Figure - available from: Case Reports in Vascular Medicine
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CT angiogram abdominal aorta with right lower extremity runoff shows a globular filling defect at the mid and distal segment of the right SFA most consistent with an arterial embolus. The right profunda artery is grossly unremarkable. There is grossly adequate 3 vessel runoff. Left superficial femoral artery is grossly patent as well as popliteal artery with 3 vessels runoff. Both external iliac arteries are grossly patent. Both common femoral arteries are grossly patent.
Source publication
Present literature demonstrates an equivocal relationship between testosterone and thrombogenicity. Herein, we describe a case in which a patient used an unspecified amount and duration of exogenous testosterone injections, subsequently developing thrombotic events in his: right radial artery, right iliac artery, superficial femoral artery, splenic...
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Citations
... There have been several case reports in which patients who were taking androgenic steroids developed pulmonary embolisms, but the relationship is still poorly defined [11][12][13]. The typical risk factors for PE and DVTs are advanced age, malignancy, pregnancy, venous stasis, obesity, and heritable hypercoagulation disorders. ...
Androgen usage has widely increased in recent times via prescribed and unprescribed means. Testosterone is a popular androgen taken by both athletes and the general population. While there is some evidence of androgens being thrombogenic, we report on a 19-year-old male who presented to the hospital after the usage of testosterone for one month, leading to the development of multiple pulmonary emboli and deep vein thrombosis. The authors hope to elucidate the relationship between testosterone usage and thrombosis formation.
... Recent literature has been equivocal on the thrombogenicity of testosteronereplacement therapy (TRT). However, numerous case reports document the relationship between the use of TRT and hypercoagulable states that can lead to PE [4,5]. ...
... One case report had a similar patient without risk factors who also used a form of TRT that contained fenugreek as its active ingredient; like our patient, he too had a first-time bilateral PE [4]. An additional case report describes another patient without risk factors and negative thrombophilia screenings who directly used exogenous testosterone that ultimately led to a firsttime bilateral PE [5]. Based on this evidence, the lack of other risk factors in our patient, and the timing of our patient's supplement use, we have a high suspicion of Eroxin provoking PE. ...
Pulmonary embolism (PE) is a potentially fatal occurrence with a broad spectrum of risk factors. A 75-year-old male presented to the emergency room with five days of shortness of breath, back pain, and hemoptysis. A CT angiogram demonstrated bilateral pulmonary emboli with a larger thrombus on the right, as well as signs of right heart strain. The patient was started on IV heparin and ultimately underwent a successful embolectomy. Evaluation to determine the underlying etiology of this patient's first-time PE was performed to further stratify his risk of recurrence and the length of anticoagulation required. The provoking factor for his PE was initially unclear as he lacked any risk factors such as recent surgeries, periods of immobility, or previous diagnosis of malignancy. The patient was noted to be on an erectile dysfunction supplement called "Eroxin," and he had been taking it for the past six months. Eroxin contains an ingredient called fenugreek, which is believed to enhance testosterone levels by inhibiting aromatase and 5-alpha-reductase activity. Fenugreek has previously been associated with the formation of PEs, and likely contributed to the PE in this patient. This is likely due to testosterone-induced polycythemia and increased platelet aggregation. This case highlights the concern around supplements as their ingredients are poorly regulated and occasionally found to be tainted with unlisted ingredients. This also highlights the importance of gathering a complete supplement history from patients as their use can lead to serious illness. Lastly, it encourages considering testosterone use as a potential thrombogenic risk factor.
