Medical Treatments for Hypogonadism do not Significantly Increase the Risk of Deep Vein Thrombosis Over General Population Risk

Abstract

OBJECTIVETo evaluate the risk of deep vein thrombosis (DVT) in men treated with testosterone replacement therapy (TRT) or Clomiphene Citrate (CC) and assess other etiologies for DVT as contributing factors. METHODSRetrospective chart review of 1180 consecutive hypogonadal men who were treated with either TRT or CC. Sixty-four percent had mixed, 16% had primary, and 20% had secondary hypogonadism. RESULTSOf the 1180 men with hypogonadism, 694 were treated with TRT, while 486 were treated with CC. Overall, 10 of 1180 (0.8%) men were diagnosed with a DVT during the treatment, 9 of whom were on TRT and 1 on CC. Of the 10 men diagnosed with DVT while on treatment, 7 (70%) had potential identifiable etiologies for DVT other than treatment for hypogonadism. None of the men were found to be polycythemic at the time of DVT diagnosis. There was a higher incidence of DVT in men treated with TRT than CC, however; the overall percentages of DVT in both treatment groups were relatively low. There was no difference in the percentages of men found to have other identifiable etiologies for DVT besides being on treatment between the TRT and CC groups. There was not a difference in testosterone levels between the TRT and CC groups. CONCLUSIONThe overall rates of DVT for TRT and CC treated patients are relatively low, and the majority of patients with DVT had other identifiable etiologies for DVT. Polycythemia was not found to be a risk factor in the patients diagnosed with DVTs. UROLOGY 124: 127−130, 2019.

Transgender patients and the role of the coagulation clinician

“…Six of the 9 men had other clear provoking VTE risks including lower extremity surgery or trauma, abdominal surgery, or prolonged air travel. 52 In the large U.S. database study of transgender patients previously discussed, the hazard ratio estimates for VTE in all patients in the transmen cohort using testosterone compared with cismen and ciswomen were low at 1.6 (CI, 0.9-2.9) and 1.1 (CI, 0.6-2.1), respectively. 5 Similar results were found in another health claims database case-control study of men with VTE and testosterone use within 15 days of VTE diagnosis during the period from 2007 and 2012, 53 with adjusted OR of 0.9 (95% CI, 0.73-1.12).…”

“…In cismen, a recent retrospective study of 694 hypogonadal men treated with testosterone found that only 9 developed VTE with a mean follow‐up of 25 months (+/‐ 21 months). Six of the 9 men had other clear provoking VTE risks including lower extremity surgery or trauma, abdominal surgery, or prolonged air travel . In the large U.S. database study of transgender patients previously discussed, the hazard ratio estimates for VTE in all patients in the transmen cohort using testosterone compared with cismen and ciswomen were low at 1.6 (CI, 0.9‐2.9) and 1.1 (CI, 0.6‐2.1), respectively .…”

“…In a retrospective study of hypogonadal cismen treated with testosterone who developed VTE, all had hematocrits <52%. 52 The use of testosterone in transmen will increase the hematocrit to levels seen in cismen but does not appear to routinely exceed the normal range.…”

Clomiphene Citrate for Male Hypogonadism and Infertility: An Updated Review

“…This patient did not subsequently exhibit polycythemia on CC. 51 Recently, Kavoussi et al 52 investigated the risk of deep vein thrombosis (DVT) in 1180 hypogonadal men either on TRT or CC and reported that only 1 out of 486 patients on CC developed DVT compared with 9 out of 694 patients on TRT. In a prospective study of 125 hypogonadal men on CC, Da Ros and Averbeck 49 did not find statistically significant differences when comparing pre-and post-treatment highdensity lipoprotein-cholesterol, triglycerides, fasting plasma glucose, and prolactin levels.…”

Monitoring Haematocrit in Paediatric Patients Receiving Testosterone Therapy in Arab Countries

“…Other reported, unexpected, and serious complications include branch retinal artery occlusion [17], cerebral infarctions [18], sensorineural hearing loss [19] and high prevalence of obstructive sleep apnoea [20]. However, testosterone therapy has not been associated with an increased risk of deep venous thrombosis [21]. Patients with elevated haematocrit may require therapeutic phlebotomy "venesection" [22] especially if packed cell volume is more than 54% [16].…”