Testosterone Therapy and erythrocytosis

[madman]

Testosterone Therapy and Men’s Health – Demystifying the Hype with Science to Provide Cutting-Edge Treatment for Your Patients (2021)

Summary 25:10-43:34 (Endocrine Society 2018 Guidelines)

Other Risks with Testosterone Therapy and How to Manage Them - T4L Education

t4leducation.com

 

[madman]

 

[madman]

 

[madman]

TESTOSTERONE THERAPY AND MEN’S HEALTH

Testosterone Therapy and Men’s Health – Demystifying the Hype with Science to Provide Cutting Edge Treatment for Your Patients Testosterone therapy is one of the most controversial topics in medicine, yet multiple medical societies endorse its use, supported by level 1 evidence showing a...

www.excelmale.com

Testosterone Therapy in Men With Hypogonadism: An Endocrine Society* Clinical Practice Guideline

This update to the Endocrine Society’s 2010 testosterone guideline, prepared by an expert panel, describes the diagnosis, screening, treatment, and monitor

academic.oup.com

Prevalence of secondary erythrocytosis in men receiving testosterone therapy

Prevalence of secondary erythrocytosis in men receiving testosterone therapy: A matched cohort analysis of intranasal gel, injections, and pellets (2023) Rohit Reddy*, Parris Diaz*, Ruben Blachman-Braun, Justin Loloi, Farah Rahman, Jesse Ory, Alexandra Dullea, Isaac Zucker, Daniel C. Gonzalez...

www.excelmale.com

Management of Erythrocytosis in Men Receiving TRT

Management of Erythrocytosis in Men Receiving Testosterone Therapy: Clinical Consultation Guide (2022) Pranjal Agrawal, Sajya M. Singh, Taylor Kohn 1. Introduction Testosterone deficiency, previously known as male hypogonadism, affects approximately 25% of all men, with a prevalence that...

www.excelmale.com

Low Testosterone in Men: Recommendations on the diagnosis, treatment and monitoring

ABSTRACT The relative proportional increase of the elderly population within many countries will become one of the most significant social transformations of the twenty-first century and, for the first time in history, persons aged 65 or above outnumbered children under five years of age...

www.excelmale.com

Take-home points

*The clinical significance of a hematocrit >54% is unknown

*Although it is not yet clear what upper limit of hematocrit level is clinically desirable, dose adjustments may be necessary to keep hematocrit below 52–54%




Hematocrit

*Some authors recommend that TTh be discontinued if hematocrit is >54%, which may be reasonable while baseline hematocrit level >50% is a relative contraindication for starting testosterone therapy. However, these recommendations are based on assumptions – the clinical significance of a hematocrit >54% is unknown

*The lack of increase in cardiovascular events with elevated hematocrit may be due to the fact that T acts as a vasodilator and has anti-atherosclerotic effects [223]. In addition, testosterone is able to decrease plasma concentrations of procoagulatory substances such as fibrinogen and PAI-1 as well as Factor XII [224] Isolated hematocrit elevations can be the result of insufficient fluid intake on a hot day. Only repeated measures of hematocrit >54% should be followed by concomitant administration of aspirin, bleeding, therapeutic phlebotomy, and/or discontinuation of TTh until hematocrit declines below 54%. After normalization of hematocrit levels, TTh can be continued with a reduced dosage

*Periodic hematological assessment is, however, indicated, i.e. before TTh, then 3–4 months and 12 months in the first year of treatment, and annually thereafter. Although it is not yet clear what upper limit of hematocrit level is clinically desirable, dose adjustments may be necessary to keep hematocrit below 52–54%

*Men with significant erythrocytosis (hematocrit >52%), severe untreated obstructive sleep apnea, or untreated severe congestive heart failure should not be started on treatment with TTh without prior resolution of the co-morbid condition

TRT and Cardiovascular Disease

Testosterone replacement therapy and cardiovascular disease (2022) Jeremy M. Auerbach and Mohit Khera The use of testosterone therapy has a complex history of apprehension and questions regarding its safety. Despite an eventual consensus that testosterone therapy was safe and effective...

www.excelmale.com

 

[tareload]

The Health Optimization Doctors RoundTable: High Hematocrit Not Important?

https://www.youtube.com/live/Wyu5GPDiXUg?feature=share

www.excelmale.com

 

[madman]

Testosterone and Cardiovascular Disease (Traverse Trial)

www.excelmale.com

*there was no increased risk of prostate cancer between the two groups and no increased risk of lower urinary tract symptoms between the two groups


28:30-29:47

Investigator Reported Adverse Events - statistically significant increase in non-fatal arrhythmias, atrial fibrillation, acute kidney injury)

*again while statistically significant the absolute numbers don't seem that different

 

[madman]

The TRAVERSE Trial Results: What Do THEY Mean?

www.excelmale.com

 

[madman]

Testosterone Therapy and the Risk of Cardiovascular Disease

Abstract The debate over the cardiovascular (CV) implications of testosterone therapy (TT) have resulted in diverging safety recommendations and clinical guidelines worldwide. This narrative review synthesizes and critically evaluates long-term studies examining the effects of TT within the...

www.excelmale.com

4. Conclusion

The therapeutic approach for TT for symptomatic hypogonadism and low testosterone levels associated with aging, obesity, and systemic illness presents challenges. These conditions are intricately linked with CVD outcomes and may confound the relationship between low testosterone and CVD. Although observational studies suggest an association between low testosterone and increased risk of CVD, results from testosterone supplementation are inconsistent. RCTs indicate that short-term TT at standard replacement is not associated with increased CVD risk. Nevertheless, the cardiovascular sub-study of T Trials observed increases in NCP and CAC, signaling the need for further investigation into potential long-term implications of TT.

The TRAVERSE trial, a landmark study unique in its capacity to evaluate CVD events, contributes valuable insights into the short-term safety of TT at lower physiological levels. However, the long-term effects and implications of mid to high physiological testosterone levels are not yet fully understood. The trials’ limitations — achievement of only low-normal testosterone levels, high discontinuation rates, brief follow-up period, and high loss to follow-up rate — suggest that the findings should be interpreted with caution. It is important to avoid generalizing the safety of TT based on these results alone and to approach the extrapolation of TRAVERSE’s conclusions to higher dosages or longer-term therapy with caution.

The decision to initiate TT requires a nuanced approach, which must account for current gaps in evidence regarding CV safety. A personalized assessment and management of CVD risk factors is essential for older men with known CVD. The CV effects of exogenous testosterone, when given to maintain physiological levels, remain to be fully explored. In this regard, an important question remains the identification of male patients with symptomatic hypogonadism who may benefit from TT. This topic continues to be the subject of ongoing debate. Hopefully, future trials will provide clarity on whether TT confers beneficial, neutral, or adverse cardiovascular effects in middle-aged and older men. Until definitive evidence surfaces, clinical practice should exercise caution and prioritize individualized care with informed discussions regarding the potential CV implications of TT.