TRT myths further debunked - Part 4

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Dr. Ranjith Ramasamy is a Harvard graduate, Ph.D., and the Director of Reproductive Urology as well as an Associate professor at the University of Miami in Florida. As a Urologist and Microsurgeon, Dr. Ramasamy specializes in the treatment of disorders of male infertility and sexual dysfunction and expert in vasectomy reversal and penile prosthesis.

He has performed and published research on men's reproductive health issues including the genetic basis of male infertility and evaluating and treating hypogonadism. He has authored more than 375 peer-reviewed publications on clinical and scientific issues in reproductive health.

He has presented at over 25 national and international conferences and coauthored several book chapters. Dr. Ramasamy has received numerous honors throughout his career, including the Arnold Belker Infertility Fellow of the Year Award, the Ira and Ester Rosenwaks New Investigator Award from the American Society of Reproductive Medicine, and the Clinician Scientist Development Grant from the American Cancer Society. He has a passion for education and mentorship. He started the Andrology fellowship and has trained 10 fellows so far.

Dr. Ramasamy published a landmark study where he took more than 350 participants who had been on testosterone therapy for at least 10 years or more, without the use of any testicular stimulants or fertility medications. The study was scheduled to last 6 months but was cut short b/c by the 90-day mark, using a specific HCG & clomiphene protocol, 96% of the participants had recovered their fertility.

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madman

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madman

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TRT myths further debunked - Part 4​


Hematocrit (3:35-6:10)

Secondary Erythrocytosis/Polycythemia/Polycythemia Vera (6:11-7:37)











 

madman

Super Moderator
post #13

Take-home points:

*the clinical significance of a hematocrit >54% is unknown

*Although it is not yet clear what upper limit of hematocrit level is clinically desirable, dose adjustments may be necessary to keep hematocrit below 52–54%




Hematocrit


*Some authors recommend that TTh be discontinued if hematocrit is >54%, which may be reasonable while baseline hematocrit level >50% is a relative contraindication for starting testosterone therapy. However, these recommendations are based on assumptions – the clinical significance of a hematocrit >54% is unknown

*The lack of increase in cardiovascular events with elevated hematocrit may be due to the fact that T acts as a vasodilator and has anti-atherosclerotic effects [223]. In addition, testosterone is able to decrease plasma concentrations of procoagulatory substances such as fibrinogen and PAI-1 as well as Factor XII [224] Isolated hematocrit elevations can be the result of insufficient fluid intake on a hot day. Only repeated measures of hematocrit >54% should be followed by concomitant administration of aspirin, bleeding, therapeutic phlebotomy, and/or discontinuation of TTh until hematocrit declines below 54%. After normalization of hematocrit levels, TTh can be continued with a reduced dosage

*Periodic hematological assessment is, however, indicated, i.e. before TTh, then 3–4 months and 12 months in the first year of treatment, and annually thereafter. Although it is not yet clear what upper limit of hematocrit level is clinically desirable, dose adjustments may be necessary to keep hematocrit below 52–54%

*Men with significant erythrocytosis (hematocrit >52%), severe untreated obstructive sleep apnea, or untreated severe congestive heart failure should not be started on treatment with TTh without prior resolution of the co-morbid condition.
 
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