Therapeutic Phlebotomy for Testosterone-Induced Polycythemia

Adverse effects of therapeutic phlebotomies: Prospective study of 587 procedures

BACKGROUND

Therapeutic phlebotomy (TP), a widely used medical procedure, can be performed on diverse patients with iron overload or polyglobulia. However, its adverse events are not well known as most of the information on phlebotomy is derived from healthy blood donors (0.1%-5.3%). In contrast, TP is applicable to a broader, more complex population with comorbidities and old age. To ascertain the incidence of adverse events in phlebotomies, we conducted a prospective study on patients who attended our Unit.

STUDY DESIGN AND METHODS

We prospectively gathered data from patients referred to our Unit for TP. Data regarding demographics, health status, and adverse events within at least 24 h of phlebotomy were gathered via a structured questionnaire during each visit.

RESULTS

Between August 2021 and September 2022, 189 patients underwent 587 procedures. Most patients were men, over 60 (57.3%) had comorbidities, and 93% underwent at least two procedures during the study period. Twenty patients (10.8%) presented 25 adverse events (4.3% of phlebotomies), usually vasovagal reactions, none of which were clinically relevant, and all were managed by nursing staff on site, with full patient recovery.

DISCUSSION

The rate of adverse events (<5%) in patients undergoing TP was low and comparable to that seen in healthy blood donors. Consequently, even old patients and those with some comorbidities can safely undergo TP when the process is carefully managed.

Testosterone Replacement Therapy and Cardiovascular Disease: Balancing Safety and Risks in Hypogonadal Men

PURPOSE OF REVIEW: The purpose of this review is to analyze the link between testosterone replacement therapy (TRT) and adverse cardiovascular (CV) events. RECENT FINDINGS: A few published studies suggest a link between TRT and CV events. These studies contained flaws, and many other studies reveal a reduction in CV events. Hypogonadism is associated with increased mortality in men with CVD. TRT in hypogonadal men can improve many CVD risk factors, reduce QT interval prolongation, lead to better outcomes in heart failure patients, and slow the progression of atherosclerosis. The use of TRT to achieve physiologic testosterone concentrations in men does not pose a threat to CV health and has demonstrated a cardioprotective effect.

[IPED Use in Recreational Sports]

IPED Use in Recreational Sports Abstract. Abtract: IPED consumers seek medical advice when uncertain as to their use. Due to shame or fear of stigmatization IPED consumers are often reluctant to talk about their drug use; they fear prejudice and a lack of experience when caring for this specific patient group. In order to strengthen trust, a non-judgmental, non-stigmatizing and supportive attitude is essential. The interaction should primarily lead to an understanding of why AAS are being used, what the patient's concerns are, and why medical help is being sought, without judgment or condemnation of the behavior. If no motivation to abstain from drug use is found during the consultation, harm reduction should be sought and the consequences of use addressed. Regular talks and active harm reduction can increase the confidence in evidence-based treatment to achieve personal motivation to abstain under medical supervision.

IPED in Recreational Sports

IPED consumers seek medical advice when uncertain as to their use. Due to shame or fear of stigmatization IPED consumers are often reluctant to talk about their drug use; they fear prejudice and a lack of experience when caring for this specific patient group. In order to strengthen trust, a non-judgmental, non-stigmatizing and supportive attitude is essential. The interaction should primarily lead to an understanding of why AAS are being used, what the patient's concerns are, and why medical help is being sought, without judgment or condemnation of the behavior. If no motivation to abstain from drug use is found during the consultation, harm reduction should be sought and the consequences of use addressed. Regular talks and active harm reduction can increase the confidence in evidence-based treatment to achieve personal motivation to abstain under medical supervision.

Monitoring Haematocrit in Paediatric Patients Receiving Testosterone Therapy in Arab Countries

Objectives Testosterone is the main agent used to induce puberty in boys in Arab countries. It is recommended to monitor haematocrit before and during androgen replacement. However, data from single centre studies indicated that this recommendation is rarely practiced by paediatricians compared to adult physicians. The aim of this study is to evaluate the monitoring of haematocrit of patients on Testosterone therapy by paediatric endocrinologists practicing in Arab countries. Methods A cross-sectional study using an online survey that was sent to all members of the Arab Society for Paediatric Endocrinology and Diabetes (ASPED), who they practice in all Arab countries. The study was carried out between July and October 2019. Ethical approval was granted by ASPED council in May 2019 (MRE2019-02Q).  Results One hundred four physicians responded to the survey from 17 countries. 81/104 (77.8%) answered the question about Testosterone monitoring (42 paediatric endocrinologists, 11 general paediatrician consultants with interest in endocrine, 16 specialists, four fellows and eight residents). Of the 81 responders 18 clinicians (22.2%) thought of monitoring the haematocrit; 15 (18.5%) thought no laboratory monitoring is needed at all. Conclusion The survey indicated that most paediatric endocrinologists in Arab countries do not monitor haematocrit in patients on testosterone replacement and majority are not aware that secondary erythrocytosis can result from androgen therapy. Raising the awareness on monitoring haematocrit during androgen replacement therapy is needed especially when reaching the adult dose.