TESTOSTERONE AND AFIB

I HAVE A FRIEND WHO HAS HAD TWO ABLATIONS FOR AFIB AT BIG TIME HOSPITALS AND STILL HAD AFIB ATTACKS
EVERY 6 WEEKS TO TWO MONTHS. HE ALWAYS HAD THE ATTACKS AT NIGHT. HE IS 78 NOW AND HIS AFIB STARTED AT 60.
NOW THE GOOD NEWS IN APRIL HE WAS TESTED FOR TESTOSTERONE AND IT WAS LOW SO HE ELECTED TO HAVE TESTOSTERONE
THERAPY. HE STARTED THE THERAPY IN MAY AND HAS NOT HAD AN AFIB ATTACK SINCE.....HE ALSO WAS TESTED PSA 3 TIMES SINCE THERAPY STARTED
AND READINGS WERE THE SAME. WHAT ARE YOUR THOUGHTS COMMENTS DID ANYONE ELSE TRY THIS. HE ALSO HAS FELT MORE ENERGY

Hi Stevebo,
This is an area of great interest to me and will share more of my experience in the next couple days when I have more time.. The short answer is there is little surprise your friend felt a lot better all around with a better level of testosterone. There are more testosterone receptors in the heart than any other organ in the body ... And that is by design and for good reason... After all the heart is a pump required to beat 60 to 80 times a minute for 80 to hopefully 100 years without missing too many beats. It needs all the hormonal energy and help it can get! There are some things to know to restore one's testosterone level with replacement therapy wisely and properly. ... More soon.

Shannon



Edited 1 time(s). Last edit at 12/30/2012 11:56AM by Shannon.

Steve,

In addition to Shannon, George Eby has posted on testosterone and afib.

Here is a link to testosterone posts on this board. [www.afibbers.org]

My post in this thread has many links to George's posts: <[www.afibbers.org];

George

Hi Stevebo,

For a general overview, like most critical hormones in our body, Testosterone declines at a relatively steep rate starting anywhere from the late 20s to the early 40s depending on one's genetics, diet and effective anabolic protein assimilation, stress, toxicity exposure and other illnesses etc. This is true for both men and women though the rates of decline and timing often vary between the sexes. For women testosterone is absolutely vital for good health, but is less prevalent in amount than in men. Estrogen's in women serve a larger portion of their anabolic role, while in men though estrogen's are also vital, they are typically found at a lesser amount than in pre-menopausal women. Men get more testosterone that define their masculinity and much of what it is to be a man, while women get a much larger share of Estradiol and other estrogens that define their body shape and femininity as well as much of the characteristic feminine sensibility.

But with either too much or two little Estradiol in a man, he will lose much of his energy and libido as the excess or deficient levels of Estradiol undermine much of the benefits of what testosterone they have. And similarly, a women with too little or too much Testosterone will often have impaired libido and poor physical health as well regardless of their Estrogen levels. It seems that even biochemically the two sexes both mirror-image as well as complement and contrast each other.

A good book for a solid overview is Dr Eugene Shippen's 'The Testosterone Syndrome' .. also the book by Harvard Urologist Dr Abraham Morgentaler 'Testosterone for Life' is also very good, including his thorough debunking of the previous sacrosanct mantra in the medical community that mistakenly assumed testosterone 'caused' prostate cancer which it does NOT! Its a classic modern medical mythology that unfortunately still mesmerizes too many main stream doctors who have not investigated the reality of what the full body of literature and studies over the last 70 years clearly shows.

After an exhautive review of every single study ever made on testostorone and the prostate, including exposing teh single study from 1941 that erroneously started the whole myth that Testosterone causes PC to grow, Dr Morgantaler

Wrote in JAMA:

"There is not now - nor has there ever been - a scientific basis for the belief that Testosterone causes Prostate Cancer to grow".

Testosterone is the principle anabolic hormone in men and is required to help prevent everything from scarcopenia to osteoperosis and can greatly improve cardiac function and cognition as well as overall energy levels, libido and a general sense of physical and mental well being.

