Anti-Aging
Updated: May 23, 2022
Is There a Connection Between Low-T and Anemia?
Published: Mar 25, 2022

Many people may not automatically connect the dots between anemia and low testosterone levels, but low T is a contributing cause of anemia, especially in older men. Several clinical trials have indicated that testosterone replacement therapy can improve anemia and its associated symptoms in men with low testosterone levels.

Approximately 10% of older adults have anemia, with men being affected at a higher rate than women. Anemia is a condition in which you are not making enough healthy red blood cells. Red blood cells pick up oxygen from the lungs, transport it through the bloodstream, and deliver it to your body organs. If you have a significant decrease in red blood cells, then the tissues and organs in your body may not be getting enough oxygen. Understanding the underlying causes and long-term consequences of anemia is critical.

Anemia is diagnosed from a blood test called a complete blood count. Hemoglobin is a measured lab value, and hematocrit is calculated. Healthy hemoglobin and hematocrit levels for men and women:

  • Hemoglobin levels 13.2 to 16.6 g/dL for men;  11.6 to 15 g/dL for women
  • Hematocrit levels are 48% to 548% for men; 35% to 45% for women

What Are the Risks of Untreated Anemia?

The symptoms of mild anemia are commonly nonspecific and are due to decreased oxygen delivery to organs in the body. All metabolic processes in the body require oxygen. Even a slight decrease in red blood cells can cause:

  • Fatigue
  • Lack of energy
  • Weakness

As anemia worsens and body cells function with suboptimal oxygen delivery, metabolic byproducts build up in your cells. You may also experience:

  • Headaches
  • Dizziness
  • Irritability
  • Reduced ability to exercise
  • Shortness of breath
  • Irregular heartbeat
  • Chest pain

There are many potential causes of anemia, including:

  • Low iron
  • B12 deficiency
  • Low testosterone
  • Sickle cell disease and other inherited blood disorders
  • Problems with red blood cell production such as aplastic anemia
  • Chronic inflammation
  • Chronic kidney disease
  • Myelodysplastic syndromes
  • Chemotherapy
  • Blood loss

In about one-third of people with anemia, no cause is found.

Knowing if Anemia Is Connected to Low-T

Although several studies have shown a connection between testosterone levels and anemia, The Anemia Trials of the Testosterone Trial is a clinical trial designed to determine whether men with unequivocally low testosterone levels and unexplained anemia would benefit from testosterone replacement therapy.

The Testosterone Trials are a series of 12 clinical trials to assess the results of testosterone supplementation in men with low T.

These trials were all placebo-controlled, double-blinded trials that enrolled 788 men.

  • Sexual Function Trial: Testosterone increases sexual activity, sexual desire, and erectile function.
  • Physical Function Trial: Testosterone increases the distance walked, but not the speed.
  • Vitality Trial: Testosterone improves mood and depressive symptoms, but not energy.
  • Cognitive Function Trial: Testosterone did not improve cognitive function.
  • Anemia Trial: Testosterone increases hemoglobin in men with anemia of unknown and known cause.
  • Bone Trial: Testosterone increases bone density and strength.

Participants had two testosterone measurements that averaged less than  275 ng/dL, and they had a low risk of prostate cancer. Of the 788 men enrolled in the trial, 64 had anemia with a known cause, and 62 had anemia without a known cause.

After 12 months, hemoglobin levels increased by 1.0 g/dL in 58% of men with unexplained anemia in the treatment group versus 22% in the placebo group. For those with explained anemia, 60% of the men in the testosterone replacement group no longer had anemia, versus 15% in the placebo group. Men who had improvement in their symptoms reported improvement in walking speed and vitality. They had improvements in general health, energy, walking ability, sexual desire, and memory. However, the improvements in general health and energy were the only statistically significant ones.

Researchers concluded that treatment with testosterone in men with low testosterone and anemia resulted in a significant increase in hemoglobin levels, whether the cause of anemia is known or not.

Low testosterone levels are associated with anemia, and:

  • Decreased energy
  • Mood changes
  • Irritability
  • Erectile dysfunction
  • Reduced sex drive
  • Enlarged breast tissue
  • Disturbed sleep
  • Increased body fat

The first step in determining whether low testosterone is causing your symptoms is to have your testosterone levels checked.

Men’s Standard Hormone Panel

Men’s Advanced Hormone Panel

How Testosterone Therapy Can Help

Scientists have long been aware of the association between testosterone and red blood cell production. They attribute testosterone as the cause of the 1- to 2-g/dL difference in hemoglobin concentration between adult men and women. Men taking anti-androgen medications to treat medical conditions frequently experience anemia as a side-effect. However, their anemia commonly resolves when they take androgen treatment.

Experts are still working to understand the connection between testosterone and anemia. Testosterone may increase the production of erythropoietin (EPO). EPO is a hormone produced by the kidney, which stimulates red blood cell production.

Testosterone may also increase red blood cells by inhibiting the secretion of hepcidin, a peptide that regulates iron absorption. An increased amount of bioavailable iron can reduce the risk of anemia due to iron deficiency, enhance the ability of red blood cells to incorporate iron,  and improve the lifespan for red blood cells.

Anemia can increase the risk of chronic disease and mortality. Anemia increases dramatically after the age of 50 and affects one in five people over age 85. Men who have anemia and low testosterone levels may benefit from testosterone replacement therapy to correct their anemia.

Testosterone replacement therapy for hypogonadism can have several beneficial effects:

  • Increase in muscle mass and strength
  • Increase in bone density
  • Increase in red blood cell production
  • Improved erectile function and libido
  • Improved mood
  • More energy

There is also risk associated with testosterone replacement therapy, including acne, sleep apnea increased estradiol, gynocomastia, and  increased red blood cell production beyond what is needed which can increase the risk of blood clots. Men should also discuss their risk of cardiovascular disease and prostate cancer with their doctor when discussing whether to start treatment.

If you have these symptoms and believe that low testosterone levels may be the cause, you may be a candidate for testosterone replacement therapy. Learn more about testosterone replacement therapy and how Invigor Medical specialists can help you determine whether testosterone replacement therapy is right for you.

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