* The cut-off number of HCT for discontinuation of TRT, ranges from 52%–54%. However, recent data suggests mortality risk reduction in the higher end of HCT (50%–52%) as compared to lower HCT(46%–49%). Therefore a 54% threshold for TRT discontinuation might be appropriate.
This is the paper the authors were referring to!
Keep in mind the limitations of that study!
Hematocrit Increase, Reduced Death in Hypogonadal Men: Implications of TTh on Anemia and Complete Blood Count and Paradigm Shift of Its Risk Factor (2025)
* Hematocrit levels show significant increase (+4% at month 96) in men receiving TTh. This increase occurred during the first 48 months, as illustrated in figure 1. Final assessment (month 96) resulted mean hematocrit was 49% (range 47-51%). No subject had hematocrit above 52%. No change in hematocrit noted so far in men not receiving TTh.
* The present study showed that increased hematocrit (up to 52% at final assessment) was independently associated with reduced mortality [5]. This confirms the current clinical guidelines recommendation of using 54% as a threshold for change in management of men receiving testosterone therapy (e.g. dose reduction or therapeutic phlebotomy) [11-15]. It should be kept in mind that dehydration can cause a temporary elevation in hematocrit [16] and therefore a high hematocrit reading should be confirmed in a second blood test, ensuring the patient is in a well hydrated state, before action is taken.
* This study has a limitation as registry design. Furthermore, the sample is relatively small. Large scale, placebo-controlled studies with large cohort over prudential period is needed to robustly confirm these results.
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