Higher testosterone levels in men (within the upper quartile of the broad reference range) are associated with lower overall mortality in a large number of double blind studies and meta-analysis with a 41% decreased chance of dying for men with total testosterone levels above 560ng/dl which is really a minimum number of barely sufficient total testo level. A much better level for most men ranges from 750ng/ml up to 1,000ng/dl depending on the body size of the man.

Free testosterone levels are much more important and more relevant in determining deficiency and sufficiency than is total testosterone in blood. as 97% or more of one's blood levels of total testosterone are strongly bound up by Sex Hormone Binding Globulin (SHBG) and more weakly by Albumin resulting in usually 3% or less actually being available for cellular binding and action where the rubber meets the road. Better levels of free testosterone in serum start at a minimum of 17pg/ml up to a high of around 29pg/ml.

The very best serum measure for total anabolic sufficiency is Androstanediol Glucuronide which is the final metabolite of all the major androgens such as Testosterone, Di-hydrotestosterone (DHT), DHEA and Androstenedione and indicates how much anabolic cellular binding and action occur as a result of metabolizing of all of the above anabolic hormones.

Cardiovascular benefits of optimal testosterone levels are reduced angina, reduction in ischemia, dilates intracoronary arteries, improves excercise tolerance, decreased inflammation, significantly decreases atherioscelerosis and improves Congestive Heart Failure, contributes toward reduction in blood pressure, improved cerebral blood flow and thus improved cognition, Nitrous oxide receptors are upregulated, helps prevent formation of a major precursor for beta amyloid protein associated with Alzheimers.

Also, total and free testosterone levels in men less than 45 years old with coronary artery disease were significantly lower than those of matched controls.

In women, low testosterone levels are strongly associated with increased all cause cardiovascular event mortality independent of other risk factors and testosterone replacement therapy.

There are numerous other benefits to optimizing one's testosterone level as well including increasing endogenous Growth Hormone secretion at night by 200% and increases in IGF1 levels by 22% in people over 50 years old. Testosterone is the very best Growth Hormone Secretagogue ( stimulator) there is.

Also, optimal testosterone levels have been shown to increase Endothelial Progenator Cells from bone marrow which are similar to stem cells used for vascular repair .. this may well be one of the central reasons for the wide cardiovascular benefits of adequate Testosterone levels in both men and women.

No to mention the well reported benefits in muscle tone and anabolic effects plus improved Libido that Testosterone is famous for.

It can indeed help with AFIB when there is a real deficiency, but testosterone is NOT a cure all for AFIB nor will it necessarily prevent AFIB attacks in someone that is already well progressed in the AFIB process. But it very much will help strengthen the heart and make the heart more resilient for handling the abuses of AFIB on the heart muscle and its a very good idea to insure your testosterone levels are better optimized prior to any ablation.

A few thing to consider:

1. It is always preferable to get a thorough hormonal assessment and replace, in modest bio-identical physiological doses, those hormones that are deficient in order to get a much better overall effect than simply replacing only one or two hormones that are missing out of the wider hormonal symphony. For example, if you are low in DHEA, T3/T4 thyroid hormone, Melatonin, Cortisol etc... addressing those too with the help of a skilled functional medicine/BHRT MD is well worth the effort in getting a much better overall health and well being benefit and often with less dosage needed for any one hormone.

2. With regard to Testosterone in men, its a good idea to check both Hematocrit, Hemoglobin and Red Blood Cell count periodically and if it gets near to, or slightly above, the upper end of those ranges, then make sure to also get the new Whole Blood Viscosity test at Meridian Valley Labs ....

Some men when taking an optimal level of testosterone can have elevated Blood viscosity when their Hematocrit is also borderline high, while many others with the same borderline high Hematocrit and optimal Testo level will be just fine and there is no need for further adjustments. In those (such as myself) who genetically are prone to higher Blood Viscosity, you can do a series of isovolemic phelbotomies once a month for four months and then repeat every with a maintenance phelbotomy of just donate blood every four months of so. This as well as increased hydration and taking nattokinase/boluke, pyncogenol, Omega 3s and other agents that help thin the blood naturally will very effectively reduce elevated blood viscosity to a healthy level while you can still benefit from the optimal testosterone levels.

