1508 ELEVATED DIHYDROTESTOSTERONE IS ASSOCIATED WITH TESTOSTERONE-INDUCED ERYTHRYOCYTOSIS

Abstract

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Medical and Nonsurgical Therapy1 Apr 20131508 ELEVATED DIHYDROTESTOSTERONE IS ASSOCIATED WITH TESTOSTERONE-INDUCED ERYTHRYOCYTOSIS Tung-Chin Hsieh, Alexander Pastuszak, Monty Aghazadeh, and Larry Lipshultz Tung-Chin HsiehTung-Chin Hsieh San Diego, CA More articles by this author , Alexander PastuszakAlexander Pastuszak Houston, TX More articles by this author , Monty AghazadehMonty Aghazadeh Houston, TX More articles by this author , and Larry LipshultzLarry Lipshultz Houston, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2986AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Contemporary literature has refuted the traditional believe of erythropoietin as the main mediator of erythrocytosis followed testosterone replacement therapy (TRT). We examined putative risk factors for erythrocytosis and lipid dysfunction associated with TRT. METHODS A prospective study was conducted in a single andrology clinic and 196 hypogonadal patients were recruited. Patients were placed on TRT for hypogonadism and pre- and post-treatment dihydrotestosterone(DHT), total T(TT), free T(FT), FSH, LH, hematocrit(Hct), and lipid panels were obtained. Erythrocytosis was defined as Hct >50%, and non-parametric analysis of the variables between baseline and follow-up was performed using SPSS. RESULTS Mean±SD age in the cohort was 50.2±14.3 years and mean follow-up after TRT initiation was 10 months. Mean baseline lab values were: TT 266.1±102.5 ng/dL, FT 8±27 pg/mL, DHT 208.8±116.9 pg/mL, FSH 7.0±9.2 mIU/mL, LH 4.2±4.7 mIU/mL, Hct 44.7±2.9%, HDL 46.3±10.8 mmol/L, LDL105.1±36.9 mmol/L. Eighty-three men were placed on topical and 102 on injectable T formulations, and 11 on subcutaneous T implants. The incidence of erythrocytosis within the cohort was 21%(42/196), and of these patients 69% were treated with injectable T, 21% with gels, and 10% with T pellets. Mean T and DHT levels at follow-up in men who did and did not develop erythrocytosis were: T 1045.3±461.8 and 797.3±450.9 ng/dL(p=0.002); DHT 748.1±440.4 and 548.1±386.4pg/mL(p=0.005) respectively. In contrast, no significant differences in LDL, HDL, or HDL:LDL ratio were observed between men who did and did not develop erythrocytosis while on TRT. However, Spearman's correlation analysis between cohort variables yielded significant correlations between changes in lipid and Hct and pre- and post-treatment TT and DHT indicating a meaningful relationship between these variables. Notably, a stronger correlation was observed between the change in hematocrit from baseline for DHT (ρ=0.303, p<0.0001) than T (ρ=0.204, p=0.015) at follow-up, and no significant relationship between FT and Hct was observed. CONCLUSIONS DHT is more strongly correlated with T-induced erythrocytosis than TT or FT during TRT. A trend toward T-induced decreased in HDL and DHT is also observed. Data from the literature support a role for DHT in the pathophysiology of cardiovascular side effects resulting from TRT. Therefore, hypogonadal men with elevated Hct on TRT should be screened for elevated DHT levels, and 5-alpha reductase inhibitors may be a novel therapy for T-induced erythrocytosis. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e618 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tung-Chin Hsieh San Diego, CA More articles by this author Alexander Pastuszak Houston, TX More articles by this author Monty Aghazadeh Houston, TX More articles by this author Larry Lipshultz Houston, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...