There is much discussion about whether testosterone replacement therapy increases the risk of blood clots. Patients often ask whether testosterone thickens blood or raises the risk of a blood clot or stroke. This myth arises from confusion between a physiological state called erythrocytosis and a genetic disease called polycythemia vera. With testosterone therapy, red blood cell levels may increase, sometimes above what is considered normal.
A new study of more than 30,000 commercially insured men is the first large comparative analysis to show no link between testosterone therapy and a higher risk of a blood clot. The study found that middle-aged and older men undergoing testosterone replacement therapy are not at increased risk of blood clots or deep vein thrombosis (DVT) (Baillargeon et al., 2015).
In fact, the American Urological Association (AUA) has made the following guideline statement regarding testosterone therapy to treat low testosterone and the risk of blood clots:
Guideline Statement 19: "Patients should be informed that there is no definitive evidence linking testosterone therapy to a higher incidence of VTE" (AUA, 2018).
" It is reassuring that as far as we can determine, no testosterone associated thromboembolic events have been reported to date.".
Supporting this, Holmegard et al. (2014) found that high endogenous concentrations of estradiol and testosterone in women and men are not associated with increased risk of venous thromboembolism (VTE), deep venous thrombosis (DVT), or pulmonary embolism (PE). Similarly, Svartberg et al. (2009) reported that higher levels of testosterone were not related to VTE risk and found no direct evidence that physiological testosterone levels or treatment doses are thrombogenic.
There is a Huge Difference in Thrombosis Risk Between TRT and Steroid Abuse!
Sometimes, the advice for men on a steroid cycle is mistakenly applied to those on TRT, especially in online forums or gyms. Men who take anabolic steroids in large doses (usually bodybuilders) have a high red cell count and worry about an increased risk of blood clots. They are often advised to give blood to lower blood counts and reduce the chance of a clot; this is called therapeutic phlebotomy. However, this practice does not apply to men on testosterone replacement therapy (TRT) to maintain optimal levels.
When treating testosterone deficiency using TRT, there is no increased risk of developing a blood clot unless there is an underlying condition. You essentially run the same risk of thrombosis as someone traveling by airplane or climbing a mountain.
Per Gonzales et al., their study indicates that testosterone affects a red blood cell precursor cell in the bone marrow, increasing red blood cell production. Interestingly, the study also shows that at high altitudes, testosterone levels slightly increase, causing the same process to help the body compensate for low oxygen (Gonzales, 2013).
"Testosterone stimulates erythropoiesis through the production of hematopoietic growth factors and acts directly on bone marrow, specifically the polychromatophilic erythroblast." "Serum testosterone levels are increased after acute exposure to high altitude. Therefore, testosterone may play a role in high-altitude tolerance" (Gonzales, 2013).
So Why Are We Not Concerned About People in Higher Altitudes Forming Clots?
They are not at an increased risk for clots unless they already have a clotting disorder (thrombophilia).
If doctors made these people give blood (Like with steroid abusers) because of "thickened blood," they would be guilty of malpractice. This comparison may sound extreme, but in this case, it could potentially kill that patient by decreasing their oxygen-carrying capacity, which you need to acclimate to higher altitudes.
Smoking and Red Blood Cell Volume
Chronic smokers are also people who typically have a high red blood cell volume. The main reason for this is that smoking decreases oxygenation due to lung damage. If we made those people give blood due to fears of them having a clot, doctors would be committing malpractice. By the way, chronic smokers are at increased risk of clots simply by being smokers. Can testosterone cause blood clots in smokers? No, it's smoking that's the issue.
Can Testosterone Cause Blood Clots in Cancer Patients?
Another study looked at the effects of exogenous testosterone on cancer patients. Interestingly, not one patient developed a blood clot while on testosterone therapy to treat low testosterone. Why is this noteworthy? People with cancer are more likely to form clots because cancer is a hypercoagulable state (meaning their blood clots more easily).
Despite cancer patients being at a higher risk for clots, testosterone therapy did not increase this risk. So, can testosterone cause blood clots in people with cancer? The studies say no (Nehra et al., 2012).
