Erythrocytosis and Polycythemia Secondary to Testosterone Replacement Therapy in the Aging Male.
Erythrocytosis and Polycythemia Secondary to Testosterone Replacement Therapy in the Aging Male.
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DOI：
10.1002/smrj.43
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发表时间：
2015-04-01
影响因子：
3.6
通讯作者：
Hellstrom, Wayne J G
中科院分区：
文献类型：
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作者：
Jones, Steven D Jr;Dukovac, Thomas;Hellstrom, Wayne J G
简介：睾酮替代疗法(TRT)是治疗老年男性性腺功能减退的常用疗法。睾丸素水平处于低水平到低正常水平的男性已被证明从激素替代中受益。最近的荟萃分析显示，血红蛋白(Hb)和红细胞压积(Hct)的增加是最常见的变种。临床上，这种反应被描述为继发于TRT的红细胞增多症或红细胞增多症。然而，最近美国食品和药物管理局关于静脉血栓栓塞症(VTE)风险的警告使Hb和Hct的增加引起了更多的关注。与雄激素替代治疗相关的风险需要进一步研究。目的：回顾有关TRT继发的红细胞增多症和红细胞增多症的现有文献。方法：通过PubMed对TRT、红细胞增多症和红细胞增多症的文献综述。主要观察指标：从基础科学、药物制剂和给药途径方面评估TRT引起的红细胞增多症和红细胞增多症的机制。回顾血细胞比容和血栓事件的风险。为静脉血栓事件高危患者的治疗提供临床建议。结果：与对照组相比，接受TRT的男性发生红细胞增多症(定义为HCT和GT；0.52)的风险增加315%。有关铁的生物利用度、促红细胞生成素的产生和骨髓刺激的机制已经被假定为解释TRT的红血球效应。TRT引起的红细胞增多症和随后的VTE风险之间的关系尚不确定。结论：所有的TRT制剂都会引起Hb和Hct的升高，但注射剂往往产生最大的影响。关于Hct升高的VTE风险的证据尚不确定。对于有静脉血栓事件危险因素的患者，假设对血液参数影响最小的配方提供了最安全的选择。需要进一步的试验来充分评估与TRT相关的血液学副作用。Jones SD Jr，Dukovac T，Sangkum P，Yafi FA和Hellstrom WJG。老年男性睾酮替代治疗后继发的红细胞增多症和红细胞增多症。《性爱医学》2015；3：101-112。
INTRODUCTION: Testosterone replacement therapy (TRT) is a common treatment for hypogonadism in aging males. Men with low to low-normal levels of testosterone have documented benefit from hormone replacement. Recent meta-analyses have revealed that increases in hemoglobin (Hb) and hematocrit (Hct) are the variants most commonly encountered. Clinically, this response is described as erythrocytosis or polycythemia secondary to TRT. However, the recent Food and Drug Administration warning regarding the risk for venothromboembolism (VTE) has made the increases in Hb and Hct of more pertinent concern. The risks associated with androgen replacement need further examination.AIM: To review the available literature on erythrocytosis and polycythemia secondary to TRT. To discuss potential etiologies for this response, the role it plays in risk for VTE, and recommendations for considering treatment in at-risk populations.METHODS: A literature review was performed through PubMed regarding TRT and erythrocytosis and polycythemia.MAIN OUTCOME MEASURES: To assess the mechanisms of TRT-induced erythrocytosis and polycythemia with regard to basic science, pharmacologic preparation, and route of delivery. To review Hct and risk for thrombotic events. To offer clinical suggestions for therapy in patients at risk for veno-thrombotic events.RESULTS: Men undergoing TRT have a 315% greater risk for developing erythrocytosis (defined as Hct>0.52) when compared with control. Mechanisms involving iron bioavailability, erythropoietin production, and bone marrow stimulation have been postulated to explain the erythrogenic effect of TRT. The association between TRT-induced erythrocytosis and subsequent risk for VTE remains inconclusive.CONCLUSIONS: All TRT formulations cause increases in Hb and Hct, but injectables tend to produce the greatest effect. The evidence regarding the risk for VTE with increased Hct is inconclusive. For patients with risk factors for veno-thrombotic events, formulations that provide the smallest effect on blood parameters hypothetically provide the safest option. Further trials are needed to fully evaluate the hematological side effects associated with TRT. Jones SD Jr, Dukovac T, Sangkum P, Yafi FA, and Hellstrom WJG. Erythrocytosis and polycythemia secondary to testosterone replacement therapy in the aging male. Sex Med Rev 2015;3:101-112.