Jones Steven D, Dukovac Thomas, Sangkum Premsant, Yafi Faysal A, Hellstrom Wayne J G
Department of UrologyTulane University School of MedicineNew OrleansLAUSA.
Department of UrologyTulane University School of MedicineNew OrleansLAUSA.
Sex Med Rev. 2015 Apr;3(2):101-112. doi: 10.1002/smrj.43. Epub 2015 Dec 2.
Testosterone replacement therapy (TRT) is a common treatment for hypogonadism in aging males. Men with low to low-normal levels of testosterone have documented benefit from hormone replacement. Recent meta-analyses have revealed that increases in hemoglobin (Hb) and hematocrit (Hct) are the variants most commonly encountered. Clinically, this response is described as erythrocytosis or polycythemia secondary to TRT. However, the recent Food and Drug Administration warning regarding the risk for venothromboembolism (VTE) has made the increases in Hb and Hct of more pertinent concern. The risks associated with androgen replacement need further examination.
To review the available literature on erythrocytosis and polycythemia secondary to TRT. To discuss potential etiologies for this response, the role it plays in risk for VTE, and recommendations for considering treatment in at-risk populations.
A literature review was performed through PubMed regarding TRT and erythrocytosis and polycythemia.
To assess the mechanisms of TRT-induced erythrocytosis and polycythemia with regard to basic science, pharmacologic preparation, and route of delivery. To review Hct and risk for thrombotic events. To offer clinical suggestions for therapy in patients at risk for veno-thrombotic events.
Men undergoing TRT have a 315% greater risk for developing erythrocytosis (defined as Hct > 0.52) when compared with control. Mechanisms involving iron bioavailability, erythropoietin production, and bone marrow stimulation have been postulated to explain the erythrogenic effect of TRT. The association between TRT-induced erythrocytosis and subsequent risk for VTE remains inconclusive.
All TRT formulations cause increases in Hb and Hct, but injectables tend to produce the greatest effect. The evidence regarding the risk for VTE with increased Hct is inconclusive. For patients with risk factors for veno-thrombotic events, formulations that provide the smallest effect on blood parameters hypothetically provide the safest option. Further trials are needed to fully evaluate the hematological side effects associated with TRT. Jones SD Jr, Dukovac T, Sangkum P, Yafi FA, and Hellstrom WJG. Erythrocytosis and polycythemia secondary to testosterone replacement therapy in the aging male. Sex Med Rev 2015;3:101-112.
睾酮替代疗法（TRT）是老年男性性腺功能减退的常见治疗方法。睾酮水平低至低正常水平的男性已证明能从激素替代中获益。近期的荟萃分析显示，血红蛋白（Hb）和血细胞比容（Hct）升高是最常出现的变化。临床上，这种反应被描述为TRT继发的红细胞增多症或红细胞增多。然而，美国食品药品监督管理局最近关于静脉血栓栓塞（VTE）风险的警告使得对Hb和Hct升高的关注更为迫切。雄激素替代相关的风险需要进一步研究。
回顾关于TRT继发的红细胞增多症和红细胞增多的现有文献。讨论这种反应的潜在病因、其在VTE风险中所起的作用以及对高危人群治疗考量的建议。
通过PubMed对TRT以及红细胞增多症和红细胞增多进行文献综述。
从基础科学、药物制剂和给药途径方面评估TRT诱导的红细胞增多症和红细胞增多的机制。回顾Hct和血栓形成事件的风险。为静脉血栓形成事件高危患者的治疗提供临床建议。
与对照组相比，接受TRT的男性发生红细胞增多症（定义为Hct＞0.52）的风险高315%。已提出涉及铁生物利用度、促红细胞生成素产生和骨髓刺激的机制来解释TRT的促红细胞生成作用。TRT诱导的红细胞增多症与随后的VTE风险之间的关联仍无定论。
所有TRT制剂都会导致Hb和Hct升高，但注射剂往往产生的影响最大。关于Hct升高导致VTE风险的证据尚无定论。对于有静脉血栓形成事件风险因素的患者，对血液参数影响最小的制剂理论上提供了最安全的选择。需要进一步试验来全面评估与TRT相关的血液学副作用。小琼斯·S·D、杜科瓦茨·T、桑库姆·P、亚菲·F·A和赫尔斯特伦·W·J·G。老年男性睾酮替代疗法继发的红细胞增多症和红细胞增多。性医学评论2015；3：101 - 112。
