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Blood donation and testosterone replacement therapy.

Benjamin Chin-Yee1, Alejandro Lazo-Langner2,3, Terrie Butler-Foster4

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Testosterone replacement therapy (TRT) can cause polycythemia, leading to elevated hemoglobin levels. Blood donation is insufficient to manage this risk, potentially increasing vascular event concerns in TRT patients.

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Area of Science:

  • Endocrinology
  • Hematology
  • Cardiovascular Medicine

Background:

  • Testosterone replacement therapy (TRT) is associated with polycythemia, a common side effect that may increase vascular event risk.
  • Canadian guidelines recommend monitoring hematocrit and discontinuing or reducing TRT if it exceeds 54% (hemoglobin ≥180 g/L).
  • Some patients and physicians incorrectly believe blood donation mitigates TRT-induced polycythemia risks.

Purpose of the Study:

  • To assess the effectiveness of blood donation in managing polycythemia in men undergoing TRT.
  • To evaluate hemoglobin levels in male blood donors self-identified as being on TRT.

Main Methods:

  • Retrospective review of male blood donors on TRT at Canadian Blood Services in Southwestern Ontario (December 2013 - March 2016).
  • Hemoglobin concentration was measured at donation/clinic visits and subsequent appointments for repeat donors.

Main Results:

  • 39 TRT patients were identified as blood donors over two years.
  • Mean hemoglobin was 173 g/L; 25% of appointments showed hemoglobin ≥180 g/L.
  • 44% of repeat donors had persistently elevated hemoglobin levels (≥180 g/L).

Conclusions:

  • Donors on TRT frequently exhibit elevated hemoglobin levels, often exceeding guideline thresholds.
  • Repeat blood donation appears insufficient to maintain hematocrit below 54% in TRT patients.
  • Persistent high hemoglobin levels in TRT donors raise concerns for vascular event risk, exacerbated by misperceptions about donation safety.