How to Lower Hematocrit While on TRT

Lowering Hematocrit Levels While on TRT

Testosterone replacement therapy patients may experience elevated hematocrit levels. Learn how to lower hematocrit while on TRT here.

Table of Contents

Overview of Testosterone Replacement Therapy

How to Lower Hematocrit While on TRT

Are you wondering how to lower hematocrit while on TRT? Testosterone replacement therapy (TRT) offers a wide range of potential benefits, including an improvement in bone density, mood, libido and sexual function, body composition, cognition, and overall quality of life.1

One significant advantage of TRT is the treatment’s cardiovascular benefits. The most extensive study investigating the connection between TRT and cardiovascular health found that in the correct dosage, men on TRT whose testosterone levels returned to normal levels were 36% less likely to have a stroke and 24% less likely to experience a heart attack.2

While TRT can lead to cardiovascular benefits, it can also increase hematocrit levels too much, leading to potential other health concerns. Read on to learn more about how to lower hematocrit while on TRT.

What Is Hematocrit?

Hematocrit is the percentage of red blood cells in your blood by volume. Age, race, and sex all factor into determining a normal range for hematocrit. A normal range for hematocrit in adult men is 41%–50%. In adult women, the range is lower: 36%–44%.3

When your hematocrit levels are too low, you have too few red blood cells, indicating you might have anemia. Conversely, high hematocrit levels mean you have too many red blood cells and may indicate conditions such as polycythemia or erythrocytosis. Symptoms for both anemia and polycythemia or erythrocytosis include fatigue, headaches, and shortness of breath.3 Read on to learn more about how to lower hematocrit while on TRT.

Understanding Hematocrit

What Does High Hematocrit Mean for Men on TRT?

For men whose low testosterone levels led to anemia, TRT also serves as a low hematocrit treatment and is one of the better supplements to increase hematocrit levels and reduce anemia symptoms.4

However, increased red blood cells from TRT may also lead to polycythemia in patients with normal hemoglobin and hematocrit levels.

Polycythemia is a condition in which the body produces too many red blood cells, and it also results in the blood becoming thicker.5When blood is too thick, as it is in patients with polycythemia, you are more likely to experience a stroke, heart attack, or pulmonary embolism. Therefore, physicians should closely monitor hematocrit in TRT patients, and it is important to learn how to lower hematocrit while on TRT.

Why Are Hematocrit Levels Important?

Hematocrit and hemoglobin levels are important indicators of your overall health. When levels are too low, it’s a sign of anemia, which can cause weakness, fatigue, shortness of breath, and other symptoms.

High hematocrit levels can also signal medical conditions like dehydration, carbon monoxide poisoning, or bone marrow disease. It can additionally lead to life-threatening blood clots, such as a pulmonary embolism. When hematocrit levels rise, blood becomes thicker, and patients experience increased platelet activation and shortened bleeding time.6

These concerns increase the risk of major bleeding complications like increased venous return. In this case, the blood struggles to return to the heart, and the brain receives less blood.7Since blood provides the brain with oxygen and glucose necessary to function properly, lack of blood flow can cause cognitive difficulties. In the long term, it can result in brain damage.8Monitoring hematocrit levels, especially for patients on TRT, is essential to preventing hematocrit levels from reaching dangerously high points. These situations are were you or a loved one should educate yourselves on how to lower hematocrit while on TRT.

How Does Testosterone Affect Hemoglobin and Hematocrit Levels?

Wondering how to lower hematocrit while on TRT? Comparing hematocrit and hemoglobin can be confusing, as both levels are used to diagnose anemia. The difference between hemoglobin and hematocrit is that hematocrit is the measure of the volume of red blood cells in the blood. In contrast, hemoglobin is a protein in those red blood cells that transports oxygen from the lungs to other tissues.

Testosterone levels are closely tied to red blood cell production.9 However, researchers are still investigating how testosterone and TRT help raise hematocrit levels.

One factor they’ve discovered is that testosterone influences the production of erythropoietin (EPO), a hormone produced by the kidneys that tells bone marrow when it needs to produce more red blood cells. In addition, testosterone helps regulate iron levels, which is helpful for anemic patients.9

What Are the Symptoms of High Hematocrit?

