Introduction: mid-20s M, medical resident in US

#1

Hi everyone! I’ve been visiting this site for a couple years and have really enjoyed keeping up with the conversations and personalities here. I am an internal medicine resident in the US in my mid-late 20s, interested in cardiology, healthy aging, and biological sciences in general.

Current meds/supplements: finasteride 1mg, tadalafil 2.5mg, algae EPA/DHA, vitD 2,000 IU, b12 100mcg, topical minoxidil foam

Future meds: hoping to start rosuvastatin 5mg soon, ApoB was 73 in last test but want to really crush my future risk of CVD. Have thought about SGLT2i vs. acarbose, and rapa, but my personality is quite risk averse and I am not yet convinced that benefits outweigh risks for me.

Current diet: WFPB w/ mediterranean slant. Lots of olive oil, nuts, whole grains, etc, with some Portfolio additions (soy milk, plant stanol ester margarine). Mostly vegan for ethical reasons but am flexible in social situations and will eat fish/seafood at restaurants.

Current exercise: ≥9,000 steps/d, brisk walking ~300 min/wk (HR @ 60-70% of max), Zone 5 all out sprint/stair climb 1x on most days, resistance training full body dumbbell/kettlebell/bodyweight 30min 2x/wk.

Sleep: Target 7hrs sleeping per night (measured w/ apple watch). I don’t like to “waste” time sleeping so I try to get the minimum needed for good health :slight_smile: .

Other “interventions”: water pick/floss/electric toothbrush, use a portable air cleaner in my apartment, wear sunscreen, try to be grateful for things especially on difficult days, keep in touch with friends/loved ones.

Very excited to join the conversation!

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#2

It sounds like you have all of the bases covered. It’s great to hear you’re aware of all of these things so early in life (late 20s or early 30s I assume). You will do well!

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#3

Welcome aboard. A statin should hopefully help you cover all your bases and you can decide later on whether or not to add more medicatiosn and supplements :slight_smile:

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#4

I appreciate the warm welcome! I agree re: covering my bases. Things are about to get really busy again so I’m just trying to get the most out of my limited time and money for now.

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#5

Welcome to the site! Always nice to have some new knowledgeable and interested people here and hope you join in with your thoughts as you move forward here. You’re starting early which is the best time for learning about this (and with more of a preventative perspective you can help move the healthcare system towards a more pro-active approach to healthcare, hopefully).

I had one question. Why tadalafil already? For the potential brain benefits?

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#6

Thanks @RapAdmin, that’s a great question. My tadalafil decision was a combination of a few factors:

  1. seems to be very safe, especially at low doses (as long as avoiding nitrate meds).
  2. preliminary research that it might reduce risk of MACE (unfortunately only trial data is in context of men w/ ED to my knowledge) but plausible biological mechanism whereby that benefit might extend to other, healthy populations. I think the observational data showing a signal of benefit for all-cause mortality/brain health is hard to disentangle from the fact that healthier people have more sex, but really interesting to keep following. (Kind of similar to observational data suggesting that more ejaculation = healthier life. Hard to argue it’s the ejaculation per se that’s responsible.)
  3. I started taking it as a bit of self-experimentation. It does seem to work as a “performance” enhancer for me and is fairly cheap, so I decided to continue for now.

I have a very low threshold to stop it and will certainly continue to follow discussions on this site :slight_smile:

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#7

Welcome to the site!

Based on your age, I’d only take the six foundational supplements - vit D, B12, Omega-3, magnesium, creatine and collagen. Rapamycin and other meds should be started in your 40s IMHO. They won’t move the needle at your age.

Finasteride, tadalifil and minoxidil are good choices to prevent later problems.

Bempedoic Acid and Ezetemibe might be better instead of a statin. It’s never to early to stop arteriosclerosis.

Good luck and welcome. :slight_smile:

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#8

Thanks for the warm welcome and the advice @DeStrider!

You make a great point about creatine, I completely forgot to mention that I also take 3-5g of creapure daily (been doing so since high school, it’s such an ingrained habit that it slipped my mind).

I’ve taken magnesium and collagen on/off, not currently taking due to trying to decrease pill/supplement burden a bit and save a bit of money too (based on the couple times I tracked diet w/ Chronometer, I’m hitting my magnesium RDA) but might add them back in the future and am always keeping an open mind.

Given the extremely long-term data w/ statins and the cheap price, I’d personally prefer a statin-ezetimibe combo but again I’m watching the bempedoic acid literature and think that’s a super reasonable option too (esp if any statin intolerance obviously :))

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#9

Just piling on to say WELCOME!!!

