Elevated plasma testosterone concentrations from males on testosterone replacement therapy are mitigated with...

Area of Science:

• Blood banking and transfusion medicine
• Endocrinology
• Biochemistry

Background:

• Donors on testosterone replacement therapy (TRT) may require frequent whole blood donation due to erythrocytosis.
• FDA guidelines restrict transfusion of plasma products from TRT donors.
• This study investigated TRT donor testosterone levels and a mitigation strategy.

Purpose of the Study:

• To quantify testosterone levels in whole blood components from TRT donors.
• To evaluate the efficacy of a pathogen reduction technology in removing testosterone.

Main Methods:

• Whole blood from TRT donors and controls was fractionated into red blood cells and plasma.
• Testosterone levels were measured using high-performance liquid chromatography-tandem mass spectrometry.
• Pathogen reduction technology (INTERCEPT Blood System) was applied to pooled plasma, with samples taken before and after UVA light and compound adsorption device (CAD) steps.

Main Results:

• TRT donors exhibited significantly higher free and total testosterone levels in plasma and red blood cell supernatant compared to controls.
• Supraphysiologic testosterone levels were detected in both controls and TRT donors.
• CAD incubation significantly reduced mean free and total testosterone by 88% and 84%, respectively (p < 0.01), while UVA light had no effect.

Conclusions:

• TRT donors have elevated testosterone levels in blood components.
• The CAD step effectively removes supraphysiologic testosterone from plasma to within reference ranges.
• These findings may support the transfusion of pathogen-reduced plasma and platelets from TRT donors.