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Cited by 59Hormonal and reproductive studiesErythropoietin and Anemia TreatmentAdrenal Hormones and Disorders

Trough serum testosterone predicts the development of polycythemia in hypogonadal men treated for up to 21 years with subcutaneous testosterone pellets

Ip, Flora F, di Pierro, Irene, Brown, Ross, Cunningham, Ilona, Handelsman, David J, Liu, Peter Y·2010·European Journal of Endocrinology
DOI 10.1530/eje-09-0717
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Abstract

Objectives: Testosterone formulations that have more steady-state pharmacokinetics, such as subcutaneously implanted testosterone pellets, may cause less erythrocytosis than i.m. injections of shorter acting androgen esters. We, therefore, sought to define the prevalence, predictors, and proximate basis (role of erythropoietin) for polycythemia (hematocrit >0.50) in hypogonadal men receiving testosterone implants long term. Design: A cross-sectional study was conducted in an academic andrology center with a longitudinal subgroup analysis. Patients: A total of 158 hypogonadal men aged 14–84 years (mean age 46.7 years) treated on average for 8 years (range 0–21 years). Measurements: Trough blood testosterone and hematocrit. Serial serum erythropoietin concentrations were measured in 16 volunteers. Results: Positive univariate associations between polycythemia (hematocrit >0.50) and log(testosterone) (odds ratio (OR) 24.7, 95% confidence interval (CI): 4.3, 141.2, P<0.01) and age (OR 1.1, 95% CI: 1.0, 1.1, P=0.03) and a borderline relationship with current smoking (OR 4.2, 95% CI: 0.9, 20.0, P=0.08) were unveiled. A sensitivity analysis using alternate definitions of polycythemia was performed to capture all potential covariants. Multivariate regression analysis incorporating all potential covariants disclosed the independent OR of developing polycythemia (after adjusting for smoking and age) for log(testosterone) to be 15.0 (95% CI: 2.5, 90.8). Duration of testosterone therapy did not alter the risk of polycythemia. A direct relationship between testosterone and erythropoietin was observed (P=0.05). Conclusions: Higher trough serum testosterone concentrations but not duration of treatment predict the development of polycythemia in men receiving long-acting depot testosterone treatment.

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Crossref · 10.1530/eje-09-0717

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  • The overall impact of varying formulations on hypogonadal symptoms and adverse events is poorly described, with limited data showing higher rates of erythrocytosis among therapies achieving higher peak testosterone levels.

    “The overall impact of the varying formulations on hypogonadal symptoms and AEs is poorly described, with limited data demonstrating higher rates of erythrocytosis noted among therapies achieving higher peak T levels.136, 137”

    From Challenges in Testosterone Measurement, Data Interpretation, and Methodological Appraisal of Interventional Trials (2016) · cites this paper as [136]

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Authors
Ip, F. F., di Pierro, I., Brown, R., Cunningham, I., Handelsman, D. J., & Liu, P. Y.
Affiliations
  • The University of Sydney (AU)
  • Royal Prince Alfred Hospital (AU)
  • Concord Repatriation General Hospital (AU)
Corresponding author
Liu, Peter Y
ORCID
Venue
European Journal of Endocrinology
Publisher
Oxford University Press (OUP)
Published
2010-02
Volume
162
Issue
2
Pages
385-390
ISSN
  • 0804-4643 (ISSN-L)
  • 1479-683X
DOI
10.1530/eje-09-0717
OpenAlex
W2101468449
Cited by
59
References
25
Citations by year
2025: 2 · 2023: 4 · 2022: 4 · 2021: 3 · 2020: 5 · 2019: 4 · 2018: 1 · 2017: 3 · 2016: 5 · 2015: 7 · 2014: 7 · 2013: 3 · 2012: 8
FWCI
2.67
Type
journal article
Language
en
Open access
closed
Locations
  • European Journal of Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Health and Medical Research Council
  • National Medical Research Council
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
  • Health Sciences › Medicine › Hematology › Erythropoietin and Anemia Treatment
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Keywords
hypogonadism, polycythemia, erythrocytosis, erythropoietin, serum testosterone, hematocrit, smoking
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Androgens, Drug Implants, Erythropoietin, Hematocrit, Humans, Hypogonadism, Injections, Subcutaneous, Longitudinal Studies, Male, Middle Aged, Polycythemia, Predictive Value of Tests, Testosterone, Prevalence, Multivariate Analysis, Logistic Models, Young Adult

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