Elsevier

Sexual Medicine Reviews

Volume 6, Issue 1, January 2018, Pages 77-85
Sexual Medicine Reviews

Review
Erythrocytosis Following Testosterone Therapy

https://doi.org/10.1016/j.sxmr.2017.04.001Get rights and content

Abstract

Introduction

A rapid increase in awareness of androgen deficiency has led to substantial increases in prescribing of testosterone therapy (TTh), with benefits of improvements in mood, libido, bone density, muscle mass, body composition, energy, and cognition. However, TTh can be limited by its side effects, particularly erythrocytosis. This review examines the literature on testosterone-induced erythrocytosis and polycythemia.

Aim

To review the available literature on testosterone-induced erythrocytosis, discuss possible mechanisms for pathophysiology, determine the significance of formulation, and elucidate potential thromboembolic risk.

Methods

A literature review was performed using PubMed for articles addressing TTh, erythrocytosis, and polycythemia.

Main Outcome Measures

Mechanism, pharmacologic contribution, and risk of testosterone-induced erythrocytosis.

Results

For men undergoing TTh, the risk of developing erythrocytosis compared with controls is well established, with short-acting injectable formulations having the highest associated incidence. Potential mechanisms explaining the relation between TTh and erythrocytosis include the role of hepcidin, iron sequestration and turnover, erythropoietin production, bone marrow stimulation, and genetic factors. High blood viscosity increases the risk for potential vascular complications involving the coronary, cerebrovascular, and peripheral vascular circulations, although there is limited evidence supporting a relation between TTh and vascular complications.

Conclusion

Short-acting injectable testosterone is associated with greater risk of erythrocytosis compared with other formulations. The mechanism of the pathophysiology and its role on thromboembolic events remain unclear, although some data support an increased risk of cardiovascular events resulting from testosterone-induced erythrocytosis.

Ohlander SJ, Varghese B, Pastuszak AW. Erythrocytosis Following Testosterone Therapy. Sex Med Rev 2018;6:77–85.

Key Words

Hypogonadism
Testosterone
Hormone Replacement
Erythrocytosis
Polycythemia

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Conflicts of Interest: A.P. is an advisory board member and consultant for Endo Pharmaceuticals. The other authors report no conflicts.

Funding: A.P. is a K12 scholar supported by a Male Reproductive Health Research Career Development Physician-Scientist Award (grant HD073917-01) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Program.

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