Testosterone therapy has helped countless men regain their energy, strength, and overall well-being. However, one common concern that arises during treatment is an increase in red blood cell count, often flagged by routine lab work. Many physicians mistakenly associate this with a dangerous blood disorder called Polycythemia Vera (PCV), but in reality, this is a normal and expected side effect of testosterone therapy called erythrocytosis
If you’re on testosterone therapy and your doctor has expressed concern about your red blood cell levels, don’t panic! Let’s break down the difference between erythrocytosis and PCV, and why most men on testosterone don’t need to worry.
What Is Erythrocytosis?
Erythrocytosis is a natural increase in red blood cell production, triggered by higher levels of a kidney hormone called erythropoietin. This happens in response to testosterone therapy, particularly injectable forms, and is the same process that occurs in:
- Athletes who train at high altitudes (to enhance oxygen delivery)
- Cyclists using performance-enhancing drugs like EPO (erythropoietin)
- People with chronic lung conditions (like COPD)
This type of red blood cell increase is not dangerous because it does not involve additional clotting factors or abnormalities in the blood.
Why Erythrocytosis Is Not a Risk
One major misconception is that having a higher red blood cell count automatically means thicker blood and a higher risk of stroke or clotting. This is simply not true in the case of testosterone therapy-induced erythrocytosis.
Unlike PCV, erythrocytosis does not cause excessive platelet production or clotting issues. In fact, studies over the last 40 years have found no link between testosterone-induced erythrocytosis and an increased risk of stroke or heart attack.
If you live at a high altitude, your body naturally produces even higher red blood cell counts than testosterone users, yet there is no medical concern. Many elite athletes actually seek this effect because it improves endurance and oxygen delivery.
What Is Polycythemia Vera (PCV)?
Now, PCV is a serious blood disorder that requires medical attention. Unlike erythrocytosis, PCV causes:
- An increase in red blood cells, white blood cells, and platelets
- Higher risk of clotting, strokes, and heart attacks
- A genetic mutation that affects blood production
If your doctor mistakenly confuses testosterone-induced erythrocytosis with PCV, they may unnecessarily recommend stopping treatment or frequent blood donations.
Do You Need Treatment for Erythrocytosis?
For most men, no treatment is needed. If your doctor is concerned, the simplest solution is to donate blood periodically—but even this is usually unnecessary.
However, if your doctor remains unsure, consulting with a hematologist (blood specialist) can provide clarity. A well-informed physician will recognize the difference between erythrocytosis and PCV and ensure you continue benefiting from your testosterone therapy without unnecessary interventions.
Final Thoughts
If you’re on testosterone therapy and have been told your red blood cell count is too high, it’s important to understand the difference between erythrocytosis (a harmless, natural response) and PCV (a serious blood disorder).
For most men, testosterone therapy-induced erythrocytosis is not dangerous and requires no treatment. If you have concerns, ask your physician for clarification or seek a second opinion from a specialist.
At Peak Health & Aesthetics, we specialize in hormone optimization and ensure that our patients receive accurate, up-to-date medical guidance. If you’re looking to optimize your health and energy levels, schedule a consultation with us today!