Testosterone Replacement Therapy (TRT) & Dangerous Blood Clots

MCS

New member
There are those of us that cannot function without TRT and that have familial (genetic) and/or acquired thrombophilia (risk of clotting). I'm in this boat - had two idiopathic (unknown origin) thrombotic events but need to start TRT. I was not on TRT at the time. Currently not on any prescription thinners.

Anyone else have a history of thrombophilia (risk of clotting) or thrombosis (blood clots) and are on TRT, other AAS, hCG, and/or aromatase inhibitors?

Here's a T-Nation post on this matter:
tnation.t-nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/does_trt_cause_a_dvt

Troubling new research on this very topic:

excelmale.com/threads/1507-Can-Testosterone-Induce-Blood-Clots-and-Thrombosis-Interview-with-Dr-Charles-Glueck?highlight=glueck

Here are the recent media articles of concern:
bizjournals.com/cincinnati/blog/2013/09/cincinnati-doctor-warns-testosterone.html?page=all
bizjournals.com/cincinnati/news/2014/02/04/cincinnati-doctor-warns-of.html

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.

Dr. Glueck's (the lead researcher) actual studies:
https://app.box.com/s/m050hbaxhj5bxrtp0yco
https://app.box.com/s/nsotn7zf975g6kj70gw3
https://app.box.com/s/hs5sei41i7o3obvjxkx1
https://app.box.com/s/v3qpftyfldfkha9egr83

"After starting testosterone patch or gel, 50 mg/day or intramuscular testosterone 400 mg IM/month, 2 men developed bilateral hip osteonecrosis 5 and 6months later, and 3 developed pulmonary embolism 3, 7, and 17 months later."

One key is to keep E2 well under 40, however all AIs themselves are known to induce thrombosis!

Other takeaways from Dr. Glueck:

1) ALL of the anti-estrogens are reported to be thrombogenic
2) Several studies (Svartbarg, Tromso) have shown that endogenous T throughout its distribution (particularly on the high end) is NOT associated with thrombotic events
3) As far as using alternatives like clomid or hCG, he stated that they are also thrombogenic.
4) T increases platelet aggregation and increases viscosity. As T is aromatized to E2 then the E2 increases resistance to activated protein C and increases clotting. In patients with hypogonadotrophic hypogonadism, plasminogen activator inhibitor is low, and is modestly increased by TT.


I sent Dr. Glueck a follow-up email suggestion that NOT being on TRT (of SOME kind) is not an option. Bottom line is that he simply doesn't think there is any safe protocol to implement along with TRT. I can***8217;t be the only one faced with this dilemma. It's turning out to be a damned if I do, damned if I don't situation.

Anyone have suggestions, please provide!
 
I'm confused as to the point of this thread and do not understand exactly what your pointing out. What doses were these patients taken? Can you post the case studies?
 
I'm confused as to the point of this thread and do not understand exactly what your pointing out. What doses were these patients taken? Can you post the case studies?

Not to be an ass, but if you read the links in my post, you would find your answers.
 
Not to be an ass, but if you read the links in my post, you would find your answers.

Well I hate to be an ass but it would be nice if you took 3 seconds to make them hyperlinks. I made it to the part in the study where they gave the men 400mg IM per month. Then I closed the link lol That idiot spiked their hemo by giving them way too much testosterone at once and is probably 100% the reason for those convoluted results.

And to top it off they are pointing to elevated estrogen as the problem, which they created while simultaneously saying don't take an AI lol

The study is worthless.
 
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not to mention the conclusion points to men greater than 65. That is what I saw reading the study for 2 minutes, if I had the time I would probably find a million reasons why it can literally be thrown in the trash IMO.
 
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Well I hate to be an ass but it would be nice if you took 3 seconds to make them hyperlinks. I made it to the part in the study where they gave the men 400mg IM per month. Then I closed the link lol That idiot spiked their hemo by giving them way too much testosterone at once and is probably 100% the reason for those convoluted results.

And to top it off they are pointing to elevated estrogen as the problem, which they created while simultaneously saying don't take an AI lol

The study is worthless.

Sorry, I couldn't understand why the links didn't automatically hyperlink like they usually do. I tried again and they won't hyperlink.

Believe me, I've been wanting to find a way to use TRT safely for the last year, and because of my pre-ex history and elevated clot risk factors, this research freaked me out. I wish I could be as confident as you in tossing it off, but you have to realize I suffered from two clots already which was not fun.

