Testosterone replacement therapy (TRT) is a common treatment for hypogonadism in aging males. Absolute polycythemia occurs when more RBCs are produced than normal and their count is truly elevated. Visual disturbances 7. However, TTh can be limited by its side effects, particularly erythrocytosis. To the extent that the increased RBCs alleviate tissue hypoxia, secondary polycythemia may in fact be beneficial. For patients with risk factors for veno‐thrombotic events, formulations that provide the smallest effect on blood parameters hypothetically provide the safest option. As the number of red blood cells grows, the blood can thicken, increasing the risk for stroke. Background: Testosterone replacement is the mainstay of treatment for male hypogonadism. TRT does have side effects. Secondary Polycythemia. Searchable abstracts of presentations at key conferences in endocrinology. Recent meta‐analyses have revealed that increases in hemoglobin (Hb) and hematocrit (Hct) are the variants most commonly encountered. 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). Clinically, this response is described as erythrocytosis or polycythemia secondary to TRT. Guy’s and St Thomas Hospital, London, UK. 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). Shortness of breath 6. Men with low to low‐normal levels of testosterone have documented benefit from hormone replacement. Symptoms of secondary polycythemia are the same as those for primary polycythemia and may include: 1. The evidence regarding the risk for VTE with increased Hct is inconclusive. 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 Abstract Introduction: Secondary polycythemia is a known adverse effect of testosterone replacement therapy (TRT). Absolute polycythemia may be primary or secondary. This increase in blood viscosity can reduce cerebral blood flow which could … The risks associated with androgen replacement need further examination. This topic discusses the causes of polycythemia and our approach to evaluation and diagnosis. KEY POINTS Testosterone therapy can cause secondary erythrocytosis. Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences. 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. Copyright © 2021 Elsevier B.V. or its licensors or contributors. [3] Other causes testosterone replacement therapy [4] and heavy cigarette smoking. To review Hct and risk for thrombotic events. 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. Sex Med Rev 2015;3:101–112. Medical Care Correction of the underlying cause of secondary polycythemia is the most important element of managment. ISSN 1470-3947 (print) | ISSN 1479-6848 (online) The association between testosterone replacement therapy and polycythemia has been reported for the past few years as this therapy has become more mainstream. Men undergoing TRT have a 315% greater risk for developing erythrocytosis (defined as Hct > 0.52) when compared with control. Endocrine Abstracts Headache 3. Further trials are needed to fully evaluate the hematological side effects associated with TRT. Confusion 11. Pain in the chest or leg muscles 9. In addition to increasing muscle and sex drive, testosterone can increase the body's production of red blood cells. Overall there was a positive correlation between peak haemoglobin concentration and mean total testosterone level (r(214)=0.138, P<0.05). However, the recent Food and Drug Administration warning regarding the risk for venothromboembolism (VTE) has made the increases in Hb and Hct of more pertinent concern. The increase in hemoglobin and hematocrit secondary to testosterone use is usually accompanied by an increase in the red blood cell count, which can lead to an increase in blood viscosity. Men with low to low-normal levels of testosterone have documented benefit from hormone replacement. Erythropoietin-secreting tumors (eg, hepatocellular carcinoma, renal cell carcinoma, adrenal a… Erythrocytosis and polycythemia secondary to testosterone replacement therapy in the aging male. Itching (pruritus) 8. Contrary to other studies, no association was found between development of polycythaemia and older age. 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. 155 (72%) were treated with i.m. Transgender men use supplemental testosterone to promote the development of male secondary sex characteristics including male pattern hair growth, muscle development, and the cessation of uterine bleeding 8. Testosterone can also act directly on the bone marrow and increase the number of EPO-responsive cells 18,19. Cookie settings. testosterone in the form of testosterone undecanoate (Nebido) or Sustanon. Burning sensations of the hands or feet 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. Data suggest that testosterone therapy has effects that may counteract the potentially increased risk of venous thromboembolism. To offer clinical suggestions for therapy in patients at risk for veno‐thrombotic events. Ruddy complexion 10. Polycythemia refers to an increased hemoglobin concentration and/or hematocrit in peripheral blood. © Bioscientifica 2021 | In secondary polycythemia, your EPO level will be high and you’ll have a high red blood cell count. However, our experience has suggested a higher rate. Conclusion: Polycythaemia is common in men receiving testosterone therapy, regardless of treatment modality. Mechanisms involving iron bioavailability, erythropoietin production, and bone marrow stimulation have been postulated to explain the erythrogenic effect of TRT. The rate of polycythaemia was higher in the i.m. Men with low to low‐normal levels of testosterone have documented benefit from hormone replacement. Recent meta‐analyses have revealed that increases in hemoglobin (Hb) and hematocrit (Hct) are the variants most commonly encountered. Men with low to low‐normal levels of testosterone have documented benefit from hormone replacement. This may include cessation … Copyright © 2015 International Society for Sexual Medicine. High blood pressure, strokes and heart attacks can occur. Polycythemia is sometimes called erythrocytosis, but the terms are not synonymous because polycythemia refers to any increase in red blood cells, whereas erythrocytosis only refers to a documented increase of red cell mass. In secondary polycythemia, 6 to 8 million and occasionally 9 million erythrocytes may occur per cubic millimeter of blood. 