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Severe erythrocytosis is rare among people using testosterone for gender-affirming care – study

During the first 20 months of testosterone therapy, the cumulative incidence of hematocrit >50.4% was 12.6%, hematocrit >52% was 1.0%, and hematocrit >54% was 0.6%. All people were taking injectable testosterone cypionate, with a median dose of 100 mg weekly.

Photo by Kamaji Ogino from Pexels.com

Gender-affirming hormone therapy (GAHT) is safe overall, with few adverse effects. And one potential effect from using testosterone for GAHT is an increase in hemoglobin and/or hematocrit, known as secondary erythrocytosis.

Current guidelines recommend monitoring hemoglobin or hematocrit routinely in the first year, some as frequently as every three months, and even if this actually possible creates barriers to care. And so a study – “Erythrocytosis in Gender-Affirming Care With Testosterone” by Alana Tova Porat, Meghan Ellwood, Marisa Rodina and Shokoufeh Dianat, and which appears in The Annals of Family Medicine – explored the incidence of erythrocytosis in the first 20 months of testosterone therapy among people receiving gender-affirming care.

After going through the charts of 282 people taking testosterone for GAHT, the researchers found that during the first 20 months of testosterone therapy, the cumulative incidence of hematocrit >50.4% was 12.6%, hematocrit >52% was 1.0%, and hematocrit >54% was 0.6%. All people were taking injectable testosterone cypionate, with a median dose of 100 mg weekly.

According to the researchers: “Severe erythrocytosis (hematocrit >54%) is a rare outcome of gender-affirming testosterone therapy.”

As such, “clinical recommendations should reconsider the need for routine frequent erythrocytosis screening within the first year of testosterone therapy for patients who prefer to minimize laboratory draws.”

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