One of the side effects of long term Lupron use is cardio vascular risk. My understanding is that the risk comes from castrate level testosterone, not from Lupron directly. Am I right? If that is the case, then do you have additional cardio vascular risk after stopping Lupron until testosterone recovers.
In some elderly patients like me, testosterone may not recover for a long time after stopping Lupron. During my first ADT break testosterone rose above 100 nine months after the last 3 month shot. My second break started with last 3 month shot of Eligard on March 2, 2021. Nine months later, on Dec 2 my testosterone was only 28. Does this imply I have the same cardio vascular risk as if I am on ADT?
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dac500
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Lupron (and similar GnRH agonists) seems to have an independent effect that may be less with GnRH antagonists and orchiectomy. It is not a significant risk unless you have pre-existing CV disease.
Thanks for clarifying. Does this mean low testosterone many not increase cardio vascular risk? I have mild aortic regurgitation. So, my risk may increase somewhat when on Lupron.
Yes, a low T-level from ADT is related to elevated cardiovascular risk as a result prolongation of the QTc interval, increasing the risk of arrhythmia's as mentioned in this article.
“We showed that ADT results in electrophysiological changes in the heart,” explained first author Thiago Gagliano-Jucá, MD, PhD, a research fellow in the Section on Men’s Health at Brigham and Women’s Hospital. “The time it takes for these cells to be able to contract again after each beat increased following ADT, and prolongation of this time is a known risk factor of ventricular arrhythmias. We are trying to piece together how ADT might be resulting in sudden deaths in some men.”
The study points out that testosterone levels affect the time necessary for cardiomyocytes to contract after a previous contraction. Reduced testosterone levels as a result of ADT prolongs the QTc interval on the electrocardiogram.
Conclusions
Men undergoing ADT for PCa experienced prolongation of the QTc. These findings might explain the increased risk of sudden cardiac death seen in these patients.
Long-Term Testosterone Therapy Improves Cardiometabolic Function and Reduces Risk of Cardiovascular Disease in Men with Hypogonadism
"The estimated reduction in mortality for the T-group was between 66% and 92%. There were also 30 nonfatal strokes and 26 nonfatal myocardial infarctions in the control group and none in the T-treated group."
It has always seemed to me that men quitting ADT should be offered TRT. Morgentaler claims that T above his 'saturation' level, which occurs well below the hypogonadism cut-off of 350 ng/dL (more like 250 ng/dL) does not stimulate PCa. Of course, there is reluctance amongst doctors & patients.
Dr. Myers, in his vlog posts, has said that new patients were at greater risk for cardio-mortality than PCa. He is a great believer in the Mediterranean fiet (40% fat), which has been proven to reduce cardio events.
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Need a vacation from adt
PSA dropping, yet testosterone rising on Lupron/Zytiga??
Testosterone level rising toward end of Lupron cycle
Monotherapy or ADT3?
