BAV & Testosterone Replacement

Is there anyone out there who knows how feasible testosterone replacement may be with a valve replacement ?

I'm 35. With a bicuspid aortic valve , and have always been told that one day I would need a replacement . I'm pretty healthy and fit.
Lift weights and cardio 4 days a week at least 1 1/2 - 2 hour sessions for what it matters .

Due to a decreasing libido and extreme daytime fatigue I had a full hormonal panel and have found out that I have low testosterone and could benefit from testosterone replacement . I'm leaning towards giving it a shot but I'm curious as to how it's going to work out later down the road if/when I get a valve replacement .

From my research and from what the endocrinologist indicated that for now I'll be fine and we just need to keep my hematocrit in check so the blood isn't too thick. Not too much of a problem hopefully because im on the low range of hematocrit . Im guessing that testosterone injections may be ok with a tissue valve but possibly not with mechanical because of the need to keep the blood thinner ? Maybe cream
Or gel would be ok with a mechanical valve ? Anyone out there with a valve replacement on testosterone therapy that could help out with their experience ?

BAV said:

but possibly not with mechanical because of the need to keep the blood thinner ?

Click to expand...

I'm going to say that talking in dumbed down language like the term blood thickness will prevent you from grasping the truth or reality or even the why of things.

a hematocrit is a measure of your red blood cells (which the specialist may have been dumbing down into "thickness").

A mechanical valve requires you to measure your blood coagulation response (also nothing to do with viscosity of the blood and further nothing at all to do with your red blood cells). This is measured with a value called INR (lets side step the details there) and reflects how long it takes a clot for form.

The purpose of Anti Coagulation Therapy (ACT) with a mechanical valve is to prevent any clot which might be formed (by, say a platelet getting too many smacks on the arse on the way through the mechanical valve gate) from growing before its caught in the wrong place (by your body) and broken down to prevent any clots forming in wrong places (like a blood vessel and blocking it causing a stroke).

So if you're trying to inform yourself about these things its important to not used dumbed down terms and keep with correct technical language:

• A hematocrit is the percentage of red blood cells in your blood
• ACT is measured by INR which is value representing clotting time relative to "normal".

To the best of my knowledge ACT will not be independent of your hemacrit levels and there is no relationship between them.

I would suggest you need to ask your endocrinologist to clarify exactly what they mean if they say management of ACT is going to be effected and by what mechanism and also what experience they actually have had with managing INR.

I suspect that this is not a reason to select for a tissue valve over a mechanical valve.

Best Wishes

My testicles stopped producing testosterone years ago before my AVR for a BAV. I have been on testosterone replacement therapy so long I can't remember when I started. Certainly before it became a recreational drug for the wealthy. It is a non issue for cardio, BAV or AVR. The symptoms of no testosterone for me were sexual disfunction, really heavy sweating for no reason, lack of energy - falling asleep in the middle of the afternoon.

I first did testosterone implants, but had trouble with the occasional infection. For many years now I use the topical gel. It's better than injections or pills. Injections you go up and down with the injection. Pills are not very effective because testosterone is destroyed by your gut. With topical testosterone, you have a pretty steady concentration, higher in the morning and lower at night....just like getting it from your testicles. I take the maximum dose and have low-normal levels and am 65 and 250lbs. It works.

You need to be tested for testosterone blood levels to assure your levels are truly very low and then are OK. You should be tested before, to justify the therapy and after you've started and then yearly. You also need to have your PSA done since testosterone can excite prostate cancer. I see a urologist for this and get blood work every 12 months. Make sure your insurance covers both the testosterone analysis and the gel, both are expensive w/o a diagnosis of hypogonadism due to old men wanting to feel young. But if you are like me and you no longer produce testosterone, and have hypogonadism it is clinically justifiable.

tom in MO said:

My testicles stopped producing testosterone years ago before my AVR for a BAV. I have been on testosterone replacement therapy so long I can't remember when I started. Certainly before it became a recreational drug for the wealthy. It is a non issue for cardio, BAV or AVR. The symptoms of no testosterone for me were sexual disfunction, really heavy sweating for no reason, lack of energy - falling asleep in the middle of the afternoon.

