How to Lower High Hematocrit Caused by Testosterone Replacement Therapy (TRT)

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CPAP and HIGH hematocrit

Hi ‍ I am diagnosed with Sleep Apnea and from next Friday I will use it I also found out that my hematocrit is always between 50-52 and hemoglobin 16.4-17.3 after 3 blood test this 3 last months .. my doctor said the high levels can be from the sleep apnea and will get better after CPAP .. how...
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Defy Medical TRT clinic doctor
It is a smart thing to measure ferritin before you donate blood (besides the hemoglobin test they run at the blood center).

First results of a ferritin-based blood donor deferral policy in the Netherlands​


BACKGROUND​

Whole blood donors are at risk of becoming iron deficient. To monitor iron stores, Sanquin implemented a new deferral policy based on ferritin levels, in addition to the traditional hemoglobin measurements.

METHODS​

Ferritin levels are determined in every fifth donation, as well as in all first-time donors. Donors with ferritin levels <15 ng/mL (WHO threshold) are deferred for 12 months; those ≥15 and ≤30 ng/mL for 6 months. The first results were analyzed and are presented here.

RESULTS​

The results show that 25% of women (N = 20151, 95% CI 24%-25%) and 1.6% of men (N = 10391, 95% CI 1.4%-1.8%) have ferritin levels ≤30 ng/mL at their first blood center visit. For repeat (non-first-time) donors, these proportions are higher: 53% of women (N = 28329, 95% CI 52%-54%) and 42% of men (N = 31089, 95% CI 41%-43%). After a 6-month deferral, in 88% of returning women (N = 3059, 95% CI 87%-89%) and 99% of returning men (N = 3736, 95% CI 98%-99%) ferritin levels were ≥15 ng/mL. After a 12-month deferral, in 74% of returning women (N = 486, 95% CI 70%-78%) and 95% of returning men (N = 479, 95% CI 94%-97%) ferritin levels increased to ≥15 ng/mL.

CONCLUSION​

Deferral of donors whose pre-donation ferritin levels were ≤30 ng/mL might prevent donors from returning with ferritin levels <15 ng/mL. This policy is promising to mitigate effects of repeated donations on iron stores.



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Testosterone Replacement Therapy (TRT) Decreases Ferritin

Testosterone replacement can cause a decrease in ferritin in men even without the presence or use of blood donations or therapeutic phlebotomies. A study gave men testosterone enanthate at a dose of 125 mg per week (it also used T enanthate with or without finasteride to see the effect of...
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Ferritin Test

Get insights into ferritin testing and its significance in assessing iron levels. By buying a ferritin test you can learn how ferritin can guide your health journey on Discounted Labs.
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PREVALENCE OF SECONDARY ERYTHROCYTOSIS IN MEN RECEIVING TESTOSTERONE THERAPY: A MATCHED COHORT ANALYSIS OF INJECTIONS, INTRANASAL GEL, AND PELLETS​


Abstract​


INTRODUCTION AND OBJECTIVE:​

In the last 80 years, varying formulations of testosterone have emerged and differing impacts on classic adverse events of polycythemia and suppression of the HPG axis are unclear. We predicted that responsive TRT causes consistent secondary hormonal changes irrespective of formulation. Based on the results of two simultaneous open label randomized clinical trials, we evaluated changes in T, hematocrit (HCt), PSA, and estradiol (E).

METHODS:​

Hypogonadal men (2 serum T <300 ng/dL by MS) were randomized into open label RCTs. Eligible subjects received: 800 mg subcutaneous T pellets, 11 mg TID intranasal T, or 200 mg×2 weeks TC for 16 weeks. Serum T, HCt, PSA, E, and OSA prevalence via STOP-BANG were collected at baseline and follow-up. Data from 75 men presented as a post-hoc analysis was reported as the mean percent change (SD). Student T-tests were used to determine change in adverse effects parameters between each formulation.

