Is TRT Putting Your Heart at Risk? Find Out Now! (2023. Health Study)

 Hey guys it's Dr. Ryan here and today we're going to talk about the holy grail of masculine energy, strength, and sexual function and that is testosterone. So studies from a decade ago supposedly proved that testosterone increased your risk for cardiovascular events like heart attack and stroke. That's why so many doctors were hesitant to prescribe TRT and if they did, they were less likely to boost you to the levels you need to be when the benefits were becoming very obvious. So, Dr. Ryan, I think the story begins in 2013 when the Journal of American Medical Association published a study that reported a 29 percent increase in heart attack, stroke, and death among testosterone users, right? There was another study in 2014 that found that testosterone doubled the risk of cardiovascular disease in men over 65, and almost tripled the risk of heart attacks in middle aged men with previous histories of heart disease. This was done within a fairly quick time period is within 90 days of receiving the prescription. So what happened after that was Time Magazine did a pretty big expose on the testosterone industry and how it was rapidly growing and talked up these two studies. Interesting. And so I'd also mentioned some big lawsuits from guys like you. took testosterone and then claimed it gave him heart attacks. And I think the MIT and others, New York Times jumped on the bad land too. I think, right? Yeah, you're absolutely right. And that's actually kind of what led the FDA to order manufacturers of testosterone to include a warning label. That's when you ever look at the prescribing insert for testosterone. If you ever pull out the insert or I'd like to call it the instruction manual for your medications, you'll see a big black. box. And that's what kind of led to the FDA putting that black box with testosterone and stating that there's an increased risk of cardiovascular side effects. Kind of like the way cigarettes and like vapes, right? Have like a label warning about cancer, right? Exactly. Exactly. I think, you know, for, for good reason, that's why a lot of conventional physicians had TRT for their patients. So the study in question. that we were talking about. The first one was done in 2013 and their premise was that they found an association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. But the issue was there were a lot of flaws in that study. So number one, there wasn't a control group of men. of the same age not taking testosterone because it wasn't a planned experiment, it wasn't a randomized controlled trial. This was a retrospective study where they, the researchers simply analyzed data mined from insurance company health records and kind of interestingly one of the lead authors was the owner of the data mining company which utilized the data set used in the study. Which is really weird, right? Because like, you know, there's, there's some sort of angle and the fact that several coauthors in the study were his employees at the time. Yeah. It might've, you know, contributed to bias with the study to a certain extent. I mean, obviously that individual may have been trying to promote his company for other publications and may have not been as discerning of the data. How did that study pass? a peer review for publication, right? And what about the, you know, the 2013? Well, that study also had a lot of issues in terms of the data that was utilized. Uh, they adjusted more than 50 variables in raw data and excluded a lot of subsets of men. And there have been a couple of individuals that actually wrote comments about how when they did their assessment of the data, they felt that the men on TRT were half as likely to suffer a cardiovascular event. And it appears that the authors were just cherry picking groups of men that were aligning with their supposition that TRT was bad for heart health. Yeah. And so after being challenged though, what's interesting is the author published a correction, but there's still many like problems with the study they didn't address. And everyone remembers like the headline or the acquisition. or accusation. They never remember like the retraction which is going to be like, accusation headlines going to be on page one. The retractions are going to be on like, you know, some hidden section or the last page of the newspaper, right? So this kind of all changed over the ensuing years to the point where we now recognize that testosterone has a wide range of cardiovascular benefits. There are a lot of review articles suggesting that testosterone might be beneficial in patients who have congestive heart failure, patients that have coronary artery disease, patients that have had strokes, right? And so I think we're kind of changing the tide when it comes to this. And um, some of the more conventional journals, for example, the New England Journal of Medicine, recently published an article in July of 2023. They kind of reversed what the thinking was back in 2013. So the article was titled Cardiovascular Safety of Testosterone Replacement Therapy. And the upshot was they found that in men with hypogonadism and pre existing or high risk of cardiovascular disease, testosterone replacement therapy was non inferior to placebo with respect to the incidence of major adverse cardiac events. This study basically was a randomized double blind trial 5, 000 men between the ages of 45 to 80. with low testosterone levels. These are people that typically have testosterone levels below deciliter and had pre existing cardiovascular disease, heart attack, stroke, etc, or had a high risk of disease. And what's kind of funny is when it comes to non fatal heart attacks and strokes, as well as fatal heart attack and strokes, seven percent of the men that received testosterone were susceptible to them and 7. 3 percent of the men in the placebo group, the people that got the placebo gel that had no testosterone had those issues. So it's kind of slightly lower in the testosterone group, so not much, but that's still lower, right? And the funny thing is they probably did it the wrong way, which is cream, right? Yeah. And gel. And that's not the most efficient way to do it or safe way to do it versus microdosing. Conjectable, right? Right, and there's a lot of other ways you can mitigate your risk of developing cardiovascular complications. If they were following a heart healthy diet, if they were using certain supplements which can reduce your risk of developing atherosclerosis, if they were exercising, having an appropriate amount of resistance training and cardio in their regimen, which obviously they weren't controlling for, I suspect the risk would have been much lower. This evidence kind of coincides with what I've seen in my practice with over 1, 500 patients, and the idea is that testosterone replacement therapy does not cause heart attack or stroke and I personally think can radically reduce your risk because it can improve your mood, improve your ability to recover from working out, improve insulin resistance, reduce inflammation. All things which I think are likely to decrease your risk significantly provided you add in the proper supplementation regimen, diet, and exercise alongside therapy. The Time Magazine article and the New York Times articles made big news, but The subsequent scrutiny of the data did not, and I think it's primarily because people react to big headlines and things that give them pause, that, that make them scared, and, you know, the retraction wasn't that interesting. And I guess for a lot of physicians, they just saw that first article and didn't, you know, take the time to read through the subsequent comments and the letters that suggested that the data was flawed. And just kind of went on that initial assumption. Yeah, because this stuff is kind of too boring, um, and scientific for like the average person. Take care. Uh, and doctors are really busy, right? So they don't really have time to read everything that comes out. So they're kind of, I guess, in my opinion, before I, uh, I work with you, I thought doctors were kind of running on like antiquated systems and software and old data and like assumptions, right? They're kind of like, you know, uh, kind of stuck in the past a little bit, right? And, uh, we call it calcified thinking, right? So I think that's kind of a The challenge, right? And that's why I think that 2023 study is a big deal because it finally proves that, hey, you know, TRT done right and it's safe for your heart. Yeah, which is reassuring. I'm really happy it was finally published because it'll hopefully turn the tide, so to speak, and make more and more physicians who are reluctant to prescribe testosterone for patients who are deserving that have, you know, cysticular hypofunction. A secondary hypogonasm that could really benefit from testosterone replacement therapy, allow them to treat them. I want my patients, and I try to instill this in them, to take a proactive approach to their health. Don't wait until you get sick and then get therapy. You want to avoid the manifestation of illness. You want to avoid the icebergs and really just reach your peak potential and thrive in every aspect of your life. And we'll put the link to the articles in the description as well. Also, if If you want to go ahead and show this to your provider, uh, just to, you know, help educate he or she, that would be a good thing and could be helpful.