Abstract

BackgroundAcute portal vein thrombosis is a rare medical event usually seen in liver disease, but it can also occur due to any inherited or acquired procoagulable state that triggers venous occlusion. Hormonal therapies have been associated with an increased risk of prothrombotic states. This case report documents a portomesenteric venous thrombosis in a postmenopausal woman with testosterone implant for the treatment of hypoactive sexual desire and discusses the importance of identifying hypercoagulable risk factors before initiating hormone replacement therapy. We want to improve the awareness of an unusual medical complication associated with hormone replacement therapy and shed light on how testosterone implants could facilitate a thrombotic event related to other risk factors such as obesity and chronic hypoxic states, as well as the importance of differential diagnosis in the evaluation of postmenopausal women on testosterone replacement therapy presenting with acute abdominal pain.Case presentationA 55-year-old obese postmenopausal Hispanic female with medical history of chronic obstructive pulmonary disease presents with intractable abdominal pain, is found to have elevated hemoglobin and hematocrit, and an abdominopelvic computed tomography scan revealing portal and superior mesenteric vein thrombosis. Further evaluation excluded inherited and acquired thrombophilia but revealed elevated testosterone levels. The patient was treated with anticoagulation, which resulted in recanalization of the portal and superior mesenteric veins.ConclusionSupraphysiologic levels of testosterone caused by testosterone implants as a treatment of hypoactive sexual desire in postmenopausal women can contribute to thrombotic events in the presence of additional prothrombotic risk factors. Therefore, testosterone therapy should include a thorough risk assessment for prothrombotic states, be tailored to patients’ physiologic testosterone levels, and have close follow-up with testosterone level monitoring.

Highlights

  • Acute portal vein thrombosis is a rare medical event usually seen in liver disease, but it can occur due to any inherited or acquired procoagulable state that triggers venous occlusion

  • Supraphysiologic levels of testosterone caused by testosterone implants as a treatment of hypoac‐ tive sexual desire in postmenopausal women can contribute to thrombotic events in the presence of additional prothrombotic risk factors

  • We report a case that describes portomesenteric venous thrombosis in a postmenopausal female on testosterone therapy to treat hypoactive sexual desire

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Summary

Conclusion

Before starting TRT in postmenopausal women with hypoactive sexual desire, it is essential to do a thorough risk assessment for medical conditions as well as inherited and acquired prothrombotic states that may further increase the risk of venous thromboembolism. Testosterone treatment should be tailored to the female physiologic testosterone levels and include close monitoring of pre- and post-treatment testosterone levels

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