Sun Sentinel Palm Beach Edition

Men with Factor V Leiden still can receive testostero­ne therapy

- Dr. Keith Roach Submit letters to ToYour GoodHealth@med.cornell. edu or to 628 Virginia Drive, Orlando, FL 32803.

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.

Dear R.C.: 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.

Dear K.J.W.: 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.

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