Men with factor V Leiden can still receive testosterone therapy

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? Does it cause clots? Or is it safe for me to do? -- R.C.

ANSWER: Factor V Leiden is a common genetic variant that increases a person’s risk for developing a blood clot. However, a person who has never had a blood clot, but who is identified as heterozygous (meaning they only have one copy of the gene, which is by far the more common scenario) for factor V Leiden is still not likely to have a blood clot during their lifetime, and is not recommended for treatment to prevent a blood clot.

Testosterone replacement therapy in men with FVL does increase the risk of blood clots in some studies, but not in others. In the studies that have shown an increase in risk, the risk has been estimated as approximately one person per thousand treated with testosterone each year. However, the risk occurs mostly during the first three months, and after two years on treatment, there is no additional risk. Thus, 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. Most of the men I have seen with this issue have elected to take the replacement.

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. -K. J.W.

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.

I want to emphasize that the benefit appears to be small. Of course, there aren’t any treatments right now ( not even the prescription medications for Alzheimer’s disease) that dramatically improve Alzheimer’s, so MCTs may be worth trying. They are generally well- tolerated, can be taken as a powder or an oil, but may cause nausea or diarrhea in a few people who take them.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell. edu or send mail to 628 Virginia Dr., Orlando, FL 32803.