Subcutaneous TRT injections reduce the number of men with high hematocrit

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madman

Super Moderator
Erythrocytosis in Subcutaneous Testosterone Replacement Therapy
Author links open overlay panel (2022)

TWilliamson, JTrussler, AMcCullough


Introduction

Intramuscular (IM) testosterone replacement therapy (TRT) is commonly administered to treat symptomatic male hypogonadism and can result in improved libido, muscle strength, and bone density. However, as many as 40-66% of men receiving IM testosterone replacement therapy may develop erythrocytosis (hematocrit ≥53%), which can result in an increased risk of vascular complications including venous thromboembolic disease. In transgender men, subcutaneous (SC) injections of testosterone have been used with improvement in patient satisfaction while maintaining a similar testosterone exposure to IM injections. Additionally, SC testosterone has been shown to be more tolerable, with less pain during injection and increased potential for self-administration.


Objective

To evaluate the rate of erythrocytosis observed in cisgender male patients undergoing SC injection of testosterone cypionate in comparison to published rates in the literature with IM testosterone cypionate.


Methods

A retrospective review of cisgender male patients receiving SC testosterone replacement therapy between January 2021 and June 2021 was conducted. Patient charts were reviewed for testosterone dose, baseline hematocrit, baseline testosterone level, sex hormone-binding globulin level prior to starting therapy, and the most recent hematocrit and testosterone levels. The rate of erythrocytosis was determined as well as the change in hematocrit from baseline.


Results

94 men were included in the cohort. 32% of men developed new-onset erythrocytosis while receiving SC testosterone cypionate. The average weekly dose of testosterone was similar between those receiving weekly and biweekly injections (100.76mg vs 111.2mg, p=0.27).


Conclusions

The SC administration of testosterone cypionate in men with symptomatic hypogonadism appears to result in a reduced rate of erythrocytosis compared with rates published in the literature for IM injection therapy. This may aid to decrease the risk of erythrocytosis and associated complications. Further study is warranted to confirm these findings in a prospective cohort.
 
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Cataceous

Super Moderator
So 1/3 getting subq developed erythrocytosis after 6 months? Doesn't seem too promising.
It's not surprising when you look at the dosing: The patients are averaging over 10 mg of testosterone per day. Meanwhile, the average for youthful production is around 6-7 mg. If you give enough guys more testosterone than they ever would make naturally then you will see side effects.
 

FunkOdyssey

Seeker of Wisdom
So 1/3 getting subq developed erythrocytosis after 6 months? Doesn't seem too promising.
32% is promising when 40-66% is normal for IM protocols. It also suggests you can do even better with more frequent administration since the implication is that high peaks are driving erythrocytosis. I think @Vince would agree it can be an effective strategy.
 

Vince

Super Moderator
32% is promising when 40-66% is normal for IM protocols. It also suggests you can do even better with more frequent administration since the implication is that high peaks are driving erythrocytosis. I think @Vince would agree it can be an effective strategy.
Yes, I would agree. When I went to daily injections I no longer had to donate blood. Also, longevity helps with stabilizing HCT levels.
 

TLR

Active Member
32% is promising when 40-66% is normal for IM protocols. It also suggests you can do even better with more frequent administration since the implication is that high peaks are driving erythrocytosis. I think @Vince would agree it can be an effective strategy.
I wish sub q worked for me….I tried it for a couple of months and didn’t change anything other than injection location (stomach)….TT level dropped from 700s to 300s and curiously e2 lowered slightly, but only by a few points….guess I have thick fat or something….
 

madman

Super Moderator



 

aneuman

Active Member
I wish sub q worked for me….I tried it for a couple of months and didn’t change anything other than injection location (stomach)….TT level dropped from 700s to 300s and curiously e2 lowered slightly, but only by a few points….guess I have thick fat or something….
Interesting, I had a similar experience both in terms of T and E2.
 
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