Bad Blood Clots & TRT

[Terax]

I'm 46, on doc prescribed 120 mg of test cyp a week for a year or so & have cycled 3 times over the last 3 years. Never had blood clots. My test level were in the low 900's when I had it checked in October. I've taken half an adult aspirin for years, but got tired of taking vitamins in November & December & so didn't take it. In early December, I injured my foot. Limped around for 2 weeks & then started getting cramps that slowly crept up my calf. In mid January, while doing a squat set I thought I was going to die. I couldn't catch my breath at all. Google told me that the symptoms indicated blood clots. Went to the doc & he said he didn't see the classic red, hot, swollen knots that would indicate blood clots. I also had a respiratory infection, so he said that caused the shortness of breath. Come back in 2 weeks if not better.

Last Wednesday, woke up with 2 swollen, red knots on my calf. Doc scheduled an ultrasound on my leg for the next day. Long story short, I had 2 clots in my calf, one near my groin that was moving as the tech scanned it. CT revealed my lungs were full of clots. They were stunned I was walking around. Patients had died from far less clots than what I had. Was given a risky clot busting treatment & released on blood thinners on Sunday with no restrictions.

Docs were all on board with the aspirin skipping + injury causing the clots. UNTIL a record check revealed I was on test. Then it was "test caused it all, you did this to yourself, you're done taking it, end of story." One specialist said he understood men love being on test & was willing to work with me on finding a safe much lower dose, & I'm definitely going to do this.

I've known from my work physicals that I've had slightly high levels on the following...

RBC 4.14 to 5.80 my level 6.17
Hemoglobin 12.6 to 17.7 my level 18.2
Hemoatocrit 37.5 to 51.0 my level 54.4

Obviously I'm not a doc, but those levels aren't dramatically out of range. I don't know if the test or if the no aspirin/injury or all three was the cause of the clots.

Now for the stupid question. I totally realize this is not worth my life, but of the dozens of questions I ask myself as I lay in bed at night, this is the one I don't know the answer to. I'm on 20mg of Eliquis daily for a week & then drop down to 10mg daily. If I wanted to run a cycle, would bumping the Eliquis up to 20mg daily while on cycle make it safe for me?

I've been lucky enough that I've never had any health problems at all before this & it's left me shaken. Honestly, a lot of my self confidence & self esteem come from the work I put in at the gym. It's scary to face the possibility that I'll be less strong after my test levels drop from the lower dose. But I'll take weaker & breathing over strong & dead any day.

[Beethoven]

What was your protocol? If you are running a cycle then I would refrain from doing so. If you are on trt than you need to look at your protocol with a knowledgeable Dr and go from there.

[Terax]

I was injecting 60 mg twice a week.

I'm not running a cycle & haven't for a year. I'm not planning on one but was curious if I ever wanted to run a cycle in the future.

[kelkel]

One of the HOF'ers here deals with a form of this. He'll chime in next time on board.

Take a look at this from Nelson Vergel:

The first time I read a paper than mentioned thrombosis risk in people on testosterone replacement (read abstract at the end of this article), my goal is to get in contact with the author. Dr Charles Glueck was kind to reply for my request for an interview to help me educate physicians and patients. He is a graduate from Harvard and Western Reserve Universities and has over 35 years of medical practice and have produced over 600 publications. He is currently the Medical Director of the Jewish Hospital Cholesterol Center. To say that he has credentials is an understatement.


I am impressed by his willingness to help anyone who may be concerned about this issue (he provides contact information below)

Here is the short interview:

Dr Glueck, Thank you so much for agreeing to educate my readers about your research.

Can you give give us a brief background of why you were interested in looking into thrombophilia and thrombosis in people on testosterone replacement therapy? Can you explain those terms to us?

Dr Glueck: As physicians who deal with deep venous thrombosis (DVT) and pulmonary embolus (PE), as well as blood clots in the eyes (central retinal vein and central retinal artery thrombosis), and ischemic stroke, and arterial blood clots, we realized that many of our referrals had started exogenous conventional testosterone therapy before sustaining their blood clots. Because we were very experienced with the diagnosis of thrombophilia and hypofibrinolysis, we hypothesized that the exogenous testosterone was interacting with underlying coagulation disorders producing the blood clots. We have now proven this in multiple publications.

In your best estimate or opinion, what is the incidence of this problem in men on testosterone replacement?

Dr Glueck: The incidence of DVT-PE or other clots in men on T therapy is not known, but our best estimates are that about 1-2% of men taking T will develop blood clots related to underlying inherited clotting abnormalities or to acquired thrombophilia (the antiphospholipid antibody syndrome). These 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. None of them 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.

