“There is a definite need for large multicenter, randomized trials to determine the true risk,” Dr. Hellstrom said. However, in light of the current evidence, he recommends what he called a “conservative” approach to testosterone prescribing:
• Before prescribing, get a baseline complete blood count.
• If the baseline hematocrit is more than 47%, consider alternative treatments, but proceed if testosterone replacement therapy seems to be the best clinical option. Repeat testing at 3 and 12 months after therapy initiation and then annually.
• If hematocrit increases above 54%, discontinue treatment until there is a further clinical assessment, as detailed by the Endocrine Society.
• Closely monitor any new diagnoses of hypertension.
• If hematocrit does rise precipitously, phlebotomy rapidly resolved the problem.
Dr Hellstrom made the following financial disclosures: consultant, advisor, or leadership position for Abbvie, Allergan, American Medical Systems, Antares, Astellas, Auxilim, Allergan, Coloplast, Endo, Lilly, New England Research Institutes Inc. Pfizer, Promescent, Reros Therapeutics, and Theralogix.
msullivan@frontlinemedcom.com