Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Im a 37 y.o. transgender man with pre-diabetes and high cholesterol/triglycerides. I had chest pain and dizziness several months ago and went to cardiology for tests. Stress echo was normal, though the symptoms were still made worse with the exercise. I was sent for a CT scan with contrast. No blockages or abnormalities. They did find a small hiatal hernia. I asked if that could cause chest pain and they reluctantly admitted that it could. I say reluctantly because despite my results being normal, she wanted to put me on a stronger statin. Ive been on statins for years and it has impaired my glucose tolerance. Rather than go on Metformin, I opted to go on strict low carb diet, monitor my glucose and lots of walking. Ive done that for two years and Im almost back in to anormal A1C. Ive worked very hard. I also switched from Simvastatin to Pravastatin. The latter has some preliminary findings suggesting it doesn't effect glucose tolerance as strongly. One of the worst statins for this...is Crestor. The cardiac nurse is convinced that I need to be on it. So I tried it for a month and surprise - my glucose is impaired again. (Morning was usually 160 at worst, two days ago it was 300. My diet has not changed.) I said no thanks to the Crestor and asked to be put back on Pravastatin. Nurse was really pushing back saying its still worth the risk because my cholesterol was too high on the Pravastin. I agreed to double my dose of it until we sort out this dispute. I get a call today from the cardiologist resident who was approached by the RN about my refusal to take Crestor. I get the same spiel about how its worth the risk. I explain patiently that A) I show no signs of heart disease. B)that my chest pain was very likely the hiatal hernia (which will be addressed separately)C) That although I understand their logic, I have worked very hard to keep my Diabetes controlled without Metformin. The common side effects of which (fecal incontinence and nausea) Ive seen with my sister and would very much like to avoid. Cardio Resident says she will "consult Endocrinology but they will likely say the same thing". Add to this that Im on Testosterone Cypionate , which she says can cause the triglycerides to read high. I told her to make sure she mentions this when she talks to the Endo. I feel like I am being forced onto a medication that I dont consent to. Here are my questions: 1) could Testosterone cypionate cause a false high reading of triglycerides on a blood test? 2) Am I being foolish in my refusal of the more aggressive statin? 3)Are there other options I am not seeing?. ### Response: How high is your cholesterol? Since youre only 37 and they are pushing statins pretty hard, I would assume that your cholesterol sucks and you almost certainly should be on atorvastatin or rosuvastatin if it is being recommended by two cardiology providers. Small hiatal hernias do not generally cause chest pain, and for sure do not cause dizziness. If your chest pain was worse with exercise, its concerning for micro vascular disease, with a normal CT.Overall while statins do increase glucose intolerance, they overall have a net benefit in decreasing risk of heart attack and stroke. While your glucose numbers may change, its less about the glucose numbers and more about reducing downstream effects.It is kind of silly frankly to avoid metformin without knowing if youll have GI side effects or not. You likely will unfortunately need metformin in the future, statin or not, and if you dont tolerate metformin there are other alternatives out there such as GLP-1 agonists and SGLT-2 inhibitors that also help with cardiovascular risk..