Management of hematocrit levels for testosterone replacement patients, a narrative review.

Exogenous testosterone increases erythropoiesis, which can lead to red blood cell overproduction and associated cardiovascular risks including blood clots, heart attack, stroke, or pulmonary embolism.

• Testosterone-induced increases in red blood cells can improve oxygen transport performance.
• Red blood cell overproduction can cause blood clots and severe sequelae such as heart attack, stroke, or pulmonary embolism.
• These side effects need to be closely monitored in testosterone replacement therapy (TRT) patients.
• The review searched PubMed and Google Scholar for relevant articles from 2000-2024.

The route of testosterone administration strongly influences the extent of hematocrit increases.

• Different testosterone preparations produce varying degrees of hematocrit elevation.
• Choosing the right testosterone preparation can minimize hematocrit-related side effects.
• Recent innovations in testosterone preparations allow treatment with less side effects on hematocrit levels.
• Depending on the route of administration, TRT can lead to significant increases in hematocrit and potential cardiovascular incidents.

The effects of testosterone-induced hematocrit elevations on cardiovascular health are controversial in the literature.

• Some studies advocate noninferior effects on cardiovascular health as compared to placebo.
• Other studies found adverse side effects on cardiovascular health from testosterone-induced hematocrit elevations.
• Elevations in hematocrit levels triggered by testosterone therapy are described as 'controversial' by the authors.

Traditional cessation of TRT for severe polycythemia leads to recurrence of hypogonadal symptoms.

• Traditionally, cessation of TRT was recommended for patients with severe polycythemia.
• Cessation of TRT can lead to the recurrence of symptoms experienced before TRT.
• Novel methods to treat hypogonadism while minimizing hematocrit-related side effects are highlighted as alternatives to cessation.

For hypogonadal patients with anemia, testosterone replacement therapy may be beneficial for restoring both healthy testosterone levels and red blood cell counts.

• TRT's erythropoietic effects may represent a therapeutic benefit rather than a side effect in anemic hypogonadal patients.
• The review identifies this dual benefit as a notable consideration in the management of hypogonadal men with concurrent anemia.
• This finding suggests that the clinical impact of TRT-induced erythropoiesis depends on the patient's baseline hematological status.