This is an age-old question that is very frequently postulated when one brings up the notion of initiating testosterone replacement therapy, or TRT for short. Where did this come from? Well, it comes from a study done decades in the past that has been essentially debunked. It was a very poorly done study that did not truly show the causation or correlation between TRT and blood clots (deep vein thrombosis, heart attack, stroke, etc).
However, people innately believe the first thing they hear, and it is very difficult to change their minds. This is known as confirmation bias. Even though there have been countless studies that have shown no causation or correlation between TRT and increased risk of blood clots, the misinformation is still out there and going strong.
Did you know that you actually have a decreased risk for cardiovascular disease (CVD) while on TRT? This has been demonstrated by several studies. [1],[2]. Men who have testosterone deficiency have an increase in their CVD risk. Testosterone and CVD are inversely related, i.e. low testosterone = increased risk for CVD and vice versa. [3],[4],[5]. This is no surprise when you consider men with low testosterone often have an increase in belly fat, decreased insulin sensitivity (i.e. diabetes), poor cholesterol, elevated C-reactive protein (CRP = inflammation), and elevated blood pressure. These men also have an increased likelihood to have atherosclerosis, which is the hardening of the arteries. Atherosclerosis is part of what leads to blood clots.
Men with low testosterone often have decreased insulin sensitivity which often leads to diabetes, a strong contributing factor to cardiovascular events. Studies have shown that men on TRT have decreased morbidity and mortality. [6]. In medicine, there are rarely absolutes. I cannot say that there is absolutely no increased risk for blood clots. What I do feel comfortable saying is that there are numerous well-done studies that show the opposite.
At the end of the day, each person needs to weigh the risk vs. reward for any decision they make. Initiating TRT is no different. The concerns regarding blood clots and cardiovascular risks associated with TRT have been debunked, providing reassurance for those considering testosterone replacement therapy. You should have an open conversation with your provider and decide what is best for you. This is exactly the type of open and honest conversations I have with my patients at their first consultation, so contact me today.
- Jones TH, Saad F. The effects of testosterone on risk factors for, and the mediators of, the atherosclerotic process. Atherosclerosis 2009; 207: 318-27.
- Araujo AB, Dixon JM, Suarez EA, Murad MH, Guey LT, et al . Clinical review: endogenous testosterone and mortality in men: a systematic review and meta-analysis. J Clin Endocrinol Metab 2011; 96: 3007-19.
- English KM, Mandour O, Steeds RP, Diver MJ, Jones TH, et al . Men with coronary artery disease have lower levels of androgens than men with normal coronary angiograms. Eur Heart J 2000; 21: 890-4.
- Haring R, Volzke H, Steveling A, Krebs A, Felix SB, et al. Low serum testosterone levels are associated with increased risk of mortality in a population-based cohort of men aged 20-79. Eur Heart J 2010; 31: 1494-501.
- Wehr E, Pilz S, Boehm BO, Grammer TB, Marz W, et al . Low free testosterone levels are associated with all-cause and cardiovascularmortality in postmenopausal diabetic women. Diabetes Care 2011; 34: 1771-7.
- Hwang, Kathleen, and Martin Miner. “Controversies in testosterone replacement therapy: testosterone and cardiovascular disease.” Asian Journal of Andrology, vol. 17, no. 2, Mar.-Apr. 2015, p. 187. Gale Academic OneFile, link.gale.com/apps/doc/A416667509/AONE?u=eugenepl&sid=bookmark-AONE&xid=2935b85a. Accessed 21 Apr. 2023.