As a result, treating low testosterone with TRT is highly unlikely to cause a blood clot. If a clot does develop, it is likely unrelated to the prescribed testosterone therapy and more related to factors such as:
Heart conditions
Smoking
High blood pressure
High cholesterol
Diabetes
Why Young Men Don't Get Blood Clots from High Testosterone Levels
One of the most compelling facts supporting the safety of testosterone replacement therapy (TRT) is this: If TRT helps men achieve testosterone levels similar to their prime years, why did they not suffer from blood clots when they were younger? During their youth, men naturally produce higher levels of testosterone, similar to those achieved through TRT.
If high testosterone levels inherently increased the risk of blood clots, we would expect to see a higher incidence of blood clots among young men in their prime years. However, this is not the case. Younger men do not experience a higher risk of blood clots due to their naturally high testosterone levels. This observation strongly supports the idea that physiological levels of testosterone, whether natural or supplemented, do not elevate the risk of blood clots.
So, Can Testosterone Cause Blood Clots?
Many studies dispel the myths about exogenous testosterone increasing the risk of blood clots. One comprehensive study examined 71,407 men on testosterone therapy and found no increase in the likelihood of blood clots. They state:
"This study did not detect a significant association between testosterone replacement therapy and risk of DVT/PE in adult men with low sTT (serum total testosterone levels) who were at low to moderate baseline risk of DVT/PE" (Baillargeon et al., 2015).
Further studies have confirmed these findings. For instance, Kavoussi et al. (2019) found that medical treatments for hypogonadism do not significantly increase the risk of deep vein thrombosis over the general population risk. Additionally, Sharma et al. (2016) reported no association between testosterone replacement therapy and the incidence of DVT and pulmonary embolism in their retrospective cohort study of the Veterans Administration database.
By now, you can see that plenty of evidence backs up the claim that TRT, for the treatment of low testosterone, will not cause blood clots. In fact, it may decrease the likelihood of major adverse cardiovascular events, including heart attacks. Low testosterone causes decreased muscle mass in men, often accompanied by an increase in visceral and subcutaneous fat. This can lead to high blood pressure, high cholesterol, obesity, and diabetes, all of which can cause blood clots.
Editor's Note: This post was originally published on January 13, 2021, and has been completely updated to include the latest studies and ensure accuracy and comprehensiveness.
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1. Baillargeon J, Urban RJ, Morgentaler A, et al. Risk of Venous Thromboembolism in Men Receiving Testosterone Therapy. Mayo Clinic Proceedings. 2015;90(8):1038-1045.
2. American Urological Association (AUA). Evaluation and Management of Testosterone Deficiency: AUA Guideline. 2018.
3. Rhoden EL, Morgentaler A. Risks of testosterone-replacement therapy and recommendations for monitoring. The New England Journal of Medicine. 2004;350(5):482-492.
4. Gonzales GF. Serum testosterone levels and excessive erythrocytosis during the process of adaptation to high altitudes. Asian Journal of Andrology. 2013;15(3):368-374.
5. Holmegard HN, Nordestgaard BG, Schnohr P, Tybjaerg-Hansen A, Benn M. Endogenous sex hormones and risk of venous thromboembolism in women and men. Journal of Thrombosis and Haemostasis. 2014;12(3):297-305.
6. Svartberg J, Braekkan SK, Laughlin GA, Hansen JB. Endogenous sex hormone levels in men are not associated with risk of venous thromboembolism: the Tromso study. European Journal of Endocrinology. 2009;160(5):833-838.
7. Kavoussi PK, Machen GL, Wenzel JL, et al. Medical Treatments for Hypogonadism do not Significantly Increase the Risk of Deep Vein Thrombosis Over General Population Risk. Urology. 2019;124:127-130. doi:10.1016/j.urology.2018.11.009
8. Sharma R, Oni OA, Chen G, et al. Association Between Testosterone Replacement Therapy and the Incidence of DVT and Pulmonary Embolism: A Retrospective Cohort Study of the Veterans Administration Database. Chest. 2016;150(3):563-571. doi:10.1016/j.chest.2016.05.007
9. Nehra A, Agarwal N, et al. Exogenous testosterone and the risk of venous thromboembolism (VTE). European Urology. 2012;62(6):920-924.
