Improvement of pruritus associated with erythrocytosis in transmasculine patients undergoing gender-affirming therapy with phlebotomy: a report of two patients

Gender-affirming hormone therapy with testosterone may be a component in the treatment plan for transmasculine individuals. Secondary erythrocytosis induced by testosterone therapy and its subsequent complications, such as pruritus, have been reported in the literature in cisgender men. This report presents two transmasculine patients who developed generalized pruritus shortly after initiating testosterone therapy for gender-affirming care. Both patients exhibited elevated hemoglobin and hematocrit levels indicative of testosterone-induced erythrocytosis. Despite treatments, including topical corticosteroids, antihistamines, gabapentin, and benzodiazepines, their symptoms persisted. Symptomatic relief was achieved through therapeutic phlebotomy. The occurrence of polycythemia vera-like pruritus underscores a significant but less commonly recognized side effect of testosterone therapy. Balancing effective gender-affirming care and patient goals with the management of associated side effects is essential for optimizing patient outcomes.