Why Cardiologists Are Seeing Heart Attacks in Healthy Men on TRT

Why Cardiologists Are Seeing Heart Attacks in Healthy Men on TRT

A cardiologist recently stated: "I'm seeing a lot of men on testosterone therapy who are otherwise quite fit and well coming in with heart attacks." But research shows TRT is cardiovascular-safe. So what's really happening?

In this episode, Dr. Kumar breaks down the dangerous disconnect between what clinical trials prove and what doctors are actually observing in practice. The answer: dosing.

Most safety research used physiological replacement doses (~100mg/week). Yet online TRT clinics routinely prescribe 200mg/week or higher—supraphysiological doses that were never tested in long-term safety studies.

Discover:

• Why the TRAVERSE trial didn't answer the real question
• The polycythemia crisis most clinics ignore
• Why injection frequency matters more than you think
• Red flags that your TRT dose is too high
• How to demand proper cardiovascular monitoring

If you're on TRT, considering TRT, or concerned about a loved one's testosterone therapy, this episode is essential listening. Based on the latest medical literature and clinical observations from board-certified physicians.

Get evidence-based answers. Stop guessing. Consult with Dr. Kumar. Telemedicine and in-office consultations, call 561-210-9999

Disclaimer:
The information provided in this podcast is for educational purposes only and is not intended as medical advice. Always consult with a qualified healthcare professional before making changes to your supplement regimen or health routine. Individual needs and reactions vary, so it’s important to make informed decisions with the guidance of your physician.

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Stay Informed, Stay Healthy:
Remember, informed choices lead to better health. Until next time, be well and take care of yourself.

Chapters

• 0:00 Hype Meets Safety Claims
• 0:57 Landmark Study And FDA Shift
• 1:25 Real‑World Red Flags Emerge
• 3:04 The Dosing Disconnect
• 4:23 Replacement Versus Supraphysiological
• 5:19 Peaks, Troughs, And Risk
• 6:18 Polycythemia: The Mechanism Of Harm
• 7:43 Sleep Apnea’s Double Whammy
• 8:48 Monitoring That Protects Hearts
• 10:12 Long‑Term Unknowns And Fluctuations
• 11:23 A Safe, Evidence‑Based Protocol
• 12:20 Choosing Expertise Over Shortcuts

Transcript

SPEAKER_01: 0:18

Testosterone replacement therapy, TRT. I mean, it's it's everywhere right now.

SPEAKER_00: 0:23

Aaron Powell It really is. It's being sold as this key to you know renewed energy, better performance, longevity. Trevor Burrus, Jr.

SPEAKER_01: 0:30

And for a little while there, it really looked like the massive medical controversy around it was well, finally settled.

SPEAKER_00: 0:36

That's right. That moment was in 2025. After this huge landmark study, the FDA actually removed the cardiovascular black box warning from testosterone.

SPEAKER_01: 0:47

Which is a massive deal.

SPEAKER_00: 0:48

A profound shift. The headline was basically TRT is cardiovascular safe. Case closed. Okay.

SPEAKER_01: 0:53

That sounds great. A clear win for men's health.

SPEAKER_00: 0:55

Wow.

SPEAKER_01: 0:56

But here's the problem we're facing today. The official data says it's safe. And yet cardiologists are sounding a very serious, very immediate alarm. The story they're telling is completely different. Trevor Burrus, Jr.

SPEAKER_00: 1:07

Completely. We're seeing these observations from experienced cardiologists like Dr. Rowan Francis. And he's quoted as saying, I'm seeing a lot of men on testosterone therapy who are otherwise quite fit and well coming in with heart attacks.

SPEAKER_01: 1:18

How is that possible? How can you have both things be true? That's the core mission of this deep dive. Right. We're jumping into the source material, the studies, the clinical notes, to figure out this research versus reality gap.

SPEAKER_00: 1:31

And the mystery, you know, it really centers on one simple question, but the answer has these huge safety implications. Which is are we studying the same TRT that patients are actually using out there in the real world?

SPEAKER_01: 1:43

And this is exactly why genuine expert medical guidance isn't just a nice to have, it's it's absolutely critical.

SPEAKER_00: 1:50

Absolutely.

SPEAKER_01: 1:50

If you're listening and you're considering this wellness journey, you need a safe path. You need an expert who gets this dosing discrepancy. We're talking about precision medicine, uh, you know, the kind of care provided by specialists like Dr. Kumar at LifeWellMD.com.

