Too Much Of A Good Thing

Not too long ago a provider questioned me about the adverse effects of testosterone supplementation. He was concerned as one of his clients, a physician, was admitted to the hospital for complications related to an increase in red blood cells (polycythemia). The client had been using 100 mg of topical testosterone for several months and the provider wondered if this could be a contributing factor. Our conversation started a lively discussion with the other doctors on staff at ZRT and I decided it was worth sharing with the community

With several articles on hypogonadism in aging males coming out in the last few years, testosterone replacement has become commonplace. And while it’s easy to see the benefits of testosterone therapy, we need to know the risks as well. Most of the adverse effects are not often seen with physiological testosterone levels and it’s usually the supra-physiological levels we see with high testosterone dosages that are problematic.

One adverse effect of elevated testosterone that occurs most frequently is secondary polycythemia. Secondary polycythemia is a condition in which an abnormal increase of red blood cells (RBCs) is generated in response to a medication/hormone or underlying condition. Erythropoietin, from the kidney and liver, is the primary hormone that stimulates production of RBCs. Testosterone works synergistically with erythropoietin which can lead to an elevated hematocrit (number of RBCs). Several studies have documented an association between testosterone supplementation (injection and transdermal) and an increase in hematocrit (i.e. polycythemia), sometimes twice as high as with placebo.

Symptoms of polycythemia may include headache, lethargy and hypertension. Complications are related to changes in the blood. An increase in blood viscosity and a decrease in circulation set the stage for blood clots, which can lead to a stroke, heart attack, pulmonary embolism or deep vein thrombosis. Polycythemia, secondary to testosterone administration, is usually reversible with dosage adjustment or discontinuation of supplementation. Blood donation is another means of ridding the body of too many red cells.

Accordingly, men receiving testosterone replacement should have their hematocrit checked before initiating therapy, six months after and then annually. And to avoid any adverse consequences, adhering to physiological dosing practices is important. Deficiency symptoms may take slightly longer to resolve with lower testosterone levels, but down-regulation of the receptors does not occur as it can with supra-physiological dosing. While not everyone using testosterone therapy will experience the complications indicated above, monitoring the RBC count can identify those men with the predisposition.

Sherry LaBeck, ND