Can Creatine Make eGFR Look Low? (TRT Q&As)
Timeline
A member reports an eGFR around 50 based on creatinine but a cystatin C-based eGFR of 88. Dr. O’Connor explains that significant muscle mass and creatine supplementation can elevate creatinine and make creatinine-based eGFR appear much worse than actual kidney function.
Dr. O’Connor discusses the member’s cardiovascular history and supports reviewing a transition toward bisoprolol and telmisartan with his cardiologist. He emphasizes that medication choices need to account for the member’s prior bypass surgery, blood pressure, heart rate, and overall cardiac protection.
A 33-year-old member describes left ventricular hypertrophy, cardiac fibrosis, and an ejection fraction of 43% despite having few symptoms. Dr. O’Connor discusses Jardiance, spironolactone, possible telmisartan, careful blood pressure and hydration monitoring, avoiding steroid doses, and giving the heart time to remodel.
Dr. O’Connor recommends considering a urologic vascular evaluation while also discussing tadalafil or sildenafil with the member’s physician. He explains that erections are strongly connected to vascular health and that low-dose tadalafil may be a reasonable option when medically appropriate.
The member reports a coronary calcium score that rose substantially over several years and a CT angiogram showing coronary plaque and narrowing. Dr. O’Connor stresses aggressive cardiovascular risk reduction, including substantially lowering LDL and discussing statin plus additional lipid-lowering therapy with the treating physician.
A 35-year-old member with low-normal testosterone, LH, and FSH asks about treatment after previously stopping TRT for fertility. Dr. O’Connor explains primary versus secondary hypogonadism and discusses repeating hormone testing and considering fertility-preserving approaches before committing to long-term testosterone therapy.
Video Summary
Andrew answers member questions by centering symptoms alongside laboratory context rather than chasing isolated numbers. Several exchanges highlight how sleep disruption, stress, and recovery capacity can distort hormone readings. The discussion reinforces why trends over time matter more than single lab snapshots.
Mid-episode questions explore dose adjustments and delivery methods, focusing on how consistency affects mood and energy. Andrew explains why rapid changes often create instability and how patience improves interpretability of results. Attention is given to recognizing when symptoms point to non-hormonal drivers.
The conversation closes by widening the lens to cardiometabolic health, tying hormones to blood pressure, lipids, and sleep quality. Rather than isolated optimization, the episode frames testosterone care as one component of durable risk management. Listeners are encouraged to align treatment decisions with long-term health outcomes.
Condition Callouts
Key Takeaways
- Testosterone symptoms must be interpreted in context, especially when sleep and stress are compromised.
- Single lab values are less informative than patterns observed over consistent dosing intervals.
- Frequent dose changes can worsen mood and energy by creating hormonal instability.
- Some symptoms attributed to testosterone deficiency originate from lifestyle or recovery deficits.
- Long-term testosterone care should align with blood pressure, lipid health, and sleep quality.