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- Title
Markers of Iron Flux during Testosterone-Mediated Erythropoiesis in Older Men with Unexplained or Iron-Deficiency Anemia.
- Authors
Artz, Andrew S.; Stephens-Shields, Alisa J.; Bhasin, Shalender; Ellenberg, Susan S.; Cohen, Harvey J.; Snyder, Peter J.; Artz, Andrew S; Stephens-Shields, Alisa J; Ellenberg, Susan S; Cohen, Harvey J; Snyder, Peter J
- Abstract
<bold>Context: </bold>Testosterone treatment of hypogonadal men improves their hemoglobin, but the mechanism is not understood.<bold>Objective: </bold>To investigate possible mechanisms by which testosterone stimulates erythropoiesis in hypogonadal older men with unexplained or iron-deficiency anemia.<bold>Design: </bold>The Anemia Trial of The Testosterone Trials, a placebo-controlled study in older, hypogonadal men.<bold>Setting: </bold>Twelve academic medical centers.<bold>Participants: </bold>A total of 95 hypogonadal men (testosterone < 275 ng/mL) ≥65 years with anemia (hemoglobin < 12.7 g/dL). They were classified as having unexplained (n = 58) or iron deficiency anemia (n = 37).<bold>Intervention: </bold>Testosterone or placebo gel for 1 year.<bold>Main Outcome Measures: </bold>Markers of iron metabolism during the first 3 months of treatment.<bold>Results: </bold>Testosterone replacement significantly (P < 0.001) increased hemoglobin in the 58 men who had unexplained anemia (adjusted mean difference 0.58 g/dL; 95% confidence interval, 0.31-0.85). Testosterone replacement tended to increase hemoglobin in the 37 men who had iron deficiency (0.38 g/dL; -0.19, 0.95), but the response was more variable and not statistically significant (P = 0.19). In men with unexplained anemia, testosterone replacement suppressed hepcidin (-8.2 ng/mL; -13.7, -2.7; P = 0.004) and ferritin (-19.6 µg/L; -32.8, -6.3; P = 0.004), but in men with iron deficiency, testosterone replacement did not. The decrease in hepcidin was moderately correlated with the increase in hemoglobin in the men with unexplained anemia (correlation coefficient -0.35, P = 0.01) but not in those with iron deficiency anemia (correlation coefficient -0.07, P = 0.73).<bold>Conclusions: </bold>Testosterone replacement of older hypogonadal men with unexplained anemia stimulates erythropoiesis associated with increased iron mobilization. This effect appears to be attenuated by iron deficiency.
- Subjects
OLDER men; IRON deficiency anemia; ERYTHROPOIESIS; ANEMIA; IRON deficiency; HEMOGLOBINS; THERAPEUTIC use of testosterone; COMPARATIVE studies; HORMONES; HYPOGONADISM; RESEARCH methodology; MEDICAL cooperation; RESEARCH; TESTOSTERONE; THERAPEUTICS; EVALUATION research; TREATMENT effectiveness
- Publication
Journal of Clinical Endocrinology & Metabolism, 2020, Vol 105, Issue 11, p1
- ISSN
0021-972X
- Publication type
journal article
- DOI
10.1210/clinem/dgaa521