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The Health Optimization Doctors RoundTable: High Hematocrit Not Important?
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<blockquote data-quote="RobRoy" data-source="post: 257688" data-attributes="member: 42893"><p>I know you were at the Androgen Society meeting but you must've been in the restroom or getting some coffee when this retrospective data mining study was discussed. It's not worth the paper it's written on. These retrospective studies cannot determine causation they can at most suggest an association. I discussed the paper with the author himself the year before last and he himself doesn't feel there's any harm in racing hematocrit with testosterone. His particular focus now is on the magnitude of change and hematocrit when somebody starts testosterones not the actual increase in hematocrit absolutely. This study is no different than the vigen and finked studies. Not worth the paper they are written on</p><p>We need to be cautious regarding the information derived from weak retrospective database studies. </p><p></p><p></p><p>In 2013 and 2014 two retrospective database studies were published that got a lot of media exposure because of their findings of increased cardiovascular events in men</p><p></p><p></p><p>The first was the Vigen Study that used a national veterans administration prescription database and the other was by Finkle who used an insurance claims database.</p><p></p><p></p><p>These studies were subsequently exposed as being extremely flawed with major limitations </p><p></p><p></p><p></p><p></p><p></p><p>The most recent study by Ory et al (Ramasamy) suggesting an increase in major adverse cardiac events in men secondary to an increase in hematocrit was also a retrospective database study based on electronic medical records. </p><p></p><p></p><p></p><p></p><p></p><p>Understand that all of these studies are retrospective studies and not a planned experiment so conclusions must be regarded extremely cautiously as these types of studies are prone to error and bias. </p><p></p><p></p><p>They have an inferior level of evidence compared with prospective studies</p><p></p><p></p><p>They are subject to confounding as other risk factors that may have been present or not measured</p><p></p><p></p><p>And most importantly retrospective studies cannot determine causation they can only show an association.</p><p></p><p></p><p>They are thought-provoking and hypothesis generating but findings have to be proven by larger more expensive prospective studies.</p><p></p><p></p><p></p><p></p><p></p><p>A recent prospective study my Strange et al showed that an increase in hematocrit of up to 52% with testosterone therapy is associated with decrease mortality. The only reason they cut it off at 52% was that no one exceeded that in their study.</p><p></p><p></p><p></p><p></p><p></p><p>So it appears that when someone wants to do a study that shows increased risk with testosterone then they always resort to a weak retrospective database study and what's most concerning is that many of these studies appear to be a data mining exercise with the express goal of obtaining a statistically significant result worthy of publication.</p><p></p><p></p><p>In terms of CV risks associated with T-induced erythrocytosis, prospective, randomized, controlled trials have failed to detect a direct relationship between T-induced erythrocytosis and subsequent risk for CV events (including stroke and deep vein thrombosis).Khera</p><p></p><p></p><p></p><p></p><p></p><p>There are no randomized or prospective studies that have documented a direct relationship between testosterone related erythrocytosis and thromboembolic events</p></blockquote><p></p>
[QUOTE="RobRoy, post: 257688, member: 42893"] I know you were at the Androgen Society meeting but you must've been in the restroom or getting some coffee when this retrospective data mining study was discussed. It's not worth the paper it's written on. These retrospective studies cannot determine causation they can at most suggest an association. I discussed the paper with the author himself the year before last and he himself doesn't feel there's any harm in racing hematocrit with testosterone. His particular focus now is on the magnitude of change and hematocrit when somebody starts testosterones not the actual increase in hematocrit absolutely. This study is no different than the vigen and finked studies. Not worth the paper they are written on We need to be cautious regarding the information derived from weak retrospective database studies. In 2013 and 2014 two retrospective database studies were published that got a lot of media exposure because of their findings of increased cardiovascular events in men The first was the Vigen Study that used a national veterans administration prescription database and the other was by Finkle who used an insurance claims database. These studies were subsequently exposed as being extremely flawed with major limitations The most recent study by Ory et al (Ramasamy) suggesting an increase in major adverse cardiac events in men secondary to an increase in hematocrit was also a retrospective database study based on electronic medical records. Understand that all of these studies are retrospective studies and not a planned experiment so conclusions must be regarded extremely cautiously as these types of studies are prone to error and bias. They have an inferior level of evidence compared with prospective studies They are subject to confounding as other risk factors that may have been present or not measured And most importantly retrospective studies cannot determine causation they can only show an association. They are thought-provoking and hypothesis generating but findings have to be proven by larger more expensive prospective studies. A recent prospective study my Strange et al showed that an increase in hematocrit of up to 52% with testosterone therapy is associated with decrease mortality. The only reason they cut it off at 52% was that no one exceeded that in their study. So it appears that when someone wants to do a study that shows increased risk with testosterone then they always resort to a weak retrospective database study and what's most concerning is that many of these studies appear to be a data mining exercise with the express goal of obtaining a statistically significant result worthy of publication. In terms of CV risks associated with T-induced erythrocytosis, prospective, randomized, controlled trials have failed to detect a direct relationship between T-induced erythrocytosis and subsequent risk for CV events (including stroke and deep vein thrombosis).Khera There are no randomized or prospective studies that have documented a direct relationship between testosterone related erythrocytosis and thromboembolic events [/QUOTE]
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The Health Optimization Doctors RoundTable: High Hematocrit Not Important?
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