I first did testosterone implants, but had trouble with the occasional infection. For many years now I use the topical gel. It's better than injections or pills. Injections you go up and down with the injection. Pills are not very effective because testosterone is destroyed by your gut. With topical testosterone, you have a pretty steady concentration, higher in the morning and lower at night....just like getting it from your testicles. I take the maximum dose and have low-normal levels and am 65 and 250lbs. It works.

You need to be tested for testosterone blood levels to assure your levels are truly very low and then are OK. You should be tested before, to justify the therapy and after you've started and then yearly. You also need to have your PSA done since testosterone can excite prostate cancer. I see a urologist for this and get blood work every 12 months. Make sure your insurance covers both the testosterone analysis and the gel, both are expensive w/o a diagnosis of hypogonadism due to old men wanting to feel young. But if you are like me and you no longer produce testosterone, and have hypogonadism it is clinically justifiable.

Click to expand...

Thanks for sharing your experience Tom.

I continued with TRT about 20 weeks ago and it has alleviated most of my low T symptoms .

I decided to go with injections but I'm wondering if I'll be able to continue once my valve is replaced. Are you on gel instead of the injections because of preference or is it your only option due to the mechanical valve and anticoagulants?

I cleared the TRT with my cardiologist before starting and he said it was fine. I'm just concerned he wasn't thinking forward to the future for eventually when my valve is replaced

BAV said:

Thanks for sharing your experience Tom.

I continued with TRT about 20 weeks ago and it has alleviated most of my low T symptoms .

I decided to go with injections but I'm wondering if I'll be able to continue once my valve is replaced. Are you on gel instead of the injections because of preference or is it your only option due to the mechanical valve and anticoagulants?

I cleared the TRT with my cardiologist before starting and he said it was fine. I'm just concerned he wasn't thinking forward to the future for eventually when my valve is replaced

Click to expand...

Implants were recommended by my urologist who also used them himself. I switched to gel since my body occasionally rejected the implant. They had to be compounded by a pharmacy and contamination during compound could have been the source of rejection. At that time injections were not recommended. The reason being was there is a spike in T that falls off until the next shot. Implants give a steady concentration and daily gel cycles up and down; up in the morning when you take the gel, falling off through the day just like your T levels do with testicles. Up in the morning after sleep, falling off through the day. At about the same time of my implant rejections my urologist retired and the practice no longer supported implants. My old and new urologist suggested the gel. This all happened before my valve replacement. Neither my surgeon, urologist or cardiologist indicated any risk due T therapy to my stenotic valve, mechanical valve or warfarin. The price of gel has dropped over the years.

I recently got a new nurse practitioner urologist. She wanted to review the various options for T therapy. It has changed since I started. Injections are more popular and there are different options. Implants are now a manufactured drug product, thus the risk of rejection is probably lower. However gel has dropped in price and now comes in a metered pump. It works for me and was cheaper than implants so I didn't switch back.

When I had my valve replacement, they gave me all my medications during my stay, including the testosterone. IIRC it helps generally in healing. The biggest risk with T therapy is it can feed prostate cancer. For some, there is one side effect, elevated estradiol, but there is a drug (off label use) that can drop estradiol. This is uncommon. I just was diagnosed with that, but I wouldn't have known w/o the routine blood testing.

I’m not a medical expert, but I’ve read a bit about this and have some experience with testosterone replacement. It sounds like your endocrinologist is on the right track by keeping an eye on your hematocrit levels, as that’s a big factor. For someone with a mechanical valve, you’re absolutely right that keeping the blood thinner is a key concern. From what I’ve learned, some people on testosterone therapy with a mechanical valve use testosterone gels or creams instead of injections to reduce the risk of thickening blood.

I’ve personally found that https://deuschem.com has a solid selection of products that might be worth looking into, including creams, which can be easier on the system if you're concerned about blood viscosity. I'd definitely recommend talking to your doctor about a tailored plan.