Category: Reproductive Endocrinology
There are ongoing concerns for safety with testosterone therapy. Our goal was to assess if MI occur at a higher frequency in patients with testosterone replacement therapy (TRT) among our Low T Center patients. These 47 community based centers across the United States have strict protocols requiring regular 1-2 week monitoring in the office for efficacy and safety.
Methods : Following IRB application and GCP training, we conducted a retrospective analysis of patients that had MI post testosterone therapy. Data was extracted from our electronic health record (Advance MD) of the multi-site Low T Centers. Prior to extraction of data; ICD-9 were updated to ICD-10, with attention to MI. We also did case findings on patients that had MI and reviewed risk factors. We defined polycythemia as hemoglobin > 17g/dl or hematocrit >49.5% in this study.
Results : 147,014 charts of patients seen between years 2009-2018 were reviewed. 60,845 patients had hemoglobin above 17g/dl and 77,132 patients had above 49.5% giving a polycythemia prevalence of 41.4% and 52.5% respectively. Using ICD definition of MI (ICD 9: 412 & ICD-10: I21.29), we identified 173 & 19 MI patients respectively (Total= 192). Of the 192 patients with MI , 40 patients (20.8%) had hemoglobin > 17g/dl , 25 (13%) had hematocrit >49.5. 152 patients (79.2%) had hemoglobin < 17 g/dl and 157 patients (87%) had hematocrit < 49.5. Comparative statistics were applied and the prevalence ratio (PR) for MI group with Hemoglobin > 17g/dl versus those with Hemoglobin < 17g/dl was 0.38 (p= 0.0026, C.I.= 0.20 to 0.71). For MI group the PR with Hematocrit> 49.5% versus those with Hematocrit < 49.5% was 0.17 (p< 0.0001, C.I.= 0.08 to 0.34)
Discussion : The current thinking is that MI occurs with polycythemia induced by TRT, but we did not find this association in our study. Our previous studies linked the incidence of MI on TRT patients with risk factors such as diabetes, hyperlipidemia and hypertension. TRT patients frequently get checked their CBC checked as part of their follow up.
Conclusion : This study suggests a non-associative role of polycythemia with MI in TRT patients. We hypothesize other mechanisms leading to MI in TRT patients including existing risk factors but were not in the scope of this pilot study. Perhaps better theoretic understanding of platelet activation and role of leukocytes in TRT related thrombosis could open new perspectives in thrombosis prediction and prevention. We would still recommend regular monitoring of H&H in TRT patients.
Robert Tan– Research, Low T Center, Houston, Texas
Low T Center
Dr. Robert S. Tan is Founder & Director of the OPAL Medical Clinic- which is dedicated to Wellness & Men’s Health. He is Clinical Professor of Family & Community Medicine & Internal Medicine (Geriatrics). University of Texas-Houston and National Research Director, Low T Institute.