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Athelete and NHCM - TRT - Testostrone replacement therapy
Hi everyone,
I’m a 42-year-old cyclist diagnosed with Non-Obstructive HCM (nHCM) in 2015. I’m looking for insight into whether TRT (Testosterone Replacement Therapy) could have triggered a rapid progression in my septal thickness.
My History
2015–2022 (7 years): Stable disease
2015 MRI: Septal thickness 17 mm
Annual echoes through 2022: 16–17 mm, no progression
Late 2023: Started TRT (testosterone gel 50 mg/day – replacement dose)
2025–2026: Sudden increase on echo
Septum now 29–30 mm
Pattern described as Reverse Curve / Apical phenotype
Current Status
Exercise capacity: Still very high
Indoor cycling ~1 hour
Can push HR to ~178 bpm without limitation
Symptoms:
New, strong “pounding” sensation in chest (not classic palpitations)
Medications & Effects
Ramipril 10 mg
Reduced LA size (48 mm → 44 mm)
Nebivolol 2.5 mg
Poor tolerance
Pounding sensation persists
SGLT2 inhibitor (brief trial)
Marked improvement
Heart felt significantly calmer
Best symptom relief so far
Questions for the Group
TRT & Hypertrophy
Has anyone seen rapid wall-thickness progression after starting TRT?
If you stopped TRT, did thickness regress or improve?
My doctors suspect possible cellular swelling rather than fixed fibrosis due to the rapid timeline.
Mavacamten (Camzyos) in nHCM
Has anyone with non-obstructive HCM tried mavacamten?
Did it help with diastolic stiffness or the pounding sensation?
SGLT2 Inhibitors
Has anyone used dapagliflozin / empagliflozin for HCM symptoms?
It worked remarkably well for me, though I know it’s not standard HCM therapy yet.
Thanks in advance for any shared experiences or insights.
I really appreciate this community.
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HugInterested in more discussions like this? Go to the Hypertrophic Cardiomyopathy (HCM) Support Group.
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Hello @athelete42, and welcome to Mayo Clinic Connect.
I'm so glad you appreciate our little online community of HCM people. It's nice to connect with others who share your same condition.
You ask some powerful questions, and it may take time for others to chime in if they can share any insight on Testosterone replacement therapy and HCM.
I did a quick little online search and found that the information seemed inconclusive or mixed.
Most articles kept saying to ask your cardiologist.
That is good advice, but it is also important the your treating physician is up-to-date on treating HCM. Do you have a good idea your physician is well versed in treating HCM?
I found this:
https://pmc.ncbi.nlm.nih.gov/articles/PMC3886770/
and this:
https://www.heartlungcirc.org/article/S1443-9506(25)00783-8/fulltext
But I could not find anything directly correlating to testosterone and HCM progression.
It must be unsettling knowing you were pretty stable and all of a sudden there is a big change in the thickness of the septum.
The pounding feeling is off-putting isn't it?
Mine was so bad it would shake the bed at night. Freaked me out, and I did not like it one bit!
They are totally gone after open heart septal myectomy at the Mayo Clinic. And I have been able to resume almost everything I could do before this condition appeared.
You sound like a super athlete, and the limitation HCM puts on our bodies is frustrating to say the least.
It does not compute in our brains. We were able to climb mountains like it was nothing, and all of a sudden (or over time) we are gasping for air just tying our shoes.
It is crazy.
It makes you feel crazy.
But you are not crazy.
You have Hypertrophic Cardiomyopathy.
Oh yay.
Have you had a second opinion?
Or have you consulted a Center of Excellence about these significant changes?