A retrospective single centre audit was conducted on the effects of polycythaemia in trans-male and native male.
Polycythaemia is a recognised side effect of testosterone treatment. It could be viewed as a maker of excess testosterone action. We examined whether lipid profiles as a marker of cardiovascular risk differed in a population of polycythaemic transmen (TM) and native males (NM).
Forty-six NM and 12 TM were identified to have polycythaemia (haematocrit ≥0.48). The mean age of TM was younger than NM (43.75 years vs 56.36 years, P>0.05). Baseline haematocrit (0.44 NM vs 0.45 TM) and polycythaemic stage haematocrit (0.52 NM vs 0.51 TM) were not different between groups but the rise of haematocrit compared to baseline was significant in both groups (P<0.01). Following either conservative management or venesection, post treatment haematocrit improved in both groups (0.47 NM vs 0.48 TM, P 0.0001).
TM have higher baseline total cholesterol (5.4±1.3 TM vs 4.5±1.2 NM mmol/l, P 0.08) and LDL (3.33±1.0 mmol/l vs 2.67±0.87 mmol/l, P 0.09). At polycythaemic stage, TM had higher total cholesterol (5.5±1.03 TM vs 4.5±0.85 NM mmol/l), LDL (3.27±0.89 TM vs 2.46±0.73 NM mmol/l), and HDL (1.34±0.19 TM vs 1.13±0.32 NM mmol/l) all P<0.01, which was also seen in post treatment total cholesterol (6.0±1.10 TM vs 4.2±0.90 NM mmol/l), LDL (3.72±0.87 TM vs 1.10±0.31 NM mmol/l), and HDL (1.39±0.23 TM vs 1.11±0.31 NM mmol/l) all P<0.01. In NM, the lipid profile improved once the polycythaemia was treated, in contrast the lipid profile deteriorated in TM (total cholesterol 5.53 mmol/l vs 6.00 mmol/l, triglyceride 1.85 mmol/l vs 2.14 mmol/l (both P<0.001), polycythaemic stage vs post-treatment).
Our data suggests that there are no differences between TM and NM haematological responses to the treatment of polycythaemia. However, the lipid profile of TM appears to deteriorate with the treatment of polycythaemia which is not seen in NM which could suggest that polycythaemia is a marker of higher cardiovascular risk in transmen.