In 2011, 5.3 million Americans received prescriptions for testosterone products like Fortesta. Like all testosterone replacement products, Fortesta can elevate the number of red blood cells, thicken the blood, and increase a man’s risk of developing blood clots — especially in the legs (a condition known as deep vein thrombosis or DVT).
What is the problem?
Fortesta can cause serious side effects, including blood clots in the legs. The condition, also known as deep vein thrombosis (DVT), can cause pain, swelling, or redness in the legs. Blood clots can also grow very large and cause serious venous damage or circulatory problems. If small pieces of blood clot break loose, they can migrate in the bloodstream (called an “embolism”) and cause a pulmonary embolism, heart attack, stroke, or death.
How Does Fortesta Cause Blood Clots?
Testosterone in Fortesta can elevate a kidney hormone called erythropoietin. This causes bone marrow to increase the number of red blood cells, which thickens the blood. The heart must work harder to force the blood into the body, which elevates blood pressure.
All of these factors can contribute to the development of blood clots — especially in older men who tend to have thinner blood vessels. In addition, some studies indicate that testosterone reduces HDL (“good”) cholesterol and increases circulating estrogen. Estrogen therapy has been linked to heart disease in both men and women.
What is a Blood Clot?
Blood clotting is an important process that prevents excessive bleeding after an emergency. Platelets (a type of blood cell) and plasma (liquid part of blood) work together to create a clot. After the injury has healed, the clot naturally dissolves. Sometimes, blood clots grow spontaneously when there is no injury. An abnormal clot can obstruct circulation and cause severe, life-threatening complications.
Treatment options for a blood clot may include:
- Oral blood-thinning drugs: Warfarin, for example. Provides long-term protection against blood clots.
- Intravenous “clot-busting” drugs: Heparin, for example. This is administered in a hospital to dissolve existing clots.
- Compression stockings: Worn on the legs to improve blood-flow and reduce the risk of new blood clots.
- Surgery: May involve a catheter, open surgery, or implantation of a filter in the inferior vena cava to catch blood clots before they reach the lungs.