Understanding Elevated Red Blood Cells on Testosterone Therapy

Florida Anti-Aging Center – Dr. Adamcik, BHRT Specialist

Testosterone therapy naturally increases red blood cell production. This is a normal and expected response to BHRT.

Why It Happens

Testosterone boosts a natural kidney hormone (EPO) that signals your body to make more red blood cells.

It also helps your body use iron more efficiently.

Mild Increases Can Be Beneficial

Better oxygen delivery

Improved energy, stamina, and exercise performance

When Levels Get Too High

If hematocrit (HCT) becomes too elevated, blood can get thicker.
Possible effects:

Headaches or facial flushing

Higher blood pressure

Rarely, increased risk of clotting

Dr. Adamcik typically becomes more cautious when HCT rises above 52–54%.

Factors That Increase the Risk

Injectable testosterone (especially larger, infrequent doses)

Higher overall dosing

Sleep apnea

Smoking

Dehydration

How We Manage It in Our Practice

Adjusting the dose or spreading injections out

Switching to a smoother delivery method (like topical BHRT)

Improving hydration

Screening and treating sleep apnea

Occasional blood donation or therapeutic phlebotomy, if needed