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These values show how thick your blood may become and how many red blood cells your body is making. Testosterone therapy can improve energy, mood, strength, and overall well-being for many people with low testosterone. Combining smoking and TRT increases the risk even more. While some people feel normal even if their hemoglobin rises, others may feel symptoms. It allows your blood to return to safe levels and gives your doctor time to adjust your treatment plan. These risks may be low for some people, but they become higher as hemoglobin rises. After hemoglobin and hematocrit return to the safe range, a doctor may approve restarting TRT.
Though not testosterone-induced, an increased thromboembolic risk from elevated Hct was demonstrated. Despite its positive effects, TTh has several common side effects, including increases in estrogen levels, gynecomastia, and erythrocytosis 10–15. High blood viscosity increases the risk for potential vascular complications involving the coronary, cerebrovascular, and peripheral vascular circulation, though there is limited evidence supporting a relationship between TTh and vascular complications. A rapid increase in awareness of androgen deficiency has led to substantial increases in prescribing of testosterone therapy (TTh), with the benefits of improvements in mood, libido, bone density, muscle mass, body composition, energy and cognition. Several guidelines by endocrine organizations for the treatment of male hypogonadism recommend against starting TTh in patients presenting with elevated hematocrit at baseline or stopping TTh when its levels cannot be controlled. Testosterone replacement therapy (TRT) can be an effective treatment for low testosterone in both males and females, addressing symptoms like fatigue, low libido, and loss of muscle mass.
There was a significant increase in the proportion of men who had anemia correction with testosterone replacement therapy compared to placebo . Testosterone treatment of boys who have delayed puberty has been shown to normalize hemoglobin levels . The majority of antipsychotics prescribed to these patients, such as haloperidol and risperidone, increase prolactin levels by acting as antagonists at dopamine (D2) receptors. Here, we present a case series of patients who presented to the hospital with hypogonadism and had improved anemia following initiation of testosterone replacement therapy. Secondary analyses of a substudy of a testosterone trial reported that testosterone supplementation may correct normocytic anemia in patients with hypogonadism and reduce the incidence of anemia in men with hypogonadism who are not anemic .
A previous hemoglobin measurement from four years prior showed a hemoglobin of 13.2 g/dL. His laboratory investigations were notable for a similar picture (Table 1) with hemoglobin of 9.1 g/dL and MCV of 93 fL. His workup for an infectious, toxic, and metabolic cause of his symptoms was found to be negative. The patient was started on a 200 mg intramuscular testosterone cypionate to be taken every 14 days. Previous free testosterone was measured ten years ago and was 42 g/dL, within the normal range. Free and total testosterone were decreased at five picograms per deciliter (pg/dL) and 215.7 nanograms per deciliter (ng/dL), respectively.
Evidence for this purported negated risk predominantly stems from its efficacy in lowering thrombotic risk in erythrocytosis from causes other than TTh, such as PV. Therapeutic phlebotomy can decrease hematocrit to within the reference range, which purportedly negates this risk. We hypothesize that this might impose a risk by decreasing tissue pO2 and depleting iron stores, which jointly inhibit PHD1-3 activity leading to HIF-α stabilization. Therapeutic phlebotomy might be initiated to decrease hematocrit to acceptable levels and maintain these between phlebotomies. Would correcting hematocrit by periodic phlebotomy not return HIF levels to their state prior to initiating TTh and thus be harmless? Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) that inhibit PHD activity, and thereby prevent HIF-α degradation, also increase thrombotic risk (55). The routine use of phlebotomy as a treatment is therefore specifically not advised in Chuvash erythrocytosis (54).
But your provider can use the results of your CBC, along with your symptoms, to narrow down or diagnose the cause. These can be signs of many health conditions, including infections, cancer, blood conditions and medication side effects. This gives your provider more information about what’s happening with different immune system cells. For a CBC blood test, a healthcare provider takes a sample of your blood and sends it to a lab.
One person may see a mild rise in hemoglobin, while another may see a rapid increase. Using a CPAP machine or getting treatment can greatly reduce your risk. Sleep apnea is one of the biggest risk factors for high hemoglobin on TRT.
In light of this controversy, the American Urological Association (AUA) issued a policy statement stating that, based upon current evidence, definitive answers on the cardiovascular risks of TTh are not currently available . Extensive debate has surrounded high impact publications with questionable methodologies and controversial conclusions that suggested significant cardiovascular risk for men on TTh with alternative studies suggesting benefit 16–20. In an official statement, the organization proposed an algorithm for TTh in patients with AOH . Primary hypogonadism represents failure of testosterone production, characterized by low serum testosterone and elevated gonadotropins. A literature review was performed using PubMed for articles addressing TTh, erythrocytosis, and polycythemia.
Testosterone stimulated erythropoiesis specifically, as the red blood cell count increased (Table 2), while platelet counts showed small increases relative to placebo (Table 2). As expected, hemoglobin and hematocrit increased in men assigned to testosterone group by an average 1.1g/dL and 4.4%, respectively (Table 2), representing 7% and 10% increase, respectively, from baseline. We have reported that administration of supraphysiologic doses of testosterone in healthy men suppresses the iron regulatory peptide hepcidin while EPO levels remained unchanged after 20 weeks of treatment (12). The mechanisms by which testosterone increases hemoglobin and hematocrit remain unclear.

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