Sunday, February 25, 2024

How To Manage Polycythemia Caused By Testosterone Replacement Therapy

Areas For Future Research

How I Manage Men on Testosterone Replacement Therapy (TRT)

With many questions regarding hematological parameters and TRT remaining unanswered, larger, multicenter prospective trials are warranted to better assess the risks of increased Hb and Hct as side effects of TRT. Furthermore, a complete understanding of the androgenic stimulation of erythropoiesis from a basic science perspective would allow for the development of therapies with fewer adverse effects. One alternative option to TRT that currently exists is the use of antiestrogens (i.e., ER

Hematocrit Trt Study Material And Methods

264 patients were admitted to the sleep unit to undertake a polysomnographic evaluation and were subsequently diagnosed with OSAS. 116 of these patients met the criteria of the study and agreed to participate. These patients reported frequent unpleasant symptoms such as daytime sleepiness, severe snoring at nighttime, etc.

The exclusion criteria left out patients who had various types of medical conditions that might have interfered with the results of the study. For example, patients who had known cardiovascular diseases, were smokers, had diabetes mellitus, lung disease or hypertension were not included in the study.

The 116 patients who participated in the study were divided into several groups, depending on the apnea-hypopnea index which basically indicates the severity of the sleep apnea. There were 3 groups mild , moderate and severe . There was also a control group of 62 individuals who had an apnea-hypopnea index of less than 5.

The study was performed using polysomnographic methods. Researchers have attached suprasternal microphones to assess the airflow of the patients during sleep. Blood samples were also drawn using a 21-gauge needle syringe after a fasting period of 8 hours. The apnea was defined as a stop of airflow for 10 seconds or more during sleep. Hypopnea was defined as a reduction of airflow between 30% and 50% as well as a decrease in capillary oxygen saturation.

Testosterone Replacement Therapy And Polycythemia In Hiv

A research letter recently published in the journal AIDS by Vorkas et al determined that testosterone use was associated with polycythemia, and intramuscular administration demonstrated a stronger association than topical use. No adverse cardiovascular or thrombotic events were observed. HIV-infected patients taking testosterone should undergo routine hematologic monitoring with adjustment of therapy when appropriate.

Polycythemia is an excessive production of red blood cells. With polycythemia the blood becomes very viscous or “sticky,” making it harder for the heart to pump. High blood pressure, strokes and heart attacks can occur.

The association between testosterone replacement therapy and polycythemia has been reported for the past few years as this therapy has become more mainstream. In addition to increasing muscle and sex drive, testosterone can increase the body’s production of red blood cells. This hematopoietic effect could be a good thing for those with mild anemia.

Although all testosterone replacement products can increase the amount of red blood cells, the study showed a higher incidence of polycythemia in those using intramuscular testosterone than topical administration . Smoking has also been associated with polycythemia and may contribute to the effects of other risk factors.

Below is an excerpt from my book, Testosterone: A Man’s Guide, further detailing the prevention and management of polycythemia.

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Trt Has The Potential To Cause Polycythemia

While individuals undergoing Testosterone Replacement Therapy often experience symptom improvement and an enhanced quality of life, there are some potential negative effects.

One is that TRT can occasionally have a blood-building effect, in which the body makes extra red blood cells. This can be beneficial for persons suffering from mild anemia. However, in those who do not have anemia, it can cause the blood to become viscous or sticky, making it difficult for the heart to pump. Polycythemia is the medical term for this illness.

Polycythemia can cause hypertension and, in some cases, an elevated risk of stroke and heart attack.

Although not every TRT patient is affected by this illness, it is critical to be aware of it and to engage in regular monitoring and preventative care to avoid consequences.

If you are taking TRT, your doctor should regularly monitor your hemoglobin and hematocrit levels through periodic bloodwork to detect any signs of polycythemia. If your results reflect this condition, there are options to control TRT-induced polycythemia.

Another Option To Treat Polycythemia: Donating Blood

A Review of Testosterone Therapy and Effect on Hemoglobin and ...

Healthy patients who are eligible to donate blood can take this route. Since the process is very similar to therapeutic phlebotomy, it typically has the same effect.

