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admin | Office Exercises | 19.03.2014
A research letter recently published in the journal AIDS by Vorkas et al determined that testosterone use was associated with polycythemia, and intramuscular administration demonstrated a stronger association than topical (testosterone patch) use. The association between testosterone replacement therapy and polycythemia has been reported for the past few years as this therapy has become more mainstream.
Although all testosterone replacement products can increase the amount of red blood cells, the study showed a higher incidence of polycythemia in those using intramuscular testosterone than topical administration (testosterone patch was the main option used -- no gels). Five of the 21 cases (24%) did not use testosterone, but had other explanations for their polycythemia: pulmonary hypertension, COPD and plasma volume contraction. The letter recommends that all HIV-infected patients taking testosterone should undergo routine hematologic monitoring and adjustment of testosterone dose or cessation of testosterone therapy as appropriate based on hemoglobin values. Below is an excerpt from my book, Testosterone: A Man's Guide, further detailing the prevention and management of polycythemia. It's important to check patients' hemoglobin and hematocrit blood levels while on testosterone replacement therapy.
The following table shows the different guideline groups that recommend monitoring for testosterone replacement therapy.
Many patients on testosterone replacement who experience polycythemia do not want to stop the therapy due to fears of re-experiencing the depression, fatigue and low sex-drive they had before starting treatment. Unless a local blood bank is willing to help, some physicians may need to write a letter of medical necessity for phlebotomy if requested by insurance companies.


The approximate amount of blood volume that needs to be withdrawn to restore normal values can be calculated by the following formula, courtesy of Dr. The frequency of the phlebotomy depends on individual factors, but most men can do one every two to three months to manage their hemoglobin this way. Some doctors recommend the use of a baby aspirin (81 mg) a day and 2,000 to 4,000 mg a day of omega-3 fatty acids (fish oil capsules) to help lower blood viscosity and prevent heart attacks. Although some people may have more headaches induced by high blood pressure or get extremely red when they exercise, most do not feel any different when they have polycythemia. With polycythemia the blood becomes very viscous or "sticky," making it harder for the heart to pump. Smoking has also been associated with polycythemia and may contribute to the effects of other risk factors.
I have seen phlebotomy given weekly for several weeks bring hematocrit from 56 percent to a healthy 46 percent.
These can be an important part of most people's health regimen but they are not alternatives for therapeutic phlebotomy if the patient has polycythemia and does not want to stop testosterone therapy.
HIV-infected patients taking testosterone should undergo routine hematologic monitoring with adjustment of therapy when appropriate.
No cases met the criteria for polycythemia vera, and no adverse cardiovascular or thrombotic events were noted among the cases or controls.


Therapeutic phlebotomy is very similar to what happens when donating blood, but this procedure is prescribed by physicians as a way to bring down blood hematocrit and viscosity. I know physicians who prescribe phlebotomy once every 8-12 weeks because of an unusual response to testosterone replacement therapy.
It is impossible to predict exactly who is more prone to developing polycythemia, but men who use higher doses, men with higher fat percentage, and older men may have a higher incidence. Among the four female cases, one was diagnosed with chronic obstructive pulmonary disease (COPD) and severe pulmonary hypertension, while the other three did not have a documented explanation for elevated hemoglobin. This simple procedure is done in a hospital blood draw or a blood bank facility and can reduce hematocrit, hemoglobin, and blood iron easily and in less than one hour.
The duration over which the blood volume is withdrawn is affected by whether concurrent fluid replacement occurs.
Because of the relatively small number of female cases and the fact that the primary hypothesis is related to testosterone use, this case-control study focused on the 21 male patients.
Unfortunately, therapeutic phlebotomy can be a difficult option to get reimbursed or covered by insurance companies.



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