Which is an absolute contraindication to starting testosterone replacement therapy?

Which is an absolute contraindication to starting testosterone replacement therapy?

• A. Polycythemia
• B. Anemia
• C. Hypertension
• D. Hyperlipidemia

Answer: (A)

Polycythemia is an absolute contraindication to starting testosterone replacement therapy because testosterone stimulates erythropoiesis, which can raise hematocrit further and increase blood viscosity. In a patient who already has polycythemia, initiating testosterone markedly elevates the risk of thrombotic events such as deep vein thrombosis, pulmonary embolism, stroke, or heart attack. Therefore, starting therapy is not safe until hematocrit is normalized or the polycythemia is addressed. Anemia, hypertension, and hyperlipidemia are not absolute barriers. Anemia is not a reason to avoid testosterone since the treatment can boost red cell production in some contexts. Hypertension and hyperlipidemia are cardiovascular risk factors that require management, but they do not by themselves contraindicate initiation of testosterone therapy.

Polycythemia is an absolute contraindication to starting testosterone replacement therapy because testosterone stimulates erythropoiesis, which can raise hematocrit further and increase blood viscosity. In a patient who already has polycythemia, initiating testosterone markedly elevates the risk of thrombotic events such as deep vein thrombosis, pulmonary embolism, stroke, or heart attack. Therefore, starting therapy is not safe until hematocrit is normalized or the polycythemia is addressed.

Anemia, hypertension, and hyperlipidemia are not absolute barriers. Anemia is not a reason to avoid testosterone since the treatment can boost red cell production in some contexts. Hypertension and hyperlipidemia are cardiovascular risk factors that require management, but they do not by themselves contraindicate initiation of testosterone therapy.