@viajesen1 Last year's TRAVESE trial was reassuring, but it comes on the heels of the TOM trial (stopped early because of cardiovascular events) and a subsequent VA retrospective that found a risk. And even the authors of TRAVERSE made it clear they weren't studying the story of people that end up at the sort of "low T" clinics that have sprung up in the last decade or so.
Although curiously, subjects receiving testosterone replacement therapy had high rates of heart arrhythmias like atrial fibrillation (which is a frequent source of clots that cause strokes), as well as an increased risk of acute kidney injury and pulmonary embolism (thromboembolic event, which includes a stroke). Despite all the money spent on a big study like this, curious results sometimes don't have clear explanations and could very well be random. A big asterisk to the study is more than 60 percent of participants dropped out before the end, and of those that stayed they were only followed for three years (and were only on TRT for two). So we have a bunch of people jumping ship for unclear reasons and it's not exactly long term.
There are other risks, such as prostate cancer. As far as I am concerned, the jury is still out, because that sort of thing really does demand long term follow up in a big study which, to my knowledge, doesn't exist.
Hypogonadism can and, for many patients, should be treated. But
lots of people want to get swole, fuck hard, and be the gunner they were are 20. Whether or not that's realistic when you're 50 is as much about the philosophy of medicine as it is about the practice, even tip-toeing into the question of what even is disease? I see the other comment you left about Adderall. That's another medical question with similar discussion going on in the background (e.g. Adderall and viloxazine treat the same thing but surprise! Patients seem to want the amphetamine - are we just treating ADHD?).
Long exhale. As long as everyone is clear on risks vs benefits and acting scrupulously, whatever, get juiced. I just think the "low T" industry has very much not been that. Caveat emptor.
Oh and one other thing
And is that increased risk not easily monitored with routine bloodwork
Stroke risk is a calculation (with something like CHA₂DS₂-VASc). You can modify risk factors (like medications you are taking) but there's really not "stroke test" in routine blood work. And those test that do exist are often about whether there is a clot
somewhere (like a pulmonary embolism or deep vein thrombosis - this is assuming you aren't symptomatic, which is a whole other mess). To find it often requires something much more extensive.
