Testosterone raises FVL clot risk

Dear Dr Roach: I have Factor V Leiden, but I have been wanting to do testosterone replacement therapy. I have heard that testosterone causes blood clots. Obviously, with FVL, that would be a huge deal for me. Is this true?

R.C.

Answer: Factor V Leiden is a common genetic variant that increases a person’s risk for developing a blood clot.

Testosterone replacement therapy in men with FVL does increase the risk of blood clots in some studies, but not in others. Roughly one man per 500 who has FVL and gets treated with testosterone will get a clot, according to the studies that show an increase in risk.

This is a small risk, but a blood clot is a significant potential problem. So the risk of getting a clot should certainly go into the discussion about whether to give testosterone replacement to a man with FVL and symptomatic low testosterone levels.

Dear Dr. Roach:

I would like to hear your views on the use of medium chain triglycerides (MCT) to slow down memory loss and dementia. Several articles I have read extol the biological process of MCTs, which, when ingested by an individual, are quickly converted into ketones that provide energy to brain cells. It seems logical to provide such neurobiological support to brain cells to help keep the brain working longer.

Answer:

There is some evidence that medium chain triglycerides slow progression of dementia in people with Alzheimer’s disease, although the degree of benefit seen was small. There is no evidence that ingesting

MCTs will prevent getting dementia in the first place.

Not every treatment that is used to treat a condition will be effective at preventing it. My opinion, based on what is known about what causes Alzheimer’s and other forms of dementia, is that MCTs are not likely to prevent them, but they may be useful at slowing progression of the disease in people with existing dementia.