Okano Sérgio Henrique Pires, Braga Giordana Campos, Cantelli Débora Aiesha Leite, Filho Luis Antônio S Pires, Brito Luiz Gustavo Oliveira, Lara Lucia Alves da Silva
Department of Gynecology and Obstetrics, University of São Paulo, Ribeirão Preto, Brazil.
Department of Social Medicine, University of São Paulo, Ribeirão Preto, Brazil.
Andrology. 2025 Mar;13(3):422-430. doi: 10.1111/andr.13695. Epub 2024 Jul 16.
Approximately, 11% of trans men experience erythrocytosis diagnosis due to testosterone administration during the first year of the gender-affirming hormone treatment (GAHT).
To identify and compare the effect of different testosterone formulations on hematocrit (Hct) and diagnose erythrocytosis in trans men.
This systematic review was based on PRISMA guidelines. We performed an electronic search of PubMed, Embase, and Web of Science in January 2024. The Newcastle-Ottawa scale was used to evaluate the quality of evidence in the observational studies.
Of the 152 records retrieved, 18 met the eligibility criteria. Studies observed an increase of up to 5% in Hct in trans men using injectable testosterone undecanoate (TU), and up to 6.9% in trans men using intermediate injectable testosterone esters (TE). Trans men using TE experience a larger increase in serum Hct levels compared to those receiving TU. Erythrocytosis prevalence varies according to the cutoff used (50%, 52%, and 54%). Erythrocytosis was also associated with tobacco use, age at initiation of hormone therapy, body mass index (BMI), and pulmonary conditions. Studies that evaluated the effect of testosterone formulation on erythrocytosis diagnosis present conflicting result. Trans men have a hazard ratio of 7.4 (95% CI: 4.1, 13.4) of developing erythrocytosis compared to cisgender men, using a 52% hematocrit cutoff.
All testosterone formulations result in an increase in Hct, irrespective of dose, formulation, and administration method. Smoking, higher age at initiation of the testosterone therapy, higher BMI, and a predisposing medical history are associated with this increase in Hct. The difference in effect of TE and TU on Hct is conflicting, although it is important to point out that these data come from observational studies, retrospective, and with a small-sample size.
在性别确认激素治疗（GAHT）的第一年，约11%的跨性别男性因使用睾酮而被诊断为红细胞增多症。
确定并比较不同睾酮制剂对跨性别男性血细胞比容（Hct）的影响，并诊断其红细胞增多症。
本系统评价遵循PRISMA指南。2024年1月，我们对PubMed、Embase和Web of Science进行了电子检索。采用纽卡斯尔-渥太华量表评估观察性研究中的证据质量。
在检索到的152条记录中，18条符合纳入标准。研究观察到，使用注射用十一酸睾酮（TU）的跨性别男性Hct升高高达5%，使用中效注射用睾酮酯（TE）的跨性别男性Hct升高高达6.9%。与接受TU的男性相比，使用TE的跨性别男性血清Hct水平升高幅度更大。红细胞增多症的患病率因所采用的临界值（50%、52%和54%）而异。红细胞增多症还与吸烟、激素治疗开始时的年龄、体重指数（BMI）和肺部疾病有关。评估睾酮制剂对红细胞增多症诊断影响的研究结果相互矛盾。以52%的血细胞比容为临界值时，跨性别男性发生红细胞增多症的风险比为7.4（95%CI：4.1，13.4），高于顺性别男性。
所有睾酮制剂都会导致Hct升高，无论剂量、制剂和给药方式如何。吸烟、睾酮治疗开始时年龄较大、BMI较高以及有易感病史与Hct的这种升高有关。TE和TU对Hct的影响差异存在矛盾，不过需要指出的是，这些数据来自观察性研究、回顾性研究且样本量较小。
