What are reasonable treatment options in this case?
Most clinical practice guidelines suggest the following steps be taken in patients with testosterone-induced erythrocytosis (these guidelines are written for cis men):
- Evaluate patient for hypoxia and sleep apnea.
- Treat with one of the following:
- Stop testosterone therapy in cis men if Hct > 54% and then reinitiate therapy with a reduced dose.
- Use therapeutic phlebotomy to lower Hct.
Our patient chose to discontinue his testosterone and allow his Hct to fall below 54% at which time testosterone was reinitiated at three-quarters of the original dose. At this new dose, he was able to achieve normal testosterone levels without a recurrence of his erythrocytosis.