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How To Manage Polycythemia Caused by Testosterone Replacement Therapy

how to manage polycythemia caused by testosterone replacement therapy

Polycythemia is a condition characterized by an increased number of red blood cells in the bloodstream. 

While polycythemia can occur on its own as a primary condition called polycythemia vera, it can also develop secondarily as a side effect of certain medications, including testosterone replacement therapy.

If you are experiencing polycythemia caused by testosterone therapy, it’s important to understand how to manage this condition appropriately under your doctor’s supervision.

Understanding Polycythemia

Polycythemia results when the body produces too many red blood cells, which raises the hematocrit level – the percentage of red blood cells in the total blood volume. 

Hemoglobin concentration also rises, as hemoglobin is the protein inside red blood cells that carries oxygen. While a normal hematocrit level is 40-54% for men and 36-48% for women, in polycythemia it can rise to 60% or higher.

There are two main forms of polycythemia:

Testosterone can stimulate red blood cell production by promoting the secretion of erythropoietin, the hormone that signals bone marrow to produce more red blood cells. For those on testosterone therapy, regular blood monitoring can help detect polycythemia early.

Signs and Symptoms

Some common symptoms of polycythemia include:

  • Fatigue and weakness
  • Headaches
  • Dizziness
  • Shortness of breath
  • Itchy skin, especially after warm baths or showers
  • Reddened face
  • Enlarged spleen

Polycythemia also increases the risk of blood clots, as the blood becomes thicker. Clots can lead to serious problems like stroke or pulmonary embolism. Prompt treatment is key.

Getting a Diagnosis

Doctors diagnose polycythemia with blood tests, medical history and a physical exam. Initial blood tests measure the red blood cell count, hematocrit level, and hemoglobin concentration.

Other diagnostic steps help determine if polycythemia is primary or secondary. 

These include:

  • Testing oxygen level in blood to rule out hypoxemia
  • Testing erythropoietin levels
  • Molecular genetic testing for gene mutations linked to polycythemia vera
  • Bone marrow biopsy

For those on testosterone therapy, polycythemia is usually secondary. Doctors will evaluate if testosterone is the likely cause.

Treatment Options

Treatment aims to lower the number of red blood cells and reduce clotting risks. Options may include:


Phlebotomy involves removing blood periodically to decrease hematocrit levels. The procedure is similar to donating blood. After phlebotomy, the body replaces the removed blood, keeping hematocrit at safer levels. Frequency varies by individual.


HydroxyureaReduces production of red blood cells
AspirinMinimizes blood clotting
JAK inhibitors like ruxolitinibLimits blood cell production

Lifestyle Changes

Lifestyle adjustments can also help manage polycythemia:

  • Staying well hydrated
  • Avoiding extreme heat or cold
  • Exercising regularly
  • Eating a healthy diet
  • Avoiding iron supplements

Monitoring Blood Levels

Regular blood tests to monitor hematocrit and hemoglobin levels are important, as is adjusting testosterone dosage if polycythemia persists.

How To Manage Polycythemia Caused by Testosterone Replacement Therapy

Testosterone Replacement Therapy (TRT) is often used to address low testosterone levels, a condition that can lead to various symptoms such as fatigue, decreased libido, and mood changes. However, one potential side effect of TRT is secondary polycythemia, which is an increase in the number of red blood cells.

If TRT is causing polycythemia, here are some steps that might be taken to manage the condition:

  1. Adjusting the Dosage: The treating physician may consider reducing the dose of testosterone. It’s important to find a balance between managing the symptoms of low testosterone and avoiding side effects like polycythemia.
  2. Phlebotomy: This is a procedure where blood is drawn out of the body, reducing the number of red blood cells and helping to lower the blood’s viscosity.
  3. Medication: In some cases, medication might be prescribed to help control the production of red blood cells.
  4. Lifestyle Changes: Staying well-hydrated can help keep the blood from becoming too thick. Regular exercise may also aid in managing the condition, but it should be noted that exercise can also stimulate red blood cell production, so it’s important to find a balanced routine.
  5. Regular Monitoring: Routine blood tests are crucial to monitor hematocrit levels (the proportion of red blood cells to the total blood volume). Regular monitoring can help identify any changes early and adjust the treatment plan accordingly.

It’s important to remember that every patient’s case is unique, and what works best will depend on their individual circumstances. These decisions should always be made in consultation with a healthcare professional.

Frequently Asked Questions About Testosterone Replacement Therapy

How does testosterone replacement therapy affect cardiovascular disease risk?

Testosterone replacement therapy (TRT) is often prescribed to treat hypogonadism, a condition characterized by low testosterone levels. However, there’s ongoing research and debate about its potential impact on cardiovascular disease.

Some studies indicate that TRT could potentially increase the risk of cardiovascular events, while others suggest it might have protective effects. It’s essential to discuss these potential risks and benefits with your healthcare provider before starting TRT.

What impact does testosterone replacement have on sexual function and desire?

Testosterone is one of the primary androgens (male sex hormones) that play a crucial role in sexual function and desire.

Many men on TRT report improvements in sexual function, including improved erectile function and increased sexual desire. However, it’s important to note that individual responses can vary, and TRT is not a guaranteed solution for all sexual function issues.

What are the risks of venous thromboembolism with testosterone replacement therapy?

Venous thromboembolism (VTE) is a blood clot that starts in a vein, and it’s a serious potential risk of TRT. Testosterone can increase the production of red blood cells, which can make the blood thicker and potentially increase clotting risks. If you are on TRT, it’s important to watch for symptoms of VTE and seek immediate medical attention if they occur.

What forms of testosterone administration are available, and how do they affect testosterone concentration?

Several forms of testosterone administration are available, including injections, skin patches or gels, and implantable pellets. 

The method of administration can impact how much bioavailable testosterone (the testosterone that your body can use) is in your system, how quickly it’s absorbed, and how long the effects last. Injections of testosterone often result in peak testosterone concentration shortly after administration, followed by a gradual decline.

Can dietary supplements and lifestyle changes improve testosterone levels?

While TRT is a direct method for increasing testosterone levels, there are also dietary supplements and lifestyle changes that can help. Certain supplements are believed to support testosterone production, and a diet rich in lean proteins, healthy fats, fruits, and vegetables can support overall health, including hormonal balance.

Regular exercise, adequate sleep, and stress management can also help maintain healthy testosterone levels. However, it’s important to approach supplements with caution and preferably under the guidance of a healthcare provider, as their safety and efficacy can vary widely.

Remember, these are general guidelines and information. Individual experiences with TRT can vary, and it’s important to have ongoing conversations with your healthcare provider to ensure the safety and effectiveness of your treatment plan.

Living with Polycythemia

Managing polycythemia requires ongoing monitoring and working closely with your healthcare providers. While symptoms can often be controlled with lifestyle changes and treatment, consistency is vital. With proper management, polycythemia can be effectively controlled.

Tailored TRT Strategies to Mitigate Polycythemia Risk

Navigating the complexities of Testosterone Replacement Therapy (TRT) and its potential side effects, such as polycythemia, can be challenging. At Physicians Rejuvenation Center, we’re committed to providing clear answers and personalized care. If you have questions or concerns about TRT, we’re here to help.

Please call us at 561-783-5153 or click here to schedule a consultation with our expert team. Let’s work together on your journey towards optimal health.