Presentation Authors: Neel Parekh*, Daniel Shoskes, Cleveland, OH
Introduction: Erythrocytosis is a known, yet detrimental side effect of testosterone therapy (TTh). Obstructive sleep apnea (OSA) is a prevalent condition associated with intermittent hypoxia during sleep, fatigue and sexual dysfunction. An association between OSA and erythrocytosis has been previously recognized, but is not well understood. The aim of this study is to evaluate the incidence and characteristics of patients on TTh who develop erythrocytosis as it relates to OSA.
Methods: Retrospective review of 37 men, mean age 62.5 year (SD10), with erythrocytosis (Hct >54%) while on TTh was performed. Baseline and peak hematocrit (Hct) and testosterone levels were assessed. Chart review identified risk factors for polycythemia, a diagnosis of OSA and compliance to treatment.
Results: The cohort of 37 men on TTh with secondary erythrocytosis received either: testopel (14), topical (12) or intramuscular (11) formulations of testosterone. 12 of 37 patients (32%) had high peak T levels (>820 ng/dL); potentially explaining their elevated Hct. In the remaining 25 patients (68%) with normal peak T levels, 5 patients harbored at least one of the following risk factors: paraneoplastic syndromes, organ transplant and blood dyscrasias. In the remaining 20 patients, 13 (65%) had OSA. Specifically, OSA was newly diagnosed in 9 patients, while the remaining four patients were already being treated with CPAP. 3 out of 4 patients had poor compliance to CPAP. Overall, a total of 12 patients (32%), with no additional risk for erythrocytosis, had either newly diagnosed or poorly controlled OSA.
Conclusions: Erythrocytosis is a known complication of TTh, particularly in patients with high peak T levels or other associated risk factors. However, in men without these risks, 32% were found to have OSA. In patients that develop unexplained erythrocytosis on TTh, consider the diagnosis of OSA.