Eligibility requirements for donating blood usually include:

  • Being in good health without conditions like common colds, HIV, Hepatitis, and other illnesses or infections.
  • Avoiding travel outside of the country to areas with high Malaria risk.
  • Having adequate iron levels, without anemia.
  • Other requirements depending on the organization collecting blood.

Whole blood donors can typically donate every eight weeks, or up to six times per year.

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Why We Need Rbcs & How They Are Made A Quick Physiology Lesson

Youve probably noticed that blood is coloured in some shade of red. This is because the main constitute of our blood is the haemoglobin of RBCs, which is a protein that forms a complex with iron molecules. Haemoglobin is composed of four polypeptides , with each bound to the red pigmented haem. Each haem binds oxygen to the iron ferrous molecule . Each polypeptide changes shape when an oxygen molecule binds to it, facilitating the binding of another oxygen molecule at another haem site. This makes a complex of haem and O2, which is transported from the lungs to tissue. Carbon dioxide will bind to the polypeptide chains and change the shape of the haemoglobin again to release the O2. The CO2 is then transported to the lungs in the bloodstream, to be breathed out . The exchange of O2 and CO2 depends on the tissue and the concentration of the gases the lungs have more O2 and less CO2, whereas its the opposite in other tissue. RBC facilitate this entire process and are therefore essential to ensure you stay alive.

The structure of haemoglobin and an RBC looks a bit like the below, where CO2 will bind to the polypeptide, and O2 binds to the haem group :

How RBCs Are Made

RBCs come from our bone marrow, and the term that describes the production of RBCs is called erythropoiesis. Youve probably heard of stem cells, and thats where we start with the process of making RBCs. Stem cells can turn into any cell in the body, if programmed to do so.

Lower Urinary Tract Symptoms

Although androgens are thought to play a large role in prostate development, no difference in prostatic androgens has been noted in men with and without benign prostatic hyperplasia . Many physicians may be concerned about TRT in the setting of BPH however, multiples studies have demonstrated either no change or improved parameters of voiding and LUTS in patients with BPH undergoing TRT, and thus, BPH should not be a contraindication to TRT in the setting of AOH .

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Erythrocytosis And Polycythemia As Adverse Drug Events During Trt

Contemporary controversy surrounding TRT centers on the risk for potential venous thromboembolism . The Food and Drug Administration recently mandated that testosterone manufacturers include a warning label stating that testosterone may increase risk of VTE . It has been proposed that the risk for VTE was due to the secondary blood profile changes however, reports of VTE not associated with erythrocytosis or polycythemia have questioned this notion. As the

Why Is Polycythemia A Potential Side Effect Of Trt

How to Prevent High Hematocrit From TRT – High Hematocrit on Testosterone Replacement Therapy

As Testosterone Replacement Therapy becomes increasingly popular, there has been an increase of reports associating TRT with polycythemia.

But why does TRT potentially lead to polycythemia?

In addition to regulating body composition and sex drive, Testosterone can increase the body’s production of red blood cells . When you raise your Testosterone levels, you may also increase your RBC count.

Although all Testosterone delivery systems can increase the amount of red blood cells, studies show a higher incidence of polycythemia in those using intramuscular Testosterone injections compared to Testosterone patches.

Smoking has also been associated with polycythemia and may contribute to this condition. If youre a smoker and youre on TRT, consider a smoking cessation program.

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A Study Conducted On 235 Men Concluded That Frequent Blood Donors Can Develop Iron Deficiency

The group of 235 men was separated into 3 categories control group with no donations, group 2 with 2 donations per year and group 3 with 3 donations per year. The age of the donors was between 17 and 65 years and their hemoglobin values were higher than 12.5 g/dl. Donors who took iron supplements before were excluded from this study to avoid interfering with the results.

Is Trt Right For You

If you are considering TRT, it is important to make sure that you are healthy enough to undergo treatment. TRT can be a risky proposition for men who have heart disease, liver disease, or kidney disease. In addition, TRT can interact with certain medications, so it is important to make sure that your doctor is aware of all the medications you are taking before starting treatment.

TRT is not for everyone, and it is important to weigh the potential risks and benefits before starting treatment. However, for men who have low testosterone levels and are experiencing symptoms as a result, TRT may be an effective treatment method.

