Medical Care Correction of the underlying cause of secondary polycythemia is the most important element of managment. KEY POINTS Testosterone therapy can cause secondary erythrocytosis. The association between testosterone replacement therapy and polycythemia has been reported for the past few years as this therapy has become more mainstream. To discuss potential etiologies for this response, the role it plays in risk for VTE, and recommendations for considering treatment in at‐risk populations. 155 (72%) were treated with i.m. Lightheadedness 5. A: This is something that is sure to come up with testosterone replacement therapy (TRT). Data suggest that testosterone therapy has effects that may counteract the potentially increased risk of venous thromboembolism. Erythrocytosis can cause symptoms of hyperviscosity, such as headache, fatigue, blurred vision and paresthesias. This increase in blood viscosity can reduce cerebral blood flow which could … This not only ensures the functionality of the HPTA but if polycythemia is a problem this will ameliorate or fix it. Jones SD Jr, Dukovac T, Sangkum P, Yafi FA, and Hellstrom WJG. Testosterone treatments are wonderfully effective in a variety of cases, but like any medical treatment, it must be administered with care by a medical professional. To review Hct and risk for thrombotic events. Fatigue 4. Introduction: A rapid increase in awareness of androgen deficiency has led to substantial increases in prescribing of testosterone therapy (TTh), with benefits of improvements in mood, libido, bone density, muscle mass, body composition, energy, and cognition. [3] Other causes testosterone replacement therapy [4] and heavy cigarette smoking. Published by Elsevier Inc. All rights reserved. Men with low to low-normal levels of testosterone have documented benefit from hormone replacement. It’s also suggested that the concurrent suppression of hepcidin via Testosterone, and elevated EPO, can lead to increased HCT 20; Testosterone lowers hepcidin, a regulator of iron bioavailability. Different testosterone formulations are available, with significantly different half-lives, which have varying influences on the development of secondary polycythemia. A literature review was performed through PubMed regarding TRT and erythrocytosis and polycythemia. This topic discusses the causes of polycythemia and our approach to evaluation and diagnosis. The most commonly reported adverse event in testosterone trials is polycythaemia. Men with low to low‐normal levels of testosterone have documented benefit from hormone replacement. This is an additional reason why I suggest individuals who are on TRT for low normal testosterone come off once every 12-18 months. Absolute polycythemia occurs when more RBCs are produced than normal and their count is truly elevated. In addition to increasing muscle and sex drive, testosterone can increase the body's production of red blood cells. Men receiving testosterone treatment should have their haematological variables monitored regularly and testosterone dose adjusted accordingly. Recent meta‐analyses have revealed that increases in hemoglobin (Hb) and hematocrit (Hct) are the variants most commonly encountered. This may include cessation … This study assessed the prevalence of polycythaemia in males receiving testosterone replacement and compared prevalence rates between different treatment preparations. To the extent that the increased RBCs alleviate tissue hypoxia, secondary polycythemia may in fact be beneficial. Sex Med Rev 2015;3:101–112. Recent meta‐analyses have revealed that increases in hemoglobin (Hb) and hematocrit (Hct) are the variants most commonly encountered. Diagnosing the specific cause of polycythemia is important for proper management of the patient. The risks associated with androgen replacement need further examination. Guy’s and St Thomas Hospital, London, UK. The risk of developing polycythemia secondary to exogenous testosterone (T) has been reported to range from 0.4% to 40%. Polycythemia refers to an increased hemoglobin concentration and/or hematocrit in peripheral blood. While our blood center could have made the decision to start charging for this service, we had to question whether participating in the treatment of the secondary effect of testosterone-induced polycythemia was passively supporting the real issue of broad overuse of TRT due to false advertising, which lacks sound scientific evidence. testosterone in the form of testosterone undecanoate (Nebido) or Sustanon. Recent meta-analyses have revealed that increases in hemoglobin (Hb) and hematocrit (Hct) are the variants most commonly encountered. Testosterone can also act directly on the bone marrow and increase the number of EPO-responsive cells 18,19. Ringing in the ears (tinnitus) 12. Conclusion: Polycythaemia is common in men receiving testosterone therapy, regardless of treatment modality. treatment group (19.4%) than the transdermal group (13.1%), as was peak haemoglobin concentration (15.58 vs 15.00 g/dl) though only the later was statistically significant (P<0.05). Mechanisms involving iron bioavailability, erythropoietin production, and bone marrow stimulation have been postulated to explain the erythrogenic effect of TRT. A raised PSA was defined as >4.4 μg/l. This risk should be weighed against the potential benefits prior to initiating therapy. One is polycythemia (also called erythrocytosis). Men undergoing TRT have a 315% greater risk for developing erythrocytosis (defined as Hct > 0.52) when compared with control. Polycythaemia was defined as at least one haemoglobin concentration ≥17 g/dl or packed cell volume ≥0.505. Secondary polycythemia most often develops as a response to chronic hypoxemia, which triggers increased production of erythropoietin by the kidneys.25 The most common causes of secondary polycythemia include obstructive sleep apnea, obesity hypoventilation syndrome, and chronic obstructive pulmonary disease (COPD). Clinically, this response is described as erythrocytosis or polycythemia secondary to TRT. