Testosterone Therapy and Heart Attacks

Hello. Uh, bit of a different video from me, but one I felt is important as a kind of testosterone PSA, if you like. I'll try to keep it short. I'm seeing a lot of men on testosterone therapy who are otherwise quite fit and well coming in with heart attacks. My name is Rohan Francis. I'm a consultant interventional cardiologist in the UK. And in just the last few months, I've seen five men admitted with the most severe form of heart attack, something called an ST elevation myioidal inffection, which means that these men had a complete occlusion of one of the arteries supplying the heart. I treated them all and they've all gone home safely, but they all suffered permanent damage to their heart. Now, if you haven't seen any of my videos before, I spend a lot of time criticizing people who share anecdotal evidence and who draw conclusions from small data sets. I'm very aware that this is exactly what I'm doing now and I am a bit apprehensive about saying this. So I do want to emphasize this is purely one doctor's observation based on my own experience. Please don't take what I'm saying as conclusive evidence of anything. But just as a doctor might try to sound the alarm about a novel infection they're seeing in their hospital, I actually felt strongly enough to mention this publicly and contradict my own code of conduct because I've been practicing for a long time and I've not seen this before. Secondly, because I have an interest in this field due to, you know, having this YouTube channel and just being interested in the science of fitness and training and because I keep tabs on misinformation being promulgated by health influencers online. I think I'm probably more attuned to asking men that I treat about testosterone, which makes me suspect that the problem is likely under reportported as in many cases men don't mention testosterone therapy on admission. I think in most part because they might consider it like a supplement rather than a medication and we know that people often don't mention supplements when you ask them what medication they take when they come into hospital. In fact, I think in every case, the men have only dulged it after I specifically asked. One chap denied it until his family left and then he told me. So, my point is that my colleagues might not even be aware that their patients are taking testosterone. And bear in mind, I'm on a one in 12 rotor. So, I'm on call every 12th day and weekend. And yet, just on my own calls, I've clocked up five male patients on testosterone therapy recently. And they all have remarkable similarities. They're all very fit guys. Some had fairly minor risk factors like high blood pressure or maybe a slightly elevated cholesterol. But none of them were smokers. All worked out regularly. They were really fit. None were diabetic. And yet they all had massive heart attacks without any proceeding angina in their 40s and 50s. The oldest was 58. And the one patient that made me realize something was going on was a few weeks back. And when I came when he came in, I asked him what medications he took and he said, "Just an anti-depressant. No big deal. " I said, "Anything else? Anything over the counter? " And he listed off a collection that immediately ran rang some alarm bells in my head. He said, "Jen, Lcarnitine, collagen, ashwagandha, vitamin D, vitamin E, turmeric, lion's mane, chilit, and a probiotic fiber supplement. " This was a practically an A to Zed of all the hot button things recommended by people like Joe Rogan or Andrew Hman. So my immediate follow-up question was whether he was on TRT, not least because he looked in great shape for his 50 odd years. And he said yes, he's been taking testosterone for 3 years for depression. So this poor chap who worked out three to four times per week. He had checked his cholesterol just 5 weeks earlier. It was normal. He had no family history and he had never smoked. had come in with a huge anterior infar. And [snorts] like all the other men, he'd been convinced to buy testosterone on online or to seek out a functional medicine doctor to prescribe them. And they had all got their information from health influencers on the internet. And once again, this is purely anecdata. Sadly, we have no research at the moment regarding this. There is, of course, ample research about the safety of testosterone replacement therapy, i. e. people who have proven clinical deficiency of the hormone, unsurprisingly, they benefit from replacing it. But not one of these men had levels in the deficient range prior to starting. And those that knew their levels after starting exogenous testosterone, these are all on private systems, so I couldn't access them, they were all in the supernormal range, i. e. the level you might expect in a 20-year-old. Now, we don't have any evidence in this patient population, i. e. people with levels that are entirely normal for their age starting on what they call TRT, but in reality we should be calling something like supernormal exogenous testosterone supplementation or perhaps something a little catchier. I'm concerned that men in this category, and I know there are other indications for testosterone like menopausal or post-menopausal women or

trans men. I'm purely talking about men taking testosterone in the absence of deficiency for things like fitness or vitality. I'm concerned they're being misled by influencers that testosterone is all gain and no pain, that entirely normal symptoms of aging are being pathized and men are being promised the ability to turn back the clock to their youth. or that other problems like obesity and metabolic disease are not being effectively addressed prior to reaching for the testosterone. And one of the guys that I treated as asked me after I'd opened up his coronary artery, should I stop taking testosterone? Because I'd kind of been chatting to him about this and I said, look, honestly, I don't know. It can be difficult to stop as your endogenous production, your own production might have reduced and you can have a paradoxical kind of crash when stopping the therapy. So, you know, would any of these men have had heart attacks anyway? There's obviously no way to know. All I can say is this feels like something new, and I would love to see some proper research in the field. The world of wellness is the wild west. People are taking all kinds of strong medicines which are marketed as something different, but they are ultimately pharmaceuticals, often unregulated, or the afterare is questionable, i. e. aiming for testosterone levels way above the natural range. And it seems logical that risk increases as dose does. All right, I'm going to leave it at that. This obviously is not a deep dive into testosterone. And once more, this is not evidence of a concrete link. Please don't cite me saying that. I'm just kind of raising some concerns. I think to sum it up, someone who I think probably is a bit of a hero to a lot of the guys who may be tempted to take testosterone, who are interested in self-optimization and productivity because he's arguably the guy who kickstarted the whole modern trend. Tim Ferris, I think he actually said it pretty well when he wrote about this a little while ago and I happened to read it. He said there's no such thing as a biological free lunch and I would agree with that. Everything has pros and cons. It's ultimately up to you to decide, but we're clearly in an area which does not have robust long-term data. So, do try to find a sensible doctor to talk to in real life and think about things carefully. All the best. Sorry, there's an important point that I should have mentioned. Um, I posted these same thoughts today just as a thread on blue sky and a reply from another interventional cardiologist said that he's noticing the same thing. Um but he also reminded me and he does general cardiology just like I do as well as um you know the interventional stuff stenting and whatnot. Um and said that he's seeing a lot of resistant hypertension in patients on testosterone. Um I think he's in the US and I think these problems are more common there. I think there are probably more people on testosterone. That's purely a guess. But um he it's I also have noticed this that patients on testosterone are uh developing quite difficult to control high blood pressure. So, you know, it's not just the acute heart attacks, but obviously high blood pressure can lead to heart attacks as well as things like strokes. Um so, listen, you know, if there are any medical students or resident doctors out there who maybe want to kind of do a bit of research, like I, you know, I can't run any proper formal trials at the moment, but you know, maybe we could try and get some reporting together and um do some things. If you have an idea about how to go about it, I don't just want people to get in touch saying, "Yes, I'd like to volunteer. " Uh, I want you to come with ideas, but you know, feel free to drop me a line and maybe we can try and write something up. Man, I keep posting serious videos. I need to do something silly soon. So uh watch this space.