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    Testosterone Replacement Therapy May Help Unexplained Anemia

    Posted: March 9, 2021

    Did you know testosterone levels may be linked to anemia? Testosterone plays a role in red blood cell production, so low T may increase your risk for anemia. However, researchers have found that testosterone replacement therapy may help improve anemia for those with low T. 

    Testosterone Replacement Therapy May Help with Red Blood Cell Production

    Two men playing soccer after getting energy levels back from testosterone replacement therapy

    Testosterone replacement therapy may help increase hemoglobin, which has been tied to things like muscle strength and physical performance.

    Testosterone may play a role in red blood cell production. Men tend to have higher red blood cell counts than women. Additionally, those levels tend to increase significantly around the time of puberty, when the body produces a lot of testosterone. 

    Researchers are still studying the possible ways testosterone affects red blood cell production. Some studies have concluded that testosterone does many different things to help with the hematologic (blood) system. For example, it may influence how much erythropoietin (EPO) you produce. EPO is a hormone your kidney produces that tells your bone marrow to make more red blood cells. Testosterone may also help with iron metabolism to help you form the iron rich proteins that carry oxygen in your red blood cells, called hemoglobin. 

    Because of this, many have studied the effects of testosterone replacement therapy on red blood cell levels. TRT may help increase hemoglobin (those proteins that carry the oxygen through your blood) and hematocrit (the ratio of red blood cells to your total volume of blood). Some studies have even linked higher hemoglobin levels to things like muscle strength, bone density, cognition, and physical performance. If you noticed, these are also some of the benefits of testosterone replacement therapy. So, red blood cells and testosterone may be linked in several ways.

    Since testosterone may influence red blood cell production, it may also play a role in anemia. 

    What is Anemia?

    Now, you’ve probably heard of anemia before, but you might not know exactly what it is. Anemia is one of the most common blood disorders. Essentially, it’s when you don’t have enough red blood cells to carry oxygen from your lungs to your organs and tissues, or your red blood cells can’t carry oxygen for some reason.

    Red blood cells are shaped in a special way to be able to carry oxygen molecules through your blood. They also contain the hemoglobin, that iron-rich protein that oxygen attaches to. They take the oxygen from your lungs and supply it to the rest of your body. Then, they also take carbon dioxide back to your lungs for your body to get rid of when you breathe out. 

    We’ve mentioned that men tend to have more red blood cells than women. However, older men are more likely to suffer from anemia than older women. Older men also tend to have lower testosterone levels.

    There are many different potential causes for anemia, from genetic disorders to vitamin deficiencies. However, an estimated ⅓ cases of anemia aren’t easily explained by one of these causes. This is especially true in older adults. 


    The symptoms of anemia can come on slowly and be quite subtle. Many also mistake the signs for other conditions. So, it’s important to talk to one of our providers if you notice any changes in your health or energy levels. 

    Some of the symptoms of anemia include:

    • Fatigue
    • Weakness
    • Pale or yellow skin
    • Irregular heart beats
    • Shortness of breath
    • Dizziness
    • Lightheadedness
    • Headaches
    • Chest pain
    • Cold hands and feet

    Health Risks

    If you have anemia, it’s important to work with a healthcare provider. Anemia can have major impacts on your health. First, it can interfere with your day-to-day life, making it difficult to take part in your normal lifestyle. However, it can also increase the risk for health issues. With untreated anemia, your organs and tissues can start to starve for oxygen. This is associated with higher risks for heart problems, disability, and faster physical decline. 

    Low Testosterone May Increase Your Risk for Anemia

    Low testosterone can cause a lot of unwanted, life-altering symptoms. For example, low energy, low libido, mood changes, weight gain, and difficulty concentrating. Some researchers believe low testosterone may also be a risk factor for anemia, since testosterone helps with red blood cell production. 

    Studies have found that adults with low T levels also had lower hemoglobin levels and at an increased risk for having or developing anemia. Researchers have suggested that low testosterone may make you more susceptible to anemia.

    Therefore, if you have low testosterone, be on the lookout for symptoms of anemia and talk to our provider if you notice any strange symptoms, like fatigue or cold hands and feet. 

    Testosterone Replacement Therapy May Help with Anemia

    Fortunately, research suggests that testosterone replacement therapy may help those with anemia and low testosterone levels. One study from South Korea looked at 58 men with low testosterone levels and symptoms of low T. In the group, about 29% of the men had anemia. However, after 54 weeks of testosterone replacement therapy, those rates fell to about 10%.

    In addition to helping with anemia rates among the men with low T, many also experienced a decrease in risk factors for metabolic syndrome. The researchers in the study concluded that the results may indicate that low testosterone levels may contribute to the risk for anemia and testosterone treatment may help increase red blood cells for those with anemia. 

    Another study, published in the JAMA Internal Medicine journal, also looked at the effects of TRT for those with anemia. They looked at a larger group of older men with low testosterone and anemia. Some of the men had anemia with explained causes and some had unexplained anemia. Some received testosterone replacement therapy for 12 months while others received a placebo. 

    The testosterone replacement therapy group noticed more significant improvements in hemoglobin levels compared to the placebo group. In fact, after 12 months, 58.3% of the men with unexplained anemia in the testosterone replacement therapy did not have anemia at the end of the study, compared to 22.2% of the men in the placebo group. For those with explained anemia, about 60% of the men in the TRT group did not have anemia after the study period, while only 14.8% of the placebo group had resolved anemia. The participants also reported feeling improvements in overall health and energy. 

    Men on Testosterone Replacement Therapy Need Quality Treatment Monitoring

    However, treatment monitoring during your testosterone replacement therapy regimen is still important. Our providers offer ongoing monitoring to help you optimize results. 

    Testosterone may help your body increase red blood cell levels. Because of this, it’s also important to get regular complete blood count labs. This is not only to help you reach a healthy level of testosterone, but also to monitor how many red blood cells you have. 

    High red blood cell count is a rare but serious potential side effect of TRT. This can make your blood thicker than normal, which can lead to other health complications. Therefore, our providers provide ongoing treatment monitoring to help you stay healthy. 

    Many of the signs of too many red blood cells in your body are similar to anemia. They include dizziness, weakness, fatigue, headaches, easy bruising, joint pain, and whooshing or pounding noises in your ears. If you notice these, you may need different treatment options.

    Convenient, Customized, Affordable Healthcare at Low T Center

    We believe taking care of your health should be convenient, affordable, and customized to your lifestyle. Our team at Low T Center are here to provide you with the healthcare you need to help you feel your best. We offer high quality, personalized care. Make an appointment today to take the first step toward better health.

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    Disclaimer: This article is made available for general, entertainment and educational purposes only. The opinions expressed herein do not necessarily reflect those of Low T Center. You should always seek the advice of a licensed healthcare professional.