Short answer: In men with low testosterone, it often helps. In the Testosterone Trials, 58.3% of older men with unexplained anemia were no longer anemic after a year of testosterone gel, against 22.2% on placebo. In TRAVERSE, anemia corrected in 45.0% at 12 months against 33.9% on placebo. The same effect can push red cells too high, which is why labels list hematocrit checks.
The Depo-Testosterone label says androgens have been reported to stimulate red blood cell production by raising erythropoietin, the kidney hormone that signals the bone marrow. Men with low testosterone can have mild anemia, and the TRAVERSE anemia paper notes that testosterone deficiency causes it.
In the Xyosted trial, mean hemoglobin rose 1.0 g/dL at 6 months and 1.1 g/dL at 1 year, and mean hematocrit rose 3.8% at 6 months and 5.4% at 1 year (section 6.1).
| Trial | Men | Result |
|---|---|---|
| Testosterone Trials (Roy 2017) | 788 men 65 or older with testosterone under 275 ng/dL; 126 anemic, 62 with no known cause | Unexplained anemia: hemoglobin up 1.0 g/dL or more in 54% vs 15%; no longer anemic in 58.3% vs 22.2%. Anemia with a known cause: 52% vs 19% had that rise |
| TRAVERSE (Pencina 2023) | 5,204 men aged 45 to 80; 815 anemic | Anemia corrected at 6 months in 41.0% vs 27.5%, at 12 months in 45.0% vs 33.9%. Fewer non-anemic men on testosterone became anemic |
Both trials used a hemoglobin of 12.7 g/dL as the anemia cutoff. In TRAVERSE, changes in hemoglobin went along with changes in reported energy. The Testosterone Trials authors noted that the overall health benefit of the rise remains to be established.
In the Testosterone Trials, 6 men who were not anemic at the start reached a hemoglobin above 17.5 g/dL. The AndroGel 1.62% label (section 5.2) says rising hematocrit may require lowering or stopping testosterone, and that more red cell mass may raise the risk of clots. It lists a hematocrit check before starting, again 3 to 6 months after, and then yearly, with treatment paused if it is high. More on this is in TRT hematocrit monitoring.
The trials only enrolled men with confirmed low testosterone, and the Testosterone Trials sorted anemia by whether a cause had been found. In older men, the authors note, no cause is found in about one-third of anemia cases, so finding the cause is part of the work-up. Whether testosterone fits, and how hemoglobin will be followed, is for the prescriber to decide. Dose Track can keep hemoglobin and hematocrit results next to each dose so trends are easy to see.
Read more on Dose Track: TRT hematocrit monitoring · Hematocrit · Erythropoiesis-stimulating agent · Low testosterone