Controversies with Testosterone Therapy - Management of Erythrocytosis and Elevated Estradiol

[madman]

Hot off the press!

25th Annual Fall Scientific Meeting of SMSNA!

Grapevine, Texas!

Great presentation!




1:29:40-1:43:30

Conclusions

 

[madman]

Outline

 

[madman]

Erythrocytosis and VTE

 

[madman]

AUA & Endocrine Society Guidelines

 

[madman]

Erythrocytosis vs Polycythemia

Primary and Secondary Erythrocytosis

 

[madman]

TRT & Erythrocytosis

Currently 3 Theories for Erythrocytosis due to TRT

TRT & Erythrocytosis

Example of some of the data looking at the rates of erythrocytosis

 

[madman]

Risk Modifiers

 

[madman]

VTE Risk

Virchow's Triad

 

[madman]

Long-term TRT in Healthy Adult Mice

 

[madman]

TRAVERSE TRIAL

 

[madman]

TRT Database - UCI

 

[madman]

FDA Stance on TRT

Thread 'FDA issues class-wide labeling changes for testosterone products'

Feb 28, 2025

FDA issues class-wide labeling changes for testosterone products

FDA issues class-wide labeling changes for testosterone products

www.fda.gov

[2/28/2025] Today, FDA informed sponsors of testosterone products about new labeling changes following the agency’s review of the findings from the Testosterone Replacement Therapy for Assessment of Long-term Vascular Events and Efficacy Response in Hypogonadal Men (TRAVERSE) clinical trial External Link Disclaimer and the results from required postmarket ambulatory blood pressure (ABPM) studies.

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• madman
• hypogonadism; t-therapy; cvd; fda
• Replies: 18
• Forum: Testosterone and Men's Health Articles

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[madman]

Management of TRT-Related Erythrocytosis

 

[madman]

Clinical Approach to TRT & Erythrocytosis

 

[madman]

* In terms of range its kind of broad but I usually like the estradiol between 20-50 pg/mL, that's what I tell patients, I rarely see someone symptomatic under 50 pg/mL, when it goes above 50 pg/mL I start discussing with them about risk and benefit of AI, I start at a very low dose of AI or change the modality, I don't like seeing it on the lab that it says less than 20 pg/mL because I start getting concerned especially long-term




Elevated Estradiol

 

[madman]

Physiology Refresher

 

[madman]

* No universally accepted "upper limit" for men on TRT



Elevated Estradiol & TRT

 

[madman]

* I would argue that you should check estradiol levels on everybody who's on TRT but these are the guidelines




AUA & Endocrine Society Guidelines

 

[madman]

Management of Elevated Estradiol

 

[madman]

TRT Database - UCI