If you are undergoing Testosterone Replacement Therapy (TRT), it’s important to be aware of erythrocytosis, a condition characterized by an increased proportion of red blood cells in the blood. Erythrocytosis leads to higher blood viscosity, commonly referred to as “thick blood.” Clinically, erythrocytosis is defined by a hemoglobin (Hb) level above 18.5 g/dl or a hematocrit (Hct) level exceeding 52% in males.

In this article, we delve into the intricacies of erythrocytosis, examining its implications and effective management strategies during Testosterone Replacement Therapy (TRT). Our goal is to equip you with thorough and actionable insights, empowering you to confidently manage your TRT journey while prioritizing your health. Join us as we embark on this enlightening exploration together.

Polycythemia and Hematocrit Explained

Polycythemia refers to an increase in the number of red blood cells in your bloodstream, leading to an elevated hematocrit level. Hematocrit is a key blood test parameter that indicates what percentage of your blood is composed of red blood cells. 

When hematocrit levels rise, your blood becomes thicker. This thicker blood can slow down circulation, making it harder for your heart to pump blood effectively. It also raises the risk of clot formation, potentially leading to serious complications like heart attacks or strokes. 

Elevated hematocrit levels can be symptomatic of underlying health issues that may require medical attention.

Common Causes of Polycythemia

Besides testosterone therapy, several other factors can lead to polycythemia. Dehydration reduces the volume of plasma in the blood, increasing hematocrit levels. 

Smoking and living at high altitudes, where oxygen levels are lower, can also cause your body to produce more red blood cells. Certain chronic conditions, such as heart or lung diseases, may also contribute to this increase.

Polycythemia is a Potential Side Effect of TRT

While TRT can significantly improve quality of life, it’s important to be aware of its potential to increase red blood cell production. The increase can lead to a higher hematocrit level, making blood monitoring an essential aspect of TRT management.

In a study that observed 347 patients receiving a total of 3,022 TRT injections over a period of 3.5 years, it was found that 25 patients (approximately 7%) developed a hematocrit level greater than 50%, and 14 patients (about 4%) exceeded a hematocrit level of 52%. These statistics underscore the importance of regular monitoring for those undergoing TRT.

If you are undergoing TRT, it’s vital to regularly monitor your blood parameters, including hematocrit levels. Adjustments to your TRT regimen may be necessary if elevated hematocrit levels are observed. 

In some cases, therapeutic phlebotomy, a procedure to remove blood from your body, may be recommended. Lifestyle interventions such as staying adequately hydrated, quitting smoking, and engaging in regular cardiovascular exercises can help maintain optimal hematocrit levels.

How To Identify Polycythemia

Identifying polycythemia early is key to effective management. Symptoms to watch for include a persistent headache, dizziness, or blurred vision, which can indicate increased blood viscosity. 

A noticeable skin reddening, especially on the face, hands, and feet, can also be a sign. However, it’s important to remember that some individuals may not exhibit any symptoms, making regular health check-ups essential.

Blood tests

Blood tests are the most effective way to detect polycythemia. These tests provide a clear picture of your hematocrit levels and help track any changes. 

For individuals on TRT, these tests are especially crucial as they help monitor the therapy’s impact on blood composition.

Consulting Healthcare Professionals

At the first sign of polycythemia symptoms or if your blood tests show high hematocrit levels, consulting a healthcare professional is imperative. They can assess your condition, suggest necessary adjustments to your TRT regimen, or recommend other treatments to manage your hematocrit levels effectively.

How To Thin Blood Caused by TRT

If you’re on Testosterone Replacement Therapy (TRT) and facing the issue of thicker blood, commonly known as increased hematocrit, you’re not alone. It’s a manageable condition, and there are several actions you can take to help thin your blood and maintain your health. 

Let’s walk through these steps together, ensuring you can continue your TRT safely and effectively.

Stay Hydrated

Drinking plenty of water is one of the simplest yet most effective ways to thin your blood. Proper hydration can reduce blood viscosity, making it easier for your blood to circulate. Aim for at least 8-10 glasses of water daily, or more, based on your activity level and environment.

Monitor Your Diet

Certain foods are known to naturally thin the blood. These include fatty fish rich in omega-3 fatty acids, garlic, ginger, and foods high in vitamin E, like nuts and seeds. Incorporating these into your diet can help manage blood thickness.

Regular Exercise

Engaging in regular physical activity can improve your circulation and blood flow. Aim for a mix of cardiovascular exercises like walking, swimming, or cycling and strength training to maintain overall health and well-being.

Avoid Smoking and Alcohol

Smoking and excessive alcohol consumption can adversely affect blood thickness. If you smoke, seek help to quit and limit alcohol intake to moderate levels.

Medication Adjustment

If your blood remains thick despite these measures, consult your healthcare provider about adjusting your TRT dosage. Modifying the treatment can help manage hematocrit levels.

Therapeutic Phlebotomy

In cases where hematocrit levels remain high, therapeutic phlebotomy, a procedure to remove blood from your body, may be recommended. This is often an effective way to lower hematocrit levels quickly.

Regular Blood Testing

Regular blood testing is crucial to monitor your hematocrit levels. These tests will guide you and your healthcare provider in making informed decisions about managing your TRT and overall health.

Consultation with a Hematologist

If managing high hematocrit becomes challenging, consulting a hematologist, a doctor specializing in blood disorders, can provide additional insights and treatment options.


What are the Risks of High Hematocrit?

High hematocrit levels can increase the risk of blood clots, which could lead to complications like stroke or heart attack. It can also make your heart work harder, potentially leading to cardiovascular issues.

What are the Normal Ranges for Hematocrit?

Normal hematocrit ranges typically are about 38.3% to 48.6% for adult males and 35.5% to 44.9% for adult females. These values can vary slightly depending on the laboratory and individual factors.

Does testosterone therapy cause blood to thicken?

Yes, testosterone therapy can lead to an increase in red blood cell production, which can cause blood to thicken, a condition known as polycythemia.

How long does it take for testosterone to cause blood clots?

The time frame for testosterone-induced blood clots can vary. Some individuals may experience changes in blood viscosity within months, while others may not have any issues for years. Regular monitoring is crucial to manage this risk.

Ready to Explore Your TRT Options? Schedule Your Free TRT Consultation Here!

Navigating the world of TRT can be challenging, but you don’t have to do it alone. At Best TRT, we’re committed to providing you with the information, support, and care you need to make informed decisions about your health. 

Schedule your free TRT consultation here to take the first step towards understanding and optimizing your testosterone levels. Our friendly experts are here to answer all your questions and guide you through the process. We’re here to support you every step of the way.

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James Harrington

James Harrington stands as a leading authority in testosterone replacement therapy (TRT). With rigorous academic training and deep-rooted experience in health and wellness, he offers unparalleled expertise to Best TRT. His blend of scholarly knowledge and real-world experience makes him an indispensable guide for anyone delving into the intricacies of TRT.

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