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15 June 2017

Testosterone treatment and risk of blood clots - what is new?

Testosterone treatment and risk of blood clots - what is new?

In discussions about side effects of testosterone treatment, prostate cancer and heart disease get most attention. However, as we have described in several study reports published here in the “Research News” section, the widespread fear of prostate cancer and heart disease is unfounded and not supported by medical research.

The expected potential side effect of testosterone treatment - which in fact is a therapeutic effect in men with anemia - is an increased level of red blood cells, known as erythrocytosis or polycythemia. In the context of testosterone treatment, erythrocytosis and polycythemia are used interchangeably to refer to an abnormal increase of hemoglobin or hematocrit, which may increase blood thickness.

Elevated hematocrit is the most common side-effect of testosterone treatment. The consequences of a high hematocrit level is unclear, but it may theoretically be associated with an increased risk of blood clots. Here we summarize the results of an analysis of the effect of testosterone treatment on risk of blood clots, published in the Journal of Investigative Medicine.

Key Points

  • An expected potential side effect of testosterone treatment is an increased level of red blood cells, which manifests as increased levels of hemoglobin and hematocrit. This “side effect” is actually a desired therapeutic effect in men with anemia.
  • It has not been directly proven that testosterone-induced elevations in hematocrit may increase risk of blood clots.
  • Because it is theoretically plausible that high hematocrit levels may increase risk for cardiovascular events – including blood clots - regular monitoring of hematocrit during testosterone therapy is important.
  • Testosterone treatment may confer several other beneficial effects that counteract possible risks of high levels of hematocrit.

Last updated: 2019
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