I am a MD of many decades duration. My focus is on prostate cancer and I was one of the 1st docs in the USA to use androgen deprivation therapy and soon after wrote about Androgen Deprivation Syndrome (ADS) and published in 1997 a paper on AAD (anemia of androgen deprivation). So, yes, testosterone deficiency leads to anemia and the use of testosterone can ↑ the red blood cell mass in the form of elevation of hematocrit (HCT). And most of the comments on this thread are quite accurate for lay persons so I congratulate all. Hemoglobin x 3 is ≈ HCT. I find the HCT more reliable then testing for Hgb (hemoglobin) but both are always included on the CBC (complete blood count) report as well as what are called red blood cell (RBC) indices (measurements of size of the red blood cell (mean cell volume or MCV) and mean cell hemoglobin concentration or MCHC. When the MCV starts to fall that is an indicator that you may be becoming iron deficient from the blood donations (depending on your diet and how much iron is in it). Some fine points for anyone:
1. The working testosterone is the free testosterone and sometimes the total testosterone is misleading. So if you have to order one versus the other, the free is more biological valuable.
2. Hematocrit levels above 50% start to worry me about a risk for a stroke or CVA or thrombosis anywhere. If your normal baseline HCT is 42 then I would titrate my use of testosterone treatment with the HCT and the free testosterone.
3. Patients with a disease called polycythemia rubra vera (called a myeloproliferative disease) often make too many RBCs and have a risk of thrombosis and sometimes bleeding. Those patients often donate blood to reduce their red blood cell mass + avoid iron in order to make themselves iron deficient so that they can't keep producing RBCs. I mention the info in the above lines since using aspirin (ASA) or anything that make ↓ platelet stickiness/aggregation might bite you in the butt if you have a tendency to bleed rather than thrombus. Often it is an issue of what you are taking re meds and supplements + any underlying disease that makes you prone to clot or to bleed.
4. Those on testosterone supplementation should be mindful of aromatization to estradiol and the need for an aromatase inhibitor to prevent gynecomastia. I have found that anastrozole (Arimidex) at 0.5 mg twice a week is usually fine to block aromatase. But measure E2 (estradiol) in your labs.
5. Beware that T → dihydrotestosterone (DHT) via 5-alpha reductase. You may wish to consider the use of a 5-alpha reductase inhibitor (5-ARI) like dutasteride (Avodart) or finasteride (Proscar). Again, measure the Biological End Point (BEP) of DHT.
6. Lastly, be aware that high normal or elevated E2 will stimulate prolactin production which will suppress dopamine. You want dopamine. Why →
Dopamine actions:
1) Decrease sensitivity of AR (androgen receptor) via prolactin decrease
2) Improve mental clarity as a result of dopamine increase
3) Enhance anti-angiogenesis via dopamine increase
4) Increase libido via dopamine increase
Stephen B. Strum, MD, FACP
