Does Stress Cause High Hemoglobin And Hematocrit On TRT?
Timeline
Timestamp
Topic
00:00
A 62-year-old man who has used TRT for 30 years asks whether stress or morning dehydration could explain a hemoglobin of 18.8 and hematocrit of 56.4%.
01:22
Dr. O’Connor identifies the elevated red blood cell measurements as androgen-induced erythrocytosis and begins explaining why men on testosterone require individualized evaluation rather than relying on one cutoff number.
03:03
The potential consequences of excessively concentrated blood are reviewed, including hypercoagulability, deep venous thrombosis, pulmonary embolism, stroke, and the importance of considering a man’s overall clotting risk.
07:42
Dr. O’Connor directly explains that stress does not cause the elevated hemoglobin and hematocrit and emphasizes evaluating CBC results together with iron studies and ferritin.
08:46
Androgen-induced erythrocytosis is explained as a dose-dependent response to testosterone and other anabolic steroids, with injectable testosterone producing particularly strong increases in red blood cell production.
12:38
Dr. O’Connor reviews additional contributors including genetics, hereditary blood disorders, sleep apnea, obesity, smoking, altitude, and testosterone dose before discussing ways to reduce the red blood cell response.
Video Summary
A 62-year-old man on long-term TRT asks whether stress or dehydration can raise hemoglobin and hematocrit. Dr. O’Connor reviews his hemoglobin of 18.8 g/dL and hematocrit of 56.4% and explains that stress itself is not the likely cause, although dehydration can concentrate the blood and influence laboratory measurements.
The discussion focuses on androgen-induced erythrocytosis, the increase in red blood cell production that can occur with testosterone and other androgens. Dr. O’Connor explains that the response is often dose-dependent and can also be influenced by genetics, sleep apnea, excess body weight, smoking, high altitude, testosterone delivery method, and underlying hematologic conditions.
Rather than relying on a CBC alone, Dr. O’Connor emphasizes reviewing iron studies, ferritin, symptoms, clotting history, cardiovascular disease, and other individual risk factors. He also discusses reducing testosterone exposure, changing delivery methods in selected men, avoiding repeated phlebotomy that depletes iron, and incorporating cardiovascular and kidney monitoring through the ABCDs™ framework.
Drug Callouts
Drug
Description
Testosterone
The member has used testosterone replacement therapy for approximately 30 years and currently has elevated hemoglobin and hematocrit. Dr. O’Connor explains that testosterone stimulates red blood cell production and that the degree of androgen-induced erythrocytosis can increase as testosterone exposure rises.
Deca Durabolin
Deca Durabolin is discussed as another androgen that can further increase red blood cell production when combined with testosterone. Dr. O’Connor uses it to illustrate how adding anabolic steroids can increase androgen exposure and potentially worsen erythrocytosis in susceptible men.
AndroGel
AndroGel is mentioned while comparing testosterone delivery methods and their effects on red blood cell production. Dr. O’Connor explains that injectable testosterone tends to produce a stronger erythrocytosis response than transdermal testosterone preparations in many men.
Xyosted
Xyosted, a subcutaneous testosterone enanthate formulation, is discussed as an alternative delivery method for selected men who develop excessive increases in hemoglobin and hematocrit with conventional injections. Dr. O’Connor notes that smaller subcutaneous doses may help some men but are not a universal solution.
Condition Callouts
Condition
Description
Androgen-Induced Erythrocytosis
Androgen-induced erythrocytosis is the central condition discussed and refers to increased red blood cell production associated with testosterone and other androgens. Dr. O’Connor emphasizes that men on TRT should have hemoglobin, hematocrit, iron studies, symptoms, and individual clotting risks evaluated together.
Deep Vein Thrombosis
Deep vein thrombosis is discussed as a potential clotting complication when blood becomes excessively concentrated or other hypercoagulable risks are present. For men on testosterone with elevated hematocrit, prior clotting history and additional risk factors can affect how aggressively erythrocytosis should be managed.
Pulmonary Embolism
Dr. O’Connor explains that a deep venous blood clot can travel to the lungs and cause a pulmonary embolism. In men using testosterone or anabolic steroids, markedly elevated red blood cell measurements should therefore be considered within the broader context of thrombotic risk.
Sleep Apnea
Sleep apnea is identified as an important contributor to elevated red blood cell production and may compound androgen-induced erythrocytosis in men on testosterone. Dr. O’Connor stresses that even men who do not believe they have sleep apnea may need to consider hypoxic causes when hematocrit remains high.
Hereditary Hemochromatosis
Hereditary hemochromatosis is discussed as one of the genetic conditions that may affect iron studies and complicate interpretation of elevated blood counts. Dr. O’Connor emphasizes that men on testosterone should not have erythrocytosis evaluated from the CBC alone when inherited iron disorders may also be present.
Thalassemia
Thalassemia is mentioned as another inherited blood disorder that can alter red blood cell measurements and iron-related laboratory findings. In men using testosterone, identifying an underlying hematologic condition is important before assuming that all abnormal CBC results are caused solely by TRT.
Key Takeaways
- Stress itself is not presented as a cause of elevated hemoglobin and hematocrit, although dehydration can temporarily concentrate blood measurements.
- Testosterone and other androgens can cause androgen-induced erythrocytosis, and the increase in red blood cell production is often dose-dependent.
- Injectable testosterone tends to stimulate red blood cell production more strongly than some other testosterone delivery methods in susceptible men.
- Sleep apnea, genetics, obesity, smoking, high altitude, testosterone dose, and underlying blood disorders can all contribute to elevated hemoglobin and hematocrit.
- CBC results should be evaluated together with iron studies, ferritin, symptoms, clotting history, cardiovascular disease, and the individual man’s overall risk profile.
- Repeated phlebotomy without addressing the underlying causes of erythrocytosis can deplete iron and may create additional problems for men on TRT.