T Nation

TRT & Dangerous Blood Clots

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 previous T-Nation post on this matter:

Troubling new research on this very topic:

Here are the recent media articles of concern:
http://www.bizjournals.com/cincinnati/blog/2013/09/cincinnati-doctor-warns-testosterone.html?page=all
http://www.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. Glueckâ??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 canâ??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!

Have you tried anything? I’m in the same boat right now.

I am at high risk for clots (factor 5) and it runs in my family. Work out regularly, juice giner and garlic regularly and take fish oil (thins blood naturally). Been on betwen 160-200mg a week for last 7 years and had no problems.

You juice ginger and garlic? Any recommendations on amounts? Do you use aged garlic at all?

I am 5 years in on TRT and never noticed any symptoms until BAM! I was in the ER on a blue Monday. Just saying be careful, absence of symptoms doesn’t mean there’s nothing there.

What is the blood test required to see if one is prone to clots?

This is new to me. Was it mentioned in the article and I just missed it? Would appreciate hearing more about AIs in this context.

PT or INR, it measures the time it takes for your blood to clot.

Dr. Glueck has said this himself several times, I would have to search for the actual research studies.

But yes that’s the catch-22. T itself is fine, until it gets converted into E2 (high E2 causes the clots). However the only way to inhibit E2 is an AI, yet these are thrombogenic by default. It’s maddening.

Then you have doctors who are reluctant to prescribe AI’s for fear of crashing a person’s E2. It’s no wonder endo’s who are clueless are afraid of testosterone.

I am not going to review that material or critic it.

The flip side is whether men with clotting factor abnormalities should be castrated?

Mini aspirin and fish oil would be useful. Avoid high RBC and hematocrit is needed and iron added to rice, flour, pasta, breads etc and vitamins may need to be avoided.

Please read this to see if there is anything useful for you: http://www.lifeextension.com/Protocols/Heart-Circulatory/Blood-Clot/Page-01