I don't believe it was said to not take AIs; it was that AIs themselves are thrombogenic (cause clots).
 
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Right but he was letting their estrogen go up, this is the problem. The dosages were not stable in the IM group. He was spiking their T levels and then they were bottoming out. There are 3 major things that cause blood pressure spikes and increased HH, this is spiking your levels too high, letting them drop to low and letting your estrogen get out of whack. This guy hit the trifecta.

The bottom line is we do not know enough about the patients or their program to know if this guy was even properly treating the subjects, so his opinion is of little value to me. Then he puts a bunch of stats in there but at the end concludes this happens in patients over 65?

This study is completely jacked up. Also were they on TRT when these events happen? or did he cut them off testosterone then it happened?

He must be seeing a specific type of patient as well, cause IMT has well over 300 and we have not had 1 single report of this.

Dr Morgentaler from the University of Harvard did a review in the New England Journal of Medicine and could not find a single case of this happening. So I do not understand why this guy had such different results.

What risks do you consider when prescribing testosterone-replacement therapy?

When patients ask about risks, I remind them that they already have testosterone in their system and that the goal of testosterone treatment is to restore its concentration back to what it was 10 or 15 years previously. And the molecule itself that we give is identical to the one that their bodies make naturally, so in theory, everything should be hunky-dory. But in practice, there are always some curveballs.

For example, testosterone can increase the hematocrit, the percentage of red blood cells in the bloodstream. If the hematocrit goes up too high, we worry about the blood becoming too viscous or thick, possibly predisposing someone to stroke or clotting events. Although, frankly, in a review that I wrote in the New England Journal of Medicine* where we reviewed as much of this as we could, we found no cases of stroke or severe clotting related to testosterone therapy. Nevertheless, the risk exists, so we want to be careful about giving testosterone to men who already have a high hematocrit, such as those with chronic obstructive pulmonary disease, or those who have a red-blood-cell disorder.

Although its rare to see swelling caused by fluid retention, physicians need to be careful when prescribing testosterone to men with compromised kidney or liver function, or some degree of congestive heart failure. It can also increase the oiliness of the skin, so that some men get acne or pimples, but thats quite uncommon, as are sleep apnea and gynecomastia (breast enlargement).

*Source: New England Journal of Medicine 2004;350:48292. PMID: 14749457.

A Harvard expert shares his thoughts on testosterone-replacement therapy - Harvard Health Publications
 
Right but he was letting their estrogen go up, this is the problem. The dosages were not stable in the IM group. He was spiking their T levels and then they were bottoming out. There are 3 major things that cause blood pressure spikes and increased HH, this is spiking your levels too high, letting them drop to low and letting your estrogen get out of whack. This guy hit the trifecta.

The bottom line is we do not know enough about the patients or their program to know if this guy was even properly treating the subjects, so his opinion is of little value to me. Then he puts a bunch of stats in there but at the end concludes this happens in patients over 65?

This study is completely jacked up. Also were they on TRT when these events happen? or did he cut them off testosterone then it happened?

He must be seeing a specific type of patient as well, cause IMT has well over 300 and we have not had 1 single report of this.

Dr Morgentaler from the University of Harvard did a review in the New England Journal of Medicine and could not find a single case of this happening. So I do not understand why this guy had such different results.



A Harvard expert shares his thoughts on testosterone-replacement therapy - Harvard Health Publications

Yeah, I do see your point - why aren't the thousands of men that have been on TRT for what, at least a year, dropping dead from DVT-PEs? It makes the results as suspect as the now-debunked research that claims TRT induces MIs and strokes. Dose dependency. Regular E2 management. And perhaps, like me, one of newer thinners like Xarelto perhaps may be the only move. Glueck did use a specific type of subject - one that has documented familial or acquired thrombophilia. Unfortunately, I fall into that category.

For a detailed look, copy and paste my links for the actual studies I posted upthread. That should answer many of your questions.

Here's an interaction for test cyp itself that when compared to Glueck's research totally confounds me:

"Hematologic: Suppression of clotting factors II, V, VII, and X, bleeding in patients on concomitant anticoagulant therapy, and polycythemia."
rxlist.com/depo-testosterone-drug/side-effects-interactions.htm


These factors, when depressed, puts one at risk for bleeding which would totally contradict the thrombogenic effects of TRT, would it not??? What am I missing here?

