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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone and Men's Health Articles
Erythrocytosis Associated With Oral Testosterone Replacement
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<blockquote data-quote="madman" data-source="post: 268944" data-attributes="member: 13851"><p><strong>Abstract</strong></p><p><strong></strong></p><p><strong>Background</strong></p><p></p><p><em>A growing prevalence of male hypogonadism has led to increased interest in the most common adverse event, erythrocytosis.<strong> Defined by hematocrit (HCT) > 49-51%, the incidence varies depending on the testosterone formulation.3 The formulations with the lowest risk of erythrocytosis are intranasal testosterone (0-2%) and oral testosterone (0.03%).</strong>3 A phase 3 clinical trial of testosterone undecanoate (Jatenzo) reported 4.8% of patients experienced an increase in hematocrit, although not severe enough to warrant therapy discontinuation.2 <strong>We present a case of erythrocytosis with oral testosterone undecanoate that prompted a change in therapy.</strong> </em></p><p></p><p></p><p><strong>Clinical Case</strong></p><p></p><p><em>Our patient is a 55-year-old male with secondary hypogonadism potentially related to obesity (BMI 37 kg/m²). AM total testosterone (TT) 151 (348-1197 ng/dL), free testosterone 4.6 pg/mL (6.8-21.5 pg/mL) and LH 3.8 mIU/mL. Labs confirmed. Secondary workup negative. <strong>HCT 43.6% prior to any therapy. The patient was treated with injectable testosterone. Despite decreasing to testosterone cypionate 80 mg weekly his HCT increased to 52.7% with a TT of 544 ng/dL. <u>He was switched to oral testosterone undecanoate 237 mg twice daily given presumably lower risk of erythrocytosis</u>. <u>However, HCT increased to 55.1% and TT to 1542 ng/dL</u>. <u>The patient donated blood and the oral testosterone dose decreased to 158 mg twice daily with starting HCT 48.9%, but this increased to 53.7%</u>. <u>TT 522 ng/dL</u>. Therapy stopped with an improvement of HCT to 45.8%-48.9%, TT 192 ng/dL, and SHBG 20 g/dL. Erythropoietin remained normal. <u>The patient does not smoke cigarettes nor has OSA</u>.</strong></em></p><p></p><p></p><p><strong>Conclusion</strong></p><p></p><p><em><strong>We present a case of oral testosterone undecanoate complicated by persistent erythrocytosis despite dose reduction. Testing for contributing etiology was unrevealing. <u>Oral testosterone replacement is considered the formulation least likely to cause erythrocytosis</u>. Certain patient characteristics like OSA, advanced age, obesity, type II diabetes mellitus, and an elevated HCT > 50% can predict the likelihood of erythrocytosis although its specific etiology is unclear.3 <u>Proposed mechanisms include elevation in dihydrotestosterone, erythropoietin stimulation, suppression of hepcidin, and relation to androgen receptor CAG repeat length</u>.1 <u>Providers should be aware of the possibility of erythrocytosis on oral testosterone</u>. Further research is needed to determine predictive characteristics for erythrocytosis and its etiology.</strong></em></p></blockquote><p></p>
[QUOTE="madman, post: 268944, member: 13851"] [B]Abstract Background[/B] [I]A growing prevalence of male hypogonadism has led to increased interest in the most common adverse event, erythrocytosis.[B] Defined by hematocrit (HCT) > 49-51%, the incidence varies depending on the testosterone formulation.3 The formulations with the lowest risk of erythrocytosis are intranasal testosterone (0-2%) and oral testosterone (0.03%).[/B]3 A phase 3 clinical trial of testosterone undecanoate (Jatenzo) reported 4.8% of patients experienced an increase in hematocrit, although not severe enough to warrant therapy discontinuation.2 [B]We present a case of erythrocytosis with oral testosterone undecanoate that prompted a change in therapy.[/B] [/I] [B]Clinical Case[/B] [I]Our patient is a 55-year-old male with secondary hypogonadism potentially related to obesity (BMI 37 kg/m²). AM total testosterone (TT) 151 (348-1197 ng/dL), free testosterone 4.6 pg/mL (6.8-21.5 pg/mL) and LH 3.8 mIU/mL. Labs confirmed. Secondary workup negative. [B]HCT 43.6% prior to any therapy. The patient was treated with injectable testosterone. Despite decreasing to testosterone cypionate 80 mg weekly his HCT increased to 52.7% with a TT of 544 ng/dL. [U]He was switched to oral testosterone undecanoate 237 mg twice daily given presumably lower risk of erythrocytosis[/U]. [U]However, HCT increased to 55.1% and TT to 1542 ng/dL[/U]. [U]The patient donated blood and the oral testosterone dose decreased to 158 mg twice daily with starting HCT 48.9%, but this increased to 53.7%[/U]. [U]TT 522 ng/dL[/U]. Therapy stopped with an improvement of HCT to 45.8%-48.9%, TT 192 ng/dL, and SHBG 20 g/dL. Erythropoietin remained normal. [U]The patient does not smoke cigarettes nor has OSA[/U].[/B][/I] [B]Conclusion[/B] [I][B]We present a case of oral testosterone undecanoate complicated by persistent erythrocytosis despite dose reduction. Testing for contributing etiology was unrevealing. [U]Oral testosterone replacement is considered the formulation least likely to cause erythrocytosis[/U]. Certain patient characteristics like OSA, advanced age, obesity, type II diabetes mellitus, and an elevated HCT > 50% can predict the likelihood of erythrocytosis although its specific etiology is unclear.3 [U]Proposed mechanisms include elevation in dihydrotestosterone, erythropoietin stimulation, suppression of hepcidin, and relation to androgen receptor CAG repeat length[/U].1 [U]Providers should be aware of the possibility of erythrocytosis on oral testosterone[/U]. Further research is needed to determine predictive characteristics for erythrocytosis and its etiology.[/B][/I] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone and Men's Health Articles
Erythrocytosis Associated With Oral Testosterone Replacement
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