NICE to have a study on TRT administered by researchers who know what they are doing.Does high hematocrit cause thrombosis and clots?
Erythrocytosis: Could This be the Key to Cardiovascular Risk:
Testosterone, thrombophilia, thrombosis.
Glueck CJ, et al. Blood Coagul Fibrinolysis. 2014.
Glueck CJ1, Friedman J, Hafeez A, Hassan A, Wang P.
1 Thrombosis Center
b Internal Medicine Residency Program, Jewish Hospital of Cincinnati, Cincinnati, Ohio, USA.
Blood Coagul Fibrinolysis. 2014 Oct;25(7):683-7. doi: 10.1097/MBC.0000000000000126.
We assessed previously undiagnosed thrombophilia-hypofibrinolysis in 11 testosterone (T)-taking men, five of whom developed deep venous thrombosis (DVT), four pulmonary embolism, one spinal cord infarction, and one osteonecrosis 3.5 months (median) after starting T gel (50-160 mg/day) or T intramuscular (50-250 mg/week). In the order of referral because of thrombosis after starting T, thrombophilia-hypofibrinolysis was studied in 11 men, and, separately, in two control groups without thrombosis - 44 healthy normal male controls and 39 healthy men taking T. Nine men had DVT or DVT-pulmonary embolism after 3.5 months (median) on T, one spinal cord infarction after 5 days on T, and one had osteonecrosis (knee and then hip osteonecrosis after 6 and 18 months on T). Four of the 11 men (36%) had high factor VIII (≥150%) vs. one of 42 (2%) controls (P = 0.005), and vs. one of 25 (4%) T-controls, (P = 0.023). Of the 11 men, two (18%) had factor V Leiden heterozygosity vs. none of 44 controls, (P = 0.04) and vs. none of 39 T-controls(P = 0.045). Of the 11 men, three had 4G4G plasminogen activator inhibitor-1 homozygosity, one prothrombin G20210A heterozygosity, one low protein S, and one high factor XI. When T was continued, second DVT-pulmonary embolism recurred in three of 11 men despite adequate anticoagulation. T interacts with thrombophilia-hypofibrinolysis leading to thrombosis. Men sustaining DVT-pulmonary embolism-osteonecrosis on T should be studied for thrombophilia. Continuation of T in thrombophilic men appears to be contraindicated because of recurrent thrombosis despite adequate anticoagulation. Before starting T, to prevent T-associated thrombosis, we recommend measures of factor V Leiden, factor VIII, and the prothrombin gene.
Three reasons why taking exogenous testosterone would put you at risk for deep venous thrombosis, pulmonary embolus:
1. High factor VIII, probably inherited
2. 4G4G homozygosity for the PAI-1 gene, inherited
3. MTHFR C677T and A1298C compound heterozygosity, inherited.
1. DO NOT EVER TAKE exogenous testosterone, HCG, clomid, or any other drug to increase testosterone levels along with concurrent anticoagulation. Of our first 58 published cases like yours, 8 of them continued or restarted testosterone along with coumadin, xarelto, or eliquis, and ALL 8 had second and third DVT-PE, including one near death. Anticoagulation WILL NOT PROTECT YOU if you start testosterone therapy.
2. If you do not take testosterone, I would not recommend coumadin, xarelto, or eliquis, and aspirin will not provide any real benefit.
3. Thyroid has no effect, one way or another.
You do not need to worry about inherited thrombophilia which would be a problem only in the following circumstances:
1. exogenous testosterone, clomid or HCG
2. orthopedic surgery hips, knees, feet. Were that to be done, you should be anticoagulated 12 hours after surgery with eliquis 2.5 mg twice per day for 1 month, provided that there were contraindications to osteonecrosis.
3. abdominal open surgery, would also require anticoagulation after surgery, as per #2
Ugh, this blows and I completely sympathize with the frustration others here are facing.
I was just about to start exogenous T, but thankfully saw this thread as I was waiting for my doc to send me my prescription. I've never had a clot, but a 1-2% risk was too much of a gamble for me, and the $400 - $500 (with insurance) for the labs was a paltry sum relative to not dying.
I had all the tests ordered by Dr. Glueck, here's what he said:
Some follow up questions I asked him:
1. Is there any medication (ex Xarelto) or supplements (ex Rutin) that you believe could prevent thrombotic events were I to take exogenous testosterone? Anything promising on the horizon?
2. If I do not go onto testosterone therapy, would you still recommend some kind of daily anti-coagulant, ex Xarelto or Warfarin?
3. The doctor also prescribed thyroid medication, I think it was Synthroid or Armour Thyroid. Do those types of medications also increase the risk of thrombotic events? To the same or lesser extent than testosterone?
Some further questions:
Given what I've inherited, is DVT-PE only a problem in the presence of exogenous test? Do you recommend any regular labs or any medication to prevent DVT-PE? Are there certain symptoms you believe are reliable early warning signs?
Interesting that he believes thyroid medication would have no effect.
Association Between Testosterone Supplementation Therapy and Thrombotic Events in Elderly Men
Yet another recent study in opposition Glueck's work which shows no difference in terms of thrombotic risk factors (clots) between those on TRT and not on TRT.
After completing Dr Glueck's blood orders, he highly recommended I d/c TRT. I have a history of superficial blood clots and took him serious. I took the blood results, and his recommendation, to the Dr that prescribed my TRT. He told me about several studies that had just come out. He said, according to my blood work, I am a clotter and will probably develop them on or off TRT. He recommended I continue TRT and also continue Eliques. Eliques help me pass my superficial clots fair quickly. He hasn't found any since I started the drug.
with all these findings as of late, who is right? the newer studies contradict what doc g has been saying and researching for years, BUT within the newer studies how do they compare with the doctor's studies? ie example:
duration of studies, age of people in them, amounts used, health of each individual?
it has been shown a few times where studies have come out, only to find out the men involved already had previous heart attacks and so on....
I believe Dr. G's studies were done with a much smaller number of individuals than the latest one. I don't have time right now to research it right now, but maybe someone can and report back on that. Coincidentally, Dr. G. was one the researchers on the latest one which makes no sense.
also how much would one put stoc into a 23andme report? ive done mine and it said something about me having 2 genomes that are bad in regards to having dvt's etc... \
but its all based upon saliva and not blood testing, where as saliva, to my knowledge, especially in regards to long term issues, can change from day to day,
where as blood work,
allthough some markers change, if u have something more than likely u have something and it wont show up differently the next blood test...