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Testosterone, thrombophilia, thrombosis.

Joel Freedman1, Charles J Glueck2, Marloe Prince1

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Testosterone therapy (TT) is linked to a higher prevalence of thrombophilia, increasing the risk of venous thromboembolism (VTE). Screening for thrombophilia before TT is crucial to identify high-risk individuals and avoid adverse outcomes.

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Area of Science:

  • Endocrinology
  • Hematology
  • Cardiovascular Medicine

Background:

  • Testosterone therapy (TT) is increasingly used for various conditions.
  • Thrombophilia, a predisposition to blood clots, is a known risk factor for venous thromboembolism (VTE).
  • The association between TT and thrombophilia requires further investigation.

Purpose of the Study:

  • To screen for previously undiagnosed thrombophilia in individuals experiencing VTE or osteonecrosis after initiating TT.
  • To compare the prevalence of thrombophilia in patients on TT with VTE/osteonecrosis to control groups.
  • To evaluate the safety and efficacy of continuing TT in thrombophilic individuals.

Main Methods:

  • Screening for thrombophilia (Factor V Leiden, prothrombin mutations, Factors VIII and XI, homocysteine, antiphospholipid antibody syndrome) in 17 cases (15 men, 2 women) with VTE or osteonecrosis post-TT.
  • Comparison with two control groups: 97 healthy individuals and 31 individuals on TT without thrombosis.
  • Analysis of serum testosterone and estradiol levels in cases on TT.

Main Results:

  • 76% of cases had at least one thrombophilia, significantly higher than normal controls (19%) and TT controls (29%).
  • Specific thrombophilias like Factor V Leiden, high Factor VIII, high homocysteine, and antiphospholipid antibody syndrome were more prevalent in cases.
  • Two patients experienced recurrent deep venous thrombosis-pulmonary embolism (DVT-PE) despite anticoagulation, with some cases showing supranormal testosterone and estradiol levels on TT.

Conclusions:

  • Testosterone therapy interacts with thrombophilia, leading to an increased risk of thrombosis.
  • Continuation of TT in thrombophilic men is contraindicated due to the risk of recurrent clots.
  • Pre-treatment screening for thrombophilia is recommended to identify individuals at high risk for VTE with TT.