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Fink J, Horie S. Novel methods for the treatment of low testosterone. Expert Rev Endocrinol Metab 2023; 18:221-229. [PMID: 37010438 DOI: 10.1080/17446651.2023.2197059] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION Testosterone replacement therapy is a promising and growing field in modern healthcare. Several novel testosterone preparations aiming at providing an efficient drug without side effects have been developed in recent years. Several oral, nasal, gel, and self-injection preparations are now available, providing a wide variety of options customized to each individual's needs. AREAS COVERED We searched Google Scholar for keywords related to the different types of testosterone replacement therapy. This review provides information about the benefits and side effects of the newest testosterone preparations, aiming at giving a summary of the options with regard to testosterone replacement therapy to healthcare professionals. EXPERT OPINION As testosterone replacement therapy is increasing in popularity, the development of novel ways of administration minimizing side effects associated with testosterone replacement therapy is growing. Nowadays, hypogonadal patients have several options to treat their conditions and can choose the most beneficial method for their individual condition.
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Affiliation(s)
- Julius Fink
- Graduate School of Medicine, Department of Urology, Juntendo University, Bunkyo-ku, Japan
| | - Shigeo Horie
- Graduate School of Medicine, Department of Urology, Juntendo University, Bunkyo-ku, Japan
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2
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Occurrence of pulmonary oil microembolism (POME) with intramuscular testosterone undecanoate injection: literature review. Int J Impot Res 2022:10.1038/s41443-022-00585-1. [PMID: 35610506 DOI: 10.1038/s41443-022-00585-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 11/08/2022]
Abstract
Testosterone undecanoate injections (TU), an oil-based depot, is a universal hormonal-based treatment which has been associated with pulmonary oil microembolism (POME). However, the rate of POME during routine intramuscular (IM) TU injection is unknown. Here, we conduct a peer-reviewed literature review investigating POME incidents in the setting of TU injections. A total of 48 articles were selected in the literature review, which included 29 studies that used TU and reported its effects. Relatively few POME cases were reported across multiple published studies, including those that focused particularly on the occurrence rate of POME while administrating IM TU. Of the 29 individual studies, which included 7 978 patients, eight studies reported a total of 88 incidence of POME cases or cough. This included episodes of cough that were not originally declared as POME. One post market review reported 223 cases per 3,107,652 injections. When POME did occur, almost all cases resolved spontaneously within 60 min without intervention. Overall, POME was observed to be rare.
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Shiraishi K, Ohmi C, Matsuyama H. Patient-reported outcomes and biochemical alterations during hormonal therapy in men with hypogonadotropic hypogonadism who have finished infertility treatment. Endocr J 2021; 68:221-229. [PMID: 33012744 DOI: 10.1507/endocrj.ej20-0365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Male hypogonadotropic hypogonadism (MHH) is effectively treated by gonadotropins with a high rate of ejaculate sperm and paternity; however, there is no information regarding the appropriate management, including patient-reported outcomes (PROs), of men with MHH who have finished infertility treatment. To compare health-related quality of life, erectile function and biochemical alterations in men with MHH who were treated with testosterone replacement therapy (TRT) or human chorionic gonadotropin (hCG). Twenty-six MHH patients (mean age: 34 years) who needed to improve their androgen deficiency symptoms underwent either hCG therapy (n = 16, started with self-injection of 2,000-7,500 IU per week) or TRT (n = 10, testosterone enanthate 250 mg every 3 weeks). The 36-item Short Form Health Survey (SF-36) questionnaire, five-item International Index of Erectile Function (IIEF-5) and hormonal and biochemical analyses were assessed every 3 months. Changes and comparison of each treatment regarding these parameters were analyzed. Both hCG and TRT significantly improved all domains of the SF-36, except for bodily pain and social functioning. hCG significantly improved the general and mental health domains compared with TRT. Significant improvements in IIEF-5 were observed with both treatments, showing significant improvement with hCG compared to TRT. TRT caused progressive testicular atrophy. There were significant decreases in waist circumference and triglycerides in both treatment groups and significant elevations in prostate-specific antigen and hematocrit. Both hCG and TRT are effective and safe, with preferable PROs by hCG, for treating androgen deficiency in men with MHH who do not need infertility treatment.
