MEN: Pitfalls of Testosterone Prescription by the Casual “Health Care Provider”

One of the known side effects of testosterone supplementation in men is an increase in Red Blood Cells. In ancient times, when men might engage in hand to hand combat, a high testosterone man with increased red blood cells meant survival, while his lower testosterone neighbor might die in battle of blood loss.  However, today  too many red blood cells, or “thick blood,” decreases the oxygen carrying capacity and is not beneficial.  Think of it like too many cars jammed on a narrow road and no one moving very fast.  The quick solution is to donate blood.  The problem is that donating blood too frequently depletes iron which is stored in ferritin.  The desired level of ferritin is 40 or more.  Less than 10, men feel short of breath, easily fatigued because their iron (which is carried by the red blood cells) becomes too low.

I am writing this article for all you men out there who give blood to decrease your red blood cell count without checking the storage form of iron, ferritin.  Please, make sure that this blood protein is checked and >40.  If it is below 40, but you have too many red blood cells, then you may donate blood to decrease the count BUT you must also take an iron supplement. The donation people do NOT check ferritin, they only check the number of red blood cells.  The red blood cells which are pulled out during the donation carry iron, stored in ferritin.  Testosterone supplementation causes lower ferritin levels because the stored iron is pulled out into the (too many) red blood cells.

The short message to the above lengthy explanation:  Check ferritin, if below 10 take iron.  If hemoglobin/hematocrit H/H is >18/54, give blood. Don’t guess, it’s an inexpensive test to accurately guide therapy.

The other major side effect of testosterone supplementation can be shrinkage of the testicles and impaired spermatogenesis.  Human chorionic gonadotropin, HCG, may help restore testicular size and promote Luteninizing Hormone which induces production of sperm. (Transl Androl Urol, 2018 Jul:7(Suppl 3):S348-S352)  Endocrine specialists or fertility specialists would be best to diagnose and treat these conditions.  However, HCG, supplementation has been found to prevent these problems.