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Osteonecrosis and central retinal vein occlusion thrombosis: 3 case reports In an observational case study, three women developed either osteonecrosis or central retinal vein occlusion thrombosis while receiving testosterone or estradiol/ testosterone for low libido. A 53-year-old postmenopausal woman received a patch that delivered testosterone 300 µg/day to improve libido. Eleven months later, bilateral hip osteonecrosis occurred. Coagulation tests showed 4G4G homozygosity of the plasminogen activator inhibitor (PAI-1) gene [outcome not stated]. A 54-year-old postmenopausal woman received an estradiol/testosterone 75mg/75mg SC implant to improve libido. Central retinal vein occlusion thrombosis developed 16 days later. Coagulation tests showed compound heterozygosity for the MTHFRC677T and A1298C mutations, along with thrombophilic high homocysteine, and 4G4G homozygosity of the PAI-1 gene [outcome not stated]. A 45-year-old woman, who had undergone oophorectomy 8 years previously, received an estradiol/testosterone 75mg/75mg SC implant to improve libido. One month later she experienced bilateral hip pain, and 2 months after receiving the implant she was diagnosed with osteonecrosis of both hips. Coagulation tests showed thrombophilic heterozygosity for the G20210A mutation of the prothrombin gene [outcome not stated]. Author comment: "Interaction of [testosterone]supplementation therapy in postmenopausal women with previously undiagnosed procoagulants led to thrombotic events, including [central retinal vein occlusion] thrombosis and [osteonecrosis]". "The temporal associations of exogenous [testosterone] or [estradiol/testosterone] led us to evaluated for underlying previously undiagnosed procoagulants". Glueck CJ, et al. Thrombosis in three postmenopausal women receiving testosterone therapy for low libido. Women’s Health 9: 405-10, No. 4, Jul 2013. 803095869 Available from: URL: http://dx.doi.org/10.2217/whe.13.31 - USA

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Reactions 23 Nov 2013 No. 1479