Testosterone induces erythrocytosis via increased erythropoietin and suppressed hepcidin: evidence for a new erythropoietin/hemoglobin set point.

Author(s): Bachman E(1), Travison TG(2), Basaria S(3), Davda MN(2), Guo W(2), Li M(2), Connor Westfall J(3), Bae H(3), Gordeuk V(2), Bhasin S(4).

Affiliation(s): Author information: (1)Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Boston Medical Center, Massachusetts. SBhasin@partners.org. (2)Section of Hematology/Oncology Sickle Cell Center, MC 712, University of Illinois at Chicago. (3)Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Boston Medical Center, Massachusetts. (4)Brigham and Women's Hospital, Department of Medicine, Section on Men's Health, Aging and Metabolism, Boston, Massachusetts.

Publication date & source: 2014, J Gerontol A Biol Sci Med Sci. , 69(6):725-35

BACKGROUND: The mechanisms by which testosterone increases hemoglobin and hematocrit remain unclear. METHODS: We assessed the hormonal and hematologic responses to testosterone administration in a clinical trial in which older men with mobility limitation were randomized to either placebo or testosterone gel daily for 6 months. RESULTS: The 7%-10% increase in hemoglobin and hematocrit, respectively, with testosterone administration was associated with significantly increased erythropoietin (EPO) levels and decreased ferritin and hepcidin levels at 1 and 3 months. At 6 months, EPO and hepcidin levels returned toward baseline in spite of continued testosterone administration, but EPO levels remained nonsuppressed even though elevated hemoglobin and hematocrit higher than at baseline, suggesting a new set point. Consistent with increased iron utilization, soluble transferrin receptor (sTR) levels and ratio of sTR/log ferritin increased significantly in testosterone-treated men. Hormonal and hematologic responses were similar in anemic participants. The majority of testosterone-treated anemic participants increased their hemoglobin into normal range. CONCLUSIONS: Testosterone-induced increase in hemoglobin and hematocrit is associated with stimulation of EPO and reduced ferritin and hepcidin concentrations. We propose that testosterone stimulates erythropoiesis by stimulating EPO and recalibrating the set point of EPO in relation to hemoglobin and by increasing iron utilization for erythropoiesis.