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Managing TRT Blood Cell Risks

Could testosterone therapy restore your health, vitality, and confidence? Discover how to balance benefits and risks.

Feeling run down, lacking energy, and losing strength? Testosterone replacement therapy can restore your vitality. However, one potential side effect – increased red blood cells – may understandably have you concerned. 

At Physician’s Rejuvenation Center, we’ve helped hundreds of men boost their testosterone safely and effectively. While research shows TRT can raise hematocrit, with close monitoring and evidence-based management strategies, we’ve kept patients’ levels optimized. 

Want to reclaim your edge without compromising your health? Read all the essential answers to your questions below. 

Does Testosterone Therapy Cause an Increase in Red Blood Cells?

Yes, testosterone replacement therapy often increases red blood cell production by elevating erythropoietin and directly activating bone marrow stem cells.

How Testosterone Boosts Red Blood Cell Formation

Testosterone stimulates your body to generate more red blood cells (a process called erythropoiesis) through two key mechanisms:

  • Increasing Erythropoietin: Testosterone elevates erythropoietin levels, the hormone produced by your kidneys that signals your bone marrow to produce more red blood cells.
  • Activating Stem Cells: Testosterone also directly interacts with hematopoietic stem cells in the bone marrow to ramp up red blood cell proliferation.

As a result, many testosterone therapy patients see their hematocrit value, which measures the percentage of red blood cells in the blood, rise above the normal upper limit of 54% in men.

What the Research Reveals About High Hematocrit with TRT

Research published in the Journal of Clinical Endocrinology & Metabolism indicates that during the first year of testosterone replacement therapy, 11% of patients may develop abnormally high hematocrit, a condition known as erythrocytosis.

This excessive elevation in red blood cell levels, especially when hematocrit exceeds 54%, makes the blood more viscous and prone to dangerous clotting.

Monitoring Hematocrit to Keep Levels in Check

Based on our own experience and findings at the Physician’s Rejuvenation Center, careful tracking of patients’ hematocrit through regular bloodwork helps us detect concerning changes early on.

This allows us to quickly adjust the testosterone dosage or administration method to prevent hematocrit from rising out of the healthy target range.

Keeping red blood cell levels optimized ensures patients can safely continue benefiting from testosterone therapy over the long term.

TRT got you worried? We make treatment safe, effective, and personalized to your needs. Talk to us today!

How Common Is Erythrocytosis with TRT?

Erythrocytosis occurs in 40% of men on injectable testosterone, 35% with subcutaneous pellets, and 15% using transdermal preparations, with peak incidence within the first year but risk continuing for up to 20 years.

Our research shows the rate varies significantly depending on the formulation:

  • Injectable testosterone carries the highest risk, with 40% of men developing erythrocytosis, as evidenced by this study. This may be due to higher peak levels compared to transdermal TRT.
  • Subcutaneous testosterone pellets also have increased risk, with a 35% incidence of elevated hematocrit, which is proven in this study featured in Sexual Medicine.
  • Transdermal TRT like gels and patches have the lowest chance of erythrocytosis at around 15%. The more stable absorption may prevent excessive red blood cell spikes.

The highest probability of erythrocytosis occurs within the first year on TRT, when up to 17% of men may develop abnormally high hematocrit levels. However, research shows hematocrit can continue slowly rising for up to 20 years of treatment.

Older age, higher testosterone doses, and conditions like obesity and smoking also predispose men to excess red blood cell production on TRT. 

Are Increased Red Blood Cells with Testosterone Therapy a Health Risk?

While research is mixed, increased hematocrit from testosterone therapy may raise blood viscosity and clotting risks, but routine monitoring and dosage adjustments can mitigate most potential cardiovascular threats.

We can confirm that studies do associate high hematocrit with:

  • Increased blood viscosity and resistance to flow, which may raise blood pressure.
  • Higher risk of blood clots, since thicker blood is more prone to clotting. This may raise the chances of heart attack and stroke.

However, some analyses indicate the erythrocytosis caused by TRT may be milder and more manageable than other conditions producing polycythemia:

  • One study published in HealthDay News saw hematocrit exceed normal limits in only 1% of transgender patients on testosterone therapy with close monitoring.

According to our experience at the Physician’s Rejuvenation Center, routine bloodwork allows us to catch rising hematocrit early. With dosage adjustments, temporary pausing of therapy, or phlebotomy if needed, we can mitigate the risks of excessive red cell production in most patients. 

How to Manage High Blood Count from Testosterone Therapy?

We’ve successfully controlled high red blood cell counts in testosterone therapy patients using several evidence-based strategies:

  • Temporarily stopping testosterone allows hematocrit to drop back into the normal range below 50% in most men, as advised in this study from the Canadian Medical Association Journal. We can then restart at a lower dose with close monitoring.
  • Switching from injected or pellet testosterone to gels, creams or patches often helps maintain hematocrit levels long-term—the transdermal route results in less erythrocytosis risk.
  • Micro-dosing more frequent, smaller testosterone doses may prevent excessive red blood cell spikes.
  • For patients with severe symptoms, phlebotomy provides rapid reduction of hematocrit when levels are dangerously high.

Lifestyle changes like staying well hydrated, exercising regularly, treating sleep apnea, and quitting smoking can also help optimize red blood cell production on testosterone therapy.

Regain your verve in the safest way possible. We’re masters at maximizing TRT’s benefits. Schedule a consultation now!