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. Secondary polycythemia - also called reactive polycythemia - is characterized by excessive production of circulating red blood cells (RBCs) due to hypoxia, tumor, or disease.It occurs in about 2 out of every 100,000 persons who live at or near sea level; incidence increases among people who live at high altitudes. Clinically, this response is described as erythrocytosis or polycythemia secondary to TRT. Men with low to low‐normal levels of testosterone have documented benefit from hormone replacement. One is polycythemia (also called erythrocytosis). Men receiving testosterone treatment should have their haematological variables monitored regularly and testosterone dose adjusted accordingly. The association between testosterone replacement therapy and polycythemia has been reported for the past few years as this therapy has become more mainstream. Primary polycythemia (polycythemia vera) is a spontaneous proliferation of RBCs in the bone marrow. Anabolic steroids have been shown to increase erythropoiesis causing secondary polycythemia.7 To our knowledge, this case is the first documented report of an AAS-induced stroke with symptoms of Gerstmann syndrome, although other areas of stroke might have been reported. Jones SD Jr, Dukovac T, Sangkum P, Yafi FA, and Hellstrom WJG. The author(s) report no conflicts of interest. Secondary polycythemia is caused by either natural or artificial increases in the production of erythropoietin, hence an increased production of erythrocytes. To review the available literature on erythrocytosis and polycythemia secondary to TRT. Fatigue 4. Lightheadedness 5. Ringing in the ears (tinnitus) 12. By continuing you agree to the use of cookies. This risk should be weighed against the potential benefits prior to initiating therapy. A: This is something that is sure to come up with testosterone replacement therapy (TRT). This study assessed the prevalence of polycythaemia in males receiving testosterone replacement and compared prevalence rates between different treatment preparations. The remaining 61 (28%) men were treated with transdermal testosterone gel. Privacy policy | Testosterone and High Red Blood Cell Count – Polycythemia The rise of testosterone replacement therapy has led to an increased instance of polycythemia. The most commonly reported adverse event in testosterone trials is polycythaemia. Clinically, this response is described as erythrocytosis or polycythemia secondary to TRT. A literature review was performed through PubMed regarding TRT and erythrocytosis and polycythemia. We use cookies to help provide and enhance our service and tailor content and ads. Recently, Lareb received a report concerning the development of secondary polycythemia while using testosterone therapy in a female-to-male (FTM) transgender patient. Published by Elsevier Inc. All rights reserved. Methods: 216 men were included in this retrospective observational study conducted from January 2009 to December 2012. Biosci Abstracts Weakness 2. 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). To discuss potential etiologies for this response, the role it plays in risk for VTE, and recommendations for considering treatment in at‐risk populations. However, men’s testosterone levels gradually decline as they get older, too. To assess the mechanisms of TRT‐induced erythrocytosis and polycythemia with regard to basic science, pharmacologic preparation, and route of delivery. Severe, chronic polycythemia secondary to increased blood viscosity can raise pulmonary arterial pressure and cause increased pulmonary resistance with potential hypoxia, resulting in cor pulmonale. Recent meta-analyses have revealed that increases in hemoglobin (Hb) and hematocrit (Hct) are the variants most commonly encountered. Clinical practice/governance and case reports. Clinically, this response is described as erythrocytosis or polycythemia secondary to TRT. Causes Dehydration is a common cause of relative polycythemia. Polycythaemia was defined as at least one haemoglobin concentration ≥17 g/dl or packed cell volume ≥0.505. Data were collected on haemoglobin concentrations, packed cell volumes, gonadotrophins, total serum testosterone concentrations and prostate-specific antigen (PSA) levels. Clinically, this response is described as erythrocytosis or polycythemia secondary to TRT. The association between TRT‐induced erythrocytosis and subsequent risk for VTE remains inconclusive. A raised PSA was defined as >4.4 μg/l. With polycythemia the blood becomes very viscous or "sticky," making it harder for the heart to pump. Recent meta‐analyses have revealed that increases in hemoglobin (Hb) and hematocrit (Hct) are the variants most commonly encountered. This not only ensures the functionality of the HPTA but if polycythemia is a problem this will ameliorate or fix it. Diagnosing the specific cause of polycythemia is important for proper management of the patient. All TRT formulations cause increases in Hb and Hct, but injectables tend to produce the greatest effect. This is an additional reason why I suggest individuals who are on TRT for low normal testosterone come off once every 12-18 months. Some take testosterone to manage symptoms like low libido, moodiness, and fatigue. 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. Erythrocytosis can cause symptoms of hyperviscosity, such as headache, fatigue, blurred vision and paresthesias. Secondary erythrocytosis, which is more common than PV, has a broad differential diagnosis that includes hypoxic lung disease, cyanotic congenital heart disease, medications (e.g., testosterone) and erythropoietin-producing malignant disorders. Different testosterone formulations are available, with significantly different half-lives, which have varying influences on the development of secondary polycythemia. Recent meta‐analyses have revealed that increases in hemoglobin (Hb) and hematocrit (Hct) are the variants most commonly encountered. The risk of elevated hematocrit seen in patients with polycythemia vera cannot be extrapolated to hematocrit elevations seen during testosterone therapy in men without blood cancer or genetic mutations. No relationship was found between PSA and mode of treatment or total testosterone concentration. Results: Overall, 38 men (17.6%) developed polycythaemia on at least one blood sample during the follow-up period. 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. 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