In those who do not get a rise in Blood Viscosity it is either because of the pronounced benefits in blood flow that are due to optimum Testosterone levels and they also lack the genetic factors that encourage an increase in BV inspite of the optimal testosterone. Either way, it is easily addressed and is not a contraindication for Testosterone Replacement Therapy, but it does highlight the significant advantage of this new Whole Blood Viscosity tests at Meridian Valley Labs.

Also, two common ways to take testosterone are Topically and by IM or Sub-cutaneous injections. Topical usually works well for most men under 60 years old, and for some even up to 80+ years old ... but a majority of men over 60 to 65 do best with injected Testosterone cypionate or enanthate.

It is vital that all men taking exogenous Testosterone get periodic testing of Estradiol/Estrone levels and DHEA-sulfate as well as SHBG, a CBC blood work up plus Albumin. Also, more occasionally they should add in Di-Hydrotestosterone, Androstanediol Glucuronide, IGF1 and IGFBP3 as well as Ferritin and morning 8:00 AM sharp serum Cortisol and Trancortin or Cortisol Binding Globulin to round out their Anabolic profile monitoring.

Always insure that as you increase your Testosterone to more optimal levels too so that you also keep Estradiol levels between a high of 30pg/ml and a low of 20pg/ml as Estradiol will tend to rise along with testosterone due to a tendency for increased aromatase activity that converts testosterone to estradiol as we age. Going below 20pg/ml and 15pg/ml in particular with hammer one's energy and libido and will encourage bone loss while allowing it to rise significantly above 30pg/ml can increase also Estrone levels leading to body fat gain and also to reduced libido and energy in men. Discuss how to monitor and adjust your Estradiol levels with your doctor as it is usually quite easy to do.

I would only use the new forms of topical pharmaceutical testosterone you now see all over TV ads if your doctor is only familiar with this form and you really need insurance reimbursement. Otherwise, myself and others in the know much prefer either a good compounded Testosterone Liposomal Gel from a reputable and solid Compounding Pharmacy, of which there are many, or go with the pharmaceutical injections.

The problem with most of the new Big Pharma bio-identical topical Testo formulas you see in Ads these days is that they are too weakly concentrated and thus need a large amount of gel or cream used as the topical delivery bases in order to get any where close to a sufficient dose. Most men need from around 75mg to 100mg a day of topical testosterone for optimal effect and its messy and requires a large surface area of skin needed toi apply that much gel with such weak concentrations of Testosterone. And 50mg/day topically is usually much too low for the real benefits of testosterone for most everyone over 50 years old.

Anyway, this is a lot to read as it is so will stop here, but anyone interested in more info can PM me as well.

Shannon



Edited 2 time(s). Last edit at 12/30/2012 02:43PM by Shannon.

Shannon thanks for sharing your knowledge. when my friend told me about this i went out and checked my testosterone levels and i was 348 which was on low nornal side 348-1197 and my free testosterone was 6.3 registered low. My doctor does not want me to do anything but when i go to florida i am going to look into this one group that tests and recommends. I had an ablation in 2008 and so far have had only 3 breakthroughs. However my mood and energy levels are not what i think they should be. I will find out and shannon what do you think or what would you do if you were me. thanks steve

I am Stevebo's friend who has had a cessation of AFIB since beginning testosterone therapy last May. My attacks were always in the early morning sleep hours and were extremely painful. I was on a 250mg Tikosyn 2xD (still am) and then, upon attack, would take Flecanide hourly until back in sinus rhythm. I still have occasional skipped beats that can run as long as seven or eight seconds, but that is all.

My electrophysiologist discounts testosterone therapy as the cause of the very welcome side effect, and my urologist says that he has never heard of it either. I see the uro next week and am going to take him a copy of your posts just to make sure that he is up to date on further testing. Prior to that appt, he will have the results of my latest blood test, scheduled for this Friday.

I thank you for your willingness to devote so much time and effort to our education. And, thank you, Stevebo, for starting this conversation.

