Does trt use qualify for the coagulation criteria in virchow’s triad? Like if someone is on trt can I technically write virchow’s triad negative in the chart?
Per 2024 AUA guidelines: Testosterone Deficiency Guideline - American Urological Association
19. Patients should be informed that there is no definitive evidence linking testosterone therapy to a higher incidence of venothrombolic events. (Moderate Recommendation; Evidence Level: Grade C)
The concern about the possible association between testosterone therapy and venothrombolic events (VTE) led the FDA to require pharmaceutical companies to add a warning to their product labeling regarding post-marketing reports of VTE; however, this decision was based on anecdotal cases and not peer-reviewed literature.358 Since the FDA warning in June 2014, four large observational studies198, 359-361 have been conducted, none of which showed an association between testosterone therapy and an increased risk of VTE.
One RCT by Maggi et al. followed 715 testosterone deficient men for 12 weeks to evaluate the effects of a 2% transdermal testosterone agent on sex drive and energy. The men in the study had a mean baseline total testosterone of 200 ng/dL and at least 1 symptom associated with testosterone deficiency (low energy or decreased sex drive). At the conclusion of the study, no men who were on testosterone therapy had a major adverse cardiovascular event or VTE, while one patient in the placebo group did.198 A five-year study by Baillargeon et al. reported that testosterone therapy did not increase the risk of VTE in patients who were on testosterone therapy, independent of the route of testosterone administration or exposure period.359 A retrospective cohort study by Sharma et al. likewise did not detect a significant association between testosterone therapy and risk of VTE,360 and neither did Li et al. who used a cohort and nested case-control analysis and found no significant association between testosterone therapy and incidence of overall VTE in men with testosterone deficiency.361
Conversely, a population-based retrospective case-control study utilizing a UK clinical database of 19,215 patients with confirmed VTE showed that there was increased risk of VTE in the first 6 months of testosterone therapy. The risk corresponded to an additional 10 cases per 10,000 person-years, which, while low in absolute terms, raised concern about using testosterone therapy in men who may be at increased risk for VTE prior to commencement of therapy.362
Thank you! I appreciate the response. I’ve had some colleagues who were adamant about it being a clear risk, but that’s obviously not the case.