High hematocrit levels can lead to a wide range of symptoms. Some of the most common high hematocrit symptoms include:3 

  • Weakness
  • Fatigue
  • Bruising easily
  • Headache
  • Dizziness
  • Shortness of breath or breathing difficulty when lying down
  • Redness of the skin
  • Itching
  • Flushing after a workout
  • Numbness, burning, or tingling in the hands and feet or arms and legs
  • Joint pain
  • Abdominal pain

Symptoms of High Hemoglobin

Symptoms of high hemoglobin levels are similar to those of high hematocrit levels but can also include:

  • Excessive sweating (hyperhidrosis)
  • Unexplained weight loss
  • Yellowing of the eyes and skin (jaundice)
If you or someone you know are suffering from these symptoms while on testosterone replacement therapy, you can read on to learn how to lower hematocrit while on TRT.

Addressing Elevated Hemoglobin and Hematocrit

Symptoms of elevated hemoglobin and hematocrit should not be ignored, as they may serve as a sign of an underlying condition. Your physician should identify and address irregularly high hematocrit levels if you’re currently on TRT, so it may be time to look into how to lower hematocrit while on TRT.

Typically, baseline hemoglobin and hematocrit tests establish your levels before beginning TRT. Then, your levels are checked three months after starting your TRT treatment to monitor for elevated hematocrit and hemoglobin. If the three-month blood work test proves normal, you may be eligible to space out lab work every six months. If the levels are still too high, your doctor may have to adjust your dosage or figure out another option on how to lower hematocrit while on TRT.

Hematocrit Level in Adults Stats

Tips on How to Lower Hematocrit while on TRT

Patients who experience high hematocrit on TRT will need to take action to restore their blood to the normal range for hematocrit. While not all patients will experience high hematocrit symptoms, TRT can elevate levels to the point where some patients develop polycythemia.

The increase in red blood cells also causes high hemoglobin. Instead of allowing the blood to carry more oxygen, the blood thickens, slowing circulation and taking less oxygen to the tissues than they need to function correctly.

However, there are many options offering excellent treatment for high hematocrit. Even for patients who want to stay on TRT, hematocrit can be controlled. If you’re wondering how to lower hematocrit while on TRT, follow these steps:

Give Blood

Giving blood is one of the most widely recommended treatments to lower high hematocrit levels on TRT. Removing one unit of blood can reduce hematocrit levels by up to 3%.10

If you’re experiencing persistent high hematocrit levels, your physician may prescribe therapeutic phlebotomy or, if you qualify, guide you to donate your blood regularly. If you do not utilize any other treatments to lower your hematocrit levels, you may need to continue periodic donations until your hematocrit levels lower or stabilize.

Lower Your TRT Dose

Lowering the dose of testosterone is sometimes a good choice for patients who show an association between therapeutic testosterone and high hemoglobin or hematocrit levels. However, men often enjoy so many benefits from testosterone therapy that they don’t want to return to the way they felt before TRT.

The standard TRT dosage is around 200 milligrams weekly, which is high enough to allow patients to lower their dose and reduce symptoms of high hemoglobin levels while still feeling the benefits of TRT.11

Drink Water

Hydrating is a standard treatment option for those experiencing high levels of hematocrit. Dehydration can cause hematocrit levels to rise even more, as the lack of fluids can make the red blood cell concentration increase.

Hematocrit and hemoglobin are measured in the context of whole blood, so plasma volume plays a key role in high hematocrit and hemoglobin levels. Dehydrated patients will have higher hematocrit and hemoglobin levels as their plasma is lowered, while patients overloaded with fluids will have lower levels.12

Treat Thyroid Issues

The thyroid hormones play a critical role in the proliferation of blood cells. Thyroid dysfunction can lead to anemia and polycythemia.13 Therefore, before you conclude your high hematocrit levels are from TRT, you should first undergo a full blood panel to determine whether you have hypo- or hyperthyroidism.

Consider Transdermal (Topical) Testosterone or Lower Dose Subcutaneous Testosterone Injections

Testosterone therapy comes in various formulations, including short-acting intramuscular injections, extended-release intramuscular injections, transdermal gels and creams, oral pills, and subcutaneous pellets.

The formulation of testosterone and high hemoglobin levels are closely connected, with transdermal testosterone significantly less likely to elevate hematocrit levels than short-acting intramuscular injections.

