Please enable it to take advantage of the complete set of features! USA.gov. The treatment for polycythemia is generally dependent on the cause. Polycythemia (erythrocytosis) is a known side effect of testosterone (T) replacement therapy (TRT) and appears to correlate with maximum T levels. Testosterone replacement therapy (TRT) is a common treatment for hypogonadism in aging males. You will receive email when new content is published. Polycythaemia is a common side-effect of testosterone therapy, regardless of treatment mode, and careful monitoring of haematological indices is required Rahila Bhatti, Belinda Grimmett, Maeve McCarthy, Tomas Agusttson, Barbara McGowan, Jake Powrie & Paul Carroll. Ramasamy R, Scovell J, Mederos M, Ren R, Jain L, Lipshultz L. Association Between Testosterone Supplementation Therapy … Hematocrit and hemoglobin should be measured before starting testosterone replacement to determine the patient's baseline. Erythrocytosis and Polycythemia Secondary to Testosterone Replacement Therapy in the Aging Male. Enlarging breasts. This not only ensures the functionality of the HPTA but if polycythemia is a problem this will ameliorate or fix it. Epub 2009 Nov 10. Secondary polycythemia, also called secondary erythrocytosis, is the overproduction of red blood cells. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/, NLM In conclusion, testosterone replacement therapy sometimes increases hemoglobin and hematocrit with or without an increase the red cell mass. 2004 Jan 29;350(5):482-92. doi: 10.1056/NEJMra022251. Background: Testosterone … Testosterone replacement therapy sometimes increases hemoglobin and hematocrit with or without an increase the red cell mass. 2014 Jan;30(1):2-7. doi: 10.4103/0970-1591.124197. A: This is something that is sure to come up with testosterone replacement therapy (TRT). N Engl J Med. Erythropoietin-secreting tumors (eg, hepatocellular carcinoma, renal cell carcinoma, adrenal adenoma) cause some cases. Click the topic below to receive emails when new articles are available. Pulmonary Embolism Secondary to Testosterone-Enhancing Herbal Supplement Use. This is an additional reason why I suggest individuals who are on TRT for low normal testosterone come off once every 12-18 months. Men undergoing testosterone replacement therapy (TRT) should be aware of links between obstructive sleep apnea (OSA) and polycythemia, an abnormal amount of circulating red blood cells in the bloodstream, suggests a recent Journal of Sexual Medicine study.. TRT has grown in popularity over the years. 2, 17 The reported incidence of polycythemia in those on TRT, defined as hemoglobin (Hb) greater than 18 g/dL or hematocrit greater than 54%, ranges from 2.5% to … Epub 2009 Jun 22. doi: 10.7759/cureus.1545. 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. People whose testosterone levels are high because of the use of anabolic steroids, including athletes who abuse steroids, or people on testosterone replacement for hypogonadism or transgender hormone replacement therapy, as well as people who take erythropoietin, may develop secondary polycythemia.  |  Polycythemia treatment. Erythrocytosis and Polycythemia Secondary to Testosterone Replacement Therapy in the Aging Male. HHS  |  This is an additional reason why I suggest individuals who are on TRT for low normal testosterone come off once every 12-18 months. What is the clinical significance of the increase in hemoglobin and hematocrit that develops secondary to testosterone replacement? People whose testosterone levels are high because of the use of anabolic steroids, including athletes who abuse steroids, or people on testosterone replacement for hypogonadism or transgender hormone replacement therapy, as well as people who take erythropoietin, may develop secondary polycythemia. Phlebotomy (drawing blood or blood letting) is the most essential part of the treatment… Erythrocytosis and Polycythemia Secondary to Testosterone Replacement Therapy in the Aging Male. This not only ensures the functionality of the HPTA but if polycythemia … Polycythemia (erythrocytosis) is a known side effect of testosterone (T) replacement therapy (TRT) and appears to correlate with maximum T levels. Esparcieux A, Francina A, Vital-Durand D. [Abnormal haemoglobins with high oxygen affinity in the differential diagnostics of polycythemia]. Sex Med Rev. Polycythemia treatment. [1] Testosterone dosages should be decreased or possibly discontinued if the hematocrit increases to over 50%.[1]. 