Ugh, this blows and I completely sympathize with the frustration others here are facing.
I was just about to start exogenous T, but thankfully saw this thread as I was waiting for my doc to send me my prescription. I've never had a clot, but a 1-2% risk was too much of a gamble for me, and the $400 - $500 (with insurance) for the labs was a paltry sum relative to not dying.
I had all the tests ordered by Dr. Glueck, here's what he said:
Some follow up questions I asked him:
1. Is there any medication (ex Xarelto) or supplements (ex Rutin) that you believe could prevent thrombotic events were I to take exogenous testosterone? Anything promising on the horizon?
2. If I do not go onto testosterone therapy, would you still recommend some kind of daily anti-coagulant, ex Xarelto or Warfarin?
3. The doctor also prescribed thyroid medication, I think it was Synthroid or Armour Thyroid. Do those types of medications also increase the risk of thrombotic events? To the same or lesser extent than testosterone?
His answers:
Some further questions:
Given what I've inherited, is DVT-PE only a problem in the presence of exogenous test? Do you recommend any regular labs or any medication to prevent DVT-PE? Are there certain symptoms you believe are reliable early warning signs?
His answers:
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Interesting that he believes thyroid medication would have no effect.
You didn't state your labs results or what your clotting disorder you've inherited is. Please advise.
If you look back on my posts, I have had a history of clots back in 2012 which both cleared on their own, although I was on a short-term course of warfarin. I am now on Xarelto 10mg as a prophylaxis against DVT-PE, but I was not on TRT, clomid, AAS, hCG at the time of the clots and am not on TRT now, so his statement about not worrying about inherited thrombophilia makes no sense. You STILL have to treat certain thrombophilia, depending on which one, regardless.
The only HRT I take is DHEA and desiccated thyroid. Since my own Total T averages in 500s, it isn't worth the risk for that extra 200-400 at this point to do TRT. My goal is to wait until a better agents comes on the market that do not exhibit the risk side effect profile of exogenous TRT. For those of us who are not hypogonadal but want to ENHANCE as oppose to REPLACE endogenous T to youthful physiologic levels, I don't think TRT can continue to be the best answer. What we need to come up with is TET (Testosterone Enhancement Therapy) for those with TT of at least 500 that want to improve their natural endogenous levels for that extra boost, not stomp out an already decent level, and avoid the HPTA suppression and side effects associated with frank TRT.
According to Glueck, anticoagulant prophylaxis does not prevent the possibility of a DVT-PE as he indicates in his papers which is unfortunate. It is not his belief. It is what has been demonstrated in actual studies.
Familial thrombophilia is not an easy diagnosis unless it is clear cut, i.e. elevated Factor VIII is NOT always inherited/familial. It is an acute phase reactant that can also be elevated from inflammation, stress, TOO MUCH THYROID HORMONE (i.e. hyperthyroidism) and even intense exercise (I have a ton of studies to prove it). Repeat testing over many months may be the only way to determine a more accurate diagnosis of familial FVIII. I fall into that category. I can have high FVIII for 3 labs in a row, and then, by some miracle, it is within range again. My thoughts: excess exogenous thyroid hormone (T3 or T4) sets in motion the coagulation cascade which can induce thrombosis as shown in the literature.
What he fails to mention is that there are no studies that show a male with higher circulating levels of endogenous T is prone to clots any more than that of one who has lower levels, so it's not so much the T itself as it is the mechanism by which the T is enhanced and to supra physiologic levels that then increases the risk mechanism. I have flat out asked him twice about clomid - since it works by endogenous stimulation of T via FSH/LH and he never replied. If you studied his work, the #1 trigger point in thrombogenesis is elevated E2 as I posted on upthread.
Also, MTHFR C677T homozygosity has only been shown to be a thrombotic risk factor if homocysteine level is elevated. That is controlled via ample doses of methyfolate, methylB12, NAC, TMG, choline, etc. I have a friend who is on TRT and is homozygous and has had no incidence of thrombotic events.
While Glueck's studies show a subset of prone individuals with inherited risk factors for thrombophilia to have had presented with actual events from TRT and other agent administration, Glueck almost seems to be on an anti-TRT campaign. And the worst of it, he offers no alternative for those who are truly hypogonadal and have no quality of life because they need TRT, yet also have a clotting disorder. WTF does he expect them to do? Have a lesser QOL, but stay alive? That's an unacceptable result we're left with.
