BERKELEY, CA (UroToday.com) - Before starting exogenous testosterone therapy (TT), to avoid the thrombotic interaction of TT with previously undiagnosed familial or acquired thrombophilia, we suggest measurement of Factor V Leiden and Prothrombin gene PCRs, Factors VIII and XI, and homocysteine. TT should not be given to patients with known thrombophilia.
Patients who have had thrombotic events while taking TT and are found to have familial or acquired thrombophilia will have second, third, and fourth thrombotic events even when fully anticoagulated, if TT is continued. TT should never be restarted in a patient with a known thrombotic event associated with a familial or acquired thrombophilia.
Concurrent provision of an aromatase inhibitor along with TT to block aromatization of TT to estradiol (E2) will not apparently protect against thrombotic events in patients with familial or acquired thrombophilias. The aromatase inhibitors themselves are thrombogenic in the presence of familial or acquired thrombophilias.
The timetable from initiation of TT to thrombotic events and from initiation of TT to both myocardial infarction and ischemic stroke is the same, about 3-5 months, suggesting a shared thrombotic pathoetiology.
Before initiating TT in patients with Klinefelter’s syndrome, test for familial and acquired thrombophilia.
If you have clinical or research questions about the relationship of TT to thrombotic events, we would be glad to help in diagnosis and therapy. Contact Dr. C.J. Glueck, email ; fax 513-924-8273; phone 513-924-8250; or mail (Cholesterol, Metabolism, and Thrombosis Center, Suite 403, 2135 Dana Avenue, Cincinnati OH, 45207 USA).
Charles J. Glueck, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Jewish Hospital Cholesterol, Metabolism, Thrombosis Center, Jewish Hospital of Cincinnati, Cincinnati, OH, USA