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Effects of Testosterone on Red Blood Cell Production

Published on Mar 15, 2023   -  4 min read


Testosterone helps in the production of red blood cells. Read the article to learn more.


Testosterone is a male sex hormone that is used to regulate many functions. For example, testosterone plays a major role in the production of red blood cells. Therefore, low levels of testosterone may increase the risk of anemia. For those with anemic conditions due to low testosterone levels, replacement hormonal therapy may help them deal with the condition.

What Is an Anemic Condition?

Anemia is a common blood disorder with a reduced number of red blood cells to carry pure oxygen from the lungs to other organs. Otherwise, the red blood cells can not carry oxygen for some reason. Red blood cells are designed in a certain way to carry oxygen through the blood. They contain hemoglobin molecules, an iron-rich protein that the oxygen attaches to. These carry oxygen from the lungs and supply it to the rest of the organs in the body. They also carry carbon dioxide from the organ, which is eliminated while breathing out.

Usually, men will have a higher count of red blood cells when compared to women. Older men suffer more from anemic conditions than women, as old age reduces testosterone levels. There are many reasons for the cause of anemia, which may vary from a genetic disorder to a vitamin deficiency.

What Are the Symptoms of Anemia?

The symptoms of an anemic condition occur slowly and are subtle, which can be mistaken for other conditions. Some symptoms include:

What Are the Causes of Anemia?

Some of the potential causes of anemic conditions are:

  • Low iron.

  • B12 deficiency.

  • Reduced level of testosterone.

  • Some inherited blood disorders like sickle cell anemia.

  • Issues in the production of red blood cells, like aplastic anemia.

  • Chronic inflammation.

  • Chronic kidney disease.

  • Myelodysplastic syndrome.

  • Chemotherapy.

  • Blood loss.

What Are the Health Risks Factors?

The anemic condition should be treated, which will significantly impact health. It can interfere with the daily activity of a person and makes it difficult to perform the day-to-day activity. When left untreated, anemia may result in the starvation of the organs and tissues for oxygen. It increases the risk of heart conditions, disability, and quicker physical decline.

How Does Testosterone Replacement Therapy Help to Deal With Red Blood Cell Production?

The testosterone hormone plays a significant role in producing red blood cells. Males have higher red blood cells when compared to females. These levels tend to increase during puberty as the body produces a lot of testosterone. Studies have shown that testosterone helps the hematological system in many ways; it regulates erythropoietin (EPO) production. EPO is a hormone produced by the kidneys that regulate the bone marrow to increase the production of red blood cells.

Testosterone also plays a role in the metabolism of iron, which helps to form an iron-rich protein called hemoglobin, which carries oxygen from the lungs to other organs. Testosterone replacement therapy plays a significant role in increasing the level of hemoglobin and hematocrit (ratio of red blood cells to the total volume of blood). Some studies show that increased hemoglobin level is also associated with increased muscle strength, bone density, cognition, and physical performance. These are some of the benefits of hormonal replacement therapy. As testosterone plays a role in red blood cell production, it can also help with anemia.

Testosterone increases red blood cells by preventing hepcidin secretion, a peptide that regulates iron absorption. An enhanced level of bioavailable iron can decrease the risk of anemia due to iron deficiency which increases the ability of iron to incorporate iron and increase the lifespan of a red blood cell.

How Does a Low Testosterone Level Increase the Risk of Anemia?

A low testosterone level may result in many unwanted and life-changing symptoms. The common symptoms are low sex drive, low energy, mood swings, weight gain, and difficulty concentrating. In addition, studies show that people with low testosterone levels result in low hemoglobin levels, leading to an enhanced risk of anemia. Therefore, a low testosterone level will make the person more susceptible to anemia. People usually under anti-androgen treatment will experience anemia as a side effect which can be treated through androgen treatment.

Does Hormonal Replacement Therapy Help With Anemia?

Hormonal replacement therapy helps deal with anemia and low testosterone levels. In addition to helping with anemic conditions in men with low testosterone levels, many also experience reduced risk factors for metabolic syndrome. Researchers conclude that low testosterone levels may pave the way for the risk of anemia, and testosterone treatment helps to deal with the increase in red blood cells in those with anemia.

A study was done with a group of older men with low testosterone levels and anemia. Some men had anemia with a cause, while others had anemia without any specific cause. Some people received testosterone replacement therapy for about 12 months, while others received a placebo. The people who received testosterone replacement therapy showed drastic improvements in their hemoglobin levels compared to the placebo group. At the end of 12 months, 58.3 % of people with anemia without any specific cause with testosterone replacement therapy did not have any symptoms of anemia at the end of the study, whereas 22.2 % of people who received a placebo resolved anemia. For people with anemia with a known cause, 60 % of the men under hormonal replacement therapy did not show any symptoms of anemia, whereas 14.8 % of people who received a placebo resolved anemia.

Why Is Treatment Monitoring Done During Testosterone Replacement Therapy?

To optimize the result, it is important to perform treatment monitoring during testosterone replacement therapy. Testosterone helps to increase the count of red blood cells; due to this, it is important to get a regular blood count. Therefore, it is done to monitor testosterone levels and check the number of red blood cells.

A high count of red blood cells is an important side effect of testosterone replacement therapy. This can increase the thickness of the blood, which may result in other complications. The signs and symptoms of this condition are similar to anemia, which include dizziness, weakness, fatigue, headache, joint pain, etc.


Testosterone is a male hormone that plays a significant role in various body functions. It also plays an important role in the production of red blood cells. A low level of testosterone will negatively impact the level of hemoglobin, which in turn affects the level of red blood cells. Reduced testosterone results in anemia, which, if not treated, may lead to complications caused by starvation of the tissues and cells. This can be treated through testosterone replacement therapy, which helps increase the production of red blood cells in the bone marrow.

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15 Mar 2023  -  4 min read




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