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Testosterone, thrombophilia, and thrombosis

Charles J Glueck1, Caitlin Richardson-Royer, Reiker Schultz

  • 11The Jewish Hospital Cholesterol Center, Cincinnati, OH, USA.

Clinical and Applied Thrombosis/Hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
|April 26, 2013
PubMed

Insights

Testosterone therapy can lead to dangerous blood clots like deep venous thrombosis (DVT) and pulmonary embolism (PE), and bone death (osteonecrosis). Patients with undiagnosed clotting disorders (thrombophilia) are at higher risk.

Area of Science:

  • Endocrinology
  • Hematology
  • Vascular Medicine

Background:

  • Testosterone therapy is increasingly used for various conditions.
  • The potential risks, especially thrombotic events, require careful consideration.
  • Undiagnosed thrombophilia-hypofibrinolysis may predispose individuals to adverse events.

Observation:

  • A study observed thrombosis, deep venous thrombosis (DVT), pulmonary embolism (PE), and hip-knee osteonecrosis in 14 patients after testosterone therapy.
  • These patients were previously healthy and had no prior history of thrombosis.
  • Several patients presented with previously undiagnosed thrombophilia-hypofibrinolysis, including Factor V Leiden, high Factor VIII, and PAI-1 4G4G homozygosity.

Findings:

  • Testosterone therapy was associated with the development of DVT, PE, and osteonecrosis in patients with underlying thrombophilia.
  • Recurrent DVT-PE occurred in some patients even with therapeutic anticoagulation when testosterone was continued.
  • High estradiol levels (a metabolite of testosterone) were observed in a significant percentage of men on testosterone therapy, suggesting a potential mechanism for E2-induced thrombophilia.

Implications:

  • Thrombophilia should be screened for before initiating testosterone therapy to mitigate risks.
  • The aromatization of testosterone to estradiol may play a role in testosterone-induced thrombophilia.
  • Clinicians should be vigilant for thrombotic complications in patients undergoing testosterone replacement therapy, particularly those with risk factors.

Keywords:
anticoagulantsblood coagulation factorsclinical thrombophiliadeep venous thrombosisendocrinologyhypercoagulabilitytestosterone

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