Blood Clots and Stroke: Warning Signs Every Lifter Should Know

Most side effects of anabolic steroids develop slowly and show up on bloodwork. Clots are different. A clot in a leg vein, the lungs, the brain or a heart artery can turn a normal day into an emergency within minutes. The people who do best are the ones who recognised the signs early and called for help immediately. This guide covers what to look for and why hormone users need to know it.

Why hormone users carry extra risk

Testosterone and other androgens stimulate red blood cell production. As hematocrit, the share of blood made up of red cells, climbs past about 52 to 54 percent, the blood becomes thicker and flows more slowly in small vessels. Androgens also affect platelets and clotting factors. A 2016 population study in the BMJ found the risk of venous clots was highest in the first six months of testosterone therapy.

Lifestyle adds to the risk:

• Dehydration from heavy sweating, diuretics or cutting water before a show concentrates the blood further.
• Long drives and flights, common for competitions and travel across Canada, leave leg veins still for hours.
• Injury or surgery means immobility and tissue damage, both strong clot triggers.
• Smoking and high blood pressure damage artery walls and make stroke and heart attack more likely.

Deep vein thrombosis (DVT)

A DVT is a clot in a deep vein, usually in the calf or thigh. Signs to watch for:

• Swelling in one leg, often around the calf or ankle
• Pain or tenderness, often described as a cramp that does not ease
• Warmth and redness or a darker colour over the area
• Visible surface veins that were not there before

A DVT is not always an ambulance call, but it needs medical assessment that day at an emergency department or urgent care clinic. An ultrasound confirms it, and treatment is usually blood-thinning medication for several months.

Pulmonary embolism (PE)

If part of a leg clot breaks off, it travels to the lungs. This is an emergency. Call 911 for:

• Sudden shortness of breath, at rest or with light effort
• Sharp chest pain that gets worse when you breathe in
• A racing heartbeat, light-headedness or fainting
• Coughing up blood

Stroke: think FAST

The Heart and Stroke Foundation of Canada teaches FAST:

Letter	Check
F: Face	Is one side of the face drooping?
A: Arms	Can both arms be raised and held up?
S: Speech	Is speech slurred or jumbled?
T: Time	Call 911 right away and note when symptoms started

Sudden severe headache, loss of vision in one eye, or sudden loss of balance can also signal a stroke. Clot-dissolving treatment works only within a few hours, so the time symptoms began matters.

Heart attack

Chest pressure or tightness, pain spreading to the arm, jaw or back, sweating, nausea and breathlessness are the classic signs. Younger people and women often have milder or unusual symptoms such as indigestion-like discomfort. Call 911. If you are not allergic, paramedics may tell you to chew an aspirin while you wait.

Lowering your risk

1. Know your hematocrit. Check a complete blood count before starting, after a few months and regularly afterwards.
2. Act on high numbers. Lowering the dose, stopping, or therapeutic phlebotomy arranged by a doctor brings hematocrit down.
3. Stay hydrated, especially with heavy training, heat or sauna use.
4. Move on long trips. Walk every hour or two on flights and stop on long drives; flex your calves while seated.
5. Control blood pressure with a home cuff and treatment if readings stay high.
6. Tell surgeons and dentists what you take before procedures.

Who should not take the risk

Anyone with a previous clot, a known clotting disorder such as factor V Leiden, a family history of early clots or stroke, or a heart rhythm problem should treat anabolic steroids as high risk and discuss any hormone use with a doctor first. Thrombosis Canada publishes plain-language guides for patients on clot prevention and treatment.