Testosterone Therapy for the Treatment of Unexplained Anemia in Men With Hypogonadism

Decreased testosterone levels are often under-recognized as a cause of anemia in males with hypogonadism. Men, as a subset, are less likely to seek medical care, especially those who struggle with complex psychiatric and social conditions, where they may lack full autonomy. Increasing testosterone levels leads to erythrocytosis by elevating erythropoietin and soluble transferrin receptor levels and suppressing hepcidin and ferritin levels. While practice guidelines on testosterone therapy for hypogonadism exist, there are no large-scale, randomized clinical trials assessing the use of testosterone replacement therapy in men with hypogonadism to evaluate its effect on anemia. Testosterone replacement therapy is also not wholly benign, and patients may be at increased risk for nonfatal cardiac arrhythmias, venous thromboembolism, and acute kidney injury. We explore two cases of patients with similar prior medical history, both of whom were found to have hypogonadism and anemia that were not otherwise explained. Both patients experienced significant improvement in their anemia following testosterone supplementation.