You suggest that "thrombophilia should be ruled out before administration of exogeneous testosterone". How can that be done and are the tests commercially available or research tools? You used these tests in your study: factor V Leiden heterozygosity, high factors VIII and XI, high homocysteine, low antithrombin III, the lupus anticoagulant, high anticardiolipin antibody lgG, and the hypofibrinolytic 4G4G mutation of the PAI-l gene. Should all be performed? Would these tests be reimbursed by insurance and, if not, what do you think the retail value would be?

Dr Glueck: The 4 tests we would do include Factor V Leiden, Prothrombin gene, Factor VIII and Factor XI, all routinely available commercially at Lab Corp and Quest (big national labs), and at almost all regional labs as well. In our experience these tests are routinely covered by insurance. If not covered, I would estimate that the cost would be expensive, $800.

You also suggest a link between high estradiol with thrombophilia. Can you explain this finding? Would anastrozole or other E2 inhibitor improve outcome if used with TRT?


Dr Glueck: We have data to show that when T is aromatized in the body to estradiol (E2), the high E2 may be the agent which directly interacts with the underlying thrombophilia to produce the clots. We do not have enough data to know whether Arimidex used to lower E2 would be protective, but we know that Arimidex alone is prothrombotic in all of the thrombophilias and hence, probably not a good idea.

In your opinion, should all men on TRT be on low dose aspirin?

Dr Glueck: Low dose aspirin would have no effect on the clotting events seen in men on T who have underlying thrombophilia and I would not recommend it.

Are you planning to do any further studies on this troubling issue?

Dr. Gluek: We are working hard to better understand this troubling issue. If any of your readers have had DVT-PE or other clots while taking exogenous T, or during hCG or clomid therapy to raise T, we would be glad to help them out with expert consultative advice free of charge. Have them contact us by email ([email protected]) or by phone (513-924-8250 (tel:%28513-924-8250)) fax (513-924-8273 (tel:%28513-924-8273)) and we will advise them on what blood samples to have drawn, and how to deal with their problem. All of their information will, of course, be entirely private and totally confidential. We will also be glad to work with their doctors in their local communities.

Thank you so much for your time and I will be contacting you in a few months to see if you have any updated data for us.


____________________________________________

ClincAppl Thromb Hemost. 2014 Jan;20(1):22-30. Epub 2013 Apr 23.


Testosterone, thrombophilia, and thrombosis.

Glueck CJ, Richardson-Royer C, Schultz R, Burger T, Labitue F, Riaz MK, Padda J, Bowe D, Goldenberg N, Wang P.


Abstract

We describe thrombosis, deep venous thrombosis (DVT) pulmonary embolism (PE; n = 9) and hip-knee osteonecrosis (n = 5) that developed after testosterone therapy (median 11 months) in 14 previously healthy patients (13 men and 1 woman; 13 Caucasian and 1 African American), with no antecedent thrombosis and previously undiagnosed thrombophilia-hypofibrinolysis. Of the 14 patients, 3 were found to be factor V Leiden heterozygotes, 3 had high factor VIII, 3 had plasminogen activator inhibitor 1 4G4G homozygosity, 2 had high factor XI, 2 had high homocysteine, 1 had low antithrombin III, 1 had the lupus anticoagulant, 1 had high anticardiolipin antibody Immunoglobulin G, and 1 had no clotting abnormalities. In 4 men with thrombophilia, DVT-PE recurred when testosterone was continued despite therapeutic international normalized ratio on warfarin. In 60 men on testosterone, 20 (33%) had high estradiol (E2 >42.6 pg/mL). When exogenous testosterone is aromatized to E2, and E2-induced thrombophilia is superimposed on thrombophilia-hypofibrinolysis, thrombosis occurs. The DVT-PE and osteonecrosis after starting testosterone are associated with previously undiagnosed thrombophilia-hypofibrinolysis. Thrombophilia should be ruled out before administration of exogenous test.

[almostgone]

I'm 46, on doc prescribed 120 mg of test cyp a week for a year or so & have cycled 3 times over the last 3 years. Never had blood clots. My test level were in the low 900's when I had it checked in October. I've taken half an adult aspirin for years, but got tired of taking vitamins in November & December & so didn't take it. In early December, I injured my foot. Limped around for 2 weeks & then started getting cramps that slowly crept up my calf. In mid January, while doing a squat set I thought I was going to die. I couldn't catch my breath at all. Google told me that the symptoms indicated blood clots. Went to the doc & he said he didn't see the classic red, hot, swollen knots that would indicate blood clots. I also had a respiratory infection, so he said that caused the shortness of breath. Come back in 2 weeks if not better.