Old Henry

Shannon, thanks for this very insightful review! I am scheduled for a blood workup next week and have requested a testosterone number too........am 59 and do use an avg of 15 mg of DHEA per day.....somedays 25mg somedays none

Tom

You're welcome Steve, TomP and Old Henry,

Steve, your total T of only 348 and Free T of only 6.3 is Very Low indeed, though all too typical for men past 50 to 55years old..

This level is associated strongly with significantly lower all cause mortality as well as muscle loss (sarcopenia), bone loss, increased foggy thinking and slowed cognitive function and increased CV disease risk across the board to name a few ... Not to mention lower energy reserves, lower libido and function and harder exercise recovery and ability to follow through with exercise without Herculean willpower.

Alas, the response of your utterly ignorant 'about this area or medicine' GP is also still far too common, but thankfully is beginning to change as the overwhelmingly strong evidence-based facts of TRT are slowly breaking through many decades of institutionalized resistance and misinformation..

Your GP may very well be a great and competent physician in most areas he treats and Im not at all suggesting you drop him or her as your primary Doc, but his remarks reveal that he simply is still in the dark ages when it comes to testosterone replacement therapy and indeed the whole field of bio-identical hormone replacement therapy (BHRT). But Steve, for sure your best course of action is to not even bring the subject up with your Dark Ages GP doc again. With his response to your such low Free and Total Testosterone level, its crystal clear you don't want him or her having anything at all to do with managing your hormone repletion program..

You can see the general improvement that is happening now in medicines growing knowledge and acceptance of the right way to do this, by way of the welcomed changing tide in medicine reflected by several Big Pharma companies now coming out with topical bio-identical testosterone formulas and advertising it for 'Low T Syndrome' everywhere... Not too long ago these same Big Pharma folks were leading the crusade to limit Testosterone ( even getting Testesterone restricted to a class III controlled drug in the US if you can believe it!!) and other Bio-identical hormones with a lot of nonsense and flat out deception (Wyeth Pharma was the Darth Vader and lead evil one for sure when it comes to deception and misleading attempts to suppress BHRT in the past) .. Fortunately, Big Pharma has finally seen the writing on the wall and since they couldn't win against this tidal wave of knowledge and effectiveness, they decided to join the party and profit from it.

They would rather have patented a synthetic analog of Testo and sold that for even more profit, but as a compromise to their normal method of business, they are now patenting the delivery bases for topical hormone application while thankfully using real bio-identical testosterone (and bio-identical Estradiol-E2 in the case of topical E2 for women).. Bio-identical simply means it is the very same molecule your body makes and knows how to fully and safely metabolize which is not always true for synthetic analogs of these hormones.

Your best bet Steve is finding a very skilled doc certified in BHRT (bio-identical hormone replacement therapy). That is, someone who has passed an AMA-approved Fellowship training program for certification in the specialty of 'BHRT' and/or 'Age Management' or 'Anti-Aging Medicine' (personally I never liked the term 'Anti-Aging' and prefer Age management which is more accurate.)

The problem with Docs who diagnose and treat hormone decline based on the typical blood 'reference ranges' ... An all too common practice called with some justified disdain: 'Reference Range Endocrinology'. Reference range endo relies on very much too broad reference ranges for hormones that are derived by taking the upper and lower 2.5% of testosterone lab results (and other hormone serum test results) from everyone who walks through that Lab over the past year for those hormone tests to define the upper and lower limit of what is deemed acceptable 'normal and healthy' levels of those hormones!

Since most Docs do not order such Hormone labs unless they suspect a hormone problem, what has happened is the vast majority of these hormone test subjects whose upper and lower 2.5% define what is considered the boundaries of normal healthy hormone levels, are mostly clearly deficient in the tested hormone(s) before they ever come to the lab!!!

