Venous disease

The use of androgen therapy in acute or chronic venous disease arises from their fibrinolytic effect, which may reduce venous fibrin plugging. One study of chronic venous insufficiency aiming to test whether androgen therapy would reduce the rate of venous ulceration involved 60 patients with venous skin changes but no ulceration being treated with below-knee compression stockings as standard therapy (McMullin et al. 1991). They were randomised to receive either stanozolol (10 mg daily) or placebo tablets for six months and androgen therapy produced a significant but modest reduction in the area of venous skin changes but no change in prospective rate of new ulcers or skin oxygenation. The side-effects comprised mostly virilisation presumably due to stanozolol treatment of women.

Another prospective two-centre study examined the role of androgen therapy in prevention of post-operative deep venous thrombosis (DVT). In this study 200 patients scheduled for elective major abdominal surgery were randomised into three groups (Zawilska etal. 1990). The first received inhaled heparin (800 units/kg) one day prior to surgery alone, a second group received the same dose of inhaled heparin plus a single injection of nandrolone phenylpropionate (50 mg) and the third group received standard heparin prophylaxis (5000 units twice daily sc). Treatments were from the day before surgery until the fifth post-operative day. Using daily 125I-fibrinogen scanning to detect DVT in 183 evaluable patients, there was no significant difference in post-operative DVT or clinically significant bleeding episodes among the three groups. Unfortunately the study had major between-centre differences and used a suboptimal detection method. It was also underpowered to reliably evaluate the claim that addition of nandrolone to nebulised heparin was as effective as standard heparin but with much lower bleeding risk. Larger and better designed studies of the effects of androgen therapy on venous disease in men seem warranted.

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