SPEAKER_00: 2:05

Aaron Powell That difference between feeling great and well and risking your long-term heart health comes down entirely to the dose and the monitoring.

SPEAKER_01: 2:13

Aaron Powell So let's start with the good news the thing that made everyone feel so confident.

SPEAKER_00: 2:16

Aaron Powell Okay, so that was the Travers trial. It wrapped up in 2023. It was the largest randomized controlled study ever done on TRT. And the conclusion was unambiguous. Over two years, they found no statistically significant increase in heart attacks, strokes, or cardiovascular deaths in the men getting testosterone.

SPEAKER_01: 2:35

Trevor Burrus, Jr. So that gave everyone a strong sense of safety.

SPEAKER_00: 2:37

It did.

SPEAKER_01: 2:38

But then you hear these stories from the real world, and it it just creates this huge cognitive dissonance. The risk feels very, very real for some people.

SPEAKER_00: 2:47

Aaron Ross Powell It does. The source material is just full of these sobering anecdotes. I mean, think about the man who started TRT, totally healthy, no history of high blood pressure.

SPEAKER_01: 2:56

Okay.

SPEAKER_00: 2:57

And within two months, his systolic pressure just spikes to 150, 160. He has a stroke. And tragically, he died six months later.

SPEAKER_01: 3:04

Aaron Powell And that's not an isolated story. There's the bodybuilder, Wagner Rocha, 55 years old, a guy who, by any measure, was fit and well.

SPEAKER_00: 3:11

Right. And he suffers heart failure, ends up hospitalized after starting TRT. These aren't sedentary guys. These are men actively trying to optimize their health.

SPEAKER_01: 3:20

So if the biggest study says it's safe, but doctors are seeing this harm, where is the disconnect?

SPEAKER_00: 3:27

Okay, let's unpack it.

SPEAKER_01: 3:28

The whole paradox seems to come down to one word dosing.

SPEAKER_00: 3:31

That is it. That is the essential insight. The safety data is, for one thing, replacement therapy. What's happening in reality in a lot of these online clinics is something else entirely, superphysiological protocols.

SPEAKER_01: 3:44

Aaron Powell So let's define that. What did the Traverse trial actually study?

SPEAKER_00: 3:48

They used primarily testosterone gel. So that's a slow, steady delivery. And they were aiming for peak levels around 500 to 600 nanograms per deciliter.

SPEAKER_01: 3:57

Aaron Powell, which is a normal, healthy physiological level.

SPEAKER_00: 4:00

Exactly. It puts you right in the zone recommended by the AUA guidelines, which aim for between 500 and 1,000, its replacement.

SPEAKER_01: 4:07

And for injectables, what's a safe, evidence-based starting dose look like?

SPEAKER_00: 4:11

Generally, it's about 100 milligrams a week, and crucially it's split into two or three smaller injections.

SPEAKER_01: 4:16

Why split it?

SPEAKER_00: 4:17

Again, the goal is restoration, a steady, healthy level. You're trying to avoid those big peaks and troughs.

SPEAKER_01: 4:22

Okay, so that's the research. Now, the reality. What are we seeing from these aggressive optimization clinics?

SPEAKER_00: 4:29

Aaron Powell Our sources show they routinely start guys at 200 milligrams a week. That's their standard starting dose.

SPEAKER_01: 4:35

Double the evidence-based dose.

SPEAKER_00: 4:36

Aaron Powell Double. And they justify it by prioritizing how the patient feels over the objective safety markers.

SPEAKER_01: 4:43

Aaron Powell And they're looking at different numbers, right? It's not about the peak, it's about the trough.

SPEAKER_00: 4:47

Aaron Powell Yes, and this is the critical technical point. They're aiming for very high trough levels. The trough is the lowest your T level gets all week, right before your next shot.

SPEAKER_01: 4:57

Aaron Powell And how high are they aiming?

SPEAKER_00: 4:58

900 to 1200. Sometimes even higher. At the lowest point of the week.

SPEAKER_01: 5:03

Aaron Powell Hold on. So if your lowest point is 1200, which is already above the normal range, how high are the peaks getting after a 200 milligram injection?

SPEAKER_00: 5:11

Aaron Powell They're soaring. I mean, potentially into the 1500 to 2000 range, you're pushing the body way beyond its natural capacity.

SPEAKER_01: 5:18

Aaron Powell's not replacement therapy.

SPEAKER_00: 5:20

It is not. Experts classify that as a low-dose steroid cycle. It's a completely different category.

SPEAKER_01: 5:25

What makes that 200 milligram of dose cross that line away from the safety data of traverse?