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Affiliation(s)
- Koji Shiraishi
- Department of Urology, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Chietaka Ohmi
- Department of Urology, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Hideyasu Matsuyama
- Department of Urology, Yamaguchi University School of Medicine, Yamaguchi, Japan
- Department of Urology, Ube-kohsan Central Hospital, Yamaguchi, Japan
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Metzger-Peter K, Kremer LD, Edan G, Loureiro De Sousa P, Lamy J, Bagnard D, Mensah-Nyagan AG, Tricard T, Mathey G, Debouverie M, Berger E, Kerbrat A, Meyer N, De Seze J, Collongues N. The TOTEM RRMS (Testosterone Treatment on neuroprotection and Myelin Repair in Relapsing Remitting Multiple Sclerosis) trial: study protocol for a randomized, double-blind, placebo-controlled trial. Trials 2020; 21:591. [PMID: 32600454 PMCID: PMC7322908 DOI: 10.1186/s13063-020-04517-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/15/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Central nervous system damage in multiple sclerosis (MS) is responsible for serious deficiencies. Current therapies are focused on the treatment of inflammation; however, there is an urgent need for innovative therapies promoting neuroregeneration, particularly myelin repair. It is demonstrated that testosterone can act through neural androgen receptors and several clinical observations stimulated an interest in the potential protective effects of testosterone treatment for MS. Here, we sought to demonstrate the effects of a testosterone supplementation in testosterone-deficient men with relapsing-remitting MS. METHODS/DESIGN This report presents the rationale and methodology of TOTEM RRMS, a French, phase 2, multicenter, randomized, placebo-controlled, and double-blind trial, which aims to prevent the progression of MS in men with low testosterone levels by administration of testosterone undecanoate, who were kept under natalizumab (Tysabri®) to overcome the anti-inflammatory effect of testosterone. Forty patients will be randomized into two groups receiving either a testosterone treatment (Nebido®) or a matching placebo. The intervention period for each group will last 66 weeks (treatment will be injected at baseline, week 6, and then every 12 weeks). The main objective is to determine the neuroprotective and remyelinating effects of testosterone using tensor diffusion imaging techniques and thalamic atrophy analyses. As secondary objectives, impacts of the testosterone supplementation will be studied using other conventional and unconventional MRI parameters and with clinical outcomes. DISCUSSION The action of testosterone is observed in different experimental autoimmune encephalomyelitis models and epidemiological studies in humans. However, despite several preclinical data and some small clinical trials in MS, clear evidence for a therapeutic effect of hormone therapy is still missing. Therefore, our goal is to demonstrate the effects of testosterone therapies in MS. As there is no effective treatment currently available on fatigue in MS, careful attention should also be paid to secondary endpoints: fatigue, cognitive functions, and other symptoms that may improve life quality. Assuming a positive outcome of the trial, this treatment could be considered as a new neuroprotective and remyelinating therapy in relapsing-remitting MS and could be applicable to other demyelinating diseases. TRIAL REGISTRATION ClinicalTrials.gov NCT03910738. Registered on 10 April 2019.
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Affiliation(s)
| | - Laurent Daniel Kremer
- Departement of Neurology, Hôpital de Hautepierre, University Hospital of Strasbourg, Strasbourg, France
| | - Gilles Edan
- Departement of Neurology, Hôpital Pontchaillou, University Hospital of Rennes, Rennes, France
| | - Paulo Loureiro De Sousa
- Laboratory of Engineering Sciences, Computer Science and Imagery (ICube), CNRS, Institute of Biological Physics, University of Strasbourg, Strasbourg, France
| | - Julien Lamy
- Laboratory of Engineering Sciences, Computer Science and Imagery (ICube), CNRS, Institute of Biological Physics, University of Strasbourg, Strasbourg, France
| | - Dominique Bagnard
- Departement of Myelin Biopathology, Neuroprotection and Therapeutic Strategies, UMR_S Inserm 1119, Strasbourg, France
| | - Ayikoe-Guy Mensah-Nyagan
- Departement of Myelin Biopathology, Neuroprotection and Therapeutic Strategies, UMR_S Inserm 1119, Strasbourg, France
| | - Thibault Tricard
- Departement of Urological Surgery, Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France
| | - Guillaume Mathey
- Departement of Neurology, Hôpital Central, University Hospital of Nancy, Nancy, France
| | - Marc Debouverie
- Departement of Neurology, Hôpital Central, University Hospital of Nancy, Nancy, France
| | - Eric Berger
- Departement of Neurology, Hôpital Jean Minjoz, University Hospital of Besançon, Besançon, France
| | - Anne Kerbrat