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. Erythrocytosis and Polycythemia Secondary to Testosterone Replacement Therapy in the Aging Male. Primary polycythemia (polycythemia vera) is a spontaneous proliferation of RBCs in the bone marrow. ISSN 1470-3947 (print) | ISSN 1479-6848 (online) However, our experience has suggested a higher rate. Ruddy complexion 10. Background:Polycythemia is the most common adverse effect of testosterone replacement therapy (TRT) and may predispose patients to adverse vascular events.Current Canadian guidelines recommend regular laboratory monitoring and discontinuing TRT or reducing the dose if the hematocrit exceeds 54% (hemoglobin ≥180 g/L). Abstract Introduction: Secondary polycythemia is a known adverse effect of testosterone replacement therapy (TRT). Copyright © 2021 Elsevier B.V. or its licensors or contributors. Recent meta‐analyses have revealed that increases in hemoglobin (Hb) and hematocrit (Hct) are the variants most commonly encountered. Overall there was a positive correlation between peak haemoglobin concentration and mean total testosterone level (r(214)=0.138, P<0.05). Burning sensations of the hands or feet To assess the mechanisms of TRT‐induced erythrocytosis and polycythemia with regard to basic science, pharmacologic preparation, and route of delivery. TRT does have side effects. Biosci Abstracts Men with low to low‐normal levels of testosterone have documented benefit from hormone replacement. Causes Dehydration is a common cause of relative polycythemia. The association between TRT‐induced erythrocytosis and subsequent risk for VTE remains inconclusive. Contrary to other studies, no association was found between development of polycythaemia and older age. As the number of red blood cells grows, the blood can thicken, increasing the risk for stroke. Results: Overall, 38 men (17.6%) developed polycythaemia on at least one blood sample during the follow-up period. Polycythaemia is a common side-effect of testosterone therapy, regardless of treatment mode, and careful monitoring of haematological indices is required Rahila Bhatti, Belinda Grimmett, Maeve McCarthy, Tomas Agusttson, Barbara McGowan, Jake Powrie & Paul Carroll 453 views Clinical practice/governance and case reports. Men with low to low‐normal levels of testosterone have documented benefit from hormone replacement. The association between testosterone replacement therapy and polycythemia has been reported for the past few years as this therapy has become more mainstream. Confusion 11. We use cookies to help provide and enhance our service and tailor content and ads. Men with low to low‐normal levels of testosterone have documented benefit from hormone replacement. Recently, Lareb received a report concerning the development of secondary polycythemia while using testosterone therapy in a female-to-male (FTM) transgender patient. With polycythemia the blood becomes very viscous or "sticky," making it harder for the heart to pump. Endocrine Abstracts Privacy policy | Clinically, this response is described as erythrocytosis or polycythemia secondary to TRT. Visual disturbances 7. However, TTh can be limited by its side effects, particularly erythrocytosis. Implantable T pellets have been used since 1972, and secondary polycythemia has been reported to be as low as 0.4% with this administration modality. Headache 3. Weakness 2. High blood pressure, strokes and heart attacks can occur. To review the available literature on erythrocytosis and polycythemia secondary to TRT. Clinically, this response is described as erythrocytosis or polycythemia secondary to TRT. However, men’s testosterone levels gradually decline as they get older, too. The evidence regarding the risk for VTE with increased Hct is inconclusive. © Bioscientifica 2021 | Shortness of breath 6. Recent meta‐analyses have revealed that increases in hemoglobin (Hb) and hematocrit (Hct) are the variants most commonly encountered. To offer clinical suggestions for therapy in patients at risk for veno‐thrombotic events. Copyright © 2015 International Society for Sexual Medicine. In secondary polycythemia, 6 to 8 million and occasionally 9 million erythrocytes may occur per cubic millimeter of blood. Secondary causes of increased red blood cell mass (e.g., heavy smoking, chronic pulmonary disease, renal disease) are more common than polycythemia vera and must be excluded. Background: Testosterone replacement is the mainstay of treatment for male hypogonadism. Symptoms of secondary polycythemia are the same as those for primary polycythemia and may include: 1. Testosterone and High Red Blood Cell Count – Polycythemia The rise of testosterone replacement therapy has led to an increased instance of polycythemia. For patients with risk factors for veno‐thrombotic events, formulations that provide the smallest effect on blood parameters hypothetically provide the safest option. All TRT formulations cause increases in Hb and Hct, but injectables tend to produce the greatest effect. 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