· See full prescribing information for complete boxed warning · Virilization has been reported in children with secondary exposure to topical testosterone products · Children should avoid contact with unwashed or unclothed application sites in men using topical testosterone products · Healthcare providers should advise patients to strictly adhere to recommended instructions for use
Disclaimer: The information provided on this page is not a substitute for professional medical advice, diagnosis, or treatment. If you have any questions or concerns about your health, please talk to a doctor.
Warnings and Precautions:
· Possible increased risk of heart attack or stroke. · Male Excel’s testosterone products are not meant for use by women. · It is not known if Male Excel’s testosterone products are safe or effective in children younger than 18 years old. Improper use of testosterone in children may affect bone growth. · Testosterone can be abused when taken at higher than prescribed doses and when used with other anabolic androgenic steroids. Male Excel’s Testosterone Lipoderm Cream is a controlled substance (CIII) because it contains testosterone that can be a target for people who abuse prescription medicines. Anabolic androgenic steroid abuse can lead to serious cardiovascular and psychiatric adverse reactions. Your doctor will check you for signs of abuse before and during treatment. · Keep your Male Excel products in a safe place to protect them. · Never give your Male Excel products to anyone else, even if they have the same symptoms you have. · Selling or giving away this medicine may harm others and is against the law.
These are not all the possible side effects. See the Full Prescribing Information for more.
What Should You Know Before Taking Male Excel’s Testosterone Lipoderm Cream?
It is not known if Male Excel’s Testosterone Lipoderm Cream is safe or effective in treating men who have low testosterone due to aging.
It is not known if Male Excel’s Testosterone Lipoderm Cream is safe or effective in children younger than 18 years old.
Male Excel l’s Testosterone Lipoderm Cream is a controlled substance (CIII) because it contains testosterone that can be a target for people who abuse prescription medicines. Keep it in a safe place to protect it, and never give it to anyone else. Selling or giving away this medicine may harm others and is against the law.
Male Excel’s Testosterone Lipoderm Cream is not meant for use in women.
Male Excel’s Testosterone Lipoderm Cream can transfer from your body to others, including children and women. Transference can happen if other people come into contact with the area where Male Excel’s Testosterone Lipoderm Cream is applied. Children and women should avoid contact with the unwashed or uncovered (unclothed) areas where Male Excel’s Testosterone Lipoderm Cream has been applied to your skin.
Early signs and symptoms of puberty have occurred in young children who have come in direct contact with testosterone by touching areas where men have used Male Excel’s Testosterone Lipoderm Cream.
Signs and symptoms of early puberty in a child who has come in direct contact with Male Excel’s Testosterone Lipoderm Cream may include:
· Abnormal sexual changes. · Enlarged penis or clitoris. · Early hair growth near the vagina or around the penis (pubic hair). · Erections or acting out sexual urges (sex drive). · Behavior problems, including acting aggressively or behaving angrily or violently.
Signs and symptoms in a woman who has come in direct contact with Male Excel’s Testosterone Lipoderm Cream may include:
· Changes in body hair. · An abnormal increase in pimples (acne).
To lower the risk of transfer of Male Excel’s Testosterone Lipoderm Cream from your body to others, you should follow these important instructions:
· Apply Male Excel’s Testosterone Lipoderm Cream only to areas of your shoulders, upper arms, or stomach area (abdomen) that a short-sleeve t-shirt will cover. · Wash your hands right away with soap and water after applying testosterone cream · After the gel has dried, cover the application area with clothing. Keep the area covered until you have washed or showered the application area well. · If you expect skin-to-skin contact with another person, wash the application area well with soap and water. · If a child or woman touches the area where you have applied testosterone cream, that area on the child or woman should be washed thoroughly with soap and water immediately.