So what has happened with respect to the field of traditional endocrinology is that they have inadvertently codified and accepted an entire pool of mostly deficient and sick people as 'normal healthy adults' who in their myopic viewpoint require no assistance!!! Just give them a Prozac for the depression, a Xanax for their anxiety, a sleeping pill for their insomnia, an ADHD drug for low energy and a Viagra for low libido and erectile dysfunction! This in spite of the fact that in about 80 to 90% of the cases of the above mentioned symptoms and problems, they can be far more effectively remedied with far fewer potential side effects by first discovering and then rebalancing those critical biochemicals that have gone missing or are at far too low levels in the aging body.

In other words, you can have every single symptom and physical signs of hormone deficiency screaming at such Docs in his exam room, and yet, if your serum lab result is with htis all too broad skewed reference range .. as in the case of Steve for total testosterone at only 348ng/dl which is at the very limit of the low end of the lab's reference range for Total Testo of (348 - 1,187ng/dl), and your Free testosterone which is what really counts is even lower at 6.3pg/ml, in that case your Doc then says "I suggest not doing anything"!?! That is called treatung the labs and not the patient while ignoring obvious signs and symptoms confirming the diagnosis of low hormone levels. What he really means by declining treatment in such a case is, "I havent got a clue what to do here and would rather you go someplace else to deal with this issue".

In addition, these ranges for hormones are age-matched with an increasingly lower range for each decade of life ... Again institutionalizing progressive deficiency as you body ages as 'optimal and healthy' !! Your physical body is the same size (or should be) that it was when you where between 25 and 30 years old and to function with levels of energy and health anywhere close to what it should and can be capable of, it needs approximately the same levels of these absolutely vital biochemical messengers to keep the wheels on the wagon and running reasonably well.

The typical method used to view, diagnose and treat hormonal decline or dysfunction, as practiced by most old school GPs, Endocrinologist and Urologist/ OB-GYNs with a method referred to as 'The Horse has Left the Barn' medicine. They use these far too broad and skewed hormonal reference ranges to justify not treating anyone until they are below (or above in some cases) the lower or upper number on these skewed ranges which typically represents late stage near total glandular failure is many cases. At this point, treatment is often far harder and with less satisfactory outcomes often. The tool kit until recently of pharmacuetical hormone-like drugs did not emphasize Bio-indentical hormones but rather these much more powerful and side effect prone synthetic hormone analogs.

It defies all common sense and logic on every level, but its what they were a taught in Med school so its hard to blame them really.

I want to emphasize that when I say don't go to your GP for hormone therapy, unless they have been specifically trained in BHRT and certified though a Fellowship program, I don't at all mean or imply that he or she isn't a great Doc in other areas of medicine. Many are just fine to see for other issues, but unless they have specific advanced training and certification in BHRT, then they will be totally lost in the woods and your testosterone treatment, if you can even cajole them to give it to you, will be guided mostly from the package insert of the Big Pharma Testosterone gel or from the minimal and not very helpful info in the PDR reference book for this new generation of topical testosterone options. And thus, these docs will be utterly lost when it comes to effective and skillful management when trying to optimize your hormone repletion and balance. So beware and be wise to chose a progressive MD who is really with it and is at the forefront of this new wave of preventive and restorative medicine.

Take care,
Shannon



Edited 3 time(s). Last edit at 12/31/2012 06:00PM by Shannon.

Found this discussion interesting as I have low testosterone levels and have been interested in a possible connection with atrial fibrillation.

In 2003 was diagnosed with testicular cancer and had an orechiectomy. Subsequently,my levels have been either below nomral or the lower range of normal. For several years post-surgery experienced some symptoms of potential low testosterone and discussed with both my oncologist (a urologist) and my internist. Ultimately decided to try testosterone replacement therapy but experienced little or no change in symptoms.....so stopped as it was expensive and inconvenient and concluded that the issue was not testoserone related. Consequently, have had low testosterone issue for many years. As part of my annual cancer tests I get my testosterone levels measured.

In March 2011 I had an ablation with Natale in Austiin and after reading a couple of articles several months ago on the relationship I asked Natale his opinion. He told me that there is no link between atrial fibrillation and testosterone deficiency and that the cause of my arrhythmia is genetics. I do not know how long I actually had arrhythmia before it was diagnosed so I cannot draw a firm conclusion connecting my atrial fibrillation and low testosterone but believe that the problem developed after my orechiectomy.

