Unlike many earlier trials, which included healthy older men, the Testosterone in Older Men with Mobility Limitation trial’s participants had physical dysfunction and high burden of comorbid conditions, such as diabetes, hypertension, obesity, and heart disease. Furthermore, testosterone fails to directly activate EPO transcription in Hep3B cells, an EPO-secreting cell line that is highly sensitive to hypoxic induction (11), thus suggesting that any putative EPO-dependent mechanism for testosterone-induced erythrocytosis may be indirect, of modest magnitude, and/or transient. However, human studies have not provided clear evidence that testosterone stimulates EPO secretion. Some people may feel fine and have no symptoms, while others may start to notice changes. The symptoms of polycythemia may not always be obvious at first. Polycythemia can cause symptoms that affect how a person feels each day, and over time, it may lead to dangerous health complications. Other studies have shown that the risk may be even higher in older men or in those taking high doses. When this happens too much, it leads to a condition called elevated hematocrit. Raising your testosterone levels can sometimes lead to lead to polycythemia. This is called polycythemia, and it’s a risk linked to all testosterone use. While taking testosterone-based HRT, your doctor will monitor your bloodwork for signs of polycythemia. Monitoring is crucial for both men and women on testosterone therapy. Elevated red blood cell counts can thicken blood, potentially causing symptoms like headaches or dizziness. Hematologic changes (sTR/log ferritin) were consistent with the expected increased iron utilization to meet the demands of increased erythropoiesis. The strengths of this study include its prospective, randomized, placebo- controlled trial design, the relatively large patient population, and a sufficient study duration to assess the chronic effects of testosterone on numerous hematologic parameters. Serum ferritin levels decreased in the testosterone group in parallel with hepcidin but remained unchanged in the placebo group (Figure 4C). As blood moves through the body, the red blood cells release the oxygen into tissues like muscles, the heart, and the brain. Without red blood cells, the body’s organs and tissues would not get the oxygen they need to stay alive and work properly. But higher levels can also lead to problems, especially if the blood becomes too thick due to too many red blood cells. One important action of testosterone is its effect on red blood cells. When these symptoms are linked to low blood levels of testosterone, doctors may prescribe testosterone therapy. If you have a high red blood cell count, then you have something called erythrocytosis. Together, you and your healthcare provider will weigh the risks and benefits of TRT to see if it could help. Once you start TRT, you’ll have regular appointments with your healthcare provider and routine blood tests. Your body will take some time to restart production of testosterone naturally. You can stay on testosterone replacement therapy for as long as it’s benefiting your symptoms and not causing health issues. This includes monitoring your testosterone level and getting other blood tests to make sure TRT isn’t harming your health.
