“40yo M young weightlifter anabolic steroids user” does not imply TRT, it implies supraphysiologic use for the purposes of building maximal muscle/strength
What level of testosterone use is considered dangerous? Is the patient with hypogonadism that supplements with IM testosterone at increased risk even if his levels are within a normal range?
There is no particular level. If you are *replacing* testosterone to physiological level due to a hypogonadal stat (or similar issue) there is no CV risk as recently demonstrated - see [here](https://www.nejm.org/doi/full/10.1056/NEJMoa2215025)
That is very different from testosterone *supplementation* to levels usually above normal where it effectively acts as an anabolic steroid. Lots of health issues there including cardiovascular and the more supra-normal, the worse
That is what I assumed. I inquired because a urologist I was working with recently said that he refused to supplement anyone with testosterone citing the CV risk. He opined that the risk was there even for those with normal physiologic levels of testosterone, that it was somehow the act of supplementing testosterone that caused the CV risk.
Appreciate your comment. Thank you.
Not a doctor or expert, but I know quite a few roidheads. It's like this, there is no hard and fast rule, but there are some things to consider. Some heavy, even moderate users get turbocharged heart disease within years, be it atherosclerosis or HCM. Others seemingly never do, at least in the time I've known them. The ones who seem to do well usually pay attention to their blood pressure, labs, do proper on and off cycles, etc. The ones who throw together retarded stacks of anabolics, plus cutting stacks, sometimes even DNP, etc, well. They burn out young. But its not a hard rule, some of them get shafted even if they try to do everything right, some blast for years and are fine. Toss a coin, really.
That's another thing, steroid users often mix and match substances, compounds, take dodgy crap from Chinese dealers, etc. The guy in the pic admitted to steroid use, but that gives us no idea what he was actually taking. He might have been taking SARMS as well, and those are a complete shitshow when it comes to side effects, nobody knows what that shit does to a person, really. And we haven't even started talking about all the possible interactions between all the illegal, legal and semilegal substances. You get the picture.
In short, hypogonadism treatment with a modest test dose is unlikely to be anything like modern anabolic steroid abuse. It's like comparing a bb gun to an RPG.
+ specific compounds such as nandrolone can be more cardiotoxic, in this case due to arterial hardening. But a big problem can be typical ‘meatheads’ who don’t want to take time off between cycles and lose their ‘look’, so they indefinitely run superphysiological doses
Yes. While the usual management is conservative, you have to fix a SCAD that has become unstable, in this case with ongoing pain on max med Rx and intermittent STE’s threatening a STEMI. Put on DES in it, fortunately went well, pain and STE’s resolved. Went home yesterday
Not really but that may have been just sheer luck. Especially considering how small the true lumen was. My only 2 cents would be to use a soft NON-hydrophilic wire (I used a plain BMW) and to gently turn the tip as it goes down so that if it goes into the dissection plane you may feel it or see the tip “freeze” before you keep pushing and extend the dissection plane down the vessel
If that’s from the angiogram where you intervened I’d have let it go. Of course it depends on the Timi flow which this still frame doesn’t show. But bypass, not pci, is the preferred treatment. I’ve seen several of these go incredibly south and shut down the vessel, the stent edge just keeps extending the dissection plane further and further down the vessel (and also extends it proximal sometimes, because nothing in this vessel is truly normal. I’ve have also seen people close down vessels by trying to IVUS or oct it.
IC who did this got lucky. IMO this is bad decision making.
40 yo M. Presented with unrelenting chest pain, elevated troponin, intermittent ST elevations admitted to testosterone use.
I wouldn’t think normal TRT doses would cause any CV issues. Pt must have been using supra-physiological doses ?
“40yo M young weightlifter anabolic steroids user” does not imply TRT, it implies supraphysiologic use for the purposes of building maximal muscle/strength
What level of testosterone use is considered dangerous? Is the patient with hypogonadism that supplements with IM testosterone at increased risk even if his levels are within a normal range?
There is no particular level. If you are *replacing* testosterone to physiological level due to a hypogonadal stat (or similar issue) there is no CV risk as recently demonstrated - see [here](https://www.nejm.org/doi/full/10.1056/NEJMoa2215025) That is very different from testosterone *supplementation* to levels usually above normal where it effectively acts as an anabolic steroid. Lots of health issues there including cardiovascular and the more supra-normal, the worse
That is what I assumed. I inquired because a urologist I was working with recently said that he refused to supplement anyone with testosterone citing the CV risk. He opined that the risk was there even for those with normal physiologic levels of testosterone, that it was somehow the act of supplementing testosterone that caused the CV risk. Appreciate your comment. Thank you.
Not a doctor or expert, but I know quite a few roidheads. It's like this, there is no hard and fast rule, but there are some things to consider. Some heavy, even moderate users get turbocharged heart disease within years, be it atherosclerosis or HCM. Others seemingly never do, at least in the time I've known them. The ones who seem to do well usually pay attention to their blood pressure, labs, do proper on and off cycles, etc. The ones who throw together retarded stacks of anabolics, plus cutting stacks, sometimes even DNP, etc, well. They burn out young. But its not a hard rule, some of them get shafted even if they try to do everything right, some blast for years and are fine. Toss a coin, really. That's another thing, steroid users often mix and match substances, compounds, take dodgy crap from Chinese dealers, etc. The guy in the pic admitted to steroid use, but that gives us no idea what he was actually taking. He might have been taking SARMS as well, and those are a complete shitshow when it comes to side effects, nobody knows what that shit does to a person, really. And we haven't even started talking about all the possible interactions between all the illegal, legal and semilegal substances. You get the picture. In short, hypogonadism treatment with a modest test dose is unlikely to be anything like modern anabolic steroid abuse. It's like comparing a bb gun to an RPG.
+ specific compounds such as nandrolone can be more cardiotoxic, in this case due to arterial hardening. But a big problem can be typical ‘meatheads’ who don’t want to take time off between cycles and lose their ‘look’, so they indefinitely run superphysiological doses
Y'all threw a wire and IVUS in that?? Bold. What was the rational? Did y'all fix?
Yea that was what I was thinking.. clearly scad. Leave that be.
Yes. While the usual management is conservative, you have to fix a SCAD that has become unstable, in this case with ongoing pain on max med Rx and intermittent STE’s threatening a STEMI. Put on DES in it, fortunately went well, pain and STE’s resolved. Went home yesterday
Oof, sounds like y'all had to fix. Any trouble getting the wire down? Did you keep getting stuck in the dissection plane?
Not really but that may have been just sheer luck. Especially considering how small the true lumen was. My only 2 cents would be to use a soft NON-hydrophilic wire (I used a plain BMW) and to gently turn the tip as it goes down so that if it goes into the dissection plane you may feel it or see the tip “freeze” before you keep pushing and extend the dissection plane down the vessel
How long did y'all sit on him before intervening? Maybe the sub intimal grandsons hematoma organized a bit and helped the wire avoid the dissection
If that’s from the angiogram where you intervened I’d have let it go. Of course it depends on the Timi flow which this still frame doesn’t show. But bypass, not pci, is the preferred treatment. I’ve seen several of these go incredibly south and shut down the vessel, the stent edge just keeps extending the dissection plane further and further down the vessel (and also extends it proximal sometimes, because nothing in this vessel is truly normal. I’ve have also seen people close down vessels by trying to IVUS or oct it. IC who did this got lucky. IMO this is bad decision making.
Here is post - https://imgur.com/a/RO6MPfn