Testosterone, Thrombophilia, and Thrombosis

[maleover]

I have experienced prior blood clots and am about to start TRT per my doc, so this is an alarming thread when I found it doing a search.

We all know that management of E2 and polycythemia is mandatory while on TRT, but how do we know there aren't other factors could play into this equation?

Since endo T has both pro- and anti-thrombotic effects, my sense is that for those of us that have hypercoagulation issues, extreme vigilance need be implemented in the monitoring of E2, CBC, and follow-up blood factors when using exo T.

Bottom line: So long as one bird-dogs those levels, is it reasonable to assume TRT is a safe bet for those with prior clot history and/or are using anticoagulants? I am not on any prescription thinners at present and would rather not take one just to be on TRT.

 

[Dr JIM]

If you have had a DVT it's most important you discover WHY! Have you had clotting factors measured?

The answer to the unanswerable question is WE DON'T KNOW.

Next!

 

[maleover]

If you have had a DVT it's most important you discover WHY! Have you had clotting factors measured?

The answer to the unanswerable question is WE DON'T KNOW.

Next!

I did show +/+ (homozygous) for the MTHFR gene mutation (HCY is normal), and +/- (heterozygous) for PAI-1 gene mutation. I also show increased heritable susceptibility to thrombosis from specific gene markers from my DNA, but those may or may be a causal factor. All of the other genetic tests known to cause thrombosis resulted in negatives (protein C, S, prothrombin 20210A, FVL, Anti PS).

The factors that are showing increased elevation are:
FXII, FV, FVIII, d-dimer, vWF.

 

[Dr JIM]

Have you had a DEEP VENOUS THROMBOSIS or NOT, since all of those markers are far to nonspecific.

I mean shit if physicians evaluated and treated every patients with an "elevated D-dimer" we would all be on anticoagulants, (which are not "blood thinners")

 

[maleover]

Have you had a DEEP VENOUS THROMBOSIS or NOT, since all of those markers are far to nonspecific.

I mean shit if physicians evaluated and treated every patients with an "elevated D-dimer" we would all be on anticoagulants, (which are not "blood thinners")

I agree, those blood fact elevation are acute phase reactants and could be from a milllion different things.

Here are the reports from my two separate incidents. (they both clear within a couple weeks; I was on coumadin for the first one for 4 mos.):
Non-Occlusive DVT:
https://app.box.com/s/icyio8g4qqs1a0t513pn
Occlusive superficial VT:
https://app.box.com/s/pwcbckxc9v5x89olzz4m

 

[maleover]

Have you had a DEEP VENOUS THROMBOSIS or NOT, since all of those markers are far to nonspecific.

I mean shit if physicians evaluated and treated every patients with an "elevated D-dimer" we would all be on anticoagulants, (which are not "blood thinners")

So, as you can see from my prior post, I did have a DVT, just not occlusive.
Other hypercoagulators seem to manage their TRT just fine with regular phelbs and E2 management, but does that guarantee I won't have an issue? Obvious answer is no. But does mean I should sh*tcan TRT. That again is a no.

 

[Dr JIM]

I can see that NOT from your prior posts UNLESS you believe ALL "blood clots" involve the deep venous system. That's why I asked that question. Moreover I believe it unusual your no longer on anticoagulants IF you did have a DVT AND no REVERSIBLE risk factor was identified.

Why, because under that scenario most patients acquire another clot absent anticoagulants.

Finally IF you had a DVT, TRT with rare exceptions is contraindicated,.

Nonetheless I believe it prudent to defer my opinion to a hematologist who is familiar with YOUR particular CASE.

 

[maleover]

I can see that NOT from your prior posts UNLESS you believe ALL "blood clots" involve the deep venous system. That's why I asked that question. Moreover I believe it unusual your no longer on anticoagulants IF you did have a DVT AND no REVERSIBLE risk factor was identified.

Why, because under that scenario most patients acquire another clot absent anticoagulants.

Finally IF you had a DVT, TRT with rare exceptions is contraindicated,.

Nonetheless I believe it prudent to defer my opinion to a hematologist who is familiar with YOUR particular CASE.

I had two hemos - one that wanted me to stay on warfarin for the full course of 6 mos. - and the other who took me off it because the DVT was non-occlusive. Did you view the links I posted which show my ultrasounds? And you're right, I did acquire the 2nd clot 4 mos. after stopping warfarin. Good point about there being no reversible risk factor yet identified (but I believe through my research, am getting loser to an answer). Brings back into question whether hemo #2 made a good decision.

 

[maleover]

Latest study linking TRT with blood clots: Testosterone, thrombophilia, and thr... [Clin Appl Thromb Hemost. 2014] - PubMed - NCBI
Here's the study protocol: http://www.e-mercy.com/images/chole...ts-with-Underlying-Clotting-abnormalities.pdf

Here's the article: Cincinnati doctor warns testosterone treatment can cause blood clots - Cincinnati Business Courier
Would like to get some feedback from those on TRT who may be or are at risk for clots as I am.

