What causes high hematocrit? High DHT?

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Nelson Vergel

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Elevated Dihydrotestosterone is Associated with Testosterone-Induced Erythrocytosis


Aghazadeh, Monty et al. The Journal of Urology

Abstract


Introduction Erythrocytosis is the most common dose-limiting adverse effect of testosterone therapy (TTh), but the mechanisms of T-mediated erythropoiesis remain unclear. In this study, we examine risk factors for erythrocytosis associated with TTh. Methods Retrospective review of 179 hypogonadal men on TTh in a single andrology clinic was performed. Demographic data, TTh formulation and duration of treatment, and 5&#945; reductase inhibitor (5ARI) use were assessed. Serum dihydrotestosterone (DHT), total T (TT), free T (FT), follicle stimulating hormone (FSH), luteinizing hormone (LH), Hematocrit (Hct), and lipid levels were extracted and changes during treatment determined. Spearman's rank correlation was used to identify relationships between change in Hct (&#916;Hct) and study variables. Results Of 179 patients, 49 (27%) developed a &#8805;10% &#916;Hct and 36 (20.1%) developed erythrocytosis (Hct &#8805;50%) at a median follow-up of 7 months. Topical gels were used by 41.3% of patients, injectable T by 52.5%, and subcutaneous pellets by 6.1%. More men who developed &#916;Hct &#8805;10% used injectable T than men with &#916;Hct <10% (65% vs. 48%, p=0.035), and were less likely to be on 5ARI (2% vs. 15%, p=0.017). Men with &#916;Hct &#8805;10% had higher post-treatment DHT levels (605.0 vs. 436.0 ng/dL, p=0.017) and lower LH and FSH levels than men with &#916;Hct <10%. Spearman's rank correlations yielded relationships between &#916;Hct and post-treatment DHT (&#961;=0.258, p=0.001) and TT (&#961;=0.171, p=0.023). Conclusion DHT may play a role in TTh-related erythrocytosis, and monitoring of DHT levels during TTh should be considered. In men who develop erythrocytosis, 5ARIs may be therapeutic.

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