title: Thrombosis in three postmenopausal women receiving testosterone therapy for low libido.
abstract: Our hypothesis was that thrombosis occurring in postmenopausal women given testosterone (T) or testosterone-estradiol (TE) to improve libido was associated with a prothrombotic interaction between T or TE with underlying inherited procoagulants. In three previously healthy, postmenopausal, Caucasian women with no antecedent thrombosis and previously undiagnosed G20210A prothrombin gene heterozygosity, hyperhomocysteinemia and 4G4G homozygosity of the PAI-1 gene, we describe central retinal vein thrombosis and osteonecrosis that developed at 16 days, 2 months and 11 months in the three cases, respectively, after T or TE therapy was started. Exogenous T or TE in postmenopausal women may be associated with thrombosis, speculatively when it is superimposed on underlying procoagulants. This small observational case series can serve as a starting point for a larger observational study with greater detail on patient history, serum T and estradiol levels, and detailed PCR and serologic assessment of thrombophilia and hypofibrinolysis.
authors.affiliation: Jewish Hospital Cholesterol Center, Cincinnati, OH 45207, USA. cjglueck@health-partners.org
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Glueck
authors.forename: Dedrick
authors.initials: D
authors.lastname: Bowe
authors.forename: Alejandro
authors.initials: A
authors.lastname: Valdez
authors.forename: Ping
authors.initials: P
authors.lastname: Wang
mesh_terms: D004958:Estradiol / Q000009:adverse effects / Q000494:pharmacology; D005260:Female; D012739:Gonadal Steroid Hormones / Q000009:adverse effects* / Q000494:pharmacology; D006621:Hip Joint; D006801:Humans; D007989:Libido / Q000187:drug effects; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics; D008875:Middle Aged; D010020:Osteonecrosis / Q000139:chemically induced* / Q000235:genetics; D017395:Plasminogen Activator Inhibitor 1 / Q000235:genetics; D017698:Postmenopause; D011516:Prothrombin / Q000235:genetics; D012170:Retinal Vein Occlusion / Q000139:chemically induced* / Q000235:genetics; D020018:Sexual Dysfunctions, Psychological / Q000188:drug therapy; D013739:Testosterone / Q000009:adverse effects* / Q000494:pharmacology; D013927:Thrombosis / Q000139:chemically induced / Q000235:genetics
chemical_list: D012739:Gonadal Steroid Hormones; D017395:Plasminogen Activator Inhibitor 1; D013739:Testosterone; D004958:Estradiol; D011516:Prothrombin; C573423:MTHFR protein, human; D042965:Methylenetetrahydrofolate Reductase (NADPH2)