From the Research
Polycythemia secondary to exogenous anabolic steroid use typically resolves within 3-6 months after discontinuation of the steroids, though this timeframe can vary based on individual factors. The resolution occurs gradually as the body's natural testosterone production and hematopoietic regulation return to normal. Anabolic steroids stimulate erythropoiesis (red blood cell production) through direct effects on bone marrow and by increasing erythropoietin production, leading to elevated hemoglobin and hematocrit levels.
Key Factors Influencing Recovery
- The severity of polycythemia depends on the specific steroid used, dosage, duration of use, and individual physiological response.
- During recovery, patients should maintain adequate hydration, avoid activities that might further increase blood viscosity, and have regular blood tests to monitor hematocrit levels.
- In severe cases where hematocrit levels are dangerously high, therapeutic phlebotomy might be necessary to quickly reduce blood viscosity and associated risks like thrombosis.
Clinical Considerations
- Patients should be aware that other steroid-induced changes, such as altered lipid profiles and liver function, may also take time to normalize after discontinuation.
- The use of anabolic-androgenic steroids (AAS) has been linked to many deleterious adverse effects, including cardiomyopathy and polycythemia, as reported in a case study 1.
- A study on the association of subcutaneous testosterone pellet therapy with developing secondary polycythemia found that the median time to development of polycythemia was 50 months 2.
- However, the most recent and highest quality study on the topic of polycythemia, published in 2025, focuses on the diagnosis and treatment of polycythemia vera, a myeloproliferative neoplasm characterized by an increased red blood cell mass and increased risk of thrombosis 3, but does not directly address the duration of secondary polycythemia caused by exogenous anabolic steroids.
Monitoring and Treatment
- Regular monitoring of hematocrit levels and other health parameters is crucial during the recovery period.
- Therapeutic phlebotomy may be necessary in severe cases to reduce the risk of thrombosis and other complications.
- Patients should be educated on the importance of adhering to a healthy lifestyle and avoiding activities that may exacerbate polycythemia during the recovery period.