Before starting testosterone therapy, men and women should get tested for blood clotting potential

Courtesy of bizjournals.com

By Barrett J. Brunsman

Staff reporter- Cincinnati Business Courier

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Testosterone replacement therapy can improve a man’s sex life, or it could lead to the loss of vision in one eye or even death because of blood clots, warns a doctor at Jewish Hospital–Mercy Health.

All men should have a simple blood test to determine whether they are at high risk for blood clots before starting testosterone replacement therapy, according to Dr. Charles Glueck of the Jewish Hospital Cholesterol and Metabolism Center in Cincinnati.

Postmenopausal women also should be tested in advance before taking testosterone to treat low libido, depression or fatigue. The U.S. Food and Drug Administration hasn’t approved such use out of concern about the hormone’s long-term adverse effects in women, according to Mercy Health.

Dangerous blood clots can develop as soon as one month after testosterone replacement therapy begins, according to a study by Glueck published Aug. 7 in the medical journal Clinical and Applied Thrombosis/Hemostasis.

“Our research found that 1.2% of men who landed in the hospital with dangerous and potentially lethal blood clots in the deep veins of the legs or in the lungs developed these clots within three months of starting testosterone therapy,” Glueck said. “Not one of these men knew previously that they had an inherited clotting disorder that put them at greater risk for developing clots, nor did their providers test them before putting them on testosterone therapy.”

Testosterone levels decrease as men age, and more men are turning to replacement therapy to try to regain their feelings of youthful vitality, according to a Mercy Health spokeswoman. Naturally occurring testosterone has a role in sex drive, and it helps men maintain muscle mass, red blood cell production, fat distribution and bone density.

To try to determine how often external testosterone use led to blood clots in deep veins or in the lungs or both, Glueck studied 596 men who had been hospitalized in the last three years.

Glueck and his research colleagues, all medical residents at Jewish Hospital, reported 18 cases in men and four in women of blood clots in the lungs or blood clots in the bones after patients started testosterone therapy. All of the men and women had a previously undiagnosed inherited tendency for increased blood clots.

Other complications suffered by some of the patients studied included loss of vision in one eye because of a temporary lack of blood flow to the retina. Others suffered osteonecrosis of the hip, which can lead to the destruction of the hip joint because of a disruption of the blood supply to the bone.

“Before starting testosterone, men and women should get a blood test for common inherited risk factors for clotting, including the Factor V Leiden mutation, homocysteine and high Factors VIII and XI,” Glueck said