Testosterone has a dose-dependent stimulating effect on erythropoiesis. Erythrocytosis or polycythemia is the most common dose-limiting effect of testosterone therapy.

Prevalence of erythrocytosis 5% – 66% in testosterone-treated hypogonadal cis men, 11.5% in testosterone-treated trans men.

Highest risk of erythrocytosis with injectable testosterone therapy. Biggest increase in the first 3 months to 1 year.

Treatment options including stopping the testosterone therapy and reinitiating at a lower dose when the hematocrit normalizes, or instituting phlebotomy while continuing testosterone therapy.

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