Blood clotting and testosterone

[November Fox]

Hi guys,

I´ve been pretty absent lately. I finally got my first appointment, but I decided to stop treatment at that specific clinic - the whole time, they were rather impolite and condescending. Instead I decided to try HRT with an UK based clinic.

The GP asked me to do some blood clotting risk testing. It runs high in my family; there´s several cases of deep vein thrombosis and one of pulmonary embolism. Now there seems to be a link between the use of testosterone and deep vein thrombosis (like described in this article here: https://www.drugwatch.com/testosterone/strokes/)

I hope this won´t stand in the way of my transition but I want to be very well informed. Do any of you have any relatives who have DVT, or do you have a heightened risk and transitioned anyway? I´d be happy to hear any experiences.

Rowan

[HeyTrace19]

It is wise to be concerned...  My father had multiple DVTs and also had his abdominal aorta replaced.  Not sure if it was a clotting issue only or if years of smoking and drinking had rendered his vessels useless.  I have been on T for 5 years, and have had an increase in platelets as well as red blood cells, making my risk for clots and stroke greater.  I try to manage it by keeping my dose as low as possible and donating blood when the composition gets too thick.  As long as you have regular blood checks (about 3 times per year for me), you should be able to catch any concerns before they become problems.  The dose really does make a difference for me.  For a while I was on a larger dose and my blood was always thicker...best to start low to minimize your risks. 

[November Fox]

Hey Heytrace

I waited a bit to see if there were any others with experience on this topic, but looks like we´re spread thin. I´m glad to know that even with a higher risk for DVT you can still transition, I will have blood tests done next week to see in "what shape" my blood is.

Thanks for your info!

[HughE]

The trouble with these studies looking at the incidence of problems among men who've gone on testosterone replacement, is that on average men going on TRT probably aren't as healthy to start with as men of comparable age who don't need T replacement. Unless this is properly controlled for (which most of the time it doesn't appear to be), then you'll see a higher risk of all kinds of problems in your hormone replacement group, which have nothing to do with the hormone replacement, but are just because their health was poor to begin with.

It's by no means established that TRT causes blood clots, for instance the study talked about in this article found no link:
http://www.webmd.com/men/news/20150720/study-sees-no-link-between-testosterone-therapy-and-blood-clots

[FTMax]

I think we discussed this in another thread (I think it is one by King Phoenix if you want to hunt for it). Most of the studies out there are going to be about cisgender men, and it won't apply to you. Testosterone in transgender men has an anti-clotting effect. That is why they ask you to stop before surgeries, because of the increased bleeding risk. So if you are at risk for DVT, being on T should lower that risk.

[November Fox]

I´m not sure I understand

So in some men it increases the chance of blood clots (like with HeyTrace) but normally T would reduce your risk? I´m just wondering because I´m in the process of getting my tests for T with a GP in the UK, and they said I should be clear for blood clotting before I can start. Surely she´s basing her ideas on something.

Thanks for thinking along. I might hunt for the other thread too.

[HeyTrace19]

I think the clotting risk can come from the Testosterone therapy producing a greater number of red blood cells, as well as platelets, in some individuals.  This makes the blood thicker and slower moving.  In addition to this Testosterone induced 'polycythemia', if you are already at risk genetically and have narrower veins due to anatomy or atherosclerosis, it can be problematic.  There has been a direct correlation for ME between Testosterone dose and red blood cell count.  It may not occur for everyone, trans or cis. Testosterone for ME has had a clotting, rather than anti-clotting effect.  You will not know how it affects you until you are on T for a bit.

[FTMax]

It may not occur for everyone, trans or cis. Testosterone for ME has had a clotting, rather than anti-clotting effect.  You will not know how it affects you until you are on T for a bit.

Yes, this. I imagine they would probably want to get an initial RBC count on you to see where you're normally running at, and then test you after a few months on T to see how it has affected that number. Higher RBC = greater risk for clots. That is manageable though. Donating blood every so often will reduce your RBC count I believe. You could also go on a lower dose of T to see if that helps.

This is the thread I mentioned earlier:

https://www.susans.org/forums/index.php/topic,207690.0.html

There are several links to studies in there that may help

[November Fox]

Thanks guys,

In the case of my family the blood clotting is caused by low amount of antitrombines in the blood, so I guess that´s what I´ll be looking for. Trace I´m not sure what you mean by ME.

King Phoenix´s been dealing with a lot of the same stuff that I have been wondering about. Thanks for the link

[HeyTrace19]

Trace I´m not sure what you mean by ME.

I mean in my experience... as in me, myself, and I.  I was referring to my own health and trying not to generalize that my outcomes are the same or different than that of others. We are all individuals, after all.

[November Fox]

Haha I thought ME was some kind of abbreviation xD Thanks for clearing it up. Let´s just see what happens...

