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Presumably it would take a dog without enlargement a significantly longer time to reach heart failure than it would a dog with enlargement

Loss of the endothelial glycocalyx links albuminuria and vascular dysfunction

PMID 30405529

In addition, low SHBG levels may reflect increased androgen binding, which reduces circulating and central androgen levels and potentially increases central IR, contributing to neurological damage [181]

Thus, there is a limit to how much can be taken up through this mechanism3

A majority (57%) say they do not cover such drugs for weight loss, while about a quarter (24%) are unsure if their largest plan cover them