The symptoms of immune hemolytic anemia include pale or yellowish skin color, tiredness or fatigue, fast heartbeat or heart rate, shortness of breath, enlarged spleen, and dark urine. The disease is diagnosed by performing several tests. The following indicate that the patient is suffering from the disease: Coombs’ test turning out positive direct or indirect; increased bilirubin levels; increased LDH level (LDH are enzymes that increase when the body is experiencing tissue damage); presence of hemoglobin in the urine; decreased serum haptoglobin level; increased reticulocyte count; and decreased hemoglobin and RBC count.
Transdermal patches (adhesive patches placed on the skin) may also be used to deliver a steady dose through the skin and into the bloodstream. Testosterone-containing creams and gels that are applied daily to the skin are also available, but absorption is inefficient (roughly 10%, varying between individuals) and these treatments tend to be more expensive. Individuals who are especially physically active and/or bathe often may not be good candidates, since the medication can be washed off and may take up to six hours to be fully absorbed. There is also the risk that an intimate partner or child may come in contact with the application site and inadvertently dose himself or herself; children and women are highly sensitive to testosterone and can suffer unintended masculinization and health effects, even from small doses. Injection is the most common method used by individuals administering AAS for non-medical purposes.