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    • Testosterone Therapy Does Not Increase DVT and Pulmonary Embolism in 71,000 Patients

      Association Between Testosterone Replacement Therapy and the Incidence of DVT and Pulmonary Embolism: A Retrospective Cohort Study of the Veterans Administration Database.

      Sharma R, et al. Chest. 2016.

      Abstract
      BACKGROUND: Testosterone replacement therapy (TRT) prescriptions have increased several-fold in the last decade. There have been concerns regarding a possible increased incidence of DVT and pulmonary embolism (PE) with TRT. Few data support the association between TRT and DVT/PE. We evaluated the incidence of DVT and PE in men who were prescribed TRT for low serum total testosterone (sTT) levels.

      METHODS: This is a retrospective cohort study, conducted using data obtained from the Veterans Affairs Informatics and Computing Infrastructure. We compared the incidence of DVT/PE between those who received TRT and subsequently had normal on-treatment sTT levels (Gp1), those who received TRT but continued to have low on-treatment sTT (Gp2), and those who did not receive TRT (Gp3). Those with prior history of DVT/PE, cancer, hypercoagulable state, and chronic anticoagulation were excluded.
      RESULTS: The final cohort consisted of 71,407 subjects with low baseline sTT. Of these, 10,854 did not receive TRT (Gp3) and 60,553 received TRT. Of those who received TRT, 38,362 achieved normal sTT (Gp1) while 22,191 continued to have low sTT (Gp2). The incidence of DVT/PE was 0.5%, 0.4%, and 0.4% in Gp1, Gp2, and Gp3, respectively. Univariate, multivariate, and stabilized inverse probability of treatment weights analyses showed no statistically significant difference in DVT/PE-free survival between the various groups.

      CONCLUSIONS: This study did not detect a significant association between testosterone replacement therapy and risk of DVT/PE in adult men with low sTT who were at low to moderate baseline risk of DVT/PE.

      This article was originally published in forum thread: Testosterone Therapy Does Not Increase DVT and Pulmonary Embolism in 71,000 Patients
      Comments 7 Comments
      1. RobRen's Avatar
        RobRen -
        Nelson, been tracking your blogs, posts, and youtube videos for the past few years and appreciate your knowledge in the TRT therapy area. I started my TRT regimen 7 years ago when I was 49 and it was a life saver for me. I played sports all my younger years in life and then continued my weight lifting regimen after my sports years ended. Weight lifting has alway been my escape from the stress of working in corporate America (going on 43 years now non stop training). That being said, I stay in very good shape with both weight training and cardio mixed 6 days a week.

        Sorry for the long introduction but need to set the background. A week ago I was diagnosed with a DVT and am trying to identify the causes. Of course my PCP (how originally recommended TRT) and Vascular Surgeon are telling me I have to get off TRT now, cold turkey. My Endocrinologist tells me, which I agree with, that my blood test are perfect Hgb 16.5 and that it's not the TRT that caused the DVT.

        Therefore I have to include the rest of the story, I had a Steroid / Cortisone injection in my back 4 months ago and 3 months into it, the injection wore off and my legs and back started hurting, (was only my back originally), when I stood up for an extended period of time. I went back on a Monday for another back injection, started getting the flu Tuesday night and spent a few days laying in bed and noticed what felt like sciatica nerve pain running from my injection site to the back of my right knee. By Monday of the following week my right leg swelled up and I had shooting pains running through it. Went to my PCP and had a ultrasound performed and diagnosed with DVT.

        I tell this story to both help others understand the symptoms and causes DVTs in TRT patients. I understand the dangers of high Hgb and control it through blood donations every 60 days. I get my blood tests by my Endocrinologist every six months. I track my Test injections, HCG injections, and Anastrozole dosage actively. I continue with the TRT treatment as I prepare to go in and have a thrombectomy / strombolysis to remove the clot as I am all too aware of the outcome of just stoping my TRT treatment.

        I guess my ask / question is - what can I do other than never use steroid / cortisone inflammatory reducing products again. As my research has enlightened me to the DVT dangers of these products as well?
      1. Nelson Vergel's Avatar
        Nelson Vergel -
        .

