Erythropoiesis

Since erythropoiesis is androgen-dependant, hypogonadal patients usually present with mild anemia (with values in the female normal range) which normalizes under testosterone treatment. Therefore, hemoglobin, red blood cell count and hematocrit are good parameters for surveillance of replacement therapy. If sufficient stimulation is lacking despite adequate testosterone therapy, lack of iron should be ruled out and treated if necessary. At the beginning of therapy we check red blood values every three months, later on annually. If too much testosterone is administered, supraphysiological levels of hemoglobin, erythrocytes and hematocrit as a sign of polycythemia can develop, indicating that the testosterone dose should be scaled down (Hajjar et al. 1997; Matsumoto et al. 1985; Sih et al. 1997). In some cases phlebotomy maybe required acutely.

Testosterone has been claimed to potentiate sleep apnea (see Chapter 15); however, only case reports about the incidence of sleep apnea during testosterone treatment have been published (Matsumoto et al. 1985) and paradoxically hypogonadism has also been cited as a cause of this condition (Luboshitzky et al. 2002). The two men who demonstrated worsening of obstructive apnea on testosterone replacement therapy had pathologically elevated erythrocyte counts and hema-tocrit (>59%), sufficient to require therapeutic phlebotomy. Increased hematocrit, increased mass of pharyngeal muscle bulk, as well as neuroendocrine effects of testosterone during therapy were discussed as possible reasons. The development of signs and symptoms of obstructive sleep apnea during testosterone therapy warrants a formal sleep study and treatment with continuous positive airway pressure (CPAP) if necessary. If the patient is unresponsive or cannot tolerate CPAP, the testosterone must be reduced or discontinued.

Sleep Apnea

Sleep Apnea

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