title: Testosterone therapy, thrombophilia, and hospitalization for deep venous thrombosis-pulmonary embolus, an exploratory, hypothesis-generating study.
abstract: Our hypothesis was that testosterone therapy (TT) interacts with previously undiagnosed thrombophilia-hypofibrinolysis, leading to hospitalization for deep venous thrombosis (DVT)-pulmonary emboli (PE). We determined the prevalence of DVT-PE associated with TT 147 men hospitalized in the last 12 months for DVT-PE. Of the 147 men, 2 (1.4%) had TT before and at the time of their DVT-PE. Neither had risk factors for thrombosis. Neither smoked. Case #1 (intramuscular T 50mg/week) had 2 PE, 6 and 24 months after starting TT. DVT-PE in case #2 (T gel 100mg/day) occurred 24 months after starting T. Both men were found to have previously undiagnosed familial thrombophilia (protein S deficiency, homocysteinemia, high Factor VIII). In case #2, on 100mg T gel/day, serum estradiol was high, 51 pg/ml (upper normal limit 42.6 pg/ml). At least 1.4% of men hospitalized for DVT-PE were on TT and had previously undiagnosed thrombophilia, suggesting a thrombotic interaction between exogenous T and thrombophilia-hypofibrinolysis. Given the increasing use of TT, our preliminary findings should facilitate design of a much-needed, multi-center, prospective study of pro-thrombotic interactions between T therapy and thrombophilia for subsequent thrombotic events including DVT-PE.
authors: Jewish Hospital Cholesterol Center, Jewish Hospital of Cincinnati, United States. Electronic address: cjglueck@health-partners.org.
authors: Charles J
authors: CJ
authors: Glueck
authors: Internal Medicine Residency Program, Jewish Hospital of Cincinnati, United States.
authors: Joel
authors: J
authors: Friedman
authors: Internal Medicine Residency Program, Jewish Hospital of Cincinnati, United States.
authors: Ahsan
authors: A
authors: Hafeez
authors: Internal Medicine Residency Program, Jewish Hospital of Cincinnati, United States.
authors: Atif
authors: A
authors: Hassan
authors: Jewish Hospital Cholesterol Center, Jewish Hospital of Cincinnati, United States.
authors: Ping
authors: P
authors: Wang
mesh_terms: D006710:Homocysteine / Q000097:blood; D020249:Hormone Replacement Therapy / Q000009:adverse effects*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D016133:Polymerase Chain Reaction; D011655:Pulmonary Embolism / Q000209:etiology*; D012307:Risk Factors; D013739:Testosterone / Q000009:adverse effects* / Q000378:metabolism; D019851:Thrombophilia / Q000378:metabolism*; D013927:Thrombosis / Q000209:etiology*; D014859:Warfarin / Q000008:administration & dosage
chemical_list: D007074:Immunoglobulin G; D007075:Immunoglobulin M; D006710:Homocysteine; D013739:Testosterone; D014859:Warfarin