TRT & Dangerous Blood Clots

[mcs2012]

Anyone else on this forum have a history of thrombophilia (risk of clotting) or thrombosis (blood clots) and are on TRT, other AAS, hCG, and/or aromatase inhibitors?

There are those of us that cannot function (or cannot recomp) 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 (clots) but need to start TRT. I was not on TRT at the time. Currently not on any prescription thinners.

I am 54 (but look much younger), been training since early 20s, however my bf % using BodPod is way too high, not healthy (30%) despite eating super clean, counting cals, low carb, intermittent fasting, paleo, keto, you name it. Training is 4x's/week and as heavy as I can lift without further injuring my back or shoulders.

My total T is low normal (mid 400s), but my free T is in the sh*tter @ 5! E2 is almost non-existent as well.

Suffice it to say, I could use some supplemental T to lean out and build some size and benefit from reduce inflammation, insulin resistance, etc.

Here's a T-Nation post on this matter:
TESTOSTERONE NATION | Does TRT Cause a DVT? - Page 1

Here's the most recent troubling new research on this very topic:
Can Testosterone Induce Blood Clots and Thrombosis? Interview with Dr Charles Glueck

Here are the recent media articles of concern:
Cincinnati doctor warns testosterone treatment can cause blood clots - Cincinnati Business Courier
Cincinnati doctor warns of 'testosterone mills' as FDA investigates health risks - Cincinnati Business Courier

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.

Here is the chief researcher's (Glueck) 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 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.
Bottom line is that he simply doesn't think there is any safe protocol to implement along with TRT. I can’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.

My doc is on TRT himself and I already have a scrip ready to go. We are talking about maybe doing a small dose of cyp (100mg E7D) along with low-dose Xarelto (a new and better blood thinner than warfarin) and 325mg aspirin + monitoring all serum clotting factors, CBC, hormone panel including E2 and other panels every couple weeks and doing phlebs regularly. Basically, being my own lab rat.

Anyone have suggestions, please provide!

 

[neural]

My initial/primary training as a physician was the brain/strokes.

If your doctor puts you on xarelto as primary prevention (as these thinners are mostly for secondary prevention or primary only if you have non-valvular a fib) and you bleed (intracranial or otherwise) he has ABSOLUTELY NO FUCKING LEG TO STAND ON... regardless of genetic predisposition.

That goes three fold if he adds aspirin. Fuck. I wouldn't/haven't even put people who have a 5%+ per year risk of stroke on xarelto/pradaxa/elequis AND aspirin. That's just malpractice. The chance of bleeding on both is 8 percent/year iirc.


You're at a much higher risk of bleeding with these drugs than developing clots from T. I'll pull the numbers later if I get the time.

 

[mcs2012]

My initial/primary training as a physician was the brain/strokes.

If your doctor puts you on xarelto as primary prevention (as these thinners are mostly for secondary prevention or primary only if you have non-valvular a fib) and you bleed (intracranial or otherwise) he has ABSOLUTELY NO FUCKING LEG TO STAND ON... regardless of genetic predisposition.

That goes three fold if he adds aspirin. Fuck. I wouldn't/haven't even put people who have a 5%+ per year risk of stroke on xarelto/pradaxa/elequis AND aspirin. That's just malpractice. The chance of bleeding on both is 8 percent/year iirc.

You're at a much higher risk of bleeding with these drugs than developing clots from T. I'll pull the numbers later if I get the time.

So, what would you recommend as a prophylactic anticoagulant? Warfarin did not prevent a DVT in one of the subjects. My doc originally suggested aspirin only.

 

[mcs2012]

My initial/primary training as a physician was the brain/strokes.

If your doctor puts you on xarelto as primary prevention (as these thinners are mostly for secondary prevention or primary only if you have non-valvular a fib) and you bleed (intracranial or otherwise) he has ABSOLUTELY NO FUCKING LEG TO STAND ON... regardless of genetic predisposition.

That goes three fold if he adds aspirin. Fuck. I wouldn't/haven't even put people who have a 5%+ per year risk of stroke on xarelto/pradaxa/elequis AND aspirin. That's just malpractice. The chance of bleeding on both is 8 percent/year iirc.


You're at a much higher risk of bleeding with these drugs than developing clots from T. I'll pull the numbers later if I get the time.

Also - According to Dr. Glueck, the chief researcher, T increases platelet aggregation AND viscosity. As T is aromatized to E2, E2 increases resistance to activated protein C and increases clotting. He theorizes that it's largely elevated E2 that is the main cause of DVTs in his subjects, so the key would be to control the estradiol by using an AI, in this case, an OTC AI because all of the prescription AIs themselves are thrombogenic,

He further thought that Xarelto would be a much more effective drug than warfarin for DVT prophylaxis. I didn't ask him about adding aspirin, but will.

 

[neural]

Full answer later.

Short answer: warfarin sucks dick as an anticoagulant chiefly because people have such a hard time staying therapeutic.


Viscosity and aggregation: Viscosity is largely due to hemoglobin/hematocrit numbers... As well as other cell lines. These should be monitored anyway.

I personally would be wary of any of the ax agents or newer oral anticoagulants. As I said: The risk of bleeding is likely larger than the increased risk of clot/stroke.


Honestly, I'd tread lightly, but 325 ASA daily would likely be sufficient... If you're not currently in a stronger anticoagulant as it stands.



And yes it does seem like a logical step is to attribute the elevated E levels to clotting... Which is why oral contraceptive pills are an independent risk factor for clots/strokes... This is not true with progesterone only pills... Only estrogen containing pills...

 

[mcs2012]

Full answer later.

Short answer: warfarin sucks dick as an anticoagulant chiefly because people have such a hard time staying therapeutic.


Viscosity and aggregation: Viscosity is largely due to hemoglobin/hematocrit numbers... As well as other cell lines. These should be monitored anyway.

I personally would be wary of any of the ax agents or newer oral anticoagulants. As I said: The risk of bleeding is likely larger than the increased risk of clot/stroke.


Honestly, I'd tread lightly, but 325 ASA daily would likely be sufficient... If you're not currently in a stronger anticoagulant as it stands.

And yes it does seem like a logical step is to attribute the elevated E levels to clotting... Which is why oral contraceptive pills are an independent risk factor for clots/strokes... This is not true with progesterone only pills... Only estrogen containing pills...

Regarding aspirin, Dr Glueck said: "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."

ASA works on preventing platelet aggregation but not thrombin. We need coverage on both.