TRT Has the Potential to Cause Polycythemia
[Intro Paragraph] While individuals undergoing Testosterone Replacement Therapy (TRT) often experience symptom improvement and an enhanced quality of life, there are some potential negative effects.
One is that TRT can occasionally have a blood-building effect, in which the body makes extra red blood cells. This can be beneficial for persons suffering from mild anemia. However, in those who do not have anemia, it can cause the blood to become viscous or “sticky,” making it difficult for the heart to pump. Polycythemia is the medical term for this illness.
Polycythemia can cause hypertension and, in some cases, an elevated risk of stroke and heart attack.
Although not every TRT patient is affected by this illness, it is critical to be aware of it and to engage in regular monitoring and preventative care to avoid consequences.
If you are taking TRT, your doctor should regularly monitor your hemoglobin and hematocrit levels through periodic bloodwork to detect any signs of polycythemia. If your results reflect this condition, there are options to control TRT-induced polycythemia.
Why does TRT cause polycythemia?
Testosterone can improve the body’s synthesis of red blood cells in addition to controlling body composition and sex drive (RBC). When your testosterone levels rise, your RBC count may rise as well.
Although all Testosterone administration techniques can increase the number of red blood cells, research suggest that those who use intramuscular Testosterone injections have a higher rate of polycythemia than those who use topical Testosterone.
Tobacco use has also been linked to polycythemia and may add to the disorder. Consider a smoking cessation program if you smoke and are taking TRT.
How to Identify Polycythemia
Working with a clinician that frequently tests your hemoglobin and hematocrit is the first step in preventing and treating polycythemia. These two variables are the most reliable indicators of increased red blood cell production.
Hemoglobin is a protein found on red blood cells that transports oxygen to tissues and organs throughout the body as well as carbon dioxide back to the lungs. Adult men have hemoglobin levels ranging from 13.5 to 17.5 grams per deciliter, whereas adult women have levels ranging from 12 to 15.5 grams per deciliter.
Hematocrit is a measurement of the fraction of red blood cells in relation to total blood volume. A packed-cell volume (PCV) test is another name for a hematocrit test. The percentage of hematocrit is calculated by comparing the measurement of packed red blood cells to the overall blood column. Ideal hematocrit ranges vary by gender and ethnicity, but the average range for adult men is 41%-50% and the average range for adult women is 36%-44%.
Any hematocrit test above the indicated range, particularly those exceeding 52%, should be investigated.
When to Test for Polycythemia
To establish a baseline, you should usually test your hemoglobin and hematocrit before beginning TRT. Then, three months after starting your TRT program, you and your provider should test again.
Following that, many established TRT patients begin testing their hemoglobin and hematocrit levels every six months. (Patient protocols may vary depending on individual reactions; always follow your provider’s instructions.)
Should I discontinue TRT if I have a high RBC count?
Stopping TRT isn’t always the best option for many individuals.
TRT is often initiated to address life-altering symptoms of Testosterone imbalance, such as poor sex drive, sexual dysfunction, lack of energy and exhaustion, fat gain, and other symptoms. Without TRT, these undesirable symptoms frequently reoccur.
You may also ask whether you should switch from injections to topical Testosterone, as the latter appears to have less of an effect on hematocrit. Many patients dislike this option as well, because their injectable routine is excellent at decreasing the symptoms of hormone imbalance.
So, what can you do to treat TRT-induced polycythemia? Continue reading to learn more.
Therapeutic Phlebotomy for Polycythemia
Therapeutic phlebotomy is similar to blood donation, except it is prescribed by doctors to lower blood hematocrit and viscosity. Taking out one pint of blood reduces hematocrit by about 3%. (results vary by patient).
Depending on your specific situation, your practitioner may propose therapeutic phlebotomy every 8-12 weeks.
The operation is straightforward and is carried out in the same manner as a blood donation. In most cases, successful therapeutic phlebotomy reduces hematocrit, hemoglobin, and blood iron levels in less than an hour.
