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Increasing testosterone increases hemoglobin and increases red blood cell production in men. And in women, too.

Luigi was 82 years old, but not quite ready to give up his sex life. He son-in-law the doctor gave him the usual prescriptions, starting with that little blue pill, Viagra. Then there was Cialis, which didn't work, either, and then some advice he told him to keep to himself. But Luigi couldn't perform with his girlfriend (Mrs. Luigi had passed away two years earlier) and was looking a little pale, too. It turned out that in addition to whatever was causing ED, Luigi was also anemic.

Then Luigi's son-in-law prescribed testosterone. It solved both problems. Luigi started feeling frisky in the boudoir once again, and his red blood cell production was greatly increased. Increased testosterone, it turns out, can result not just in higher libido but in higher hemoglobin and higher hematocrit (red blood cell production), too.

Testosterone Changes How Red Blood Cells Are Made

In the United States, doctors write prescriptions for nearly $2 billion in testosterone injections every year. There are so many men taking testosterone that stock analysts take revved up hormones into account when making economic predictions [1]. In younger men, excessively high hemoglobin levels and excessive red blood cell production are a well-known complication of testosterone treatment [2].

And increases in both hemoglobin and hematocrit are even more marked when men over 60 take testosterone [3].

Researchers didn't know for many years why testosterone should increase red blood cell production. In younger, healthier men, taking testosterone shots did not lead to greater production of the red blood cell production stimulant hormone erythropoietin, also known as EPO [4]. However, researchers turned out to discover that there was one more variable in the equation. When men get testosterone, and there is something going on in their bodies that increases the need for oxygen, then the cells that make EPO are activated [5]. It's not just the testosterone. It's also getting hot and heavy, or, in the case of older men, maybe having angina or chronic obstructive pulmonary disease or diabetes, or all three and more, that makes the critical difference. In addition to activating oxygen-sensitive EPO-producing cells, testosterone also reduces the production of hepcidin, which keeps the gut from absorbing iron or locks it inside a specialized kind of white blood cell, and also reduces the production of ferritin, which serves as a kind of "jail" for iron in the bloodstream [6].

What Do Men Have to Do to Get Testosterone Shots?

Younger men may "know a guy" who sells them illegal testosterone. This usually doesn't work out well. They may get ripped or pumped up, but they may also develop acne, mood swings, and cancer. Just like older men, younger men really need to get testosterone from their doctor. There's general agreement that testosterone injections are OK even in younger men who have unusually low levels of testosterone in their  lab results [7]. But there's no way to fake the lab results.

Older men have more "reasons" that their doctors should give them testosterone replacement, some of which may surprise you:

  • Chronic use of opioids results in testosterone depletion [8]. "Doctor, I used to be hooked on oxycodone" would actually be a reason at least to run the labs.
  • Obesity lowers testosterone levels. However, instead of testosterone shots, the doctor could also refer you to get stomach reduction surgery [9].
  • Low testosterone levels can result in osteoporosis [10]. Some men get testosterone injections so they won't develop brittle bones.
  • Marijuana use lowers testosterone levels, too [11]. "Doc I smoke a lot of pot" will at least get your doctor's attention.

The best approach to this issue with your doctor, however, is simply stating what you want. If you want testosterone in hopes it will rejuvenate your love life, just say so. Your doctor can think of many more reasons to give you the hormone, or not, than you can. You don't necessarily have to visit your son-in-law the doctor, like Luigi.

In addition to testosterone replacement, it helps to work on those aspects of your lifestyle that create lower testosterone. There are lots of reasons not to abuse opioid medications. The so-called low-T is one of them. There are also reasons not to overdo cannabis consumption. Low testosterone is just one of them. And it's best to maintain a healthy weight. Fat cells feminize men by producing an enzyme that turns testosterone into estrogen. The fatter you are, eventually the more feminine you are. Focus on these lifestyle improvements and anything your doctor does for you will work better.

Testosterone Helps Hemoglobin and Hematocrit in Women, Too

Testosterone replacement therapy turns out to be a tool for achieving high hemoglobin levels in women as well as men [12], although the doses of testosterone given to women are much smaller than those given to men. Particularly if libido is an issue along with concerns with red blood cell count, women should not be hesitant to ask their doctors about this underutilized tool of women's hormone replacement.