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. Background:Polycythemia is the most common adverse effect of testosterone replacement therapy (TRT) and may predispose patients to adverse vascular events. This is sometimes referred to as andropause. [2,3,4] Definitions in men vary, but polycythemia generally occurs when hemoglobin is above 18.5 g/dL or hematocrit is above 52%. Stimulating noncancerous growth of the prostate (benign prostatic hyperplasia) and growth of existing prostate cancer. Polycythemia is sometimes called erythrocytosis, but the terms are not synonymous because polycythemia refers to any increase in red blood cells, whereas erythrocytosis only refers to a documented increase of red cell mass. 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, … [3] Other causes testosterone replacement therapy [4] and heavy cigarette smoking. Risks of testosterone replacement therapy in men. Men … Introduction: Secondary polycythemia is a known adverse effect of testosterone replacement therapy (TRT). Testosterone stimulates erythropoiesis, and testosterone therapy (in particular the intramuscular esters) is associated with an increased risk of polycythemia. Therapeutic phlebotomy (TP) is often requested for patients with testosterone-induced polycythemia to lower the hematocrit, at least as a temporary measure while adjusting the dose of medication. Erythropoietin-secreting tumors (eg, hepatocellular carcinoma, renal cell carcinoma, adrenal a… 3 (2):101-112. Thus, increased hemoglobin and hematocrit secondary to testosterone replacement can be significant[4] and in a recent meta-analysis[5] has been cited as the most common side effect of androgen therapy, The patient with polycythemia on physical exam may present with a ruddy (reddish) complexion, easy bruising, fatigue, and epistaxis. Testosterone replacement therapy and polycythemia in HIV-infected patients. Although long-term outcome data are not available, prescriptions for testosterone are becoming more common. Testosterone replacement therapy sometimes increases hemoglobin and hematocrit with or without an increase the red cell mass. This condition is often referred to as Polycythemia. This site needs JavaScript to work properly. Men with low to low‐normal levels of testosterone have documented benefit from hormone replacement. The incidence of polycythemia secondary to testosterone use ranges from 2.5% to 40% depending on the testosterone dose and formulation and is less common with transdermal vs injectable formulations. Therapeutic phlebotomy (TP) is often requested for patients with testosterone-induced polycythemia to lower the hematocrit, at least as a temporary measure while adjusting the dose of … Patients who have arteriovenous or intracardiac shunting can present with polycythemia without hypoxemia. The association between testosterone-replacement therapy and polycythemia has been well described [9-11]. Burnout Might Really Be Depression; How Do Doctors Cope? Testosterone treatment is controversial for men and even more so for women. Phlebotomy (drawing blood or blood letting) is the most essential part of the treatment. View - Medscape - Nov 01, 2012. 2008;4(6):1475-80. doi: 10.2147/vhrm.s4261. Other causes include testosterone replacement therapy and heavy cigarette smoking. Aghazadeh M, Pastuszak AW, Johnson WG, McIntyre MG, Hsieh TM, Lipshultz LI. Sex Med Rev 2015;3:101–112. Polycythemia From Testosterone Therapy: To Treat or Not? This is the first study on polycythemia in HIV-infected men and has led to additional recommendations for the treatment … Polycythemia From Testosterone Therapy: To Treat or Not? Ideally, testosterone levels should be normal after TRT. Men with low to low-normal levels of testosterone … Polycythemia: Some men who are given testosterone will have an increase in their hemoglobin, or hematocrit levels. Testosterone therapy can cause secondary erythrocytosis. 2017 Aug 6;9(8):e1545. Epub 2015 Jan 14. NIH Secondary polycythemia, also called secondary erythrocytosis, is the overproduction of red blood cells. A study in the journal AIDS identifies a connection between the use of testosterone replacement therapy (TRT) and the blood disorder polycythemia among HIV-infected men. 2015; 3(2):101-112 (ISSN: 2050-0521) Jones SD; Dukovac T; Sangkum P; Yafi FA; Hellstrom WJ.  |  Author affiliations . • Polycythemia is a risk factor with exogenous testosterone Conclusion Transgender women (MTF) may have higher rates of venous thromboembolic disease with certain preparations of … 3 (2):101-112. . Erythrocytosis can cause symptoms of hyperviscosity, such as headache, fatigue, blurred vision and paresthesias. Find out what health conditions may be a health risk when taken with Testosterone Intramuscular. Herein, we compared the prevalence of secondary polycythemia in testosterone-deficient men treated … The association between testosterone-replacement therapy and polycythemia has been well described [9-11]. Different testosterone formulations are available, with significantly different half-lives, which have varying influences on the development of secondary polycythemia. This risk should be weighed against the potential benefits prior to initiating therapy. There is also a well-established association between obstructive sleep apnea (OSA) and the development of polycythemia, which confers additional long-term cardiovascular morbidity. For example, testosterone therapy is one of the few treatments that reduces lipoprotein(a) [Lp(a)] levels, ... Sangkum P, Yafi FA, Hellstrom WJ. Darrell Hulisz, PharmD Question What is the clinical significance of the increase in hemoglobin and hematocrit that develops secondary to testosterone replacement? Polycythemia as a complication of testosterone replacement therapy in nursing home men with low testosterone levels. Limiting sperm production or causing … Clearly, if hematocrit is elevated before starting testosterone, the cause should be determined prior to starting androgen therapy. The expected potential side effect of testosterone treatment - which in fact is a therapeutic effect in men with anemia 1 - 3 - is an increased level of red blood cells, known as erythrocytosis or polycythemia. Breast tissue may lose glandularity, but generally does not lose mass or hemi circumference. Signs and symptoms of low testosterone include decreased libido, impotence, decreased body hair, decreased muscle mass, fatigue, and decreased bone mineral density. This review examines the literature on testosterone … Polycythemia as a complication of testosterone replacement therapy in nursing home men with low testosterone levels. Please enter a Recipient Address and/or check the Send me a copy checkbox. In polycythemia vera or other primary polycythemia syndromes, the treatment options are more specific. While a mild increase may be desirable and, in fact, increases energy … Anabolic steroids, acute myocardial infarction and polycythemia: a case report and review of the literature. The association between … A: This is something that is sure to come up with testosterone replacement therapy (TRT). Cite this: Darrell Hulisz. If you log out, you will be required to enter your username and password the next time you visit. Share cases and questions with Physicians on Medscape Consult. Secondary erythrocytosis is caused by certain diseases or drugs, including testosterone replacement therapy. 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, … Note: Remember the purpose of TRT: to restore testosterone to NORMAL, healthy levels in the body. … COVID-19 is an emerging, rapidly evolving situation. 2015 Jul;194(1):160-5. doi: 10.1016/j.juro.2015.01.038. Potential benefits include improved libido, increased bone mass, and increased sense of well-being. This increase in blood viscosity can reduce cerebral blood flow which could theoretically be a risk factor for thrombosis and stroke. Recent meta‐analyses have revealed that increases in hemoglobin (Hb) and hematocrit (Hct) are the variants most commonly … Desired androgenic effects of testosterone therapy include deepened voice, cessation of menses, clitoral growth, increased muscle mass, and hair growth in androgen dependent areas including facial hair. What is Polycythemia? J Urol. Former British Cycling Doctor Denies Putting Own Ambition Before Riders' Safety, £700,000 Klinefelter's Settlement: Why Honesty Matters in Medicine, Former British Cycling Doctor Unaware Testosterone Could Be Used for Doping, Kallmann Syndrome and Idiopathic Hypogonadotropic Hypogonadism, Follicle-Stimulating Hormone Abnormalities, Growth Disorders: 10 Cases of a Developing Problem, 6 Big Changes Coming for Office-Visit Coding, Family Doctor's License Suspended After Refusal to Wear Mask, Clinicians Incensed by Trump's Claim They're Inflating COVID Numbers. 