- Department of Neurology, Hôpital de Pontchaillou, University Hospital of Rennes, Rennes, France
| | - Nicolas Meyer
- Departement of Public Health, GMRC University Hospital of Strasbourg, Strasbourg, France
| | - Jérôme De Seze
- Centre d᾿Investigation Clinique INSERM 1434, Strasbourg, France.,Departement of Neurology, Hôpital de Hautepierre, University Hospital of Strasbourg, Strasbourg, France
| | - Nicolas Collongues
- Centre d᾿Investigation Clinique INSERM 1434, Strasbourg, France.,Departement of Neurology, Hôpital de Hautepierre, University Hospital of Strasbourg, Strasbourg, France
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Kempegowda P, Quinn LM, Chandan JS, Shepherd L, Kauser S, Rahim A, Bates A. Long-term testosterone undecanoate replacement therapy: Impact of ethnicity. Clin Endocrinol (Oxf) 2020; 92:428-433. [PMID: 31943322 DOI: 10.1111/cen.14157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Testosterone replacement therapy (TRT) is indicated for symptomatic male hypogonadism. However, the safety and efficacy profiles across different ethnicities for long-term TRT remain unclear. OBJECTIVE To measure the impact of ethnicity on various biochemical parameters following testosterone undecanoate (TU) replacement. METHOD A retrospective analysis of 50 male patients treated with TU from 2006 to 2017 in a large secondary care centre was performed. Changes in total testosterone, PSA, haematocrit, haemoglobin, total cholesterol and low-density lipoprotein (LDL) over eight years of treatment were analysed. Wilcoxon rank sum test was used to assess differences in these parameters between Caucasians and South Asians. RESULTS Thirty-one Caucasians (age: median (IQR) 55.0 years (49.0-68.0); total duration of follow-up 6.1 years (2.9-9.3)) and 19 South Asians (age: median (IQR) 52.0 years (38.0-69.0); duration of follow-up 6.5 years (1.3-8.4)) were treated with TU during the study period. There was no significant difference in total testosterone levels between the two ethnicities. We noted a higher free and bioavailable testosterone in South Asians than Caucasians, albeit within their reference range. PSA was higher in Caucasians than South Asians at two and eight years of TU therapy. After one year of TRT, haematocrit was higher in South Asians than Caucasians at one year, whereas LDL and total cholesterol were significantly higher in Caucasians than South Asians. CONCLUSIONS Caucasians have a tendency towards increased PSA, total cholesterol and LDL compared with South Asians with TU replacement therapy. There is a higher increment of haematocrit in South Asians following one year of TU replacement therapy. All biochemical changes following TRT were within the respective reference ranges suggesting no apparent risk of prostate cancer and venous thromboembolism.
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Affiliation(s)
- Punith Kempegowda
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | | | - Joht Singh Chandan
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Lisa Shepherd
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Samina Kauser
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Asad Rahim
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Andrew Bates
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Morgunov LY, Denisova IA, Rozhkova TI, Stakhovskaya LV, Skvortsova VI. Hypogonadism and its treatment following ischaemic stroke in men with type 2 diabetes mellitus. Aging Male 2020; 23:71-80. [PMID: 30064273 DOI: 10.1080/13685538.2018.1487932] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Premature mortality in Russia is a major socio-economic problem, especially from acute cerebrovascular diseases which constitute 21.4% of the total mortality and is a considerable contributor to chronic disability. Risk of vascular catastrophe is higher in males than females, thought, in part, due to anti-atherosclerotic effects of oestrogens in females whilst an associated age-related deficiency of testosterone is observed in men. Clinical symptoms such as high blood pressure, changes in lipid profile, insulin resistance, obesity, and blood coagulation factors often accompany declining testosterone in males and reduced total testosterone is considered a cardiovascular risk factor. In the present study, the prevalence of hypogonadism in men who had suffered ischaemic stroke was evaluated along with the efficacy of testosterone undecanoate injections (TU) in patients with testosterone deficiency and type-2 diabetes (T2DM) in the acute phase of hemispheric ischaemic stroke. Hypogonadism was present in 66.3% of patients with ischaemic stroke, 50% with T2DM, and 26.3% without T2DM, respectively. TU treatment, at both the 2 and 5-year observation points, demonstrated significant improvements in biochemical, physical, and mental parameters. This supports that testosterone deficiency is a contributing factor in ischaemic events and that long-term testosterone therapy could play an important role in patient recovery.
