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.
Daniell HW. Erythropoietin Resistance During Androgen Deficiency. Arch Intern Med. 2006;166(17):1923. doi:10.1001/archinte.166.17.1923-a