BERKELEY, CA (UroToday.com) - There is a “target rich” environment for thrombophilia in unselected subjects, with the prevalence of the four major inherited thrombophilias being 5% for the factor V Leiden, 5% for the prothrombin gene mutation, 5% for high factor VIII, and 5% for high factor XI, for an aggregate of 20%. This does not include the common presence of the lupus anticoagulant, with or without the antiphospholipid antibody syndrome. In the presence of one of these familial thrombophilias, the risk of deep venous thrombosis-pulmonary embolus (DVT-PE) rises from ~1/1000 to ~8-10/1000, and when testosterone is added on top of one of these familial thrombophilias, then the risk of DVT-PE rises to ~80-100/1000.[1, 2, 6]
Both the U.S. FDA and Canada Health have warned about increased risk of DVT-PE in men given testosterone.
Because of potentially catastrophic DVT-PE when exogenous testosterone is given to men (or women) with either familial or acquired thrombophlia,[2, 3, 4, 5, 7, 8] we recommend that screening for procoagulants be carried out before starting testosterone therapy. These tests include PCR analyses for the factor V Leiden and prothrombin gene mutations, and serologic tests for factors VIII and XI, homocysteine, and the lupus anticoagulant. If these thrombophilias are present, then testosterone therapy is probably contraindicated because of a very unfavorable risk/benefit ratio. Moreover, if these thrombophilias are present, and even with fully adequate anticoagulation, if testosterone therapy is then given, recurrent thrombosis occurs.
I am glad to provide consultation for any physician who has questions about testosterone and the risk of thrombosis, or who has a patient who sustained thrombosis when given testosterone therapy. Contact me by email at , provide me with the details of the case, and I will advise, free of charge.
References:
- Freedman J, Glueck CJ, Prince M, Riaz R, Wang P. Testosterone, thrombophilia, thrombosis. Transl Res. 2015
- Glueck CJ, Wang P. Testosterone therapy, thrombosis, thrombophilia, cardiovascular events. Metabolism. 2014;63(8):989-94.
- Glueck CJ, Bowe D, Valdez A, Wang P. Thrombosis in three postmenopausal women receiving testosterone therapy for low libido. Women's Health (Lond Engl). 2013;9(4):405-10.
- Glueck CJ, Hutchins RK, Jurantee J, Khan Z, Wang P. Thrombophilia and retinal vascular occlusion. Clin Ophthalmol. 2012;6:1377-84.
- Glueck CJ, Friedman J, Hafeez A, Hassan A, Wang P. Testosterone, thrombophilia, thrombosis. Blood Coagul Fibrinolysis. 2014
- Glueck CJ, Friedman J, Hafeez A, Hassan A, Wang P. Testosterone therapy, thrombophilia, and hospitalization for deep venous thrombosis-pulmonary embolus, an exploratory, hypothesis-generating study. Med Hypotheses. 2015
- Glueck CJ, Richardson-Royer C, Schultz R, Burger T, Bowe D, Padda J, et al. Testosterone Therapy, Thrombophilia-Hypofibrinolysis, and Hospitalization for Deep Venous Thrombosis-Pulmonary Embolus: An Exploratory, Hypothesis-Generating Study. Clin Appl Thromb Hemost. 2013
- Glueck CJ, Goldenberg N, Budhani S, Lotner D, Abuchaibe C, Gowda M, et al. Thrombotic events after starting exogenous testosterone in men with previously undiagnosed familial thrombophilia. Transl Res. 2011;158(4):225-34.
Written by:
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.
Cholesterol and Metabolism Center, Jewish Hospital, Suite 430, 2135 Dana Avenue, Cincinnati, OH 45207 USA