Should You Worry About Blood Clots Before A Vasectomy? (TRT Q&As)
Timeline
Timestamp
Topic
00:00
Should I worry about blood clots if I am having a vasectomy while on testosterone?
Dr. O’Connor explains that clot risk depends more on the procedure, inflammation, immobility, age, genetics, previous clot history, and overall cardiovascular risk than on testosterone alone.
Dr. O’Connor explains that clot risk depends more on the procedure, inflammation, immobility, age, genetics, previous clot history, and overall cardiovascular risk than on testosterone alone.
08:09
Why do testosterone pellets sometimes extrude after insertion?
Pellet extrusion can occur despite reasonable technique because individual anatomy, activity level, insertion depth, and tissue characteristics may all contribute, and Dr. O’Connor generally prefers other testosterone delivery methods for men.
Pellet extrusion can occur despite reasonable technique because individual anatomy, activity level, insertion depth, and tissue characteristics may all contribute, and Dr. O’Connor generally prefers other testosterone delivery methods for men.
33:25
Could my testosterone dose be too high if I become sleepy when my levels peak?
A viewer using approximately 200 to 250 mg weekly reports post-meal fatigue and increased sleepiness near testosterone peaks, prompting Dr. O’Connor to question whether the weekly dose is excessive.
A viewer using approximately 200 to 250 mg weekly reports post-meal fatigue and increased sleepiness near testosterone peaks, prompting Dr. O’Connor to question whether the weekly dose is excessive.
48:20
Can I use testosterone if I am 45 and already have multiple coronary stents?
Dr. O’Connor emphasizes that severe premature coronary disease requires aggressive cardiovascular risk management and individualized evaluation before deciding how testosterone fits into the overall treatment plan.
Dr. O’Connor emphasizes that severe premature coronary disease requires aggressive cardiovascular risk management and individualized evaluation before deciding how testosterone fits into the overall treatment plan.
57:20
Should I use research peptides or nandrolone for a rotator cuff injury?
Dr. O’Connor discusses BPC-157, TB-500, and nandrolone but stresses the limited clinical evidence for research peptides and warns that reducing pain does not necessarily mean the underlying injury has healed.
Dr. O’Connor discusses BPC-157, TB-500, and nandrolone but stresses the limited clinical evidence for research peptides and warns that reducing pain does not necessarily mean the underlying injury has healed.
77:50
Does testosterone worsen benign prostatic hyperplasia?
Dr. O’Connor says testosterone may modestly affect prostate growth but does not automatically prevent a man with BPH from receiving TRT, provided dosing and prostate symptoms are monitored appropriately.
Dr. O’Connor says testosterone may modestly affect prostate growth but does not automatically prevent a man with BPH from receiving TRT, provided dosing and prostate symptoms are monitored appropriately.
Video Summary
A man on testosterone asks whether a vasectomy could increase his risk of a blood clot. Dr. O’Connor explains that clot risk depends heavily on the type of procedure, inflammation, immobility, personal history, genetics, age, and other risk factors rather than testosterone alone.
The Q&A also covers testosterone-related erythrocytosis and repeated phlebotomy, testosterone pellet extrusion, fatigue on higher-dose TRT, whether testosterone can be used after multiple coronary stents, and the potential use of peptides or nandrolone for a rotator cuff injury. Dr. O’Connor repeatedly emphasizes individualized risk assessment rather than relying on a single laboratory number or treatment rule.
Later questions address free testosterone targets, acne after stopping TRT, benign prostatic hyperplasia, tadalafil, cardiovascular risk, and estrogen management. Throughout the discussion, Dr. O’Connor stresses blood pressure, heart health, kidney health, cholesterol, red blood cells, and the broader ABCDs™ when evaluating long-term testosterone use.
Drug Callouts
Drug
Description
Testosterone
Testosterone is discussed throughout the Q&A in relation to clot risk, erythrocytosis, dosing, fatigue, cardiovascular disease, prostate health, estrogen effects, and long-term monitoring. Dr. O’Connor repeatedly emphasizes individualized dosing and cardiovascular risk assessment rather than treating testosterone levels in isolation.