It’s fantastic you are starting so young!!! *says while feeling very jealous :slight_smile:

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#10

Thank you @Beth :). I first found this site during medical school when I had a very passionate cardiology attending discuss pros/cons of aggressive early apoB lowering and I wanted to learn more. Very glad that I fell down this rabbit hole.

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#11

Have you ever tried acell injections with prp for hair loss. People get good results

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#12

Hi @Mathew_Thomas, thanks for bringing that up. No, I haven’t tried acell w/ prp because finasteride and topical minoxidil are both FDA approved, effective, safe, and relatively cheap. Since my hair loss is pretty minimal right now, I only need fin/topical min.

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#13

This is something new I’ve learnt… Will explore this

#14

Re Tadalafil: it also has immunologic benefits: “Phosphodiesterase-5 inhibition with tadalafil exerts anti-inflammatory effects and ameliorates cognitive function and MMN parameters. Tadalafil could be a promising candidate for chronic treatment in other inflammatory pathologies associated with mild cognitive impairment.” Tadalafil Treatment Improves Inflammation, Cognitive Function, And Mismatch Negativity Of Patients With Low Urinary Tract Symptoms And Erectile Dysfunction | Scientific Reports
And this " Based on the pharmacological mechanism of PDE5Is, they are of unique value in the fight against infectious diseases and may be effective in combination with direct antiviral drugs. The anti‑infection mechanisms of PDE5Is and their roles in COVID‑19 were reviewed in the present study." Anti‑infection mechanism of phosphodiesterase‑5 inhibitors and their roles in coronavirus disease 2019 (Review)
And other references describing impact on T cells, CD 8, Tregs.
Great stuff!!

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#15

Never heard of this… interesting:

Acell MatriStem is “porcine urinary bladder matrix,” derived from pig bladder cells, that has proven to be very helpful in wound healing. Wound healing has been at the forefront of research into hair cloning and hair follicle regeneration.

https://www.realself.com/question/maryland-md-prpacell-treatment-hair-loss-prp

#16

Yeah, PDE5i seems to have many potential positives based on preclinical studies in animals, large observational cohorts, small trials in people w/ BPH/ED, and post-hoc analyses or follow-up studies of large RCTs for ED treatment. The consistently positive findings make me bet that PDEi likely has some benefit in healthy people, but I don’t think we have strong enough data to be very confident in that claim. Kind of like many of the other interventions discussed here that might be worth taking/implementing :slight_smile:

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#17

welcome!

Wondering if you’ve seen any worsened orthostatic hypotension in elderly taking low dose tadalifil? I was taking low dose and my pcp took me off after a physical due to suspecting OH. I never noticed anything physically but benefits and would prefer to take it daily. I was taking 5mgd.

#18

Thanks for the welcome!

Disclaimer that this isn’t medical advice and you should continue to follow your pcp’s recommendations, but I’m happy to talk about what I know re: tadalafil in a general sense.

Tadalafil could exacerbate orthostatic hypotension, especially when taken with other BP-lowering meds but possible when taken alone. To be fair, the data is a bit mixed as to how often tadalafil does this at ED doses and in who, and I can’t say I’ve personally seen this. But regardless, orthostatic hypotension increases the risk of falling, especially in older adults, which could be quite dangerous. So totally reasonable to watch out for hypotensive symptoms in older adults taking tadalafil (or really any other drug that might affect BP) and weigh the risk of falling heavily in the risk:benefit analysis. What’s less clear is how important a measured significant drop in BP is if not reporting any symptoms. But still, probably better to err on the side of caution given the risks.

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#19

Welcome to participating in the forum and also having an interest in this area, as it will shape your career in unanticipated ways. Having knowledge outside of the norm, and having a range of possible different from colleagues is an interesting place to be.

If it’s not on your DDx, you’ll miss it, and I deal with patients daily, who have had clear diagnoses missed, but understandably so.

I’d encourage you to review the work of Mark Houston who is a state of the art cardiologist in Nashville (st. thomas and vanderbilt) but is also an anti-aging and regenerative medicine specialist. His approach is significantly different from main stream, yet, he is working in the mainstream and highly sought after. It takes almost a year to get an appt with him.

You might want to head in his footsteps.

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#20

Thank you for tht insight. I’m not really seeking medical advice, but definitely am looking for more support for the argument that tadalafil might contribute to OH. I was also taking some OTC magnesium supplements and was trying a small dose of lithium orotate around the same time. Maybe one of those products contributed as well.
Best wishes in your field of work!

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