Last Wednesday, woke up with 2 swollen, red knots on my calf. Doc scheduled an ultrasound on my leg for the next day. Long story short, I had 2 clots in my calf, one near my groin that was moving as the tech scanned it. CT revealed my lungs were full of clots. They were stunned I was walking around. Patients had died from far less clots than what I had. Was given a risky clot busting treatment & released on blood thinners on Sunday with no restrictions.

Docs were all on board with the aspirin skipping + injury causing the clots. UNTIL a record check revealed I was on test. Then it was "test caused it all, you did this to yourself, you're done taking it, end of story." One specialist said he understood men love being on test & was willing to work with me on finding a safe much lower dose, & I'm definitely going to do this.

I've known from my work physicals that I've had slightly high levels on the following...

RBC 4.14 to 5.80 my level 6.17
Hemoglobin 12.6 to 17.7 my level 18.2
Hemoatocrit 37.5 to 51.0 my level 54.4

Obviously I'm not a doc, but those levels aren't dramatically out of range. I don't know if the test or if the no aspirin/injury or all three was the cause of the clots.

Now for the stupid question. I totally realize this is not worth my life, but of the dozens of questions I ask myself as I lay in bed at night, this is the one I don't know the answer to. I'm on 20mg of Eliquis daily for a week & then drop down to 10mg daily. If I wanted to run a cycle, would bumping the Eliquis up to 20mg daily while on cycle make it safe for me?

I've been lucky enough that I've never had any health problems at all before this & it's left me shaken. Honestly, a lot of my self confidence & self esteem come from the work I put in at the gym. It's scary to face the possibility that I'll be less strong after my test levels drop from the lower dose. But I'll take weaker & breathing over strong & dead any day.

Did they mention checking for any genetic clotting disorders such as Leiden Factor V or any others? I have Leiden Factor V and suffered with some clotting issues after a long struggle with viral cardiomyopathy, mitral valve disorder, atrial fibrillation, congestive heart failure, and an ejection fraction of ~15%. Eventually worked up to a biventricular pacemaker, kept it for ~ 8 months, caught a staph infection in my blood, and had to have the pacer removed to clear the staph from my body.
It was after the pacer implantation that I developed the clotting problems. My left arm started swelling and I had red spots w/ unusual bruising. Cardiologist ordered an ultrasound and sure enough blood clot in l. arm. They tried me on several anticoagulants, but the only one that kept my PT/INR in range was Arixtra, a low molecular weight heparin. However, my hematologist said long term use wasn't an option.They wanted to put in a Greenfield device to catch clots on the way back to the heart, but there was no way I was going with that after the issues I had with staph and the pacemaker. LOL, it may have been a good choice because now lawyers advertise on TV looking for people that have had these type of filters break, move, etc.
Anyway, fast forward 5-7 years and I'm feeling like hell and am.trying to find a Dr. to work with me regarding some form.of TRT. It wasn't easy finding a Dr. who.would work with me on TRT though. I've had Drs. and endos be all on board to prescribe TRT until they see the scar from the pacemaker removal then its out of the question.
I finally found a Dr. to.work with me although it is an old school TRT. 200 mg every 2 weeks. It is outdated, but better than walking around with a total T of 173 and a free T of God knows what.
Prior to any form of TRT, my hematocrit was ~ 52% and it had been years since I cycled. Of course, hemoglobin is also elevated. I keep a very close eye on my hematocrit, donate blood at every opportunity, and drink water like crazy. At times, I have been in the upper 50s and make dang sure to address it immediately. I replenish RBC ridiculously fast.
My Dr. has a standing order in my file for a CBC whenever I ask for it, and if needed will write me a script for a therapeutic phlebotomy. It sucks because they charge you to draw your blood, and then throw it away, but anyway.
Now before I went on TRT, the wife and I discussed it, discussed the potential risks, but when I opted for TRT, she is 100% behind me.
As far as TRT, if you have found a specialist to work with you to find a safe and hopefully optimal dosage and protocol, I would count your blessings. It took me years and several dead end appointments. Of course, educate yourself so you can be more in charge/have ownership of your TRT.
As far as the cycling, I would shy away from that for a good while, possibly always. I think if you get situated on a reasonable protocol, you will surprised at how well you feel and how much you can progress with a solid fitness/nutrition program. (Many of us like HIT training ).
You're 46, so.you probably have family relying on you and.I would include them in this decision.
I can honestly say I don't regret being on TRT, even though I'm on an outdated protocol.

