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The discussion by Spivak¹ of chronic anemias in the elderly would have been more complete if it had included consideration of the potential contribution by hypogonadism to these anemias in older men.

Male hypogonadism characteristically is accompanied by decreasing red blood cell mass and develops frequently with advancing age, having been documented in 25% of men with chronic renal failure (CRF)² and many men with malignancies, including 80% of those receiving sustained-action opioids.³ Hematocrit levels in hypogonadal men improve during replacement testosterone therapy because of a combination of androgen stimulation of erythropoietin (EPO) production and direct stimulation of androgen-dependent erythropoietic cells. Among older men, however, testosterone levels are rarely examined as a factor potentially contributing to anemia, even though the origin of these anemias remains unknown in a large percentage.

Before EPO therapy became available, androgens were widely used to treat many chronic anemias including the anemia of CRF, a . . . [Full Text of this Article]

AUTHOR INFORMATION
Harry W. Daniell, MD

RELATED LETTERS

Erythropoietin Resistance During Androgen Deficiency—Reply
Jerry L. Spivak
Arch Intern Med. 2006;166(17):1923-1924.
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Erythropoietin Levels and Androgens Use: What Is Their Relationship in the Correction of Anemia?
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Arch Intern Med. 2007;167(3):309.
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