Erythrocytosis from Testosterone Therapy does not Cause Heart Disease, or Strokes

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Why do some men have elevated Red Blood cell counts after their testosterone replacement?

50% of men who receive Testosterone replacement therapy (TRT) have elevated Red Blood cell counts, and high Hemoglobin and Hematocrits. The numbers that are considered normal are usually normal for men at sea level, and an elevated H/H doesn’t necessarily mean that a man will have any negative effects

If you have lung problems, or disease:

For those men who have COPD, Chronic Bronchitis, or asthma, high counts are an adaptation that help you live with a compromised ability to oxygenate your blood. You should not get your blood dumped because the high counts are keeping you alive!

If you live at high altitude or if you spend a large amount of time at high altitudes, then you don’t necessarily need your blood phlebotomized because you need higher counts to live or vacation there. Men who live at high altitude have adapted to a lower oxygen level making more RBCs.

If you are an extreme athlete, or you train excessively you may have high red blood counts to help you collect and distribute oxygen during your exercise. You won’t have to remove blood unless this level remains a year after you stop excessive exercise.

Why are doctors telling us to get phlebotomies (blood dumped) all the time?

The problem with having a diagnosis of Erythrocytosis from TRT is that it is almost always confused with the disease called Polycythemia Vera (PCV).  PCV does carry with it a high risk of blood clots, strokes and heart attacks.  The two conditions are completely different, but ER doctors and surgeons only know that a high H/H is a sign of PCV, and PVC causes blood clotting…but they don’t know that elevated H/H from TRT or adaptation to a disease doesn’t cause the same medical problems as Polycythemia vera..

One of the ways we can separate the disease of PVC from the condition of Erythrocytosis:

The CBC will show us the difference.  PVC his elevated RBCs, H/H, Platelets and WBCs…all of them are elevated.  Erythrocytosis only has an elevated RBC, and H/H. If your doctor gets excited about your elevated blood count, please tell him we have evaluated you for PVC and you don’t have that, so you are not in danger for clotting or CVDx.


Here are the differences between PCV and Erythrocytosis from TFT:

Polycythemia Vera Erythrocytosis
Blood test: high RBC, High H/H and High platelets, High WBC Blood test: only high H/H and RBC
Abnormal Platelets, increase clotting Normal Platelets, no increase clotting
Genetics: + Jak 2 mutation Genetics: no mutation
Cause is genetic requires blood dumping to lower all counts or hydroxyurea meds Causes: High Altitude, TRT, COPD, Familial cause
Treatment: requires blood dumping to lower all counts or hydroxyurea meds Treatment not necessary to keep it below HCT of 50.  Some people do better with higher counts especially COPD, High Altitude

Living, exercise at high altitude.

A lot of Research that supports the theory that these patients are at risk for blood clots and coronary artery disease. No research paper that says high H/H from T causes CVDX, Stroke, or Blood clots.
Abnormal platelet number and function cause the vascular diseases and clotting TFT is associated with normal platelet counts and functions.
Jak 2 increases clotting factors and platelet production, and erythropoietin from the kidneys  and increases clotting. Way it works:  T directly stimulated the bone marrow to make more RBCs. No other blood products are elevated

Remember: It is not T that causes high H/H to require blood dumping, it is the confused medical community that goes crazy when they see high H/H and cry malpractice!  In many cases we are dumping blood to appease the primary care doctors.  We ideally would like to keep a man’s H/H below 20/55.

Other reasons for elevated H/H:

  1. Do you have COPD, Asthma or chronic bronchitis? Don’t get your blood dumped. The high counts are helping you.
  2. Do you have, or have you had elevated platelet count with your elevated red blood cell count? If you have, please tell your primary or your BioBalance Health Nurse Practitioner you will be evaluated for PCV with a genetic test.
  3. Do you live for part of the year at high elevation? If yes, then it is not necessary to phlebotomize you to get your counts down because you need those RBCs.
  4. Do you eat high iron foods (liver, braunsweiger, pate, bone marrow, Deep green leafy veggies)? If so of if you are taking iron, you can stop because you shouldn’t need it while taking T, because the bone marrow is stimulated to make more red cells with T.
  5. Do men in your family die of CVDX before age 50? Then you might have PCV! Get an iron panel + a Jak 2 genetic test.


Blood Phlebotomies:

Men over 70, should only have 250 cc removed at one time and told not to exercise for a few days. Blood pressure and blood volume take longer to equilibrate after the age of 70. Make sure these patients have a lot of water and that they drink it and eat something after the phlebotomy.  Remember you just removed blood sugar, dropped their blood pressure, and dehydrated them by removing blood. They may be dizzy, but they have to sit until they are stable.

Blood tests for erythrocytosis/ PCV:


Iron panel


Jak-2 mutation

Hereditary hemochromatosis

This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author.  (314) 993-0963.

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