Regardless.....no issue with arrhythmia since the ablation!!!!


Steve
Spring, Tx.

Hi Steve,

Im interested in what kind of testosterone you were given, by what kind of doctor and in what doses did you take it and for how long?? You can PM me if you prefer with this info.

If I had a dollar for everyone I have worked with as a BHRT coach who had tried testosterone from a well-meaning, but not so well trained doc in this area, and thus never got anywhere close to an adequate dose and delivery form for the hormone, I'd be a much richer man today.

And I totally concur with your and Dr. Natale that there is no direct link between testosterone and AFIB. An indirect association could well occur if a person has very low testosterone AND other factors that are predisposing them to AFIB to begin with, and in such a case, depending on the degree of progression of the AFIB its conceivable and quite possible that restoration of a more optimal level of testosterone could help lessen AFIB breakthroughs .. at least for a while.

But there is no causal relationship between AFIB and testosterone that independent of other more fundamental drivers for AFIB.

In a way, you could look at it as roughly analogous to Magnesium levels. If you are low in magnesium, for many people with less than advanced AFIB progression, then restoring a better and more consistent level of IC magnesium (as well as adequate Potassium, taurine etc) can indeed help quiet the beast for a good long while. But that is NOT the same as a direct 'cure'.

And if genetics for AFIB are strong and the progression and remodeling/fibrosis are advanced, it is very unlikely restoring magnesium and potassium alone is going to make you suddenly free from AFIB for the rest of your life.

That doesn't at all mean it isn't worthwhile doing everything you can to restore optimal magnesium/potassium levels and to reduce fibrosis by whatever means you can that works. But the old gold standard for proclaiming a drug, nutrient or method as a true 'cure' is to stop taking it for the long term and see what happens? If you find yourself back in AFIB then, you may have been 'managing' the condition and it is a strong incentive to continue taking the missing biochemical, but the reason you had AFIB to begin with is likely more fundamental than the deficiency alone in any one or several minerals or hormones.

Shannon

While I am disappointed that you see no causal connection between testosterone and Afib, I plan to stay on it, primarily because of the otherwise unexplained cessation of symptoms, but because,too, of the other benefits that I have found since starting therapy.

My EP traces my Afib to a regurgitating mitral valve, and, related or not, I have always been vagal. If the valve becomes too inefficient, he recommends a repair or replacement and, at that time, a maze procedure. Am hoping that I get the next 78 years w/o incident. I have surely enjoyed the first 78!

Old Henry

Old Henry,
Just because Testosterone doesnt have any well documented causal relationship with AFIB, that doesn't at all invalidate your experience as noted in my post above. In your case, with low enough endogenous levels it may well have contributed in an indirect way toward helping your heart stay quieter.

Plus there are many other health benefits as well to restoring a better T level.
Shannon

Shannon.....sent you a PM

Steve

Shannon, I am going to floirda soon and have looked up several TRT groups in Tampa and will see where is takes me. I am impressed with Old Henrys
results and also other benefits. I am low and want to get the numbers up to what was normal for me. The story continues now to find the right group to help me.
On Facebook i found a TRT group it was closed but ask to join and they accepted me so asking questions there. I am not giving up on this thanks

Hi Shannon
I have been recently diagnosed with Afib I also have tremors in my left leg and arm still waiting to find out what the cause of the tremors are they manifested before the afib and have been thinking of trying TRT .I asked my doctor to check my test levels they came back as 480 blood test and 22 free test I am 49yrs old my doctor says these are completely normal although I am sceptical from what I have been reading do you have any advice

I have injected myself with 1ml of testosterone cypionate yesterday and seem to be feeling better my pulse was 70 bpm and blood preasure was 114 over 84 this morning. Since afib started 3 weeks ago my pulse was much higher at around 90 -110 in the morning I was due to take a bisoprolol yesterday at 3pm however I thought Id leave it out to see how the testosterone worked on its own ,just wondering if thats a good idea