Erythrocytosis Following Testosterone Therapy
Open accessAbstract
INTRODUCTION: A rapid increase in awareness of androgen deficiency has led to substantial increases in prescribing of testosterone therapy (TTh), with benefits of improvements in mood, libido, bone density, muscle mass, body composition, energy, and cognition. However, TTh can be limited by its side effects, particularly erythrocytosis. This review examines the literature on testosterone-induced erythrocytosis and polycythemia. AIM: To review the available literature on testosterone-induced erythrocytosis, discuss possible mechanisms for pathophysiology, determine the significance of formulation, and elucidate potential thromboembolic risk. METHODS: A literature review was performed using PubMed for articles addressing TTh, erythrocytosis, and polycythemia. MAIN OUTCOME MEASURES: Mechanism, pharmacologic contribution, and risk of testosterone-induced erythrocytosis. RESULTS: For men undergoing TTh, the risk of developing erythrocytosis compared with controls is well established, with short-acting injectable formulations having the highest associated incidence. Potential mechanisms explaining the relation between TTh and erythrocytosis include the role of hepcidin, iron sequestration and turnover, erythropoietin production, bone marrow stimulation, and genetic factors. High blood viscosity increases the risk for potential vascular complications involving the coronary, cerebrovascular, and peripheral vascular circulations, although there is limited evidence supporting a relation between TTh and vascular complications. CONCLUSION: Short-acting injectable testosterone is associated with greater risk of erythrocytosis compared with other formulations. The mechanism of the pathophysiology and its role on thromboembolic events remain unclear, although some data support an increased risk of cardiovascular events resulting from testosterone-induced erythrocytosis. Ohlander SJ, Varghese B, Pastuszak AW. Erythrocytosis Following Testosterone Therapy. Sex Med Rev 2018;6:77-85.
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Adverse events associated with testosterone supplementation include polycythemia, possible cardiovascular events, venous thromboembolism and prostatism.
“Adverse events associated with testosterone supplementation include polycythemia420, possible cardiovascular events421, venous thromboembolism422 and prostatism423.”
From Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies (2018) · cites this paper as [420]
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References 81 · Cited by 168
Research works printed but not linked: 1
- [72]Bhasin S Issues in testosterone replacement in older men J Clin Endocrinol Metab 1998 83 10 3435 48 9768643
- Authors
- Ohlander, S. J., Varghese, B., & Pastuszak, A. W.
- Affiliations
- University of Illinois Chicago (US)
- Baylor College of Medicine (US)
- Corresponding author
- Pastuszak, Alexander W.
- Venue
- Sexual Medicine Reviews
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-01
- Volume
- 6
- Issue
- 1
- Pages
- 77-85
- ISSN
- 2050-0513 (ISSN-L)
- 2050-0521
- PMC
- PMC5690890
- OpenAlex
- W2615527675
- Cited by
- 168
- References
- 81
- Citations by year
- 2026: 11 · 2025: 28 · 2024: 12 · 2023: 20 · 2022: 34 · 2021: 20 · 2020: 19 · 2019: 11 · 2018: 11 · 2017: 1
- FWCI
- 1.68
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Sexual Medicine Reviews (acceptedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12HD073917)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Hematology › Erythropoietin and Anemia Treatment
- Health Sciences › Medicine › Genetics › Myeloproliferative Neoplasms: Diagnosis and Treatment
- Keywords
- testosterone replacement therapy, erythrocytosis, polycythemia, androgen deficiency, testosterone formulations, hepcidin, iron sequestration, erythropoietin, thromboembolic risk, cardiovascular risk, blood viscosity, bone marrow stimulation
- MeSH terms
- Androgens, Humans, Hypogonadism, Male, Polycythemia, Testosterone, Hormone Replacement Therapy, Men's Health
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