problem: Hematocrit elevations with testosterone replacement therapy
I have been treating this elderly man with testosterone for the
months. His hemoglobin and hemotaocrit are climbing, the last Hct
53%? I think he needs the testosterone treatment, what should be
It is fairly common to have increases in hemotcrit with testosterone
replacement therapy. The mechanism of this is due to direct stimulation
erythropoieten synthesis from androgens. In fact, this had been
years in the treatment of malignancy-related anemia, prior to the
the more expensive epogen. However, in a man without anemia, testosterone
replacement can result in too much of a rise. The concern is related
epidemiological data indicating that the risk of stroke increases
hemotocrits above 46%. Obviously, hypoxic responses secondary to
should be addressed first with smoking cessation techniques. The
question is how is the testosterone being replaced. In general,
in hemotocrit is proportional to the area-under-the-curve for the
testosterone. Men being replaced with injectable forms of testosterone,
have a much greater exposure to testosterone and higher hematocrits
man given a smoother administration with patches or gels. If the
already using patches or gels, I would recommend reducing the dose
having a follow-up CBC in 6 weeks. I would be concerned about hematocrits
above 52% .
Dobs, M.D., M.H.S.
Medical Director, Professor of Medicine and Vice Chair, Department
of Medicine for Clinical Research
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