SPEAKER_00: 5:31

Aaron Powell It's the sheer magnitude and the delivery. The safety study was for physiological replacement. The aggressive protocol is for supraphysiological delivery.

SPEAKER_01: 5:41

There's an analogy in the sources that really drives this home.

SPEAKER_00: 5:44

Oh, it's perfect. Relying on the traverse data to say 200 milligrams a week is safe. It's like claiming it's safe to drive your car at 120 miles an hour.

SPEAKER_01: 5:53

Because the study proved it was safe to drive at 55.

SPEAKER_00: 5:56

Exactly. The safety profile just doesn't translate when you double the force.

SPEAKER_01: 5:59

Wow. Okay. So if high dosing is the problem, what's the actual mechanism of harm? What's the most direct thing cardiologists are seeing?

SPEAKER_00: 6:08

Here's where it gets really interesting. It all comes down to something called secondary polycythemia.

SPEAKER_01: 6:13

Polysythemia.

SPEAKER_00: 6:14

This is the most measurable, most dose-dependent, and frankly most dangerous side effect of high dose TRT.

SPEAKER_01: 6:20

We've called it thicker blood. Can you get a bit more technical for us? What's happening inside the body?

SPEAKER_00: 6:25

So injectable testosterone, especially at these high doses, acts as a powerful stimulant on your bone marrow. It tells the marrow to just overproduce red blood cells. So your hematocrit and your hemoglobin 2 key lab markers start to climb. And when they climb, your blood literally becomes a thicker, more viscous fluid. Aaron Powell That's a great way to put it. And when the blood gets that thick, what's the first organ to feel the strain?

SPEAKER_01: 6:50

The heart.

SPEAKER_00: 6:51

The heart. Your heart is a pump designed for a certain fluid viscosity. Now you're forcing it to push molasses through your circulatory system. The resistance is immense.

SPEAKER_01: 7:01

Aaron Powell And that strain is what the sources call severely inhibited cardiac output. It's an immediate mechanical problem.

SPEAKER_00: 7:08

Aaron Powell And it leads to two immediate consequences. First, rapid, severe hypertension, those systolic spikes to 150, 160. That's just pure physics, resistance in the pipes. And the second a dramatically increased risk of thrombotic events. Precisely. You get a higher risk of DVT, pulmonary embolism, stroke, and of course heart attack. This is why the safety guidelines are so incredibly firm on this.

SPEAKER_01: 7:33

And there are hard lines that should never be crossed. The listener needs to know these numbers.

SPEAKER_00: 7:38

Absolutely. The critical safety threshold is this when a patient's hematocrit goes over 54%, testosterone therapy must be stopped. Period.

SPEAKER_01: 7:47

And what happens then?

SPEAKER_00: 7:49

The patient needs therapeutic phlebotomy. It's basically a monitored blood donation to immediately thin the blood and reduce that strain on the heart. Ignoring that 54% threshold is just reckless.

SPEAKER_01: 8:01

Which brings us to the safety gaps. The things that make this already serious risk even worse, things often overlooked by these optimization clinics.

SPEAKER_00: 8:10

The single biggest one is the combination of high-dose TRT and undiagnosed sleep apnea. We call it the double whammy for polycythemia.

SPEAKER_01: 8:18

Okay, break down that double whammy for us.

SPEAKER_00: 8:20

With sleep apnea, you're experiencing chronic hypoxia. You're being starved of oxygen maybe dozens of times a night.

SPEAKER_01: 8:26

And the body's response to that is a survival response.

SPEAKER_00: 8:29

The body panics and tells the bone marrow, make more red blood cells. We need to carry more oxygen.

SPEAKER_01: 8:34

So the body is already ramping up red blood cell production on its own.

SPEAKER_00: 8:37

Aaron Powell Right. Now you add a second powerful artificial stimulus on top of that, the high-dose injectable TRT, you've essentially hit the accelerator twice. I see. And when those two drivers collide, the source material says hematocrit levels don't just creep up. They can skyrocket dangerously high.

SPEAKER_01: 8:55

So if you're getting high dose TRT without being screened for sleep apnea, you are playing Russian roulette with your blood viscosity.

SPEAKER_00: 9:02

It's one of the clearest signs of poor, non-specialized care.

SPEAKER_01: 9:05

Aaron Powell And that's just one example of a monitoring failure. What other cardiovascular markers are being ignored?

