SUN-099 “When T stands for Thrombosis: A rare case of Testosterone-induced Hematological Havoc”

Abstract Disclosure: R. Nadeem: None. D. Tahir: None. M. Herrera: None. F. Pooja: None. P.B. Frechie: None. Introduction:Increased public awareness of androgen deficiency along with the beneficial outcomes of testosterone therapy has raised concerns for androgen overprescription, abuse and adverse effects. Although limited published evidence supports an elevated risk of blood clots, especially in younger adults, we report a case of a 38-year-old male with acute-onset cerebrovascular accident, myocardial infarction, extensive renal infarct and acute limb ischemia secondary to testosterone induced erythrocytosis.Case Presentation:The patient was a 38-year-old male with past medical history of type 2 diabetes, hypertension, and hypogonadism on intramuscular testosterone for one month, who presented with acute-onset confusion and right sided weakness. His blood work was remarkable for hemoglobin of 20 g/dL, previously 14g/dl a month ago, and hematocrit of 54%. CT head without contrast showed left sided middle cerebral artery infarct, requiring mechanical thrombectomy, complicated by intracranial hemorrhage while on dual antiplatelet therapy (DAPT). Following DAPT interruption, he developed an acute ST elevation myocardial infarction with multivessel occlusion requiring stenting. Echo revealed ischemic cardiomyopathy and a newly formed left ventricular thrombus. DAPT therapy was resumed, along with heparin. The patient’s medical history lacked constitutional symptoms suggesting any primary hematologic cause for erythrocytosis. He was a non-smoker and had no personal or family history for vascular, cardiac or lung disease. Further blood work showed normal erythropoietin levels, negative JAK2 mutation, with no concern of steroid or anabolic drug abuse - except for the testosterone replacement therapy. His hospital stay was complicated by gastrointestinal bleeding, acute left renal artery occlusion and extensive right external iliac infarction threatening ipsilateral limb ischemia. His hematocrit and hemoglobin normalized following the gastrointestinal bleeding and remained normal thereafter, with no further clotting seen.Discussion:This case demonstrates the potential for severe and rapid-onset complications with testosterone use, even in young individuals over a short period. It emphasizes the importance of careful monitoring during therapy and consideration of risk regardless of age. Current studies do indicate a potential link between blood hyper viscosity and thromboembolic complications, but the evidence stays inconclusive with lack of evidence-based guidelines on the management of testosterone induced erythrocytosis and expert consensus varying. The case also highlights the need for larger well designed clinical trials, as existing studies are limited by smaller sample size and lack of direct correlation between testosterone therapy-induced erythrocytosis and thromboembolic events. Presentation: Sunday, July 13, 2025