Testosterone and Apixaban: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Aug 8, 2026 · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Apixaban
Testosterone
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Taking Eliquis (apixaban) with testosterone can raise your risk of bleeding. Apixaban is a blood thinner, and testosterone can lower some of the natural clotting factors your body makes. When you put those two together, your blood may be a little slower to clot, so you could bruise or bleed more easily.
The good news is this is very manageable. Please don't stop or change either medicine on your own. Watch for things like unusual bruising, nosebleeds, pink or red urine, or black stools, and let your doctor or pharmacist know if you notice them. Your care team can keep an eye on you and adjust your plan as needed.
Effect: Increased bleeding risk with concomitant apixaban and testosterone (additive/pharmacodynamic).
- Mechanism: Testosterone suppresses hepatic synthesis of clotting factors (II, V, VII, X) and may affect plasma protein binding, augmenting anticoagulant effect. Neither drug is a prodrug.
- Direction: Enhanced anticoagulation/bleeding.
- Onset: Delayed. Evidence: Probable (largely derived from oral anticoagulant/17-alkylated androgen case reports).
- Management: Apixaban lacks a routine INR measure, so monitor clinically for bleeding, review CBC/hemoglobin, and reassess at testosterone initiation and discontinuation. Individualize therapy.
What happens
An increased risk of bleeding
Interaction Deep Dive
Taking testosterone alongside warfarin can raise the likelihood of bleeding. Several case reports have shown lengthened prothrombin time and hemorrhagic events when oral anticoagulants are given together with 17-alkylated androgens45678. According to reports, testosterone can suppress clotting factors II, V, VII, and X, potentially causing bleeding in patients who are also receiving anticoagulant therapy 3. When testosterone and warfarin must be used together, obtain INR determinations and intensify prothrombin time monitoring, especially at the start or cessation of testosterone treatment 231.
Why it happens (mechanism)
Modification of coagulation factor, hepatic synthesis, and competitive inhibition of plasma protein binding by testosterone
How to manage this interaction
Keep taking both medicines exactly as prescribed unless your doctor tells you otherwise. This interaction can be managed with closer attention from your care team.
- Your team may monitor you more closely, especially when testosterone is first started or later stopped, since your bleeding risk can shift at those times.
- Your doses may need to be adjusted and individualized by your care team.
- Watch for and promptly report signs of bleeding: easy bruising, nosebleeds, bleeding gums, pink or red urine, black or bloody stools, or unusual fatigue.
- Tell any new prescriber that you take both an anticoagulant and testosterone.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) It has been thoroughly documented that anabolic steroids produce significant interactions with dicumarol, which is another anticoagulant. Anabolic steroids increase the anticoagulant effect of dicumarol, possibly by decreasing the formation of clotting factors and increasing their breakdown. The 17-alpha-alkylated steroids (fluoxymesterone, oxandrolone, oxymetholone, methylTESTOSTERone, methandrostenolone, stanozolol) seem more prone to trigger this reaction than the non-substituted steroids 45678.
b) A marked increase in the anticoagulant effects of warfarin was reported in a 69-year-old woman after she used a vaginal ointment containing testosterone propionate. The mechanism behind this interaction is not clear 4.
Common questions
Can I take Testosterone and Apixaban together?
Combining apixaban (Eliquis) with testosterone can increase bleeding risk, so keep taking both as prescribed but watch for bleeding and let your care team monitor you closely, especially when testosterone is started or stopped. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Testosterone and Apixaban interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How is the Testosterone and Apixaban interaction managed?
Keep taking both medicines exactly as prescribed unless your doctor tells you otherwise. This interaction can be managed with closer attention from your care team. Your team may monitor you more closely, especially when testosterone is first started or later stopped, since your bleeding risk can shift at those times. Your doses may need to be adjusted and individualized by your care team. Watch fo… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
- Can You Take Baobab Fiber With Eliquis (Apixaban)?
- Can You Replace an Evening Apixaban Dose With Berberine?
- Can I Take Ginkgo With Apixaban (Eliquis) and Atorvastatin?
- Pharmacist Instructing To Reuse Single Dose Testosterone Vials
- Is Frozen Testosterone Still Safe To Use?
- Pharmacy Not Filling My Testosterone Prescription On Time
Questions for your pharmacist
- Does my dose of Testosterone or Apixaban need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (8)
- Product Information: AZMIRO intramuscular injection, testosterone cypionate intramuscular injection. Slayback Pharma LLC (per FDA), Princeton, NJ, 2024.
- Product Information: ANDROGEL(R) topical gel, testosterone topical gel. Unimed Pharmaceuticals,Inc, Marietta, GA, 2007. DailyMed
- Product Information: DELATESTRYL(R) IM injection, testosterone enanthate IM injection. Indevus Pharmaceuticals,Inc, Lexington, MA, 2007.
- Lorentz SM & Weibert RT: Potentiation of warfarin anticoagulation by topical testosterone ointment. Clin Pharm 1985; 4:332-334.
- Robinson BH, Hawkins JB, Ellis JE, et al: Decreased anticoagulant tolerance with oxymetholone. Lancet 1971; 1:1356. PubMed
- Longridge RG, Gillam PM, & Barton GM: Decreased anticoagulant tolerance with oxymetholone. Lancet 1971; 2:90. DOI
- Edwards MS & Curtis JR: Decreased anticoagulant tolerance with oxymetholone. Lancet 1971; 2:221. DOI
- Schrogie JJ & Solomon HM: The anticoagulant response to bishydroxycoumarin. II. The effect of D-thyroxine, clofibrate, and norethandrolone. Clin Pharmacol Ther 1967; 8:70-77. PubMed
Keep reading about Apixaban
Keep reading about Testosterone
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