Venous thromboembolism (VTE) is a multifactorial disease; age, a prior history of deep vein thrombosis, cancer, surgery, obesity, prolonged immobility, pregnancy, oral contraceptive agents, thrombophilia, have been identified as major risk factors. Thrombophilia is a heritable or acquired prothrombotic state that increases the tendency to venous thromboembolism. The use of anabolic steroids is strongly linked to venous thromboembolism, due to their role in thrombus formation. We present a case of a venous thromboembolism in a 26-year old male who had undergone a testosterone abuse and had a previously undiagnosed genetic thrombophilia, with discussion upon literature regarding the heritable thrombophilia and prothrombotic effects of testosterone.
1. Tapson VF. Acute pulmonary embolism. N Engl J Med. 2008 Mar 6;358(10):1037-52. DOI: 10.1056/NEJMra072753
2. National Clinical Guideline Centre (UK). Venous Thromboembolic Diseases: The Management of Venous Thromboembolic Diseases and the Role of Thrombophilia Testing [Internet]. London: Royal College of Physicians (UK); 2012 Jun. http://www.ncbi.nlm.nih.gov/books/NBK132796/
3. Dickerman RD, McConathy WJ, Schaller F, Zachariah NY. Cardiovascular complications and anabolic steroids. Eur Heart J. 1996 Dec;17(12):1912.
4. Mazoyer E, Ripoll L, Gueguen R, Tiret L, Collet JP, dit Sollier CB, et al.; FITENAT Study Group. Prevalence of factor V Leiden and prothrombin G20210A mutation in a large French population selected for nonthrombotic history: geographical and age distribution. Blood Coagul Fibrinolysis. 2009 Oct;20(7):503-10. DOI: 10.1097/ MBC.0b013e32832f5d7a
5. Bienvenu T, Ankri A, Chadefaux B, Montalescot G, Kamoun P. Elevated total plasma homocysteine, a risk factor for thrombosis. Relation to coagulation and fibrinolytic parameters, Thrombosis Research, 1993 April;70(2):123-25. DOI: 10.1016/0049-3848(93)90153-F
6. Spiroski I, Kedev S, Antov S, Arsov T, Krstevska M, Dzhekova-Stojkova S, et al. Methylenetetrahydrofolate reductase (MTHFR-677 and MTHFR-1298) genotypes and haplotypes and plasma homocysteine levels in patients with occlusive artery disease and deep venous thrombosis. Acta Biochim Pol. 2008;55(3):587-94. Epub 2008 Sep 18.
7. Quéré I, Chassé JF, Dupuy E, Bellet E, Molho-Sabatier P, Tobelem G, et al. Homocysteine, 5,10-methylenetetrahydrofolate reductase and deep venous thrombosis. Survey of 120 patients in internal medicine. Rev Med Interne. 1998 Jan;19(1):29-33. DOI: 10.1016/S0248-8663(97)83696-X
8. Simone B, Stefano VD, Leoncini E, Zacho J, Martinelli I, Emmerich J, et al. Risk of venous thromboembolism associated with single and combined effects of Factor V Leiden, Prothrombin 20210A and Methylenetethraydrofolate reductase C677T: a meta-analysis involving over 11,000 cases and 21,000 controls. Eur J Epidemiol. 2013 Aug 1;28(8):621-47. DOI: 10.1007/s10654-013-9825-8
9. Hickey SE, Curry CJ, Toriello HV. ACMG Practice Guideline: lack of evidence for MTHFR polymorphism testing. Genet Med. 2013 Feb;15(2):153-6. DOI: 10.1038/gim.2012.165
10. De Stefano V, Rossi E. Testing for inherited thrombophilia and consequences for antithrombotic prophylaxis in patients with venous thromboembolism and their relatives. A review of the Guidelines from Scientific Societies and Working Groups. Thromb Haemost. 2013 Oct;110(4):697-705. DOI: 10.1160/TH13-01-0011
11. Ilhan E, Demirci D, Güvenç TS, Calık AN. Acute myocardial infarction and renal infarction in a bodybuilder using anabolic steroids. Turk Kardiyol Dern Ars. 2010 Jun;38(4):275-8.
12. Choi BG, McLaughlin MA. Why men’s hearts break: cardiovascular effects of sex steroids. Endocrinol Metab Clin North Am. 2007 Jun;36(2):365-77. DOI: 10.1016/j.ecl.2007.03.011
13. Glueck CJ, Goldenberg N, Budhani S, Lotner D, Abuchaibe C, Gowda M.et al. Thrombotic events after starting exogenous testosterone in men with previously undiagnosed familial thrombophilia. Transl Res. 2011 Oct;158(4):225-34. DOI: 10.1016/j.trsl.2011.06.003