Read through some.of.the stickies and make a list of questions to take with you when you see your endo/specialist.

Sorry for the long post, but I'm a third shifter and need to crash. If you have any questions about my past health issues, post them.up here or PM me and if I can help, I will.
Also, there's a really good groups of guys in here on protocols way more modern than mine that have a butt ton load o knowledge and are always helpful.

[almostgone]

Also, I enjoy lifting and learning with the guys in the HIT dungeon thread. Great group of guys and a lady or two that are just plain fun to discuss lifting and the lifestyle that goes with it. We post workouts, share notes, suggestions, etc. HIT isn't for everyone, but check it out sometime, you may like.it.

**Marcus's HIT Dungeon**

[almostgone]

Just looking at your hematocrit and hemoglobin values reminded me that if you find out what your hemoglobin value is at a blood donation, multiply by 3 and you'll have a rough idea of your hematocrit. Kind of helps you keep track of your hematocrit values in between lab work.

[Terax]

Lots of good info guys. Good to know that aspirin isn't gonna do jack, which was something I was wondering. According to Dr. Gluek, guys who were predisposed to clots had them happen within 3 months. It took me 3 years to develop them. Is it so hard for a human body to be black & white with things without throwing in a shit load of variables?

I have an appt with a hematologist on the 12th & he's gonna run the tests to see if I have the genetic markers that makes me a risk for clots. You would think he would have did the tests while I was in the hospital, but I guess he wants that office visit fee. Lol

I'm very lucky to have a doc willing to work with me on trt. My test level before I started trt was 26. I definitely do not wanna go back to feeling like complete shit physically & mentally again.

[kelkel]

I'm very lucky to have a doc willing to work with me on trt. My test level before I started trt was 26. I definitely do not wanna go back to feeling like complete shit physically & mentally again.

What knocked your T down so low? Were you tested just off cycle?

[APIs]

I had both PEs and DVTs after ankle surgery once. Like the OP, my lungs & right leg were dotted with them and I was lucky to have lived.

If OP is genetically prone to clotting, then this is something you'll have to work out with your Docs. They should have done testing to ascertain whether genetics had something to do with the incident.

Sounds like your ankle injury was a contributing factor. I was found not to be genetically prone to them and the Docs figured it was just dumb luck combined with my leg being immobile after ankle surgery.

While my Docs thought the Test probably didnt help the situation, they felt I was safe on TRT moving forward with proper monitoring of my hematocrit levels etc.

As an added precaution, I do take Lovenox injections for a time after any surgery now...

[almostgone]

I'm very lucky to have a doc willing to work with me on trt. My test level before I started trt was 26. I definitely do not wanna go back to feeling like complete shit physically & mentally again.

Dang. Whenever, I read posts with people that have T levels that low I'm amazed that they still felt like even getting out of bed. Curious as to why it was that low.

[Terax]

When my test was 26, I was 5 months out from a cycle. I went through my pct (don't recall what the details were, it's been 2 years) that I put together with research on info I got on this board. My doc put me on 3 months of Clomid to try to restart my system but my natural test never came back. I started on 120 mg a week after we gave up. On a side note, my 1st cycle 3 years ago, I had my test level checked & it was something like 125. So I had been on the low side for quite a while.

& yeah, when I was at 26, it was horrible. Lifting hurt like hell & the day after was worse. I felt awful & I was depressed as hell. When all the docs were telling me I could never take test again, my mind was panicked. Hopefully the doc who's gonna work with me will do right by me & not automatically stick me with the bare minimum because 'test is evil'.

[kelkel]

Were you ever screened for an adenoma?

[Terax]

Back with an update.

No, I've never been screened for adenoma & had to Google it to find out what it was. I'll ask my doc about it when I see him in 3 months.

Saw the blood specialist & I don't have any of the genetic markers that make me prone to blood clots, so that's a huge plus. The doc plans on taking me off blood thinners in 5 months.

I had dropped my Test dose to 40mg a week & my Test levels were 299. I def want it higher than that, but my HGB was 16.7 & the doc wants it below 15. I went back & looked at a 2008 physical before I had ever taken Test & my level was 16.3, so 16.7 is pretty close to normal for me. But 15 or less is where they want me.

Almostgone mentioned therapeutic phlebotomy, & after some research it seems that drops your HGB for 4 to 8 weeks while your body replenishes it's supply. It seems if I donated blood once a month, would this keep my HGB levels down. Is this a correct assumption?

[kelkel]

Yes, donating while blood can knock you down a couple points. A Double Red Blood Cell donation will get you arguably about 4 pts lower. You also can't donate monthly. Normally (in the states) it's about every 53 days for whole blood and twice that for DRBC.