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Affiliation(s)
- L Y Morgunov
- Ucebnyj centr innovacionnyh medicinskih tehnologij RNIMU imeni N I Pirogova, Moskva, Russian Federation
| | - I A Denisova
- Ucebnyj centr innovacionnyh medicinskih tehnologij RNIMU imeni N I Pirogova, Moskva, Russian Federation
| | - T I Rozhkova
- Ucebnyj centr innovacionnyh medicinskih tehnologij RNIMU imeni N I Pirogova, Moskva, Russian Federation
| | - L V Stakhovskaya
- Ucebnyj centr innovacionnyh medicinskih tehnologij RNIMU imeni N I Pirogova, Moskva, Russian Federation
| | - V I Skvortsova
- Ucebnyj centr innovacionnyh medicinskih tehnologij RNIMU imeni N I Pirogova, Moskva, Russian Federation
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du Plessis J, Bester HL, Julyan M, Cockeran M. Acute changes in haematocrit leading to polycythaemia in late-onset hypogonadism patients that receive testosterone replacement therapy: a South African study. JOURNAL OF ENDOCRINOLOGY, METABOLISM AND DIABETES OF SOUTH AFRICA 2019. [DOI: 10.1080/16089677.2018.1553344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Jesslee du Plessis
- Medicine Usage in South Africa (MUSA), North-West University, Potchefstroom, South Africa
| | | | - Marlene Julyan
- Medicine Usage in South Africa (MUSA), North-West University, Potchefstroom, South Africa
| | - Marike Cockeran
- School for Computer, Statistical and Mathematical Sciences, North-West University, Potchefstroom, South Africa
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Wolf J, Keipert D, Motazedi H, Ernst M, Nettleship J, Gooren L. Effectiveness and tolerability of parenteral testosterone undecanoate: a post-marketing surveillance study. Aging Male 2017; 20:225-234. [PMID: 28812471 DOI: 10.1080/13685538.2017.1364234] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
This observational post-marketing study of parenteral testosterone undecanoate (TU) in a non-selected population aimed to: examine the effectiveness of TU as treatment of hypogonadism; record adverse drug reactions (ADR) quantitatively particularly regarding polycythemia, prostate safety and cardiovascular-related metabolic risk factors; and verify whether recommended injection intervals apply to routine clinical practice. Eight hundred and seventy subjects from 259 outpatient units scheduled to visit the clinic six times were included. Effectiveness and tolerability of TU administration were assessed on a 4-point scale. Body weight, waist girth, blood pressure, hemoglobin levels, hematocrit, prostate-specific antigen (PSA), and digital rectal prostate examination were assessed. Over 90% of subjects completed the observational duration of 52.8 ± 9.7 weeks (mean ± SD) and 56% judged effectiveness as very good, 30.8% as good. 63.1% judged tolerability as very good, and 24.4% as good. No adverse effects on indicators of cardiovascular risk were observed. Polycythemia occurred in one subject and a supranormal hematocrit in one subject. Four subjects developed supranormal PSA levels. Prostate carcinoma was found in one subject, one subject had recurrence of a previously surgically treated prostate carcinoma, and the other two showed no indication of malignancy. Parenteral TU is safe, effective, and well-tolerated in clinical practice proving a good therapeutic option for hypogonadism.
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Affiliation(s)
- Jan Wolf
- a Urologische Facharztpraxis , Frankenwaldklinik , Kronach , Germany
| | | | | | | | - Joanne Nettleship
- e Department of Oncology and Metabolism , University of Sheffield , Sheffield , UK
| | - Louis Gooren
- f Department of Internal Medicine , Endocrine Section, VU Medical Centre , Amsterdam , The Netherlands
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Chandrapal JC, Nielson S, Patel DP, Zhang C, Presson AP, Brant WO, Myers JB, Hotaling JM. Characterising the safety of clomiphene citrate in male patients through prostate-specific antigen, haematocrit, and testosterone levels. BJU Int 2016; 118:994-1000. [PMID: 27226135 DOI: 10.1111/bju.13546] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the safety profile of clomiphene citrate (CC) in men being treated for hypogonadism or infertility by measuring prostate-specific antigen (PSA), haematocrit (Hct), and testosterone levels. PATIENTS AND METHODS We identified patients presenting to our institution who were placed on CC, 50 mg every day or every other day, for male infertility and/or symptomatic hypoandrogenism between September 2013 and April 2016. Patients with documented exogenous testosterone, human chorionic gonadotrophin, or anastrozole use within 2 weeks of baseline evaluations were excluded. Our primary outcomes were the effects of CC on PSA, Hct, and total testosterone levels evaluated at the 3, 6, 9, or 12 months of follow-up. Outcomes were averaged within patients across visits and summarised by mean, median, range, standard deviation (SD) and the 95% confidence interval (CI) for the mean. RESULTS A total of 77 patients had recorded PSA, Hct, and/or testosterone values. The mean (SD, range) age and body mass index was 34 (6, 22-51) years and 31 (6, 22-52) kg/m2 , respectively. The mean (SD) follow-up was 358 (29) days. Within this group, CC concentration was changed in 24 patients (31%) and was discontinued in 24 patients (31%). The median (range) duration of CC therapy before discontinuation was 127 (44-161) days. The use of CC significantly raised both mean total and bioavailable testosterone levels by 200 ng/dL and 126 ng/dL, respectively (P < 0.001). This increase in testosterone had significant clinical effects with improvements in Androgen Deficiency in Aging Male questionnaire scores (P < 0.01) but not Sexual Health Inventory for Men scores. CC had no effect on mean PSA (1 ng/dL, 95% CI 0.8-1.1) or Hct (49%, 95% CI 41-53) levels, which were within normal ranges. CONCLUSIONS As more men are placed on CC for infertility or hypogonadism, characterising the safety effect profile becomes important. Our study found that CC significantly increased testosterone levels without changing PSA or Hct values. Because the biochemical response to CC can vary, we suggest scheduling laboratory evaluation at regular intervals; however, ordering routine assessment of PSA and Hct may not be necessary.
