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Thrombosis in the family? Careful with those steroids...

If there is a history of thrombosis in your family, you might want to think twice before using anabolic steroids. There's a good chance that a cycle of steroids will mess things up for you in a big way. This is the conclusion you would draw if you were to read the case study that haematologists at Weill Cornell Medicine in New York published in Blood Coagulation & Fibrinolysis.

Blood clots from steroids
If you browse the medical literature you'll find dozens of cases of steroids users developing dangerous blood clots. But why do these affect one steroids user and not the other? It probably depends on your genes, doctors usually say. But they don't know for sure.

What's special about the study that the New York haematologists are about to publish is that they do know for sure that genetic propensity plays a role. The leading figure in their study is a 20-year-old bodybuilder, of whom it was already known when he was 15 that he had a 'bad' antithrombin protein gene. [Spatial structure of this protein is shown below.] Antithrombin ensures that blood doesn't clot when it doesn't need to.

Wrong genes
Thrombosis in the family? Careful with those steroids...
The father of the bodybuilder had the same 'bad' gene. He had had a dangerous blood clot in his leg, as his sister the bodybuilder's aunt had had after giving birth. His father had also had pulmonary embolism [a blood clot in his lungs] and his aunt had had a stroke.

Doctors had discovered five years previously that the bodybuilder had too little antithrombin when they analysed his blood. Because the guy was healthy despite the low concentration, he didn't have to take any medication. But when he started to use the testosterone preparation Sustanon five years later, things went wrong within five weeks.

Coughing blood
The bodybuilder injected himself twice a week with 250 mg Sustanon. Initially he had no problems, but in the fourth week of the course he started to become short of breath, particularly when exercising. He had palpitations and started coughing blood, so he went to hospital.

Scans showed blood clots in the bodybuilder's legs and lungs and the doctors discovered that his heart was malfunctioning. His heart capacity had decreased by three-quarters.

Blood thinners
The doctors put the bodybuilder on a drip and gave him heparin, a blood thinner, and synthetic thrombonin. They removed clots in critical veins by surgically introducing tissue plasminogen activator.

The treatment was successful. The clots disappeared and the bodybuilder's heart capacity improved. The bodybuilder was able to return home after a week, but had to keep taking blood thinners for a couple of weeks. When the doctors saw him eight months later he was completely healthy.

What had happened?
Testosterone and probably other anabolic steroids too boosts the amount of thromboxane A2 receptors in blood platelets. [Circulation 1995; 91:27422747.] Because this receptor plays a key role in blood clotting, testosterone supplementation can increase the chance of blood clots forming.

Estradiol also boosts the likelihood of blood clot formation. Because testosterone is converted into estradiol in the body it can indirectly increase the chance of thrombosis.

And lastly, testosterone stimulates the production of EPO. [Nephron. 1995;70(3):282-6.] EPO makes the blood thicker and thus also increases the chance of blood clots developing.

"Therefore, a combined increase in platelet aggregability, and an elevated hematocrit in anabolic steroid users will contribute to the increased risk of thrombosis", the researchers wrote. "Our case highlights the need for young male carriers of known thrombophilias to exercise caution prior to the use of anabolic steroids."

Blood Coagul Fibrinolysis. 2016 Sep;27(6):717-9.

Blood clots in the heart destroy bodybuilder's liver 16.07.2009

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