[Nate]

My personal experience has been an increase of my RBC count with HRT.  As well, I had phalloplasty and didn't have to stop taking it. In fact I was on heparin for a week after and Aspirin for a month.  I am not sure where the information that T on transguys is a anti-clothing but I wold be curious to know

[FTMax]

My personal experience has been an increase of my RBC count with HRT.  As well, I had phalloplasty and didn't have to stop taking it. In fact I was on heparin for a week after and Aspirin for a month.  I am not sure where the information that T on transguys is a anti-clothing but I wold be curious to know

"DVT is an uncommon side effect of hormone treatment in transmen. In the Ott study (see above) transmen were found to develop DVT, but at a rate lower than that of transwomen. In the Leinung study (see above) none of the 50 transmen who were studied developed DVT. In fact, one 2003 study found that testosterone acted as an anti-clotting agent, providing some protection against DVT. (Toorians) One study of cisgender men found that testosterone therapy encouraged blood clots from both patch and intramuscular delivery, although in that study an inherited tendency was thought to be behind the occurrences. (Glueck 2011) In some cases testosterone from HT can also be aromatized (transformed) into estrogens, which can then lead to DVT. (Glueck 2013)"

[shean R]

I too have had problems with increase in my RBC.  I gave blood a few times and it was still too high for my Dr's liking so decreased my T dosage which in turn decreased my RBC, but now my T is down VERY low almost non-existent.  My Dr and I are trying to find that sweet spot where I am happy with my T levels and she is happy with my RBC levels.   

[AnxietyDisord3r]

I think we discussed this in another thread (I think it is one by King Phoenix if you want to hunt for it). Most of the studies out there are going to be about cisgender men, and it won't apply to you. Testosterone in transgender men has an anti-clotting effect. That is why they ask you to stop before surgeries, because of the increased bleeding risk. So if you are at risk for DVT, being on T should lower that risk.

Wow. So I discussed my surgery with my endo and my PCP, in detail, and neither of them said anything about my needing to stop testosterone before surgery. FWIW, my dose is really low (too low IMO) and I haven't noticed any change in my bleeding.

Should I take matters in my own hands and skip my next dose? I hate this idea, could lead to estrogen rebound of epic proportions and a major depressive event. Or maybe nothing would happen. Just yuck, I hate this idea.

[FTMax]

I think we discussed this in another thread (I think it is one by King Phoenix if you want to hunt for it). Most of the studies out there are going to be about cisgender men, and it won't apply to you. Testosterone in transgender men has an anti-clotting effect. That is why they ask you to stop before surgeries, because of the increased bleeding risk. So if you are at risk for DVT, being on T should lower that risk.

Wow. So I discussed my surgery with my endo and my PCP, in detail, and neither of them said anything about my needing to stop testosterone before surgery. FWIW, my dose is really low (too low IMO) and I haven't noticed any change in my bleeding.

Should I take matters in my own hands and skip my next dose? I hate this idea, could lead to estrogen rebound of epic proportions and a major depressive event. Or maybe nothing would happen. Just yuck, I hate this idea.

They probably didn't mention it because it's not their call to make. That is at the discretion of the surgeon, so I would look through your paperwork from them and see if it is listed there. If you don't see anything about it, I would call their office to confirm. Every surgery I've gone to, they've said outright in the consultation whether or not I'd be able to continue hormones, and if not, when I would be able to resume. If you had a consult and they didn't say anything, they might not care.

I had to stop 2 weeks prior to top surgery, and resumed 1 week after. I did not have to stop for my hysterectomy. I will have to stop 1 month in advance of my phalloplasty. If it makes you feel better, I had no issues with stopping for top surgery. No reverting, no re-emergence of Lucifer's unholy waterfall. I was very tired, but that's about it.

[AnxietyDisord3r]

The surgeon said it was strictly up to my doctor.

Again, I've had blood draws and cut myself plenty of times recently and haven't noticed any change in blood clotting.

No symptoms like I've been bingeing on wood ear mushrooms or too much aspirin.

And Max, yes, I am scared about my period returning, but I am more worried about a scary major depression episode, which is tied to my estrogen cycle. I'm having enough problems as it is when my T drops towards the end of the week to a lower level and that crap kicks on like an ancient wall A/C.

[FTMax]

The surgeon said it was strictly up to my doctor.

Again, I've had blood draws and cut myself plenty of times recently and haven't noticed any change in blood clotting.

No symptoms like I've been bingeing on wood ear mushrooms or too much aspirin.

And Max, yes, I am scared about my period returning, but I am more worried about a scary major depression episode, which is tied to my estrogen cycle. I'm having enough problems as it is when my T drops towards the end of the week to a lower level and that crap kicks on like an ancient wall A/C.

Hm, that's interesting. Well, make a call and confirm with them. I would imagine if the surgeon has left it up to them, that you won't be required to stop.