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Family Physician
Family Physician, Doctor
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Experience:  Emergency Medicine and Family Practice for over 26 years
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This question actually falls between endocrinology and cardiology

Resolved Question:

This question actually falls between endocrinology and cardiology so I hope you can help. I suffered a very mild heart attack 2 and a half years ago (I'm 40 years old now) was a heavy smoker, quit and all my indicators are in very good range and echo shows very little damage and 100% function. So my heart is fine as far as Im concerned.

I have no thyroid (treat with Synthroid) due to Hashimoto's 20 years ago and see an endocrinologist annually and a recent exam showed that I have a total testosterone level of about 200 and free testosterone of 7. My cardiologist is very straightforward that he would not like me to take testosterone supplements but I know his focus is strictly managing my heart issues. I think long term effects of low testosterone can be more troublesome eventually.

So, two fold question.

Is there any significant heart risk in trying a short round of low dose testosterone therapy (200 mg) or is my cardiologist being super protective of his area?
also
I am considering having a child with my girlfriend and know that supplements can effect a man's fertility. Would the effect be significant on a low dose trial (200 mg)? I have a normal sperm count now (20 million+).

Any feedback would be greatly appreciated.
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. Rick, MD replied 1 year ago.
Those are very good questions. Let me go over them in order:

Expert:  Dr. Rick, MD replied 1 year ago.
Wayne,

Let's talk about your heart first. Testosterone, which is converted by your body to an active form called DHT can, even at low doses, raise you "bad" cholesterol levels which can lead to arterial disease. In a large Swedish study this was lined to more sever heart disease.

So. To answer your question. In my opinion your cardiologist is not being over protective in this area. Especially when you realize that DHT can cause an increased risk of prostate problems, even prostate cancer...along with a higher incidence of diabetes.

2. Taking testosterone supplement, even at low dose, will make your testes stop or decrease the amount of testosterone they produce. This will STOP your production of sperm. No sperm. No pregnancy.

Is there anything else you would like to discuss at this point or have all your questions been answered to your satisfaction?

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS

Dr. Rick, MD, Board Certified MD
Category: Medical
Satisfied Customers: 7852
Experience: 20+ years as a doctor. Internal Medicine Internship in NYC
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Expert:  Family Physician replied 1 year ago.
Thank you for your question:

The answer to this question is not as simple as it may appear. There are both potential risks and potential benefits on cardiovascular risk factors and heart disease. Testosterone deficiency may increase the risk of obesity, metabolic syndrome and diabetes - all of which are associated with a higher risk of heart disease.
http://www.ncbi.nlm.nih.gov/pubmed/23378050
Testosterone replacement also help lipid (cholesterol) levels in men with low testosterone.
http://www.ncbi.nlm.nih.gov/pubmed/23422242
You should be aware as this article summary states - the overall effect of testosterone replacement is not fully understood. This is still an area of some disagreement.

As for the issue of fertility with testosterone supplements - this also is not an absolute. There is evidence that use of injections of HCG can preserve fertility in men undergoing testosterone replacement therapy
http://www.ncbi.nlm.nih.gov/pubmed/23260550

I believe your best option would be to get a second opinion from another cardiologist and another endocrinologist who may feel differently about your overall best treatment approach.
Family Physician, Doctor
Category: Medical
Satisfied Customers: 12601
Experience: Emergency Medicine and Family Practice for over 26 years
Family Physician and 6 other Medical Specialists are ready to help you

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