Testosterone Doubles Risk of Thromboembolism

Jinzang

Member
A new study finds an increased risk of venous thromboembolism (VTE) in the six months after starting testosterone replacement therapy compared to the six months before the therapy was initiated. The abstract says:

This case-crossover study analyzed data on 39 622 men from the IBM MarketScan Commercial Claims and Encounter Database and the Medicare Supplemental Database from January 1, 2011, to December 31, 2017, with 12 months of follow-up. Men with VTE cases who were free of cancer at baseline and had 12 months of continuous enrollment before the VTE event were identified by International Classification of Diseases codes. Men in the case period were matched with themselves in the control period.

A total of 39 622 men (mean [SD] age, 57.4 [14.2] years) were enrolled in the study, and 3110 men (7.8%) had evidence of hypogonadism. In age-adjusted models, testosterone therapy use in all case periods was associated with a higher risk of VTE in men with (odds ratio [OR], 2.32; 95% CI, 1.97-2.74) and without (OR, 2.02; 95% CI, 1.47-2.77) hypogonadism. Among men without hypogonadism, the point estimate for testosterone therapy and VTE risk in the 3-month case period was higher for men younger than 65 years (OR, 2.99; 95% CI, 1.91-4.68) than for older men (OR, 1.68; 95% CI, 0.90-3.14), although this interaction was not statistically significant (P = .14).
 
The consensus seems to be that at worst VTE is slightly elevated for the first 6 months of testosterone therapy. Many other studies either show no risk or statistical irrelevance. What this study does not establish is if it is causation or correlation. Ie...what underlying health issues / disease was causing the hypogonadism in the first place, and what effect, if any, would that have on VTE incidents.

With medical studies you need to evaluate the entire body of evidence. If you’re hypogonadal and start testosterone there may be some risks associated with that. However, not treating your hypogonadism also comes with risks. As with everything in life.....your mileage may vary.

Study: Testosterone Replacement Does Not Increase DVT Risk - Renal and Urology News

Testosterone therapy and venous thromboembolism: A systematic review and meta-analysis. - PubMed - NCBI
 

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Estradiol (E2)

A form of estrogen produced from testosterone. Important for bone health, mood, and libido. Too high can cause side effects; too low can affect well-being.

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Dihydrotestosterone is a potent androgen derived from testosterone. Affects hair growth, prostate health, and masculinization effects.

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The biologically active form of testosterone not bound to proteins. Directly available for cellular uptake and biological effects.

Scientific Reference

Lakshman KM, Kaplan B, Travison TG, Basaria S, Knapp PE, Singh AB, LaValley MP, Mazer NA, Bhasin S. The effects of injected testosterone dose and age on the conversion of testosterone to estradiol and dihydrotestosterone in young and older men. J Clin Endocrinol Metab. 2010 Aug;95(8):3955-64.

DOI: 10.1210/jc.2010-0102 | PMID: 20534765 | PMCID: PMC2913038

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