Stop using Male Excel’s Testosterone Lipoderm Cream and call your healthcare provider immediately if you see any signs and symptoms of puberty in a child or changes in body hair. The same applies if you notice increased acne in a woman that may have happened through accidental touching of the area where you have applied Male Excel’s Testosterone Lipoderm Cream.
Do not use Male Excel’s Testosterone Lipoderm Cream if you:
· Have breast cancer or have or might have prostate cancer. · Are pregnant. Male Excel’s Testosterone Lipoderm Cream may harm your unborn baby. Pregnant women should avoid contact with the area of skin where Male Excel’s Testosterone Lipoderm Cream has been applied.
Before using Male Excel’s Testosterone Lipoderm Cream, inform your healthcare provider about all of your medical conditions, including if you have breast cancer, prostate cancer, urinary problems due to an enlarged prostate, heart, kidney, or liver problems, or problems breathing while you sleep (sleep apnea).
Inform your healthcare provider of all medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Especially tell your healthcare provider if you take insulin, medicines that decrease blood clotting (blood thinners), or corticosteroids.
Male Excel’s Testosterone Lipoderm Cream can cause serious side effects, including:
· If you already have an enlarged prostate gland, your signs and symptoms can worsen while using Male Excel’s Testosterone Lipoderm Cream (including changes in urination). · Possible increased risk of prostate cancer.] · Blood clots in the legs or lungs. Signs and symptoms of a blood clot in your leg can include leg pain, swelling, or redness. Signs and symptoms of a blood clot in your lungs can include difficulty breathing or chest pain. · Possible increased risk of heart attack or stroke.[sw4] · In large doses, Male Excel’s Testosterone Lipoderm Cream may lower your sperm count. · Swelling in your ankles, feet, or body, with or without heart failure. This may cause serious problems for people with heart, kidney, or liver disease. · Enlarged or painful breasts. · Having problems breathing while you sleep (sleep apnea).
The most common side effects of Male Excel’s Testosterone Lipoderm Cream include increased prostate-specific antigen (a test used to screen for prostate cancer), mood swings, high blood pressure, increased red blood cell count, acne, and skin irritation where the gel is applied.
This is the most important information to know about Male Excel’s Testosterone Lipoderm Cream. For further information, talk with your healthcare provider.
Tell your healthcare provider if you have any side effect that bothers you or does not go away.
These are not all the possible side effects of Male Excel’s Testosterone Lipoderm Cream. For more information, ask your healthcare provider or pharmacist.
Please click here to see full prescribing information, Medication Guide, and complete boxed warnings for the product.
You are encouraged to report any adverse side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
ADDITIONAL IMPORTANT SAFETY INFORMATION AND BLACK BOX WARNING
WARNING: Drugs with thyroid hormone activity, alone or together with other therapeutic agents, have been used for the treatment of obesity. In euthyroid patients, doses within the range of daily hormonal requirements are ineffective for weight reduction. Larger doses may produce serious or even life-threatening manifestations of toxicity, particularly when given in association with sympathomimetic amines such as those used for their anorectic effects.
What Should You Know Before Taking Male Excel’s desiccated thyroid [tetraiodothyronine sodium (T4 levothyroxine) and triiodothyronine sodium (T3 liothyronine)]?
PLEASE NOTE: The information provided on this page is not a substitute for professional medical advice, diagnosis, or treatment. If you have any questions or concerns about your health, please talk to a doctor.
This is not an Orange Book product and has not been subjected to FDA therapeutic equivalency or other equivalency testing. No representation is made as to generic status or bioequivalency. Each person recommending a prescription substitution using this product shall make such recommendations based on each such person’s professional opinion and knowledge upon evaluating the active ingredients, excipients, inactive ingredients and chemical information provided herein. All prescription substitutions and/or recommendations using this product shall be made subject to state and federal statutes as applicable.
What is Male Excel’s desiccated thyroid?
· Male Excel’s desiccated thyroid is a prescription medicine used to treat a condition called hypothyroidism from any cause, except for cases of temporary hypothyroidism, which is usually associated with an inflammation of the thyroid (thyroiditis). It is meant to replace or supplement a hormone that is usually made by your thyroid gland.
