Not all hematocrit elevation is problematic. This is particularly important for men who are already hypertensive before starting therapy. They’re not incorrect that elevated hematocrit requires attention; they’re just focused on the wrong mechanism. The medical establishment has warranted concern about high hematocrit, but for the wrong reasons. Current guidelines typically recommend holding or reducing TRT if hematocrit reaches or exceeds 54%. Concierge Medicine is the future of healthcare. Elevated hematocrit in isolation isn’t necessarily dangerous, so it’s not a reason to immediately discount TRT.
Testosterone replacement therapy (TRT) can raise hemoglobin and hematocrit levels because it increases the body’s production of red blood cells. This increased iron, in turn, leads to a greater production of red blood cells, and it is that greater amount of red blood cells that results in the thicker blood or polycythemia that can occur with the testosterone injections. Testosterone replacement therapy (TRT) can raise hemoglobin and hematocrit because it stimulates the body to make more red blood cells. When you start testosterone replacement therapy (TRT), your body responds by making more hemoglobin, hematocrit, and red blood cells. Testosterone administration raised mean testosterone levels into the mid-normal range for young men and resulted in an increase in red blood cells that was accompanied by an increase in serum EPO, suppression of hepcidin and ferritin levels, and an increase in soluble transferrin receptor (sTR).
The dose of testosterone plays a major role in how your blood markers change. Pellets are small cylinders implanted under the skin that release testosterone over several months. Some clinicians report that patients switching from IM to SubQ injections see a decrease in hemoglobin over time. Research has found that IM injections lead to the highest rate of erythrocytosis (high hematocrit) among all TRT options. Understanding these patterns can help explain why some people develop high hemoglobin and others do not.
Because of this, people using injections often need more frequent blood tests to monitor their red blood cell count. These two factors can strongly influence how much your hemoglobin and hematocrit rise during treatment. A higher testosterone dose causes a stronger boost in red blood cell production.
In discussions about side effects of testosterone treatment, prostate cancer and heart disease get the most attention. At a hematocrit percentage above 54%, stopping testosterone is advised by the American guideline,3 whereas the European guideline suggests that phlebotomy should be considered at this level.10 This hematocrit value was derived from the Framingham cohort study. Evidence-based guidelines on the management of erythrocytosis secondary to testosterone are lacking, and current guidelines based on expert consensus are variable. In addition, initiation of testosterone therapy should be limited to those patients who show both clinical and biochemical evidence of androgen deficiency to avoid complications caused by unnecessary drug exposure.2,3 Interestingly, exogenous testosterone was used initially as a treatment for anemia.