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Are There Other Treatments For Polycythemia

For general heart health and to help prevent heart attacks, some doctors may recommend daily aspirin and/or omega-3 fatty acids .

These can be an important part of a heart health regimen, but they are not typically alternatives for therapeutic phlebotomy if you have polycythemia and want to continue TRT.

There are prescription medications that slow the production of red blood cells directly, but patients often prefer trying therapeutic phlebotomy first. The latter has a good safety profile and has been shown to be effective for many patients.

Caution About Frequent Blood Donations:

How To Lower Blood Pressure On Trt

The study presented evidence that donating blood more than once or twice per year can significantly deplete iron stores and can lead to anemia. Moreover, the medical industry relies on donations of a healthy supply of blood rich in iron, so certain donors might not be eligible for repeat donations.

Likewise, measuring the hemoglobin level only might not be a reliable indicator of a person being suitable for blood donation or not. The ferritin levels should also be taken into account to prevent anemia in various donors.

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Polycythaemia Secondary To Hormone Replacement Therapy With Tibolone

Philip Young-Ill Choi


We present the case report of a patient with severe polycythaemia associated with tibolone. In our 65-year-old postmenopausal patient who initially presented with haemoglobin 203g/L and haematocrit 0.63 , the cessation of tibolone, a synthetic hormone replacement therapy, led to a dramatic and sustained resolution of this patients polycythaemia to normal haematological values. Tibolone possesses oestrogenic, androgenic, and progestogenic properties. Tibolone therapy may be an infrequently recognized contributor towards polycythaemia in postmenopausal patients presenting to haematology clinics.

1. Introduction

Polycythaemia secondary to testosterone replacement therapy has been well described however we present a case of tibolone-associated polycythaemia.

Tibolone is a synthetic steroid prodrug used to relieve menopausal symptoms and to reduce bone demineralization . It is variably metabolized into three predominant metabolites: 4-isomer and 3– and 3-hydroxytibolone . The 4-isomer has strongest progestogenic and androgenic activity, while 3-hydroxytibolone possesses the most potent oestrogenic activity via oestrogen receptor .

Tibolone has previously been demonstrated to be associated with minor elevations in Hb and Hct . However, cases of severe polycythaemia have not been reported in the literature to our knowledge.

2. Case Presentation

3. Discussion

4. Conclusion

Conflicts of Interest

How Frequently Should I Donate Blood Or Get Therapeutic Phlebotomy

The frequency of phlebotomy is determined by individual characteristics, and your clinician should collaborate with you to build a personalized plan.

A blood draw every two to three months is usually suggested for TRT patients who have polycythemia. It is critical not to overdraw blood, as this might result in anemia, iron shortage, and other complications.

After starting therapeutic phlebotomy, you and your provider should continue to monitor your hematocrit and hemoglobin levels. Your test findings aid in determining if the treatment is adequate.

Regular blood tests can also tell you if your red blood cell production has stabilized. RBC production can sometimes return to normal without a clear cause.

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Are There Any Long

There is some concern that long-term use of testosterone replacement therapy may cause adverse health effects. In particular, there is some concern that TRT may increase the risk of heart disease, stroke, and prostate cancer. However, more research is needed to determine whether TRT actually causes these adverse health effects.

Are There Natural Ways To Increase Testosterone Levels

Low Testosterone (Hypogonadism): 7 Causes (Dietary, etc.) and Ways to Increase Testosterone Levels

Yes, there are a few natural ways to increase testosterone levels. One way is to eat foods that are rich in zinc, such as oysters, beef, and lamb. Another way is to exercise regularly, since exercise can help boost testosterone levels. Additionally, getting plenty of sleep can help keep testosterone levels high.

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What Is Trt And What Are Its Benefits

TRT, or testosterone replacement therapy, is a medical treatment that involves the administration of synthetic hormones to replace those that are naturally produced by the body. TRT has a variety of potential benefits, including improved mood, increased muscle mass and bone density, and reduced fat mass. However, TRT is not without its risks, and it is important to weigh the potential benefits against the potential risks before starting treatment.

