Can patients on testosterone (hormone replacement) therapy donate blood?

Testosterone Therapy and Blood Donation

Patients on testosterone therapy should not donate blood as their red blood cells show decreased survival after transfusion, reduced effectiveness in recipients, and blood donation is insufficient to manage testosterone-induced polycythemia. 1, 2

Impact of Testosterone Therapy on Blood Parameters

Testosterone therapy commonly causes erythrocytosis (increased red blood cell production), which is its most frequent side effect 3. This occurs through several mechanisms:

• Increased iron bioavailability
• Enhanced erythropoietin production
• Direct bone marrow stimulation 4

The risk varies by administration route:

• Injectable testosterone: 43.8% risk of erythrocytosis
• Transdermal patches: 15.4% risk
• Gels: 2.8-17.9% risk (dose-dependent) 5

Why Blood Donation Is Not Recommended

1. Reduced Transfusion Effectiveness: Red blood cells from testosterone therapy patients show:

   • 25% lower hemoglobin increments in recipients
   • 80% higher odds of recipients requiring additional transfusions within 48 hours 1

2. Altered RBC Characteristics:

   • Increased susceptibility to oxidative stress (1.45-fold change)
   • Decreased membrane deformability
   • Lower post-transfusion recovery (41.6% vs. 55.3% in controls) 1

3. Insufficient for Managing Polycythemia: Research shows that repeat blood donation is insufficient to maintain hematocrit below the recommended threshold of 54% in testosterone therapy patients 2

Proper Management of Testosterone-Induced Erythrocytosis

The appropriate approach for managing erythrocytosis in testosterone therapy patients is:

1. Regular Monitoring:

   • Check hemoglobin/hematocrit at baseline before starting therapy
   • Follow-up 1-2 months after initiation
   • Monitor every 3-6 months during first year
   • Annual monitoring thereafter 5

2. Intervention When Needed:

   • Temporarily discontinue testosterone if hematocrit exceeds 54%
   • Consider dose reduction when restarting therapy
   • Consider switching from injectable to topical formulations 5, 3

3. Medical Supervision:

   • Therapeutic phlebotomy under medical supervision may be indicated
   • Recheck hematocrit within 1-2 months after intervention 5

Clinical Implications and Risks

Elevated hematocrit from testosterone therapy increases blood viscosity, potentially raising the risk of thromboembolic events 5. Recent research demonstrates that developing polycythemia (hematocrit ≥52%) while on testosterone therapy increases the risk of major adverse cardiovascular events and venous thromboembolism by 35% in the first year of therapy 6.

The practice of self-directed blood donation to manage testosterone-induced polycythemia creates a false sense of security while potentially introducing compromised blood products into the donation supply 2.