Axiron (underarm testosterone) is approved for men with hypogonadism. Unfortunately, recent studies indicate that only 50% of men on testosterone actually have hypogonadism — for the rest, life-threatening side effects like pulmonary embolism (blood clots in the lungs) may outweigh any benefit of Axiron.
Can Axiron Cause a Pulmonary Embolism?
The Prescribing Information for Axiron contains warnings about blood clots in the legs, which may cause pain, swelling, and redness. If these blood clots break loose, they can potentially travel to the lungs and cause a pulmonary embolism.
Should I Have a Blood Test?
It is a good idea to have a blood test before starting testosterone replacement therapy — low testosterone cannot be conclusively diagnosed based on symptoms alone. Axiron is only approved for men with hypogonadism (little or no testosterone) due to a medical condition. Be aware that testosterone levels fluctuate during the day, and men who are in hypogonadal levels one day may be fine the next.
In addition, you may belong to the 5% of men who have genetic risk-factors (such as Factor V Leiden, high Factor VIII, etc.) that significantly increase your risk of blood clotting. In October 2011, the journal Translational Research published a study linking several cases of pulmonary embolism to the use of testosterone in men with genetic risk-factors.
What is a Pulmonary Embolism?
Pulmonary embolism occurs when blood clots get trapped in the lungs. Many cases are caused by blood clots in the legs that travel to the heart and get stuck in pulmonary arteries. During a pulmonary embolism, blood clots prevent oxygen-rich blood from reaching tissues in the lungs, causing cells to die. The condition is like a heart attack in the lungs.
Symptoms of a Pulmonary Embolism
- Chest pain (may feel like a heart attack)
- Stabbing feeling in chest that gets worse when breathing deeply, coughing, or bending
- Rapid breathing or shortness of breath
- Coughing up blood
- Leg pain, swelling, and redness (symptom of blood clot)
- Skin, lips, and nails may turn blue-gray (cyanosis)
- Skin is sweating and clammy
- Changes in heart rhythm (rapid or irregular heartbeat)
- Dizziness or lightheadedness
What Should I Do?
Call 911 and seek emergency medical attention immediately if you suspect a pulmonary embolism. Without diagnosis and treatment, about 33% of pulmonary embolisms are fatal. In the hospital, doctors will probably give you an intravenous (IV) clot-busting drug.
If this does not work or the blood clot is very large, doctors may use a long, flexible tube called a catheter to remove the clot. If you cannot take a blood-thinner, you may receive a filter to catch blood clots before they reach the lungs.