Volume 20, Issue 2 (March 2018) 20, 195–199; 10.4103/aja.aja_51_17
Association of subcutaneous testosterone pellet therapy with developing secondary polycythemia
Katherine Lang Rotker1, Michael Alavian1, Bethany Nelson1, Grayson L Baird2, Martin M Miner1, Mark Sigman1, Kathleen Hwang1
1 Division of Urology, Brown University, Providence, RI 02903, USA 2 Department of Biostatistics, Lifespan Healthcare System, Providence, RI 02903, USA
Correspondence: Dr. KL Rotker (klrotker@gmail.com)
Date of Submission 02-Mar-2017 Date of Acceptance 28-Aug-2017 Date of Web Publication 05-Dec-2017
Abstract |
A variety of methods for testosterone replacement therapy (TRT) exist, and the major potential risks of TRT have been well established. The risk of developing polycythemia secondary to exogenous testosterone (T) has been reported to range from 0.4% to 40%. Implantable T pellets have been used since 1972, and secondary polycythemia has been reported to be as low as 0.4% with this administration modality. However, our experience has suggested a higher rate. We conducted an institutional review board-approved, single-institution, retrospective chart review (2009–2013) to determine the rate of secondary polycythemia in 228 men treated with subcutaneously implanted testosterone pellets. Kaplan–Meyer failure curves were used to estimate time until the development of polycythemia (hematocrit >50%). The mean number of pellets administered was 12 (range: 6–16). The mean follow-up was 566 days. The median time to development of polycythemia whereby 50% of patients developed polycythemia was 50 months. The estimated rate of polycythemia at 6 months was 10.4%, 12 months was 17.3%, and 24 months was 30.2%. We concluded that the incidence of secondary polycythemia while on T pellet therapy may be higher than previously established.
Keywords: hypogonadism; pellet; polycythemia; testosterone
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