Sleep apnea and RBC, Hemoglobin and Hematocrit numbers

[WrenchHead80]

I've asked this question in my intro thread but never got it answered probably because I ask a lot of questions so some go missing.

I've noticed my numbers before starting TRT and since being on it have stayed about the same. Am I right to say they are on the high side of ok? Or are they considered normal? I worry about them becoming elevated more and either having to stop TRT or giving blood too often. Personally I don't feel the TRT should be blamed since as I mentioned my numbers were like this before starting TRT.

I donated blood in the past to see if my numbers would stay lower but they seem to go right back to were they where so I'm thinking something else is causing it. Only thing I could come up with is sleep apnea. My body isn't getting enough oxygen while I sleep and it compensates by raising those numbers to help get more oxygen. Does that make sense? What else can be causing it?

Has anyone discovered they had sleep apnea and since starting treatment there RBC, Hemoglobin and Hematocrit numbers went down?

Here are before TRT and later labs showing RBC, Hemoglobin and Hematocrit numbers

 

[Vince Carter]

some guys have higher RBC/HCT/et al.., due to their own physiology, like living at or having grown up at altitude in the mountains, let's say. But those increasing are an offshoot of using too much testosterone and a look at your dose and Free T would be where I would start, not having your Free T over the lab range, not sleep apnea or a sleep study. I'm just opposed to those thing me personally and may not be great advice for you.

 

[Systemlord]

I don't see a problem, your RBC and hematocrit are identical to pre-TRT. Your concern is unwarranted and you're worrying about something that may never come to pass. Anyone who is on TRT should get a sleep study done regardless.

If no sleep apnea is detected, then if it levels get high then you just donate some blood.

 

[WrenchHead80]

Thanks guys for the advice. I will be looking into a sleep study to put it to rest.

I don't wake up during the night gasping for air or feel like I don't get a good night sleep but my wife does say I snore. I'll look into finding a place to go to and update the tread with the outcome.

 

[WrenchHead80]

Forgot to update.

I had the appointment with the Dr. a few weeks ago. I explained why I felt I may have sleep apnea and showed him my blood work. He asked me a bunch of questions and looked inside my mouth to see if I had a narrow air way. He felt there was a very small chance I have it based on everything. He said if I wanted to he would try to get the okay threw my insurance for the sleep test but felt it may not be easy, since I show no signs of a problem. He also informed me if I did have slight apnea it would be hard to get the equipment threw my insurance. So I felt it wasn't worth the trouble of looking into it anymore. He said if I change my mind I can always give him a call and he can try to put it threw.

 

[Nelson Vergel]

Sleep Apnea Is Associated With Polycythemia in Hypogonadal Men on Testosterone Replacement Therapy


Background
Polycythemia (erythrocytosis) is a known side effect of testosterone (T) replacement therapy (TRT) and appears to correlate with maximum T levels. There is also a well-established association between obstructive sleep apnea (OSA) and the development of polycythemia, which confers additional long-term cardiovascular morbidity. Synergy between TRT and OSA in the development of polycythemia remains poorly understood.

Aim
The objective of this study was to retrospectively assess the relationship of OSA and secondary polycythemia in hypogonadal men receiving TRT.

Methods
We performed a retrospective chart review of all men treated by a single provider from 2015 to 2019 for the diagnosis of hypogonadism. Patients who developed a hematocrit of 52% or greater were classified as having polycythemia. OSA was identified via clinical documentation or use of nocturnal continuous positive airway pressure. Demographics, laboratory values, treatment details, and comorbidities were recorded. Data were reported as mean ± SD for parametric variables and median [interquartile range] for non-parametric values.

Outcome
The primary outcome of this study was the association between OSA and polycythemia in hypogonadal men on TRT.

Results
474 men were included in this study. 62/474 (13.1%) men met the criteria for the diagnosis of polycythemia with a median hematocrit of 53.6 [interquartile range 52.6, 55.5]. Univariate analysis demonstrated a strong positive association between polycythemia and the concomitant diagnosis of OSA in hypogonadal men (P = .002). Even after correcting for age, body mass index (BMI), and peak T levels in the multivariate analysis (P = .01), this relationship remained significant with an odds ratio of 2.09 [95% CI 1.17, 3.76]. 37 men on TRT with polycythemia and OSA were included in the final cohort with a mean age of 59.2 ± 11.4 years, mean BMI of 32.4 ± 6.0, and median time from TRT initiation to polycythemia diagnosis of 3 years. All patients diagnosed with OSA were prescribed continuous positive airway pressure with poor compliance noted in 52.8% of men. 37.8% were managed via phlebotomy and 59.5% were managed via dose de-escalation of TRT. In hypogonadal men on TRT with polycythemia, BMI was the only risk factor strongly associated with OSA (P = .013).

Clinical Translation
In hypogonadal men (particularly those with elevated BMI) on TRT who develop secondary polycythemia, a diagnosis of OSA should be strongly considered.

Strengths & Limitations
This is a single provider retrospective study and further studies are needed to assess generalizability.

Conclusions
In this retrospective single-center cohort, the development of polycythemia in hypogonadal men on TRT was associated with an increased prevalence of OSA.

Lundy SD, Parekh NV, Shoskes DA. Obstructive Sleep Apnea Is Associated With Polycythemia in Hypogonadal Men on Testosterone Replacement Therapy. J Sex Med 2020