[Spyderman57]

Hello Kelkel,
Do you have any recent info regarding DVT and Testosterone ? I'm an amateur bodybuilder, 5'11", 230 lbs. Last year, I started experiencing great pain in my right calf. At first, I thought I pulled a muscle. It got worse and worse and I finally went to a doctor. After extensive examinations, MRI, X-Rays, etc. they couldn't find anything significant. One doctor, suggested an ultrasound. The Ultrasound was forwarded to a specialist in SF and upon receipt they told me to come immediately to the hospital. The vascular specialist stated that I had blood clots in my right leg. Two of the there arteries were blocked and they suggested a by-pass to correct the problem. I had the bypass from the top of my leg to the knee. It was successful and after approximately six-months I started a test/tren cycle and I was back to squatting, deadlifting and doing full leg workouts. Everything was fine until approximately 11 months later. I started experiencing the same calf pain and I immediately recognized the feeling. I told my wife "the clots are back." Sure enough, the lower portion of my leg, from knee down, was clotting. The lower portion of my leg and foot were not getting sufficient blood flow. Back in the hospital 11 months later and I went through three operations this time. The first was angioplasty and it didn't work, the second was another by-pass from the knee down to the foot, the third was plastic surgery to help the healing process.

It has been over three months, i'm on Eliquis 5mgs. two times a day and I've started walking on treadmill. My most recent ultrasound showed no clotting. My upper body weight workouts have been difficult, but I push through them. I'm haven't started doing any leg workouts. Believe it or not, I'm actually thinking of starting another cycle. The doctor is not sure if my injury is a result of test use. He's not a specialist when it comes to steroids . I read the info posted about Dr. Gluek and I sent him and email. I have also consulted with another doctor who specializes in steroid use . His practice is dedicated solely to steroid users. What is your take on Test and DVT? Have you had anymore discussions with BB'ers about the issue? I'd like some help in determining the cause of my DVT.

BTW my legs look just like yours with all the veins popping like crazy. That's why they call me Spyderman.

[j2048b]

Hello Kelkel,
Do you have any recent info regarding DVT and Testosterone ? I'm an amateur bodybuilder, 5'11", 230 lbs. Last year, I started experiencing great pain in my right calf. At first, I thought I pulled a muscle. It got worse and worse and I finally went to a doctor. After extensive examinations, MRI, X-Rays, etc. they couldn't find anything significant. One doctor, suggested an ultrasound. The Ultrasound was forwarded to a specialist in SF and upon receipt they told me to come immediately to the hospital. The vascular specialist stated that I had blood clots in my right leg. Two of the there arteries were blocked and they suggested a by-pass to correct the problem. I had the bypass from the top of my leg to the knee. It was successful and after approximately six-months I started a test/tren cycle and I was back to squatting, deadlifting and doing full leg workouts. Everything was fine until approximately 11 months later. I started experiencing the same calf pain and I immediately recognized the feeling. I told my wife "the clots are back." Sure enough, the lower portion of my leg, from knee down, was clotting. The lower portion of my leg and foot were not getting sufficient blood flow. Back in the hospital 11 months later and I went through three operations this time. The first was angioplasty and it didn't work, the second was another by-pass from the knee down to the foot, the third was plastic surgery to help the healing process.

It has been over three months, i'm on Eliquis 5mgs. two times a day and I've started walking on treadmill. My most recent ultrasound showed no clotting. My upper body weight workouts have been difficult, but I push through them. I'm haven't started doing any leg workouts. Believe it or not, I'm actually thinking of starting another cycle. The doctor is not sure if my injury is a result of test use. He's not a specialist when it comes to steroids . I read the info posted about Dr. Gluek and I sent him and email. I have also consulted with another doctor who specializes in steroid use . His practice is dedicated solely to steroid users. What is your take on Test and DVT? Have you had anymore discussions with BB'ers about the issue? I'd like some help in determining the cause of my DVT.

BTW my legs look just like yours with all the veins popping like crazy. That's why they call me Spyderman.

I recently had a dvt in my left calf i will pm u some info, as i had a doc who sent me a script for a ton of clotting disorders to be checked, u may have a clotting disorder u are not aware of, i did all bw and it all came back with no clotting disorders, so it was determined mine was caused by cutting off circulation at the site due to my current job,

I had previously been on trt for over 10 yrs, veen off since.may 2017, and was told by my hemotologist to get back on test as my levels were 175, 245, and after a brief bought of clomid my levels only raised to 314,

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