Also, patients who expect to be on long-term TRT could also consider switching to lower-dose subcutaneous testosterone injections to manage their hematocrit and hemoglobin levels.5

Avoid or Reduce Consumption of Red Meats

Looking for another tip on how to lower hematocrit while on TRT? Just as increasing the consumption of red meat can help raise hemoglobin and hematocrit levels in anemic patients, reducing or eliminating the consumption of red meat can help lower elevated hematocrit levels in patients.14

Fix Sleep Apnea

Untreated sleep apnea, high hematocrit, and high hemoglobin are interconnected, so sleep apnea needs to be controlled entirely before undergoing TRT. Sleep apnea is a severe sleep disorder in which breathing stops and starts. When oxygen saturation drops as breathing stops, hematocrit increases.15

Since sleep apnea creates a low-oxygen environment, the body attempts to compensate for the lack of oxygen by producing more red blood cells to carry oxygen or concentrating the red blood cells by decreasing the other components of the blood. Over time, the body acclimates to low oxygen levels, and hemoglobin and hematocrit remain elevated.

Reduce Inflammation

Numerous studies analyzing the effects of inflammation on hematocrit levels find significant correlations. As hematocrit levels are considered to be a marker for cardiovascular morbidity and mortality, scientists have studied the association between cardiovascular inflammation and hematocrit levels..16

Some studies found that high hematocrit levels may signify an elevated inflammatory response.17 You can reduce inflammation through exercise, avoiding inflammatory foods, managing stress levels, and maintaining a healthy weight.

Consider Curcumin (Turmeric)

Curcumin, a compound found in turmeric, is believed to be a natural anti-inflammatory. Studies looking at the supplement as a high hemoglobin symptoms treatment found it can produce a dose-dependent decline in hemoglobin and hematocrit levels.18

Curcumin or turmeric can be so effective as an anti-inflammatory treatment and in reducing elevated red blood cells that high doses may cause iron-deficiency anemia. 

Read on to see several more tips on how to lower hematocrit while on TRT.

Stop Smoking

The severe and extensive effects of smoking on your lungs are widely known. However, recent studies also connect smoking to blood component concerns, including elevated hematocrit and hemoglobin.

Although smoking has a long-term association with elevated white blood cell levels, red blood cell elevation was short-term, indicating that quitting smoking can quickly restore elevated hematocrit levels to a normal range.19

The Impact of Smoking on Hematologic Parameters

Treat High Blood Pressure with Losartan

Losartan, a blood pressure medication and type 1 receptor antagonist, can significantly lower hematocrit levels. Studies show that patients can reduce elevated hematocrit levels by 4% at the correct dosage. In addition, the treatment is considered to be both safe and effective.20

Consider Eating More Grapefruit

Eating more grapefruit may seem like an odd recommendation for those looking into how to lower hematocrit while on TRT. However, grapefruit contains a flavonoid called naringin. When researchers isolated naringin from grapefruit, they found that the compound helped eliminate old red blood cells and balance hematocrit levels.

In one study, 36 patients added grapefruit to their daily diet over 42 days. At the start of the study, participants’ hematocrit levels ranged from 36.5% to 55.8%. By the end, they ran from 38.8% to 49.2%.21

Interestingly, grapefruit had a differential effect on hematocrit levels; that is, the fruit lowered hematocrit levels in patients with the highest levels. It also served as a low hematocrit treatment, raising the levels of patients with the lowest percentages. The grapefruit did not seem to affect normal hematocrit levels.22

These methods and more are all beneficial if you are looking into how to lower hematocrit while on TRT.

Impact of Grapefruit Hematocrit Level in Adults Stats

Can Hematocrit Stabilize in Men on TRT?

Hematocrit levels can stabilize independently as the body acclimates to TRT, especially if one uses some of the methods of how to lower hematocrit while on TRT.

A study tracking hematocrit levels on both short- and long-term TRT patients found that initial spikes in hematocrit levels during early treatment diminished over time, with the body adapting to the increased testosterone and no longer experiencing high hematocrit symptoms. Therefore, TRT treatments should be able to continue as the body adjusts.22

Patients who implement treatments to reduce their high hematocrit levels can often lower their hematocrit while on TRT and keep it low through lifestyle changes, such as drinking more water, quitting smoking, and treating sleep apnea. However, your hematocrit levels can remain high even with other lifestyle changes if you don’t work to improve these levels.

