Erythrocytosis Following Testosterone Therapy

Ohlander, Samuel; Varghese, Bibin; Pastuszak, Alexander W.

doi:10.1016/j.sxmr.2017.04.001

Cited by 129 publications

(101 citation statements)

References 87 publications

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“…In addition, trans men on testosterone undecanoate exhibited lower erythrocytosis rates (9.2% were >50 Hct %, and 0 were >52 Hct %), compared to trans men on testosterone esters (15.9% were >50 Hct %, and 6.8% were >52 Hct %) or gel (12.8% were >50 Hct %, and 2.6% were >52 Hct %). We were not able to correlate this finding with differences in testosterone levels, which might be explained by the fact that pharmacokinetic profiles of these formulations mostly differ with respect to peak concentrations and overall stability of serum concentrations (Ohlander et al ., ), parameters which were not measured in our study.…”

Section: Discussionmentioning

confidence: 64%

“…Comparative studies in hypogonadal men have shown that the rate of erythrocytosis is higher in men receiving short‐acting intramuscular injections, compared to transdermal or subcutaneous routes (Dobs et al ., ; Pastuszak et al ., ). An explanation might be found in the fact that short‐acting intramuscular injections cause a rapid supraphysiological peak shortly after injection, decreasing to low levels when the next injection is near, whereas transdermal systems and pellets result in more stable serum concentrations (Ohlander et al ., ). Administration of testosterone undecanoate, an oil vehicle‐based formulation which is injected intramuscularly every 12 weeks, results in more stable serum concentrations than intramuscular injections with testosterone esters (Schubert et al ., ).…”

Section: Discussionmentioning

confidence: 97%

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Prospective evaluation of hematocrit in gender‐affirming hormone treatment: results from European Network for the Investigation of Gender Incongruence

et al. 2018

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In trans persons on gender-affirming hormonal treatment, a decrease (in trans women) or increase (in trans men) in hematocrit is often observed. Reference ranges for evaluation of hematocrit levels in trans persons have not been established. This prospective cohort study is part of the European Network for the Investigation of Gender Incongruence (ENIGI). At the Ghent and Amsterdam sites, we included 625 hormone-naïve trans persons. Gender-affirming hormonal treatment was initiated at the first visit. In trans men, serum hematocrit (Hct) levels increased during the first year (+4.9 Hct %, 95% CI 3.82-5.25), with the most pronounced increase during the first 3 months (+2.7 Hct %, 95% CI 1.94-3.29). Trans men receiving testosterone esters had a larger increase in serum hematocrit levels compared to trans men receiving testosterone undecanoate (Δ 0.8 Hct %). Of 192 trans men, 22 (11.5%) developed serum hematocrit levels ≥50.0%. Trans men on testosterone undecanoate were less likely to develop hematocrit levels ≥50% or ≥52%, compared to trans men on testosterone esters, and were less likely to develop hematocrit levels ≥50%, compared to trans men on testosterone gel. In trans women, serum hematocrit had dropped by 4.1 Hct % (95% CI 3.50-4.37) after 3 months, after which only small decreases were observed. In conclusion, serum hematocrit levels can be found in the reference range of the perceived gender as from 3 months after the initiation of gender-affirming hormonal treatment.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 97%

Prospective evaluation of hematocrit in gender‐affirming hormone treatment: results from European Network for the Investigation of Gender Incongruence

et al. 2018

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“…Patients on IM therapy are at highest risk of erythrocytosis and, therefore, continued monitoring of HCT is most important in this subgroup. 23 Consideration should be given to switching these patients, particularly those who are already demonstrating signs of erythrocytosis, to lower doses or to topical agents. 24…”

Section: Virtual Visitmentioning

confidence: 99%

Clinical pearls to managing men’s health conditions during the COVID-19 pandemic

Witherspoon

Fitzpatrick²,

Patel³

et al. 2020

CUAJ

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“…Clearly, given data linking elevated haematocrit levels with increased morbidity/mortality, an evidence-based threshold value that can be used in clinical practice is needed. A further issue in using TTh may be the testosterone preparation and its mode of delivery[28]. A recent comprehensive review suggested short-acting, injectable testosterone is associated with greater risk of elevated haematocrit compared with other preparations[28].…”

mentioning

confidence: 99%

“…A further issue in using TTh may be the testosterone preparation and its mode of delivery[28]. A recent comprehensive review suggested short-acting, injectable testosterone is associated with greater risk of elevated haematocrit compared with other preparations[28]. This raises the possibility that the rate of change in serum testosterone concentration may be mechanistically important; short-acting injectable testosterone could lead to steeper rises and falls in hormone levels that in turn has effects on erthrocytosis.…”

mentioning

confidence: 99%

Testosterone Therapy: An Assessment of the Clinical Consequences of Changes in Hematocrit and Blood Flow Characteristics

König

Balabani

Hackett

et al. 2019

Sexual Medicine Reviews

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Introduction. Clinical guidelines indicate that haematocrit should be monitored during testosterone replacement therapy (TTh) with action taken if a level of 0.54 is exceeded. Aim. To consider the extent of changes in haematocrit and putative effects on viscosity, blood flow and mortality following TTh. Methods. We focused on literature describing benefits and possible pitfalls of TTh including increased haematocrit. We used data from the BLAST RCT to determine change in haematocrit after 30 weeks of TTh and describe a clinical case showing the need for monitoring. We consider the validity of the current haematocrit cutoff value at which TTh may be modified. Ways in which haematocrit alters blood flow in the micro-and macro-vasculature are also considered. Main Outcome Measures. (1) change in haematocrit, (2) corresponding actions taken in clinical practice and (3) possible blood flow changes following change in haematocrit. Results. Analysis of data from the BLAST RCT showed a significant increase in mean haematocrit of 0.01, the increase greater in men with lower baseline values. While, none of 61 men given TTh breached the suggested cutoff of 0.54 after 30 weeks, a clinical case demonstrates the need to monitor haematocrit. An association between haematocrit and morbidity and mortality appears likely but not proven and , may be evident only in patient subgroups. The consequences of an increased haematocrit may be mediated by alterations in blood viscosity, oxygen delivery and flow. Their relative impact may vary in different vascular beds. Conclusions. TTh can effect an increased haematocrit via poorly understood mechanisms and may have harmful effects on blood flow that differ in patient

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Erythrocytosis Following Testosterone Therapy

Cited by 129 publications

References 87 publications

Prospective evaluation of hematocrit in gender‐affirming hormone treatment: results from European Network for the Investigation of Gender Incongruence

Prospective evaluation of hematocrit in gender‐affirming hormone treatment: results from European Network for the Investigation of Gender Incongruence

Clinical pearls to managing men’s health conditions during the COVID-19 pandemic

Testosterone Therapy: An Assessment of the Clinical Consequences of Changes in Hematocrit and Blood Flow Characteristics

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