Is therapeutic phlebotomy covered by insurance?
Unfortunately, qualifying for reimbursement or getting therapeutic phlebotomy covered by insurance can be challenging.
Some doctors will write a letter of medical necessity that the patient can provide to their insurance company to justify the surgery. CPT 39107, icd9 code 289.0 are the CPT reimbursement codes for therapeutic phlebotomy.
(Please keep in mind that Defy Medical is a concierge clinic and does not handle or take insurance or contact insurance carriers; patients should contact their insurance carrier directly to see whether any surgeries or therapies are covered.)
Therapeutic Phlebotomy at the Defy Medical Tampa Clinic
Defy Medical provides therapeutic phlebotomy (as needed) at our Tampa, FL facility. Receive your therapeutic phlebotomy in a calm environment with providers you already know and trust. Consult the Tampa clinic.
Another Option to Treat Polycythemia: Donating Blood
This option is available to healthy patients who are qualified to donate blood. Because the procedure is so close to therapeutic phlebotomy, it usually has the same result.
Blood donation eligibility requirements typically include:
- Being in good health, free of common colds, HIV, Hepatitis, and other illnesses or infections.
- Avoiding travel outside of the country to Malaria-risk areas.
- Having sufficient iron levels without anemia
- Other standards vary according to the entity collecting the blood.
Donors of whole blood can normally donate every eight weeks, or up to six times per year.
How Frequently Should I Donate Blood or Get Therapeutic Phlebotomy?
The frequency of phlebotomy is determined by individual characteristics, and your clinician should collaborate with you to build a personalized plan.
A blood draw every two to three months is usually suggested for TRT patients who have polycythemia. It is critical not to overdraw blood, as this might result in anemia, iron shortage, and other complications.
After starting therapeutic phlebotomy, you and your provider should continue to monitor your hematocrit and hemoglobin levels. Your test findings aid in determining if the treatment is adequate.
Regular blood tests can also tell you if your red blood cell production has stabilized. RBC production can sometimes return to normal without a clear cause.
Who is Most Likely to Experience Polycythemia as a TRT Side Effect?
It is impossible to anticipate who will be predisposed to polycythemia. However, the following elements may play a role:
- Increased Testosterone dosing in your TRT protocol
- A high body fat percentage
- advancing years
- Behavioral issues such as smoking
People with increased red blood cell production may have the following symptoms:
- An rise in headaches and high blood pressure
- becoming hot and red-faced during activity or exertion
- Dizziness, fatigue, and a lack of energy
- When lying down, you may have shortness of breath.
Patients with polycythemia frequently have NO symptoms. As a result, meticulous testing over time is the most effective strategy to diagnose and treat this problem.
Is Polycythemia Caused by Anything Other Than TRT?
There are various forms of polycythemia, each of which can be caused by a variety of factors.
A genetic abnormality within the bone marrow leads it to overproduce red blood cells, resulting in primary polycythemia.
Secondary polycythemia can be brought on by:
- Sleep apnea or a respiratory problem
- Obstructive Pulmonary Disease (COPD) (COPD)
- Disease of the lungs
- Heart disease or cardiovascular disease
- Certain types of cancer and/or endocrine tumors
- Drugs that improve performance
If you have any of these illnesses and begin Testosterone Replacement Therapy, your risk of getting polycythemia may increase.
Are There Any Other Polycythemia Treatments?
Some doctors may recommend daily aspirin and/or omega-3 fatty acids for overall heart health and to help prevent heart attacks (fish oil capsules).
These can be a significant part of a heart health regimen, but they are not usually substitutes for therapeutic phlebotomy if you have polycythemia and want to keep TRT.
There are prescription drugs that directly limit red blood cell synthesis, but patients frequently opt to try therapeutic phlebotomy first. The latter has a favorable safety profile and has been found to be efficacious in a wide range of patients.