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Affiliation(s)
| | - Spencer Nielson
- University of Utah School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Darshan P Patel
- Division of Urology, University of Utah, Salt Lake City, UT, USA
| | - Chong Zhang
- Division of Epidemiology and Biostatistics, University of Utah, Salt Lake City, UT, USA
| | - Angela P Presson
- Division of Epidemiology and Biostatistics, University of Utah, Salt Lake City, UT, USA
| | - William O Brant
- Division of Urology, University of Utah, Salt Lake City, UT, USA
| | - Jeremy B Myers
- Division of Urology, University of Utah, Salt Lake City, UT, USA
| | - James M Hotaling
- Division of Urology, University of Utah, Salt Lake City, UT, USA
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Jones SD, Dukovac T, Sangkum P, Yafi FA, Hellstrom WJG. Erythrocytosis and Polycythemia Secondary to Testosterone Replacement Therapy in the Aging Male. Sex Med Rev 2015; 3:101-112. [PMID: 27784544 DOI: 10.1002/smrj.43] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Testosterone replacement therapy (TRT) is a common treatment for hypogonadism in aging males. 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. Clinically, this response is described as erythrocytosis or polycythemia secondary to TRT. 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 risks associated with androgen replacement need further examination. AIM To review the available literature on erythrocytosis and polycythemia secondary to TRT. To discuss potential etiologies for this response, the role it plays in risk for VTE, and recommendations for considering treatment in at-risk populations. METHODS A literature review was performed through PubMed regarding TRT and erythrocytosis and polycythemia. MAIN OUTCOME MEASURES To assess the mechanisms of TRT-induced erythrocytosis and polycythemia with regard to basic science, pharmacologic preparation, and route of delivery. To review Hct and risk for thrombotic events. To offer clinical suggestions for therapy in patients at risk for veno-thrombotic events. RESULTS Men undergoing TRT have a 315% greater risk for developing erythrocytosis (defined as Hct > 0.52) when compared with control. Mechanisms involving iron bioavailability, erythropoietin production, and bone marrow stimulation have been postulated to explain the erythrogenic effect of TRT. The association between TRT-induced erythrocytosis and subsequent risk for VTE remains inconclusive. CONCLUSIONS All TRT formulations cause increases in Hb and Hct, but injectables tend to produce the greatest effect. The evidence regarding the risk for VTE with increased Hct is inconclusive. For patients with risk factors for veno-thrombotic events, formulations that provide the smallest effect on blood parameters hypothetically provide the safest option. Further trials are needed to fully evaluate the hematological side effects associated with TRT. Jones SD Jr, Dukovac T, Sangkum P, Yafi FA, and Hellstrom WJG. Erythrocytosis and polycythemia secondary to testosterone replacement therapy in the aging male. Sex Med Rev 2015;3:101-112.
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Affiliation(s)
- Steven D Jones
- Department of UrologyTulane University School of MedicineNew OrleansLAUSA
| | - Thomas Dukovac
- Department of UrologyTulane University School of MedicineNew OrleansLAUSA
| | - Premsant Sangkum
- Department of UrologyTulane University School of MedicineNew OrleansLAUSA
| | - Faysal A Yafi
- Department of UrologyTulane University School of MedicineNew OrleansLAUSA
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