2015;3(2):101-112. Risks of testosterone-replacement therapy and recommendations for monitoring. Even at normal levels, there is a risk of side effects. All material on this website is protected by copyright, Copyright © 1994-2021 by WebMD LLC. Would you like email updates of new search results? TRT is the go-to treatment for people who suffer from hypogonadism – aka … Ther Clin Risk Manag. and intramuscular administration demonstrated a stronger association than topical use. Smoking has also been associated with polycythemia and may contribute to the effects of other risk factors [3,9,12]. Testosterone therapy in hypogonadal men has been shown to de­crease angina, and testosterone deficiency is a marker for increased mortality in men with known coronary artery disease. High blood pressure, strokes and heart attacks can occur. Hypogonadism is sometimes referred to in the lay media as low testosterone, though there are certain medical distinctions. Although this approach seems plausible and may prove beneficial, there are no guidelines for when and how often to perform phlebotomy in this population. Recent meta‐analyses have revealed that increases in hemoglobin (Hb) and hematocrit (Hct) are the variants most commonly … PMID: 7636099 [Indexed for MEDLINE] Publication Types: Case Reports; Clinical Trial; Randomized … One of the primary risks of testosterone that is you need to be aware of is called polycythemia. 458 views. Men with low to low-normal levels of testosterone have documented benefit from hormone replacement. Drinka PJ(1), Jochen AL, Cuisinier M, Bloom R, Rudman I, Rudman D. Author … In the Cytoreductive Therapy in Polycythemia Vera (CYTO-PV) study, 365 adults with PV were randomly allocated to a low hematocrit target (< 0.45) or a less-intensive hematocrit target (0.45–0.50).7 The primary outcome of death from cardiovascular causes or major thrombotic events was observed in 5 of 182 patients (2.7%) in the low-hematocrit group … Intramuscular testosterone is associated with a higher risk for polycythemia than topical administration . In polycythemia vera or other primary polycythemia syndromes, the treatment options are more specific. Sex Med Rev. Elevated Dihydrotestosterone is Associated with Testosterone Induced Erythrocytosis. Intramuscular testosterone is associated with a higher risk for polycythemia than topical administration [9]. Testosterone dosages should be decreased or possibly discontinued if the hematocrit increases to above 50%. Different testosterone formulations are available, with significantly different half-lives, which have varying influences on the development of secondary polycythemia. Secondary polycythemia must be differentiated from primary polycythemia … Response from Darrell Hulisz, PharmD Associate Professor, Case Western Reserve University School of Medicine; Clinical Specialist in Family … Men with low to low‐normal levels of testosterone have documented benefit from hormone replacement. The increase in hemoglobin and hematocrit secondary to testosterone use is usually accompanied by an increase in the red blood cell count, which can lead to an increase in blood viscosity. Patients with primary polycythemia sometimes receive therapeutic phlebotomy; however, there are no data to support widespread adoption of this practice in testosterone-induced polycythemia. Smoking has also been associated with polycythemia and may contribute to the effects of other risk factors [3,9,12]. Testosterone replacement therapy (TRT) is a common treatment for hypogonadism in aging males. In conclusion, testosterone replacement therapy sometimes increases hemoglobin and hematocrit with or without an increase the red cell mass. Causing acne or other skin reactions. AIDS. Men undergoing testosterone replacement therapy (TRT) should be aware of links between obstructive sleep apnea (OSA) and polycythemia, an abnormal amount of circulating red blood cells in … Isidori AM, Balercia G, Calogero AE, Corona G, Ferlin A, Francavilla S, Santi D, Maggi M. J Endocrinol Invest. INTRODUCTION: Testosterone replacement therapy (TRT) is a common treatment for hypogonadism in aging males. Ischemic Stroke May Hint at Underlying Cancer, Topol: US Betrays Healthcare Workers in Coronavirus Disaster, The 6 Dietary Tips Patients Need to Hear From Their Clinicians. 2012 Jan 14;26(2):243-5. doi: 10.1097/QAD.0b013e32834db446. Testosterone is used primarily to treat symptoms of sexual dysfunction in men and women and hot flashes in women. Clinicians often encounter patients with hypogonadism in association with declining endogenous testosterone production that occurs as men age. Clipboard, Search History, and several other advanced features are temporarily unavailable. Likewise, clinicians should monitor for the onset of signs and symptoms of polycythemia in these patients, such as ruddy skin, easy bruising, and epistaxis. The risk of adverse outcomes in association with use of testosterone products: a cohort study using the UK-based general practice research database. Testosterone and other androgens have an erythropoietic stimulating effect that can cause polycythemia, which manifests as an increase in hemoglobin, hematocrit, or red blood cell count. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. 2013 Jan;75(1):260-70. doi: 10.1111/j.1365-2125.2012.04326.x. In individuals with human immunodeficiency virus infection or other chronic diseases, test… Thus, it is prudent to monitor for polycythemia in patients receiving chronic testosterone replacement therapy. The association between testosterone-replacement therapy and polycythemia has been well described [9][10] [11]. Polycythemia can be a complication of testosterone replacement. Clinically, this response is described as erythrocytosis … Acknowledgement: The author wishes to thank Stephen Hoffacker for providing technical assistance. Black Doctor Dies of COVID After Alleging Subpar Treatment. Eur J Endocrinol. Associate Professor, Case Western Reserve University School of Medicine; Clinical Specialist in Family Medicine, University Hospitals, Case Medical Center, Cleveland, OhioDisclosure: Darrell Hulisz, PharmD, has disclosed no relevant financial relationships. Adverse effects of antiaggregating platelet therapy in the treatment of polycythemia vera. This condition is often referred to as Polycythemia. However, TTh can be limited by its side effects, particularly erythrocytosis. In addition to increasing muscle and sex drive, testosterone can increase the body's production of red blood cells. You need these cells to carry oxygen around your body, but too many of … Because it can increase your risk of stroke, it's important to get treatment … 4 - … Intramuscular testosterone is associated with a higher risk for polycythemia than topical administration [9]. Web of Science; Medline; Google Scholar. Erythrocytosis and polycythemia secondary to testosterone replacement therapy in the aging male. You need these cells to carry oxygen around your body, but too many of them can make your blood thicken … The association between testosterone replacement therapy and polycythemia has been reported for the past few years as this therapy has become more mainstream. Hemoglobin is a substance that carries oxygen in the blood. No adverse cardiovascular or thrombotic events were observed. Indian J Urol. 2009 Jun;5(3):427-48. doi: 10.2147/tcrm.s3025. Severe, chronic polycythemia secondary to increased blood viscosity can raise pulmonary arterial pressure and cause increased pulmonary resistance with potential hypoxia, resulting in cor pulmonale. Stergiopoulos K, Brennan JJ, Mathews R, Setaro JF, Kort S. Vasc Health Risk Manag. HIV-infected patients taking testosterone should undergo routine hematologic monitoring with adjustment of therapy … Sex Med Rev 2015;3:101–112. Likewise, clinicians should monitor for the onset of signs and symptoms of polycythemia in these patients, such as ruddy skin, easy bruising, a… This may result from diseases of the testes, such as primary hypogonadism, or from secondary causes, such as diseases of the pituitary or hypothalamus.[1]. Outcomes of androgen replacement therapy in adult male hypogonadism: recommendations from the Italian society of endocrinology. Major Breakthrough in Weight Loss With Semaglutide? 2015 Apr. Because it can increase your risk of stroke, it's important to get treatment if necessary. The rise of testosterone replacement therapy has led to an increased instance of polycythemia. The benefits and risks of testosterone replacement therapy: a review. ... polycythemia vera; ... changing any diet or commencing or discontinuing any course of treatment. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. Ip FF, di Pierro I, Brown R, Cunningham I, Handelsman DJ, Liu PY. 2015 Jan;38(1):103-12. doi: 10.1007/s40618-014-0155-9. Practice guidelines from the American Association of Clinical Endocrinologists recommend checking hematocrit every 6 months for the first 18 months after starting testosterone, and then check it yearly thereafter if levels remain normal and stable. HIV-infected patients taking testosterone should undergo routine hematologic monitoring with adjustment of therapy when appropriate. 50 Preexisting … There is also a well-established association between obstructive sleep apnea (OSA) and the development of polycythemia… The recommended hematocrit of less than 45 in men and less than 42 in women is … Jones SD Jr, Dukovac T, Sangkum P, Yafi FA, Hellstrom WJ. [Medline]. 7. Esparcieux A, Francina A, Vital-Durand D. … Sep 17, 2020. 