Health is a major concern among users of TOT. Remaining at optimum health is also vital for the treatment to efficiently raise your testosterone levels. Self-monitoring and professional monitoring are essential to determine biomarkers, and track the progress of the therapy among men using non-injectable testosterone and injectable options. One of the most important ways to achieve this is by doing regular bloodwork tests. It allows you to monitor how the use of testosterone effects red blood cell counts. To help you get a better understanding of the treatment, symptoms, and outcomes, learn how to take care of hemoglobin and hematocrit levels while on TOT.
The Effects of TOT on Hemoglobin and Hematocrit Levels
There is a noticeable correlation between high testosterone levels and high hemoglobin (the protein inside red blood cells). Testosterone stimulates erythropoietin production, which increases RBC (red blood cell) count and oxygen saturation. This increased production of RBC’s is called erythrocytosis. Erythrocytosis is the most common adverse reaction to testosterone therapy, occurring in up to 40% of users. Patients using an injectable testosterone delivery system experience higher rates of erythrocytosis than those using transdermal delivery systems or pellets.
How to Treat Elevated Levels
The good news is that this condition is easily treatable through therapeutic phlebotomy. Work with your physician to monitor your hemoglobin and hematocrit levels to make sure they stay under 20 g/dL for Hemoglobin, and 52-54% blood volume for Hematocrit. If they are elevated above these reference ranges, periodically giving blood (via therapeutic phlebotomy) will lower hemoglobin and hematocrit levels. Currently, the Endocrine Society Guidelines state that hematocrit levels over 54% warrant discontinuation of TOT. At the optimal dosage levels of TOT, however, it is rare to have chronically elevated hematocrit values. However, it is still crucial to stay on top of these biomarkers (and treat where appropriate.)
TOT Does Not Cause Polycythemia
Dr. Neil Rouzier is a well-known clinician and respected thought leader in the TOT space. He is very outspoken regarding his belief that many doctors are confused regarding whether testosterone causes polycythemia (a blood thickening disorder that increases the risk of blood clots.) He is adamant in his opinion that TOT DOES NOT cause polycythemia, nor does it create an increase in arterial or venous thrombosis. As such, he believes that many physicians are over-phlebotomizing their patients and lowering ferritin levels too far.
Monitoring Ferritin Levels
Ferritin levels are a measure of your iron stores, which should remain above 100 ng/mL. Iron is much more than making blood, as it is also crucial for proper thyroid function. When iron gets too low, so will your RBC count. Rouzier states that the erythrocytosis which testosterone causes is commonly extrapolated to be just as harmful as polycythemia. It is both an incorrect and inappropriate extrapolation due to a misunderstanding of both erythrocytosis and polycythemia. In spite of the widespread use of phlebotomy to treat erythrocytosis, erythrocytosis is NOT the same thing as polycythemia. It’s important to monitor every aspect of your health during your Testosterone Optimization Treatment.
Always follow the advice of a certified TOT medical professional, but ask them to explain every step of the process to you. If you want to stay on top of your health and fully understand what your physician is trying to achieve, get a copy of the TOT Bible and learn everything you can about your treatment. 
