(P-BC-10) Blood Donations from Polycythemic Males on Testosterone: Hemoglobin Results from a Large US Blood Provider

Background/Case Studies: Polycythemic donors on testosterone therapy (TT) may require blood donation or therapeutic phlebotomy to mitigate the risk for thrombosis when dose reduction is not feasible. FDA guidelines allow donors with a prescription from their healthcare provider (HCP) to donate red blood cells (RBC) more frequently than every 56 days. TT donors not meeting allogeneic eligibility are drawn without charge and their products discarded.

Anecdotally, many TT donors are < age 55 and on injectable TT for bodybuilding. Dose reduction/change in administration route can ameliorate polycythemia. While a desirable range for hemoglobin (Hb) maintenance is not known, there is concern that overly aggressive Hb depletion could paradoxically increase thrombotic risk (Endocr Connect 2024;13(10):e240283). Several societies recommend target Hb < 18g/dL, while avoiding iron deficiency and overcorrection below mid-range Hb values (15.7g/dL).


Study

Design/Methods: TT donors advised to donate blood by their HCP in 2024 were analyzed. All presentations from male donors with an available Hb value were included. Data were grouped by presentation frequency (1-10+). Summary statistics for the change in median Hb (ΔHb) with successive presentations were calculated and % pre-donation Hb values below cutoffs were assessed.

Results/Findings: Data from 44,350 unique male TT donors with 1 to 25 presentations were analyzed. Of these, 15,342(34.6%) presented 1x; 2,016 (4.5%) presented ≥7x, and 456(1.0%) ≥10x. Median(IQR) Hb of male TT donors across all presentations was 17.2(2.1)g/dL (mean±SD 17.2±1.6g/dL). Median Hb decreased with an average ΔHb of -0.09g/dL for each additional presentation (p< 0.05) (Figure 1A). Of TT donors presenting only once, 8,815(57.5%) had Hb 15.7-18g/dL. As the number of presentations increased, those with Hb 15.7-18g/dL were observed less often, declining to 46.7% for donors presenting ≥10x. In contrast, presentations at Hb < 15.7g/dL rose steadily from 10.2% for 1 presentation to 31.7% with ≥10x (p< 0.05). Individual and mean Hb trajectory of “high-frequency donors” (≥10x) shows their Hb fell ~0.19g/dL over the year to 16.6±1.8g/dL (mean±SD) (Figure 1B).

Conclusions: At our blood center, < 5% of all male TT donors presented >6x (i.e., more frequently than regular allogeneic donors are permitted). Many donors are already at target Hb (i.e., < 18g/dL), and as donation frequency exceeds usual allogeneic eligibility (7-25 times a year), between 23-32% have at least one Hb value below the median for healthy males.

There is a need to investigate whether TT donors with polycythemia who donate more often than the average non-TT donor and lower their Hb below recommended thresholds develop absent iron stores. Further, cohort studies estimating their risk for thrombotic events are needed for rigorous investigation of the role of regular phlebotomy in polycythemic TT donors.