Too many red blood cells are a side effect of Testosterone Therapy

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Why should every man who takes testosterone have a CBC (Complete Blood Count) blood test every year?

Every man who takes testosterone should be aware that one of the lab tests they should get yearly, or more often, is a CBC or a complete blood count.  This test can save you from one of the most worrisome side effects of testosterone therapy! That is Erythrocytosis.  The definition of this condition is an increase of red blood cells which is inherited and complicated by smoking (yes even cigars), vitamin C ingestion, testosterone replacement, foods, medications, altitude, iron containing vitamins and hypoxia from other diseases like COPD.

When men come in to get testosterone therapy and already have a high RBC (red blood count) I generally check to see if they are on any medications or vitamins with vitamin C and iron that worsen this issue.  I also direct them to avoid pate, liver, and liver containing preparations like braunsweiger.  All of these common foods and vitamins can raise the blood count without the help of testosterone.

“What is the problem?” you ask.  When people make too many red blood cells they make the blood thicker.  Blood is composed of cells and liquid called plasma.  The cells are considered a “solid” part of the blood and make it thicker. Thick blood is harder to “push” through each heart contraction, and at first raises blood pressure.  As it worsens to a HCT (hematocrit) over 55% RBCs, then hematologists suggest that blood must be removed to avoid stroke, heart attack and stress on the heart.

When the hematocrit is 47-50% we suggest that our patients donate blood if possible (if they are not on other medications or have not had hepatitis, or AIDS, HIV, in the past). When your HCT is 50% or higher, blood donation centers will not accept it, so a patient will need a prescription for a therapeutic phlebotomy, and they can schedule this at the Red Cross every 3-6 months.

With a HCT between 50-55 % we will schedule several therapeutic donations in a short period of time to bring the level down to a baseline that is acceptable and then these patients maintain maintenance levels at 55% or lower.

Testosterone is the next issue that can be adjusted to assist in lowering the HCT.

  • Lower Testosterone dose and extend time between shots.
  • For T pellets-lower dose and use only 100 mg pellets and insert them every 4 months, watching for slow increases in baseline of both Free T levels and HCT.
  • D/C all supplements with Vitamin C and Fe, and all foods with both

Issues that can skew the HCT results include:

  1. Blood draws after 12 hours of no food OR WATER. If you have to be fasting for a blood draw, then please drink only water during the time you should be fasting.  Exceptions are before surgery.
  2. Recent travel to high altitudes.
  3. Diet high in iron, red meat, and liver.
  4. High doses of Vitamin C supplementation—those with Erythrocytosis should avoid Vitamin C and Iron supplements.
  5. Dehydration from exercise or hot weather.

In these cases, we will repeat the CBC under ideal conditions before we begin phlebotomies. Other blood tests that are often ordered to rule out other issues include:

Ferritin Level, TIBC (Total iron binding capacity), and the genetic test for Hemochromatosis.   These are important when prescribing phlebotomies because iron can get low even though the HCT is high. In these cases iron-containing foods should be increased before phlebotomies only until a normal HCT baseline is achieved.

If the attempts to decrease the HCT is unsuccessful or indicates other hematologic diseases then the help of a Hematologist will be obtained and Testosterone supplementation will be held until HCT is safe.

This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author, with Brett Newcomb, MA., LPC., Family Counselor, Presenter and Author. www.BioBalanceHealth.com

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