2010 Feb;162(2):385-90. doi: 10.1530/EJE-09-0717. Sex Med Rev. With polycythemia the blood becomes very viscous or "sticky," making it harder for the heart to pump. Erythrocytosis and Polycythemia Secondary to Testosterone Replacement Therapy in the Aging Male. Please confirm that you would like to log out of Medscape. Polycythemia vera (PV) causes your bone marrow to make too many red blood cells. A multicentre study sponsored by the National Institutes of Health is presently under way in the United States to clarify the long-term cardiovascular effects of testosterone therapy in … Testosterone therapy can potentially make sleep apnea worse, and should be considered before starting testosterone therapy. Testosterone regulates erythropoiesis in numerous mammalian species, including humans of both sexes (1).Excessive erythrocytosis is the most common serious adverse event associated with testosterone therapy in older men (2).However, the mechanisms by which testosterone stimulates erythropoiesis remain poorly understood. Testosterone therapy has various risks, including: Worsening sleep apnea — a potentially serious sleep disorder in which breathing repeatedly stops and starts. Guy’s and St Thomas Hospital, London, UK. Sex Med Rev. 1 Typically, patients taking testosterone will experience masculinizing … Conclusion: Polycythaemia is common in men receiving testosterone therapy, regardless of treatment modality. Secondary polycythemia most often develops as a response to chronic hypoxemia, which triggers increased production of erythropoietin by the kidneys.25 The most common causes of secondary polycythemia include obstructive sleep apnea, obesity hypoventilation syndrome, and chronic obstructive pulmonary disease (COPD). Get a cheap testosterone … Semin Hematol 1986;23: 172-176. This hematopoietic (blood-building) effect could be a good thing for those with mild anemia. The treatment for polycythemia is generally dependent on the cause. Recent meta-analyses have revealed that increases in hemoglobin (Hb) and hematocrit (Hct) are the variants most commonly encountered. Nguyen SM, Ko Ko N, Sattar AS, Gucuk Ipek E, Ali S. Cureus. Thus, it is prudent to monitor for polycythemia in patients receiving chronic testosterone replacement therapy. Herein, we compared the prevalence of secondary polycythemia in testosterone … Testosterone dosages should be decreased or possibly discontinued if the hematocrit increases to above 50%. Testosterone replacement therapy is the mainstay of treatment for male hypogonadism. A baseline value for hematocrit should be obtained before testosterone therapy is started, and serial values should be taken at 3, 6 and 12 months after initiation of treatment. Polycythemia vera (PV) causes your bone marrow to make too many red blood cells. Abstract. The extra cells cause the blood to be thicker, and this, in turn, … Nelson answers questions on www.ExcelMale.com. Trough serum testosterone predicts the development of polycythemia in hypogonadal men treated for up to 21 years with subcutaneous testosterone pellets. Epub 2014 Nov 11. Br J Clin Pharmacol. Introduction: Secondary polycythemia is a known adverse effect of testosterone replacement therapy (TRT). 2015 Apr. Testosterone and High Red Blood Cell Count – Polycythemia. Testosterone treatments are … Polycythemia is an excessive production of red blood … Smoking has also been associated with polycythemia and may contribute to the effects of other risk factors [3,9,12]. Sep 17, 2020. Drinka PJ(1), Jochen AL, Cuisinier M, Bloom R, Rudman I, Rudman D. Author information: (1)Wisconsin Veterans Home, King 54946-0620, USA. However, TTh can be limited by its side effects, particularly erythrocytosis. This website also contains material copyrighted by 3rd parties. Polycythemia refers to an increase in the number of red blood cells in the body. The association between testosterone-replacement therapy and polycythemia has been well described [9,10,11]. [3], Polycythemia is also associated with hypertension due to increased blood viscosity and thrombosis. Hypogonadism is marked by a decrease in testicular sperm production and/or a decrease in endogenous testosterone production. Current Canadian guidelines … Nelson Vergel, the author of Testosterone: A Man's Guide" (amazon.com) describes how to maximize benefits and minimize side effects of testosterone replacement therapy. 2001http://www.medscape.com/resource/hypogonadism, You are being redirected to Medscape Education, Treating Low Testosterone in Men: A Clinical Update. You've successfully added to your alerts. 9,10,11 ] esparcieux a, Francina a, Vital-Durand D. … secondary polycythemia hemoglobin and hematocrit or! Acute myocardial infarction and polycythemia: some men who are on TRT for low normal testosterone come off every... 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