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Elevated Dihydrotestosterone is Associated with Testosterone Induced Erythrocytosis

2015; Lippincott Williams & Wilkins; Volume: 194; Issue: 1 Linguagem: Inglês

10.1016/j.juro.2015.01.038

1527-3792

Monty Aghazadeh, Alexander W. Pastuszak, William G. Johnson, Matthew McIntyre, Tung‐Chin Hsieh, Larry I. Lipshultz,

Sexual Differentiation and Disorders

No AccessJournal of UrologyAdult Urology1 Jul 2015Elevated Dihydrotestosterone is Associated with Testosterone Induced Erythrocytosis Monty Aghazadeh, Alexander W. Pastuszak, William G. Johnson, Matthew G. McIntyre, T. Mike Hsieh, and Larry I. Lipshultz Monty AghazadehMonty Aghazadeh Scott Department of Urology, Baylor College of Medicine, Houston, Texas , Alexander W. PastuszakAlexander W. Pastuszak Scott Department of Urology, Baylor College of Medicine, Houston, Texas Center for Reproductive Medicine, Baylor College of Medicine, Houston, Texas , William G. JohnsonWilliam G. Johnson Scott Department of Urology, Baylor College of Medicine, Houston, Texas , Matthew G. McIntyreMatthew G. McIntyre Urology Associates of Mobile, Mobile, Alabama , T. Mike HsiehT. Mike Hsieh Department of Urology, University of California, San Diego, San Diego, California , and Larry I. LipshultzLarry I. Lipshultz Scott Department of Urology, Baylor College of Medicine, Houston, Texas Center for Reproductive Medicine, Baylor College of Medicine, Houston, Texas View All Author Informationhttps://doi.org/10.1016/j.juro.2015.01.038AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Erythrocytosis is the most common dose limiting adverse effect of testosterone therapy but the mechanisms of testosterone mediated erythropoiesis remain unclear. In this study we examine risk factors for erythrocytosis associated with testosterone therapy. Materials and Methods: A retrospective review was performed of 179 hypogonadal men on testosterone therapy at a single andrology clinic. Demographic data, testosterone therapy formulation and duration of treatment, and 5α-reductase inhibitor use were assessed. Serum dihydrotestosterone, total testosterone, free testosterone, follicle-stimulating hormone, luteinizing hormone, hematocrit and lipid levels were extracted, and changes during treatment were determined. Spearman's rank correlation was used to identify relationships between change in hematocrit and study variables. Results: Of 179 patients 49 (27%) experienced a 10% or greater change in hematocrit and erythrocytosis (hematocrit 50% or greater) developed in 36 (20.1%) at a median followup of 7 months. Topical gels were used by 41.3% of patients, injectable testosterone by 52.5% and subcutaneous pellets by 6.1%. More men who experienced a change in hematocrit of 10% or greater used injectable testosterone than men with a change in hematocrit of less than 10% (65% vs 48%, p=0.035), and were less likely to be on a 5α-reductase inhibitor (2% vs 15%, p=0.017). Men with a change in hematocrit of 10% or greater had higher posttreatment dihydrotestosterone levels (605.0 vs 436.0 ng/dl, p=0.017) and lower luteinizing hormone and follicle-stimulating hormone levels than men with a change in hematocrit of less than 10%. Spearman's rank correlations yielded relationships between change in hematocrit and posttreatment dihydrotestosterone ρ=0.258, p=0.001) and total testosterone (ρ=0.171, p=0.023). Conclusions: Dihydrotestosterone may have a role in testosterone therapy related erythrocytosis and monitoring dihydrotestosterone levels during testosterone therapy should be considered. In men in whom erythrocytosis develops, 5α-reductase inhibitors may be therapeutic. References 1 : Risks of testosterone-replacement therapy and recommendations for monitoring. N Engl J Med2004; 350: 482. Google Scholar 2 : The benefits and risks of testosterone replacement therapy: a review. Ther Clin Risk Manag2009; 5: 427. 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Google Scholar © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byHayden R, Bennett N and Tanrikut C (2016) Hematocrit Response and Risk Factors for Significant Hematocrit Elevation with Implantable Testosterone PelletsJournal of Urology, VOL. 196, NO. 6, (1715-1720), Online publication date: 1-Dec-2016. Volume 194Issue 1July 2015Page: 160-165Supplementary Materials Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Keywordstestosteronehormone replacement therapydihydrotestosteronepolycythemiaMetrics Author Information Monty Aghazadeh Scott Department of Urology, Baylor College of Medicine, Houston, Texas Equal study contribution. More articles by this author Alexander W. Pastuszak Scott Department of Urology, Baylor College of Medicine, Houston, Texas Center for Reproductive Medicine, Baylor College of Medicine, Houston, Texas Equal study contribution. More articles by this author William G. Johnson Scott Department of Urology, Baylor College of Medicine, Houston, Texas More articles by this author Matthew G. McIntyre Urology Associates of Mobile, Mobile, Alabama More articles by this author T. Mike Hsieh Department of Urology, University of California, San Diego, San Diego, California Financial interest and/or other relationship with AMS. More articles by this author Larry I. Lipshultz Scott Department of Urology, Baylor College of Medicine, Houston, Texas Center for Reproductive Medicine, Baylor College of Medicine, Houston, Texas More articles by this author Expand All Advertisement PDF downloadLoading ...