        RobRen

        Sorry to hear about your DVT. Corticoid steroids may have accelerated it but difficult to know. I do not know if you have read this interview:


        Can Testosterone Induce Blood Clots and Thrombosis? Interview with Dr Charles Glueck



        If I had DVT, I would run these tests as mentioned by Dr Glueck


        "You suggest that "thrombophilia should be ruled out before administration of exogeneous testosterone". How can that be done and are the tests commercially available or research tools? You used these tests in your study: factor V Leiden heterozygosity, high factors VIII and XI, high homocysteine, low antithrombin III, the lupus anticoagulant, high anticardiolipin antibody lgG, and the hypofibrinolytic 4G4G mutation of the PAI-l gene. Should all be performed? Would these tests be reimbursed by insurance and, if not, what do you think the retail value would be?

        Dr Glueck: The 4 tests we would do include Factor V Leiden, Prothrombin gene, Factor VIII and Factor XI, all routinely available commercially at Lab Corp and Quest (big national labs), and at almost all regional labs as well. In our experience, these tests are routinely covered by insurance. If not covered, I would estimate that the cost would be expensive, $800."

        I would also take a baby aspirin, vitamin E and omega 3 oil capsules as they are blood thinning. Your doctor probably prescribed a blood thinner also.

        Would I get off TRT if I had DVT? Probably not unless my genetic tests really show a propensity for getting it. Only 2 percent of men seem to have these genetic mutations.
      1. RobRen's Avatar
        RobRen -
        Thanks for sharing the article Nelson.

        I am scheduled to see a Hematologist after I get the DVT out of my leg (Thrombectomy / Thrombolysis). Had the factor V test run already and it was negative. Will get these other tests run and see how they come out.

        Although this DVT scares the hell out of me so does having low T. Intend on continuing my TRT treatment per my Endocrinologist suggestion but may drop my T level to around 600 instead of 800 to 1000.
      1. Nelson Vergel's Avatar
        Nelson Vergel -
        That is a good thing since factor V is the main one. Did they put you on any blood thinners or are you just on baby aspirin and fish oils?
      1. RobRen's Avatar
        RobRen -
        Quote Originally Posted by Nelson Vergel View Post
        That is a good thing since factor V is the main one. Did they put you on any blood thinners or are you just on baby aspirin and fish oils?

        Sorry for the delay in responding Nelson but wanted to provide input from my hematologist visit. According to him there is no conclusive evidence relating my TRT treatment (Testosterone cypionate, HCG, and Anastrozole) to getting a DVT. As you might expect, I was pretty happy to hear that after my PCP and Vascular Surgeon were adamant that I stop the TRT treatment.

        The only thing that changed prior to me getting the DVT was the injections in my back to relieve lower back pain caused from playing football for 13 years. Young and dumb brother - run through them and not around them.

        I had been on TRT for 7 years and it has improved my quality of life. I played sports during my younger years up into the collegiate level, as I mentioned above and continued lifting 5 days a week until I was 49. All the sudden it didn't matter what I did, I was losing muscle mass, sex drive, and energy, much less the will to keep fighting it.

        TRT changed that for me but wish our health care system would recognize the value and come up with a solution for the high Hematocrit / Hemoglobin. I struggle with this so donate blood every 50 to 60 days and now I am on blood thinner for the next 6 months. Hoping a side effect will be to lessen the effect of high Hgb but we will see. By the way the blood thinner medicine kind of puts an end to the local blood banks wanting to allow me to donate blood so that will be a problem.

        Have a suspicion high Hemoglobin could play a role in getting the DVT as well.

        Thanks for all you do researching and providing information for those of us on TRT.
      1. JPB's Avatar
        JPB -
        Although I am not on TRT, I was on a blood thinner three months last year for a DVT. Luckily after 3 months the clot cleared. I had quit the blood thinner (Xarelto) prior to the scan because it was wrecking me in the gym. It has taken another 4-5 months to recover from the blood thinner. Regarding your back injections, I believe corticosteroids can raise DVT risks. Coincidentally, at the time I injured my leg I was on a short course of prednisone. The clot manifested about 2 months after the injury.
      1. RobRen's Avatar
        RobRen -
        Quote Originally Posted by JPB View Post
        Although I am not on TRT, I was on a blood thinner three months last year for a DVT. Luckily after 3 months the clot cleared. I had quit the blood thinner (Xarelto) prior to the scan because it was wrecking me in the gym. It has taken another 4-5 months to recover from the blood thinner. Regarding your back injections, I believe corticosteroids can raise DVT risks. Coincidentally, at the time I injured my leg I was on a short course of prednisone. The clot manifested about 2 months after the injury.

        Thanks for for the info. I have always tried to think things through logically and not jump to conclusions but have to believe the corticosteroids injections I had in my back played a major role. Ultimately, though I think it was a combination TRT, Corticosteroid, and inactivity because of the flu.
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