Differences in hematocrit impact between different application protocols

[Phil Goodman]

The Effect of Route of Testosterone on Changes in Hematocrit: A Systematic Review and Bayesian Network Meta-Analysis of Randomized Trials - PubMed

All types of testosterone are associated with increased hematocrit; however, the clinical concern of this increase remains questionable, warranting future studies. This is the first network meta-analysis to quantify mean hematocrit change and compare formulations, given the absence of...

pubmed.ncbi.nlm.nih.gov

Abstract​

Purpose: We sought to compare testosterone formulations and determine the degree that hematocrit increases vary by testosterone therapy formulation. As head-to-head trials are rare, network meta-analysis of the contemporary studies is the only way to compare hematocrit changes by testosterone type, including topical gels and patches, injectables (both short-acting and long-acting) and oral tablets.

Materials and methods: We conducted a thorough search of listed publications in Scopus®, PubMed®, Embase®, Cochrane CENTRAL, and ClinicalTrials.gov. A total of 29 placebo-controlled randomized trials (3,393 men) met inclusion criteria for analysis of mean hematocrit change after testosterone therapy. Randomized controlled trial data for the following formulations of testosterone were pooled via network meta-analysis: gel, patch, oral testosterone undecanoate, intramuscular testosterone undecanoate, and intramuscular testosterone enanthate/cypionate.

Results: All types of testosterone therapies result in statistically significant increases in mean hematocrit when compared with placebo. Meta-analysis revealed all formulations, including gel (3.0%, 95% CI 1.8-4.3), oral testosterone undecanoate (4.3%, 0.7-8.0), patch (1.4%, 0.2-2.6), intramuscular testosterone enanthate/cypionate (4.0%, 2.9-5.1), and intramuscular testosterone undecanoate (1.6%, 0.3-3.0) result in statistically significant increases in mean hematocrit when compared with placebo. When comparing all formulations against one another, intramuscular testosterone cypionate/enanthate were associated with a significantly higher increase in mean hematocrit compared to patch, but no differences in hematocrit between other formulations were detected.

Conclusions: All types of testosterone are associated with increased hematocrit; however, the clinical concern of this increase remains questionable, warranting future studies. This is the first network meta-analysis to quantify mean hematocrit change and compare formulations, given the absence of head-to-head trials.

 

[Phil Goodman]

I found this interesting since a common theme on here is that oral t is always better with regard to hematocrit impact. However, at least according to this analysis, when considering averages the oral t had a slightly higher impact. This is due to the outlier users that had a surprisingly large impact to their hematocrit (over 8% in some cases).

I’d say more studies should be done to better identify which users would be more likely to have the more drastic impact occur. The only theory I can come up with off the top of my head is that differences in digestion between users could play a large role in that. And that application method (oral) has easily the widest variability in impact… which if the digestibility is behind the differences that would make sense. While there could be some differences in absorbability between users on topical, and even some differences between breakdown via IM or sub q administration, I’d imagine there could be much more variability when it comes to digestion.



Just some food for thought (pun intended).

 

[Vince]

It makes me wonder how much estrogen increases hematocrit. We definitely know that Testosterone increases it, we also know estrogen at times will increase hematocrit.

 

[WhiteMale]

Dropping daily Cyp inj and going to Topical's got me from donating every 56 days to once per year just on that one thing, in a vacuum.

Oral is going to impact the liver so pick your poison if going that delivery route because of HCT.