Dear Dr. Roach: My mom had a throat and palate infection that was treated in 2017, and about two weeks later, she had a heart attack. In 2023, she had pneumonia and was briefly hospitalized and treated, but again about two weeks later, she had another heart attack. We asked her cardiologist if there is a relationship, and he was not aware of any. But this seems too unlikely to be a coincidence. What is your experience on this? — A.C.S.
Answer: A heart attack happens when the demand by the heart for blood is greater than the ability of the blood vessels to provide blood to the heart. In practice, this almost always means that there are blockages in the blood vessels. However, an increase in the workload of the heart, such as strenuous exercise or an infection (fever tends to increase heart rate, and the blood flow from the heart usually increases with serious infection), can be what tips a person over to a heart attack. It’s possible that this is what happened with your mom. The timing of two weeks after the event is longer than expected, but it’s possible.
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Inflammation in the blood, whether from chronic infection or inflammatory conditions like rheumatoid arthritis, increases heart disease risk in the long term, so if there is a connection and it’s not just coincidence, that would be the most likely mechanism.
Dear Dr. Roach: You wrote about the dangers of testosterone replacement in men over 70 in your column a few months ago. Could you please describe the dangers of this again?
My husband is 73 and injects testosterone every 10 days or so. He’s not feeling too well overall, but he doesn’t know from what. He’s been to the cardiologist, but the studies came back fine. He says he feels nerves in his stomach, a bit of shortness of breath, and he also feels tired and without much energy. — E.D.
Answer: There are clear dangers from excess testosterone use, especially in older men. Some men use very high doses of testosterone or other androgens for muscle building. This can cause heart damage, blood clots and stroke, and I recommend strongly against this, which is generally used illicitly.
By contrast, for men in whom testosterone therapy is given appropriately, the dangers are quite small, and in most men, the benefits outweigh the risks. Men should have a clear reason to receive it, such as having low bone density, low libido, loss of body hair or development of breast tissue, in addition to repeatedly low testosterone levels (including a level taken between 8 a.m. and 10 a.m., when testosterone levels are highest). In these men, the goal is to return the testosterone level to normal, and the risks of the catastrophic outcomes listed above appear to be very small or zero. Testosterone levels should also be measured during therapy.
I can’t speculate on what’s causing your husband’s symptoms. Nonspecific symptoms, such as low energy, can be caused by low testosterone, but unless there are more specific symptoms of low testosterone, I generally do not recommend testosterone replacement.
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