How do you manage a patient on long-term testosterone therapy who develops a hematocrit of 52% but wants to continue treatment?

I have a higher threshold than the AUA to intervene. If hematocrit is above 54%, I will ensure they do not have sleep apnea and will adjust the dose. I also ask their PCP to weigh in on any other causes of elevated Hct. Above 56%, I will stop treatment to ensure the above has been addressed. If thei...

The AUA cutoff is the same as the Endocrine Society: 54%. The rationale is due to increased risk of thrombotic events. Treatment includes reducing the dose, lengthening the interval, or doing smaller, more frequent injections.

Evaluation and Management of Testosterone Deficiency (2024)