RESULTS:​

Median age was 45 years old. Baseline T, HCt, PSA, and E were 223.5 ng/dL, 43.9%, 0.70 ng/mL, and 23.2 ng/mL respectively. Prevalence of OSA was 16% in TC, 12% in intranasal T, and 12% in T pellets. Follow-up values in all three formulations showed increases in T and E, with the largest increases seen in TC (+157%, +23.0%) followed by intranasal T (+114%, +14.5%) and pellets (+79%, +1.4%) (p=0.01). Of note, nasal T showed a decrease in HCt (45.2 to 44.4) while both longer acting formulations showed increases in HCt. Participants positively screened for existing OSA showed no significant differences in HCt before and after four months of treatment (p=0.994 and 0.289). Mean PSA in all three treatment groups was unchanged (0.70 ng/mL).

CONCLUSIONS:​

Prevalence of OSA among men with testosterone deficiency was 13%. Intranasal T appears to have minimal impact on HCt compared to TC and T pellets despite significant increases in serum T and E when controlled for OSA. While the results of these single center RCTs support evidence that intranasal T avoids adverse effects due to its biomimetic short-acting properties, further investigation is required to elucidate predispositions and effects from long term TRT.



Source of Funding:​

Support by National Institutes of Health Grant R01 DK130991 and Clinician Scientist Development Grant from the American Cancer Society to RR
 

Secondary Polycythemia in Men Receiving Testosterone Therapy Increases Risk of Major Adverse Cardiovascular Events and Venous Thromboembolism in the First Year of Therapy​


Abstract
Purpose: An unsafe hematocrit threshold for men receiving testosterone therapy (TT) has never been tested. This study seeks to determine whether secondary polycythemia among men receiving TT confers an increased risk of major adverse cardiovascular events (MACE) and venous thromboembolic events (VTE).

Materials and methods: Using a multi-institutional database of 74 million patients, we identified 2 cohorts of men with low testosterone (total testosterone <350 ng/dl) who received TT and subsequently either developed polycythemia (5,887) or did not (4,2784). Polycythemia was defined as hematocrit ≥52%. As a secondary objective, we identified 2 cohorts of hypogonadal men without polycythemia, who either did (26,880) or did not (27,430) receive TT. Our primary outcome was the incidence of MACE and VTE in the first year after starting TT. We conducted a Kaplan-Meier survival analysis to assess differences in MACE and VTE survival time, and measured associations following propensity score matching.

Results: A total of 5,842 men who received TT and developed polycythemia were matched and compared to 5,842 men who did not develop polycythemia. Men with polycythemia had a higher risk of MACE/VTE (number of outcomes: 301, 5.15%) than men who had normal hematocrit (226, 3.87%) while on TT (OR 1.35, 95% CI 1.13-1.61, p <0.001). In hypogonadal men who received testosterone, no increased risk of MACE and VTE was identified as compared to hypogonadal men naïve to TT.

Conclusions: Developing polycythemia while on TT is an independent risk factor for MACE and VTE in the first year of therapy. Future research on the safety of TT should include hematocrit as an independent variable.
 
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TRT and erythrocytosis

Testosterone therapy and secondary erythrocytosis (2021) Joshua White, Francis Petrella, and Jesse Ory Secondary erythrocytosis is one of the most common adverse events associated with testosterone therapy (TT). Upon encountering this, clinicians will often either adjust TT dosing, stop...
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Blood pressure responses to testosterone therapy are amplified by hematocrit levels in opioid-induced androgen deficiency: a double-blind, randomized, placebo-controlled trial​


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Blood pressure responses to testosterone therapy are... : Journal of Hypertension

18 years old) receiving opioid treatment and total testosterone less than 12 nmol were randomly assigned to receive either TRT or placebo. Baseline and 6-month measurements included anthropometric measurements, office blood pressure (OBPM), 24-h ambulatory blood pressure, blood samples, and...
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