What are reasonable treatment options in this case?

Ignore the elevated Hct and continue testosterone therapy
Stop testosterone therapy to allow Hct to fall to more acceptable levels
Reduce the dose of testosterone
Institute phlebotomy while continuing testosterone therapy

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.

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