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See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Almost every week I hear from my male patients that their PCP doctor has scared them by telling them to stop taking testosterone pellets because their Hematocrit is too high. Alternatively, their doctor recommended a lower dose of T. These two recommendations are those doctors who don’t understand all the good that the testosterone is doing for these men. My male patients come to me for Testosterone pellets to treat their ED, lack of libido, loss of muscle, inability to think, weight gain, lack of motivation, anxiety attacks, poor stamina, arthritis, loss of balance, and basically everything that makes a man a man! The most amazing thing is that I can treat them with ONE hormone, Testosterone in pellet form, and cure all these problems! If a man stops taking Testosterone, they get these symptoms again and have to take a multitude of drugs to feel just a fraction better! The treatment for a high H/H is simple…it is a routine removal of blood, either a blood donation or a phlebotomy (removal of 500 cc of blood) in the office, every 2-6 months to keep their H/H under control. The advice their doctors give them is going to cause them great pain and actually shorten their lives and there is little risk if any to removing blood every few months! In the event that a man demands that I lower their dose…..and I do it…the next inevitable phone call is to complain that their symptoms are coming back! They literally blame me for the advice of their PCP! I would like to tell these men that the same doctors who could not help them with their low T are the same ones who are giving them the advice to lower or stop their testosterone therapy with T pellets. It is human nature and especially that of doctors to try to criticize the advice of the doctor who got better results with a patient than they did! So, if you develop a condition called erythrocytosis secondary to your testosterone replacement, then you can keep your T therapy, if you are compliant and follow your testosterone doctor’s directions and get your blood removed when it is scheduled. This should prevent any severe reaction from your doctor. This is a typical response to my patient who has concerns. However, I have given my patients many sources of written and video information about every aspect of testosterone replacement, the risks and benefits including erythrocytosis. These include my book, Got Testosterone? was given to them on the first visit. We also have over 650 informational blogs and videos on You Tube, FAQs and a very extensive handout given to each of them on the first visit. They just have to read! I have read your concern about erythrocytosis and testosterone replacement that was brought up by your PCP. It is true that T replacement increases the H/H in both sexes. It is useful if you are anemic, but if you have a genetic response to testosterone that elevates your H/H above what is considered normal, then we advise blood donation or phlebotomy every 2-6 months. It is true that the dose of T can affect the H/H, but men often need a high dose of T to feel normal. The removal of blood is low risk and effective. I am a Specialist in Hormone Replacement Medical care with a 38-year history of replacing bioidentical hormones and 23 years of experience replacing bioidentical hormones with T and E2 pellets. You came to me because your doctors were not helping you with the symptoms of testosterone deficiency and because I have the most experience in the Midwest. #1. The first issue that we must always consider while we treat anyone is the primary goals for treatment, the relief of low testosterone which is why you came to me. You made an appointment with me because you had un-addressed issues that your PCP (Primary Care Doctor) didn’t treat satisfactorily Your symptoms were treated with testosterone pellets successfully at a dose that is individual to you. Your health as you get older is also dependent on your blood level of free Testosterone (the total T is not significant) by delaying the diseases of aging. The level that is required to treat your symptoms is the young healthy Free T blood level of a young and healthy man. Most labs give a reference range for older men which reflects the fact that free testosterone levels drop with age. Old men don’t feel well BECAUSE they have low free T. The low free T level is why you don’t feel well. Our practice has found that everyone has an ideal free T level that we try to maintain, and these are young-healthy level but not old-man level. That is what we have been trying to achieve for our patients. #2. The second issue is a side-effect that you, as an individual, have experienced with pellets and will experience with any T replacement that you receive that is a high enough dose to treat your symptoms. Erythrocytosis is a side effect that some men experience on any form of testosterone, however its occurrence doesn’t mean you are on too much testosterone, it means you have a side effect of having a normal free T level. Erythrocytosis is genetic, and your free T blood level stimulates the production of too many red blood cells. We don’t stop the treatment that is making you better, to treat the side effects of it. We treat the side effects. We treat this side effect with phlebotomies to keep your H/H within the safe range. Did your medical doctor/cardiologist tell you why this is important? We tell you: too many red blood cells can increase the work of the heart, however the Hematologists that we consult with give us the HCT% number we should stay below is 58%. We like to keep your HCT% below 52% but that requires you to be compliant with your regular blood donated or phlebotomized in our office (that takes an appointment). You must be compliant to keep your H/H normal. These 2 issues are at odds with one another. I cannot give a man enough testosterone to treat his symptoms, without stimulating some production of RBCs. I have no other low T treatment that doesn’t stimulate your bone marrow to make red cells BUT I do have a simple treatment to remove your extra blood cells routinely to keep you from having too many blood cells circulating. Only you can make the decision to choose health with T pellets and do phlebotomies regularly as recommended, or to stop T and allow your blood count to decrease., and your symptoms will come back. I want you to read your post-pellet instructions, locate my book Got Testosterone? and read it especially the section on Erythrocytosis, and look at FAQs (frequently asked questions) on the www.biobalanacehealth website, read related episodes of my 677 blogs and or listen to my health casts for your answers. You can imagine how I feel when my patients don’t read what I provide to them in multiple forms to answer their questions. In the future you should read the information I have given you or come in for an appointment to discuss these matters.