Here's more:
"Drug Interactions

Androgens may increase sensitivity to oral anticoagulants. Dosage of the anticoagulant may require reduction in order to maintain satisfactory therapeutic hypoprothrombinemia."
drugs.com/pro/testosterone.html
 
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Right but he was letting their estrogen go up, this is the problem. The dosages were not stable in the IM group. He was spiking their T levels and then they were bottoming out. There are 3 major things that cause blood pressure spikes and increased HH, this is spiking your levels too high, letting them drop to low and letting your estrogen get out of whack. This guy hit the trifecta.

The bottom line is we do not know enough about the patients or their program to know if this guy was even properly treating the subjects, so his opinion is of little value to me. Then he puts a bunch of stats in there but at the end concludes this happens in patients over 65?

This study is completely jacked up. Also were they on TRT when these events happen? or did he cut them off testosterone then it happened?

He must be seeing a specific type of patient as well, cause IMT has well over 300 and we have not had 1 single report of this.

Dr Morgentaler from the University of Harvard did a review in the New England Journal of Medicine and could not find a single case of this happening. So I do not understand why this guy had such different results.



A Harvard expert shares his thoughts on testosterone-replacement therapy - Harvard Health Publications

In looking again at Glueck's papers, I need to clarify the following since it appears you have misinterpreted the results:

Read the chart on p3 of the "Testosterone, Thrombophilia, and Thrombosis" paper. The IM doses were:

150mg/every 2 weeks
200mg/week
250mg/every 2 weeks


These are TRT doses.

The 400mg dosing was documented in the "Thrombotic events after starting exogenous testosterone in men with previously undiagnosed familial thrombophilia" paper was in only TWO MEN and was only a ONCE A MONTH dose!

Nowhere in the research does it mention using supraphysiologic "bodybuilding" dosages.

Therefore, the risk is apparent. As small a study it is, the research is evident and points out negative outcomes for those with inherited or acquired clotting disorders. Why the thousands of men on TRT have not started running to their locals ERs with DVT-PEs is maybe only a matter of time.

The thing then is to FIND A SOLUTION and not debate the research and turn a blind eye here. Perhaps a newer anticoagulant like Xarelto could counteract the effects of TRT, as warfarin was ineffective. No studies have yet been done with Xarelto or any of the other newer class of thinners.
 
still terrible dosage schedule, except the one in the middle, and if your dealing with a patient that has this medical history, even 200mg a week is too much for him.

You do realize the 2 week dosages were probably spiking their T levels to 2,000 PLUS ng/dl and dropping them to 500?

Its not always the total level, it is also the fluctuations that play a role in side effects.

I really wish I had time to waste with studies like these but I don't, this study is obvious from the beginning the guy is clueless. I am not saying these patients that had prior health history have no risk, I am just saying this guy did just about everything he could to give them a damn heart attack.
 
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still terrible dosage schedule, except the one in the middle, and if your dealing with a patient that has this medical history, even 200mg a week is too much for him.

You do realize the 2 week dosages were probably spiking their T levels to 2,000 PLUS ng/dl and dropping them to 500?

Its not always the total level, it is also the fluctuations that play a role in side effects.

I really wish I had time to waste with studies like these but I don't, this study is obvious from the beginning the guy is clueless. I am not saying these patients that had prior health history have no risk, I am just saying this guy did just about everything he could to give them a damn heart attack.

Bottom line is that TRT at any level a risk to men with clotting issues, period. Instead of wasting time discrediting the research, why not find focus on finding a SOLUTION for us. No one with any sense should be doing T without a doc's advice to start with.
 
Bottom line is that TRT at any level a risk to men with clotting issues, period. Instead of wasting time discrediting the research, why not find focus on finding a SOLUTION for us. No one with any sense should be doing T without a doc's advice to start with.

You're making the same error as someone categorically dismissing the study, only in the other direction.
 
How am I making an error?

By uncritically accepting the conclusion of the study: "Bottom line is that TRT at any level a risk to men with clotting issues, period"

You argued against dismissing the study, yet you dismiss the analysis of the studies' flaws.
 
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By uncritically accepting the conclusion of the study: "Bottom line is that TRT at any level a risk to men with clotting issues, period"

You argued against dismissing the study, yet you dismiss the analysis of the studies' flaws.

What's your interpretation of the flaws from what you gleaned in the studies? Maybe you see something I fail to.
 
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