder to attain I resorted to other means (test) for the most part. the point I'm getting at is that I was always athletic and in amazing shape but the more I grew the more my Bp started climbing and the more I noticed my endurance and overall cardio fitness were lacking. I am in the medical field and have ran several ekg's on myself in the past yr. I am regrettably on the verge of a 1st degree heart block and also lvh is quiet visible. to understand the anatomy and physiology of the heart and muscular system will explain alot. obviously your heart is a muscle so with training it's going to grow somewhat but when u factor in things such as obesity or significant muscle mass your heart then as much more tissue to perfuse then it eer has before more resistance if you will. so the more resistance the harder it works the more the ventricle thickens. it's really as simple as that as for the testosterone I firmly believe that something that can make your muscles grow like this drug can it will certainly do the same for your heart.  my advice is to keep exercising regularly eat a very clean healthy diet and most of all get regular monitoring of your hearts electrical activity as well as mechanical function such as rate and regularity. I am a very big advocate for Ekg's they most def can't tell you every single thing but to a trained professional they can provide very important and vital information that can help you prevent future heart disease or control anything existing.  I hope this helps man and I understand where your coming from have a good one
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