Why wouldn't you want your testosterone as high as possible? Dr. Ben House has a good answer. High testosterone upregulates EPO, which tells your body to make more red blood cells. More red blood cells means more viscous blood. You're not pumping blood anymore, you're pumping oil. Now add... left ventricular hypertrophy. The heart wall thickens, and it's pushing against more back pressure with every beat. As Ben puts it, your heart is pumping ketchup against a bunch of extra muscle. You don't want to run that for decades, assuming you get decades.show more

If you’re pinning test you have a higher chance of drowning in women than dying of a heart attack

This is why it is important to monitor these things while on testosterone therapy. Erythrocytosis happens in a minority of patients on TRT.

@grok is there good evidence that what he’s saying is true for specifically TRT users? I’ve seen a lot of info to the contrary so please help clarify.

Testosterone raises erythropoietin, which increases red blood cell production, which increases blood viscosity. With supraphysiological levels, this can genuinely lead to erythrocytosis/polycythemia, with a real risk of thrombosis. The clinical consensus marks hematocrit >54% as the point where you have to lower the dose or do phlebotomy.

checks and balances

Thee is a list of issues I see every day in my office from the horrible abuse and misinformation and social media irresponsible grifters recommending. It is a problem

This is a good reason to donate blood, no?

Just look at the side effects of too much testosterone use from bodybuilders. Those are living examples of what too much testosterone does to your body.

Helpful caveat. For the 40+ crowd I care more about sleep, lifting, and body fat than chasing the highest number on a lab printout.

@grok He is conflating abuse with high doses and zero management. His statement is in the very least inflammatory if not misleading without context. Explain it correctly because the data doesn’t support him.

Why do they both look unwell

Higher T is not always better blood. EPO can raise red cell load and thicken what the heart has to push. The ceiling question is viscosity, not just the hormone number.

Drink more water. Sweet tea has a lot of water in it.

@grok summarize all; and tell us what to do based on that

Quest lab says normal total is 250 to 1100 ng/dL. And normal Free is 35 to 155 pg/ml. So, if a person stays below those two upper limits do you consider that safe?

Yeah the “as high as possible” framing misses the tradeoff. More isn’t automatically better if the blood gets thicker and the heart is working against that for years. Context matters.

Uhhhh….prostrate cancer?

The science here is pretty solid, so let’s look at the numbers. Testosterone bumps up your hematocrit by messing with EPO and hepcidin, and those aren't just theoretical risks—the data backs it up. Guys who hit secondary polycythemia while on TRT are showing higher rates of heart issues and blood clots within the first year, which is exactly why docs draw the line at 54% hematocrit. On the heart muscle side, a 2025 Danish study really put it into perspective: long-term steroid users were seeing about three times the risk of heart attacks and nine times the risk of cardiomyopathy compared to everyone else. Just keep in mind that’s almost entirely about supraphysiological doses—the stuff guys take to get massive. It’s a completely different conversation than someone who’s just on a monitored, doctor-prescribed replacement dose.

Stick a needle in a vein to bloodlet yourself, use low-dose PDE5 inhibitor + Telmisartan to prevent LVH Now you are immune, enjoy blasting 10g Test 👍 🤡

Cool....we've all heard the negative parts of high T by pencil neck males....now give us the massive benefits and also explain how simple blood donations help with this.

Donate blood 🩸 2 times a year and your good to go

Pumping ketchup is a great analogy. I was on the arbitrary 200mg/week. Hematocrit came back over 50 on my latest test (total over 1500, free at 208). Cut the dose in half and will retest in a couple months. Thought I would feel flat, but feel great 💪🏻

Hematocrit under 50 and hemoglobin under 16.5 donate blood as needed. Take CoQ10, resveratrol, fish oil as well