Testosterone Pellets
Testosterone pellets are discussed after a healthcare provider asks why some patients experience pellet extrusion. Dr. O’Connor describes extrusion as a recognized problem and generally prefers more adjustable testosterone delivery methods for men.
Xarelto (Rivaroxaban)
Xarelto is discussed during the blood-clot portion of the Q&A as an anticoagulant used after significant venous thromboembolism. Dr. O’Connor contrasts stronger anticoagulation with aspirin-based prophylaxis and emphasizes balancing clot prevention against bleeding risk.
Eliquis (Apixaban)
Eliquis is discussed in the context of long-term anticoagulation after Dr. O’Connor’s previous postoperative pulmonary embolism. The discussion illustrates how treatment decisions after a major clot depend on the individual clinical situation rather than testosterone use alone.
Nandrolone
Nandrolone is discussed as a possible option someone is considering for a rotator cuff injury. Dr. O’Connor warns that pain relief or increased strength does not prove that the underlying tendon or joint injury has healed and may encourage premature return to training.
Tadalafil
Tadalafil is discussed as an FDA-approved treatment option for benign prostatic hyperplasia as well as erectile dysfunction. Dr. O’Connor considers it a useful option in men on testosterone who also have urinary symptoms, while noting that side effects and individual tolerance still matter.
Condition Callouts
Condition
Description
Deep Vein Thrombosis
DVT is discussed in relation to surgery, inflammation, immobility, age, genetics, and testosterone use. Dr. O’Connor emphasizes that clot risk in men on TRT should be assessed from the complete clinical picture rather than assuming an elevated hematocrit or testosterone therapy is the sole cause.
Pulmonary Embolism
Pulmonary embolism is discussed through Dr. O’Connor’s own postoperative experience after major hip surgery. The example illustrates how a provoked clot can occur from major tissue injury and impaired venous flow even when testosterone-related erythrocytosis is not clearly the primary cause.
Androgen-Induced Erythrocytosis
Elevated hemoglobin and hematocrit are discussed as common effects of testosterone therapy. Dr. O’Connor cautions against repeatedly phlebotomizing men based on one threshold without considering symptoms, iron status, cardiovascular risk, sleep apnea, testosterone dose, and prior clot history.
Atherosclerotic Cardiovascular Disease
A 45-year-old with multiple coronary stents asks whether testosterone can still be used. Dr. O’Connor emphasizes aggressive management of LDL, ApoB, Lp(a), blood pressure, glycemic risk, and overall cardiovascular disease before treating testosterone as a separate issue.
Benign Prostatic Hyperplasia
BPH is discussed as a condition that may be modestly influenced by testosterone and more strongly affected by greater androgen exposure. Dr. O’Connor says men with BPH do not automatically need to avoid TRT but should use conservative dosing and appropriate prostate monitoring.
Acne
Acne is discussed in a man who stopped TRT hoping his chest acne would resolve. Dr. O’Connor explains that testosterone-related acne can involve DHT, skin biology, genetics, and hormonal changes and may persist even after testosterone is discontinued.
Key Takeaways
- Blood-clot risk around surgery depends on the procedure, inflammation, immobility, genetics, age, prior clot history, and overall health rather than testosterone alone.
- Repeated phlebotomy for testosterone-related erythrocytosis should not be automatic because iron depletion and the complete cardiovascular risk profile also matter.
- Testosterone pellets can extrude even with reasonable insertion technique, making more adjustable testosterone delivery methods preferable for some men.
- Fatigue or excessive sleepiness near testosterone peaks may be a reason to reassess whether the TRT dose is higher than necessary.
- Men with established coronary artery disease require aggressive cardiovascular risk management before testosterone decisions are considered in isolation.
- Testosterone may modestly worsen BPH in some men, but the condition does not automatically prevent carefully monitored TRT.