When should I not take Male Excel’s desiccated thyroid?
· Male Excel’s desiccated thyroid should not be used for weight loss. Do not use Male Excel’s desiccated thyroid if you have hyperthyroidism, overactive thyroid, uncorrected adrenal problems, or are allergic to any of its ingredients.
What warnings should I know about Male Excel’s desiccated thyroid?
· Large doses of Male Excel’s desiccated thyroid may cause serious or life-threatening side effects, including chest pain, increased pulse rate, rapid, strong, irregular heartbeat, and excessive sweating. · Male Excel’s desiccated thyroid should be used with caution in people with heart disease, on diabetes medication, or on blood thinning medication. · Children may experience partial hair loss in the first few months of thyroid therapy, but this will usually go away on its own.
What should I tell my healthcare provider?
· Tell your doctor immediately if you experience chest pain, increased pulse rate, rapid, strong, irregular heartbeat, excessive sweating, or any other unusual event. · Tell your doctor about any other medical conditions you may have, especially heart disease, diabetes, blood clotting problems, and adrenal or pituitary gland problems. The dose of other drugs you may be taking to control these conditions may have to be changed while you are taking Male Excel’s desiccated thyroid. · If you have diabetes, check your blood sugar levels and/or the glucose in your urine, as ordered by your doctor and immediately tell your doctor if there are any changes. · Tell your doctor if you are allergic to any foods or drugs, are pregnant or plan to become pregnant, are breastfeeding or are taking any other drugs, as well as prescription and over-the-counter products.
What are the side effects of Male Excel’s desiccated thyroid?
· Side effects may include chest pain, increased pulse rate, rapid, strong, irregular heartbeat, or excessive sweating. If you experience these side effects, immediately contact your doctor.
What other medications might interact with Male Excel’s desiccated thyroid?
· Male Excel’s desiccated thyroid can interact with some medications, such as oral anticoagulants, which are medicines used to thin the blood, insulin or oral medications used to treat diabetes, certain medications used to treat high cholesterol levels, and estrogen-containing birth control pills.
IMPORTANT RISK INFORMATION
Thyroid hormones, including Male Excel’s desiccated thyroid, should not be used alone or in combination with other drugs to treat obesity or weight loss. In patients with normal thyroid levels, doses of Male Excel’s desiccated thyroid used daily for hormone replacement are not helpful for weight loss. Larger doses may result in serious or even life-threatening events, especially when combined with certain other drugs used to reduce appetite.
· Male Excel’s desiccated thyroid is contraindicated in patients with uncorrected adrenal insufficiency, untreated thyrotoxicosis, and hypersensitivity to any component of the product. · In the elderly and patients with cardiovascular disease, Male Excel’s desiccated thyroid should be used with greater caution than younger patients or those without cardiovascular disease. · Use of Male Excel’s desiccated thyroid in patients with diabetes mellitus or adrenal cortical insufficiency may worsen the intensity of their symptoms. · The therapy of myxedema coma requires simultaneous administration of glucocorticoids. · Concomitant use of Male Excel’s desiccated thyroid with oral anticoagulants alters the sensitivity of oral anticoagulants. Prothrombin time should be closely monitored in thyroid-treated patients on oral anticoagulants. · In infants, excessive doses of Male Excel’s desiccated thyroid may produce craniosynostosis. · Partial loss of hair may be experienced by children in the first few months of therapy but is usually transient. · Adverse reactions associated with Male Excel’s desiccated thyroid therapy are primarily those of hyperthyroidism due to therapeutic overdosage. · Many drugs and some laboratory tests may alter the therapeutic response to Male Excel’s desiccated thyroid. In addition, thyroid hormones and thyroid status have varied effects on the pharmacokinetics and actions of other drugs. Administer at least 4 hours before or after drugs that are known to interfere with absorption. Evaluate the need for dose adjustments when regularly administering within one hour of certain foods that may affect absorption.
Please click here to see full prescribing information, including BOXED WARNING and important safety information.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088