SPEAKER_00: 9:12

It's systemic. I mean, blood pressure is critical, it has to be checked regularly. Hematocrit and hemoglobin need to be monitored every three to six months, lipid panels. Sometimes TRT can hammer your HDL, the good cholesterol. You have to watch that.

SPEAKER_01: 9:25

What about the baseline assessment? Before you even start.

SPEAKER_00: 9:28

A true expert, someone like Dr. Kumar at LifeWellmd.com, does a thorough baseline risk assessment, family history of early heart disease, any signs of pre-existing subclinical coronary artery disease. You have to know what system you're working with before you add this powerful hormonal load.

SPEAKER_01: 9:46

And beyond these monitoring failures, there are some big blind spots in the science itself when it comes to these 200 milligram a week protocols.

SPEAKER_00: 9:54

Oh, huge. The biggest is the duration blind spot. Traverse was two years. We have zero systematic safety data on what happens after five years, ten years, twenty years of this kind of use.

SPEAKER_01: 10:05

And cardiovascular problems are often cumulative.

SPEAKER_00: 10:08

They are. They might not show up for a long, long time. If you're on high doses today, you're part of an unmonitored long-term experiment.

SPEAKER_01: 10:14

Aaron Powell There's also the roller coaster effect, that huge weekly spike and then the deep trough.

SPEAKER_00: 10:18

Right. We just don't know what kind of stress that intense weekly fluctuation puts on the cardiovascular system. Is it worse than a steady-state dose from a gel or more frequent micro injections? The research isn't there. We just can't assume it's safe.

SPEAKER_01: 10:31

Aaron Powell So this all boils down to a need for precision. If you want the benefits of TRT without these catastrophic risks, you need a physician who is meticulous.

SPEAKER_00: 10:41

The proper evidence-based approach is just it's fundamentally different. You start low, 100 milligrams a week, or an equivalent dose.

SPEAKER_01: 10:49

You check blood work.

SPEAKER_00: 10:50

At six to eight weeks, you check the levels, then you adjust the dose incrementally.

SPEAKER_01: 10:54

Incrementally based on objective data, not just how do you feel.

SPEAKER_00: 10:59

Exactly. And you monitor those critical markers, hematocrit, blood pressure, lipids, closely and regularly. It's a commitment to safety first, because without safety, the effectiveness is meaningless.

SPEAKER_01: 11:10

And that is exactly the kind of evidence-based comprehensive care offered by experts like Dr. Kumar at LifeWellMD.com. This is his specialty health, wellness, and longevity, all guided by the highest standards.

SPEAKER_00: 11:21

It's so important to vet your provider. Dr. Kumar is a member of the Androgen Society and the ISSM, the International Society for Sexual Medicine. This shows a commitment to the most current, rigorous, and safe protocols.

SPEAKER_01: 11:33

Life Well MD really is the answer to these safety gaps. They do the rigorous monitoring of hematocrit of blood pressure, they screen for sleep apnea, they avoid the risks of this superphysiological dosing that has become so common elsewhere. They're prioritizing your long-term health.

SPEAKER_00: 11:49

The goal is sustained safe wellness, not a short-term, risky performance boost disguised as medicine.

SPEAKER_01: 11:57

So, what does this all mean for you, the listener? The main takeaway is this: TRT can be safe, it can be profoundly effective, but dosing is everything.

SPEAKER_00: 12:06

Everything.

SPEAKER_01: 12:07

These aggressive 200 milligram a week starting doses are just not backed by the safety data. They carry real, measurable cardiovascular risks, especially polycythemia and hypertension.

SPEAKER_00: 12:18

And we really need to recognize what's happening. The shift from replacement, which is, you know, aiming for 500 to 700 NGDL, to optimization, aiming for 900 to 1200 at the trough.

SPEAKER_01: 12:28

Yeah.

SPEAKER_00: 12:28

That's a move from medical treatment into performance enhancement.

SPEAKER_01: 12:31

It's a totally different game.

SPEAKER_00: 12:32

It's a fundamental change. And the long-term safety of that is just. It's a scientific unknown. You have to proceed with caution and expertise.

SPEAKER_01: 12:40

Don't prioritize the immediate feeling of high tea over your long-term cardiovascular health. If you are ready to start a wellness journey, make sure it's guided by real expertise, by rigor, and by safety.

SPEAKER_00: 12:51

Choose the safe path. Choose the evidence based path.

SPEAKER_01: 12:53

We encourage you to contact Dr. Kumar and his team at lifewellmd.com to start your personalized safe wellness journey. The number to call is 561 2109999.

SPEAKER_00: 13:03

That's 561 210 9999.