For TRT patients whose high hematocrit persists despite lifestyle changes, hematocrit may be managed and stabilized with therapeutic phlebotomy or regularly scheduled blood donations if the patient cannot change their dosage of TRT.23 

How Long Does It Take for Hematocrit to Decrease While on TRT?

When on TRT, hematocrit and hemoglobin levels typically increase for the first three to six months, then stabilize and remain within the normal range for the duration of the treatment.24

When it comes to how to lower hematocrit while on TRT, patients using lifestyle changes or therapies as treatment for high hematocrit will see their levels lower at varying rates, depending on the treatment.

Patients who choose blood donation or therapeutic phlebotomy to keep hematocrit levels lower may immediately see a decrease in hemoglobin, blood iron, and hematocrit on TRT.

What Is a Hematocrit Test?

What is a hematocrit test, or HCT? Medical terms like these describe the standard blood test used to measure the blood’s proportion of red blood cells. The HCT is included in routine lab testing or a complete blood count (CBC).

Patients with a high HCT may be dehydrated, have polycythemia, or suffer from heart or lung disease. Conversely, patients with a low HCT may have anemia or vitamin or mineral deficiencies.

What to Expect During a Hematocrit Test

Since the HCT is a simple blood test, there’s no need to fast beforehand or undergo special preparations. A blood sample is typically drawn by injecting a needle into a vein in your arm. Then, you can resume normal activities immediately after your test. It typically takes anywhere from a few days to a few weeks to receive the results of your HCT test. Your doctor will be able to determine if your levels are high or low.

Hematocrit Test

Does Donating Plasma Lower Hematocrit?

Plasma is the fluid that makes your blood liquid. Your blood is composed of plasma, white blood cells, red blood cells, and platelets. Since your hematocrit level is the percentage of red blood cells suspended in your plasma, reducing the plasma increases the percentage of red blood cells and causes high hemoglobin and hematocrit.

However, donating whole blood is an effective high-hematocrit treatment.

How Often Should You Donate Blood on TRT?

The standard time frame between blood donations is once every eight weeks. However, patients using blood donation to manage hematocrit on TRT may obtain a doctor’s prescription that allows them to donate twice as often.

Patients experiencing elevated hematocrit or symptoms of high hemoglobin levels should discuss their blood donation schedule with their physician to ensure they don’t lower their iron and ferritin levels.

Can High Hematocrit Cause High Blood Pressure?

You may experience systemic hypertension or high blood pressure when your body has elevated hematocrit levels. With higher hematocrit levels, blood can become thicker and denser, slowing its path through the body and leading to higher blood pressure.
How to Lower Hematocrit While on TRT

Start Reaping the Rewards of TRT Now with Help from Immortal Male

If you or a loved one are looking to learn more about how to lower hematocrit while on TRT or how you can get started on TRT treatment, reach out to our team at Immortal Male.

When you choose Immortal Male’s comprehensive testosterone replacement therapy, you will receive support from the Immortal Male team every step of the way. Every aspect of your health and well-being can benefit from your treatment and the care you receive from our highly qualified team of medical professionals.

The first step to restoring your health with Immortal Male is ordering your At-Home Hormone Test Kit. Once completed, you will receive a detailed diagnosis and customized treatment plan that considers your complete hormone panel and lifestyle. From here, we’ll be able to discuss where to go next and how testosterone replacement therapy can help you achieve the various outcomes and overall wellness you’ve been pursuing.

Contact Immortal Male and Begin Testosterone Replacement Therapy

Contact Immortal Male today if you’re thinking about starting TRT or if you have further questions on how to lower hematocrit while on TRT. We will be able to help guide you during your journey and provide you with the support you need.

Journal of Clinical Endocrinology and Metabolism

Stephanie T. Page, John K. Amory, F. DuBois Bowman, Bradley D. Anawalt, Alvin M. Matsumoto, William J. Bremner, J. Lisa Tenover, Exogenous Testosterone (T) Alone or with Finasteride Increases Physical Performance, Grip Strength, and Lean Body Mass in Older Men with Low Serum T, The Journal of Clinical Endocrinology & Metabolism, Volume 90, Issue 3, 1 March 2005, Pages 1502–1510,