 

[Dr JIM]

The "study" you cited is nothing more than a retrospective analysis of patients whom were on TRT and developed a "clot".

What is clearly missing is the COMBINED number of patients whom were treated effectively yet who did NOT develop a clot!

Why? Because without knowing the incidence or prevalence of this TRT "related" complication (DVT) the authors recommendation (pre-TRT thrombophillia screening) is BOGUS

Jim

 

[maleover]

The "study" you cited is nothing more than a retrospective analysis of patients whom were on TRT and developed a "clot".

What is clearly missing is the COMBINED number of patients whom were treated effectively yet who did NOT develop a clot!

Why? Because without knowing the incidence or prevalence of this TRT "related" complication (DVT) the authors recommendation (pre-TRT thrombophillia screening) is BOGUS

Jim

The thing that scares me is the incidence of higher risk for those on TRT who have had a prior history. So, for these higher-risk cases, don't you think pre-TRT thrombophilia screening should be warranted?

The takeaway I got out of it was as long as you manage E2 levels (as that is what combines with the clotting disorders to form clots), risk is minimized.

 

[Dr JIM]

We DONT KNOW the incidence mate, for either higher or lower risk patients, period.

Nonetheless IF you have had a DOCUMENTED history of a DVT while on TRT, the risk of developing another clot is believed to be inordinately high, such that TRT is contraindicated.

That IS NOT the same as saying those whom test positive for a clotting disorder should not be placed on TRT.

Why? BECAUSE WE DONT KNOW what that risk is OR, if controlling E-2 levels modulates that risk.

As I've suggested previously, follow your HEMATOLOGISTS advice.

And IF they don't agree? Go with that SPECIALIST which suits your fancy.

Why, because chances are the studies (each is using for "advice"), DONT AGREE either!

 

[maleover]

We DONT KNOW the incidence mate, for either higher or lower risk patients, period.

Nonetheless IF you have had a DOCUMENTED history of a DVT while on TRT, the risk of developing another clot is believed to be inordinately high, such that TRT is contraindicated.

That IS NOT the same as saying those whom test positive for a clotting disorder should not be placed on TRT.

Why? BECAUSE WE DONT KNOW what that risk is OR, if controlling E-2 levels modulates that risk.

As I've suggested previously, follow your HEMATOLOGISTS advice.

And IF they don't agree? Go with that SPECIALIST which suits your fancy.

Why, because chances are the studies (each is using for "advice"), DONT AGREE either!

What if you have documented non-occlusal DVT as I did (see upthread) not on TRT?

Finding a good hemo is tough. Been to two already and they both were clueless about HRT in general. Must keep looking. Only HRT/anti-aging docs really know, but then their not hemos.

 

[maleover]

We DONT KNOW the incidence mate, for either higher or lower risk patients, period.

Nonetheless IF you have had a DOCUMENTED history of a DVT while on TRT, the risk of developing another clot is believed to be inordinately high, such that TRT is contraindicated.

That IS NOT the same as saying those whom test positive for a clotting disorder should not be placed on TRT.

Why? BECAUSE WE DONT KNOW what that risk is OR, if controlling E-2 levels modulates that risk.

As I've suggested previously, follow your HEMATOLOGISTS advice.

And IF they don't agree? Go with that SPECIALIST which suits your fancy.

Why, because chances are the studies (each is using for "advice"), DONT AGREE either!

Upon further investigation into the article I posted above, I have gleaned more information and have complete studies now:
https://app.box.com/s/m050hbaxhj5bxrtp0yco
https://app.box.com/s/nsotn7zf975g6kj70gw3
https://app.box.com/s/hs5sei41i7o3obvjxkx1
https://app.box.com/s/v3qpftyfldfkha9egr83

And here are the takeaways:
1) On the basis of published data, when a patient has a major gene familial thrombophilia like factor V Leiden or Prothrombin gene heterozygosity, or familial high Factors VIII or XI, or acquired thrombophilia (lupus anticoagulant, anti phospholipid antibody syndrome), exogenous testosterone appears to be contradicated absolutely, irrespective of the E2 level, although most events occur when E2 is >42.6.

2) There have been 10 cases with major gene thrombophilia FULLY ANTICOAGULATED (with warfarin) who had second or even third thrombotic events when exogenous T therapy was continued.

3) There is one case in which Arimidex by itself caused thrombosis in a V Leiden heterozygote.

Doesn't all this seem a huge concern for anyone with elevated clot risk factors that is already on or is about to commence TRT??? Yes, most events occur when E2 is >42.6, but that doesn't guarantee us that thrombosis won't occur otherwise.

I have already been to two hemos. Neither of them would condone, let alone understand HRT/TRT.

Bottom line is that I need to start TRT. With my prior history & elevated FVIII, I am deadlocked as to what to do now.