I recently received a text message from a patient concerned that testosterone was increasing his risk for heart attacks and blood clots. This patient said that his friend recently had a heart attack caused by a blood clot after being on testosterone for 6 months. The cardiologist told the friend that the testosterone was most likely the cause. The friend was advised to stop the testosterone and to tell his friends that taking testosterone is linked to increased cardiovascular risk. My patient was highly concerned and asked my opinion in whether he should continue his testosterone.
What does the science say about testosterone and heart attacks?
It’s really important when making any medical decision to rely on the science and not one particular case study or anecdotal story. Many times I will hear doctors say, “I had a guy on testosterone who came in with a blood clot.” My response is always “well I have had 1,000 men on testosterone who haven’t had a blood clot.” Both of our statements are personal experiences in treating patients, and we came to two very different conclusions. That is what is called anecdotal evidence. We both have to read what the peer reviewed medical studies show in order to make any conclusions. Without this research we are just giving our opinion based on clinical experience.
Prior to 2014, the studies that looked at the beneficial or harmful cardiovascular effects with higher endogenous or treated testosterone, the results were 46 to 0 showing benefit. Then two studies were published at the end of 2013 and early 2014 that showed increased cardiovascular risk. As a result of those two studies, the The US Food and Drug Administration (FDA) issued a warning about testosterone and potential cardiovascular risk. Lawyers started mass advertising that you could be awarded large compensation if you have had a heart attack and been prescribed testosterone. Chat rooms and online blogs exploded with misinformation about testosterone. Patients were being told by their doctors to stop taking it. The truth is that the two studies that turned the testosterone world on its head were extremely flawed and should have never been published as is.
It would take too much time to explain why those studies were flawed, but here is an excellent video of world renowned testosterone expert Dr. Abraham Morgentaler discusses the two flawed studies showing testosterone and increased cardiovascular risk. Once you watch this video you will understand why there is so much unnecessary fear of testosterone use. This is a must watch:
What about testosterone and blood clots?
Time and time again I will hear and read patients talking about how testosterone is making their “blood thick” and that their doctor told them they needed to donate blood to prevent blood clots. The reason for this is that testosterone causes your bone marrow to increase red blood cell production and as a result patients’ hemoglobin and hematocrit levels elevate above the upper end of the normal range. This causes alarms to go off and doctors mistakenly think this increases their risk of blot clots. They refer to this phenomenon as polycythemia vera.
I want to be very clear about this next statement: There has not been one published medical study that shows testosterone increases a patients risk of blood clots. Testosterone causes erythrocytosis which is an increase in red blood cell counts, hemoglobin and hematocrit. This is not associated with increased blood clot risk. Polycythemia vera also causes an increase in red blood cell counts, but there is also an elevation in platelets and endothelial dysfunction, both of which do increase your risk of blot clots. Watch this short video of Dr. Neal Rouzier discussing the risks of blood clots and testosterone:
What should you do if your hemoglobin and tematorict are elevated and you are on testosterone?
The short answer is that you should listen to your doctor and do as he or she says. For my patients, I reassure them that testosterone hasn’t been shown to increase your risks of blood clots, strokes and heart attacks (despite the FDA warning about this) and that they should continue to use it. The majority of the science shows a decrease in morbidity and mortality when patients have testosterone in the upper quartile of the normal range vs patients with low testosterone levels.
In summary, many patients and doctors believe that testosterone increases a patients risk for heart attack, stoke and blood clots. The current volume of published medical evidence does not support that opinion. In fact there are 46 studies which show the complete opposite that were published in the most respected medical journals in the world.
If you would like more information or to make an appointment to get your blood levels checked, please call Dr. Breen’s office at 949-342-8277.