TRT is most commonly used to treat men who have low levels of testosterone, a condition known as hypogonadism. Low testosterone levels can cause a variety of symptoms, including fatigue, depression, and reduced muscle mass. Testosterone replacement therapy can help to improve these symptoms and allow men to live more normal lives.

Testosterone Replacement Therapy Insurance

A comprehensive guide to the benefits and risks of testosterone replacement therapy can help men understand this treatment’s potential advantages and disadvantages. Testosterone replacement therapy, or TRT, is a hormone replacement therapy used to treat men with symptomatic low testosterone. It involves taking hormones like testosterone to supplement the body’s naturally-occurring testosterone. While it can help those with low testosterone levels, it can also come with several risks. These include an increased risk of prostate cancer, cardiovascular issues, and gynecomastia. It is also important to note that there is evidence suggesting that testosterone replacement therapy may increase the risk of stroke. It is essential to consult a physician before beginning any hormone replacement therapy to assess the potential health risks and benefits. Furthermore, it is often recommended that patients discuss the potential side effects with a healthcare provider to ensure they are comfortable with the potential risks. While testosterone replacement therapy can be beneficial for men with low testosterone levels, it is important to understand the potential risks and benefits before beginning any hormone replacement therapy.

The final decision is yours. Ask for a discussion about the options available and whether your particular practice uses them.

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Why Does Trt Cause Polycythemia

Testosterone can improve the bodys synthesis of red blood cells in addition to controlling body composition and sex drive . When your testosterone levels rise, your RBC count may rise as well.

Although all Testosterone administration techniques can increase the number of red blood cells, research suggest that those who use intramuscular Testosterone injections have a higher rate of polycythemia than those who use topical Testosterone.

Tobacco use has also been linked to polycythemia and may add to the disorder. Consider a smoking cessation program if you smoke and are taking TRT.

Preventing And Managing Polycythemia

How To Lower Blood Pressure On Trt

It’s important to check patients’ hemoglobin and hematocrit blood levels while on testosterone replacement therapy. As we all know, hemoglobin is the substance that makes blood red and helps transport oxygen in the blood. Hematocrit reflects the proportion of red cells to total blood volume. A hematocrit of over 52 percent should be evaluated. Decreasing testosterone dose or stopping it are options that may not be the best for assuring patients’ best quality of life, however. Switching from injectable to transdermal testosterone may decrease hematocrit, but in many cases not to the degree needed.

The following table shows the different guideline groups that recommend monitoring for testosterone replacement therapy. They all agree about measuring hematocrit at month 3, and then annually, with some also recommending measurements at month 6 after starting testosterone .

Many patients on testosterone replacement who experience polycythemia do not want to stop the therapy due to fears of re-experiencing the depression, fatigue and low sex-drive they had before starting treatment. For those patients, therapeutic phlebotomy may be the answer. Therapeutic phlebotomy is very similar to what happens when donating blood, but this procedure is prescribed by physicians as a way to bring down blood hematocrit and viscosity.

Volume of Withdrawn Blood =

Weight à ABVÃ/


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Therapeutic Phlebotomy Due To Trt May Be Covered At A Blood Bank Now

high hematocritIngestion of grapefruit lowers elevated hematocrits in human subjects.

Hematocrit may stabilize after long term testosterone replacementGuo W, Bachman E, Vogel J, Li M, Peng L, et al. The Effects of Short-Term and Long-Term Testosterone Supplementation on Blood Viscosity and Erythrocyte Deformability in Healthy Adult Mice. Endocrinology. Short-term high dose testosterone increased hematocrit and whole blood viscosity in both females and castrated males. This effect diminished after long-term treatment, in association with increased erythrocyte deformability in the testosterone-treated mice, suggesting the presence of adaptive mechanism.

Testosterone Replacement Therapy and Blood DonationsâAllow individuals on prescription testosterone to donate blood and blood components more frequently than every eight weeks without examination or certification of health by physician at time of donation, provided the donor is referred with a prescription by a physician containing instructions regarding frequency of phlebotomy and hematocrit/hemoglobin limits and to be exempt from placing special labeling about the donor’s disorder on the blood components. This approval is granted under the condition that only the Red Blood Cells collected from these individuals may be distributed the plasma and platelet components from these individuals should not be distributed for transfusion.â


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