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AndroGel and Erythrocytosis: Supplements With the Best Evidence

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At a glance

  • Direct answer / No cited study of a supplement lowering hematocrit in AndroGel users
  • AndroGel 1.62% label / Check hematocrit before starting, at 3 to 6 months, then annually [2]
  • AndroGel 1.62% label, elevated hematocrit / Stop therapy until hematocrit decreases to an acceptable concentration [2]
  • Testosterone gel effect / Hemoglobin and hematocrit rose 7% to 10% over 6 months [3]
  • Route comparison / Mean hematocrit +3.0% with gel vs +4.0% with intramuscular enanthate or cypionate [4]
  • Curcumin trial / Lowered IL-6 and other cytokines, not hematocrit [5]
  • Phlebotomy threshold / A review states phlebotomy when hematocrit exceeds 52% [6]

Does Testosterone Gel Raise Hematocrit?

Testosterone raises red blood cell mass, and topical gel is no exception. In a randomized trial of older men with mobility limitation, daily testosterone gel for 6 months raised hemoglobin and hematocrit by 7% to 10%, with erythropoietin up and ferritin and hepcidin down at 1 and 3 months [3]. A network meta-analysis of 29 placebo-controlled trials in 3,393 men found mean hematocrit rose 3.0% with gel and 4.0% with intramuscular enanthate or cypionate, compared with placebo [4].

What Did the Supplement Studies Measure?

Naringin is a citrus flavonoid. In iron-overloaded mice, naringin at 30 mg/kg/day reduced nonheme iron in the hippocampus, and amyloid-beta plaque numbers fell with 30 or 60 mg/kg/day [7]. Brain iron and plaques were measured, not hematocrit.

IP6, or inositol hexaphosphate, is a polyphosphorylated carbohydrate found in plant foods and in mammalian cells; the review cited here is about protection against cancer by dietary IP6 and inositol [8].

In a post-hoc analysis of a randomized trial of 117 adults with metabolic syndrome, curcumin 1 g/day for 8 weeks lowered TNF-alpha, IL-6, TGF-beta and MCP-1 more than placebo (P<0.001) [5]. Cytokines, not hematocrit, were measured.

Quercetin bound iron in laboratory solutions [10]. A small randomized study in sarcoidosis, 12 patients on quercetin and 6 on placebo, measured oxidative stress and inflammation markers, not hematocrit [11].

What the Labels Say About Blood Counts

The AndroGel 1.62% label's polycythemia warning says to check hematocrit before starting treatment, that it would be appropriate to re-evaluate hematocrit 3 to 6 months after starting and then annually, and that if hematocrit becomes elevated, therapy should be stopped until hematocrit decreases to an acceptable concentration. It adds that an increase in red blood cell mass may increase the risk of thromboembolic events [2]. The generic testosterone gel 1% label gives the same schedule [1].

A 2025 review states that therapeutic phlebotomy is indicated when hematocrit exceeds 52% [6]. Whether testosterone-induced erythrocytosis raises thromboembolic risk remains unclear [12].

Frequently asked questions

Does testosterone gel raise hematocrit?
Daily testosterone gel raised hemoglobin and hematocrit by 7% to 10% over 6 months in a randomized trial of older men [3]. Across 29 placebo-controlled trials, mean hematocrit rose 3.0% with gel versus placebo [4].
Do any supplements lower hematocrit on AndroGel?
No cited study tested that. Naringin was studied for brain iron in mice [7], curcumin for cytokines in metabolic syndrome [5], and quercetin for iron binding in the laboratory [10] and for inflammation markers in sarcoidosis [11].
What does the AndroGel label say about hematocrit?
The AndroGel 1.62% label says to check hematocrit before starting, re-evaluate at 3 to 6 months, then annually, and to stop therapy until hematocrit decreases to an acceptable concentration if it becomes elevated [2].
Is phlebotomy used for high hematocrit on testosterone?
A 2025 review states therapeutic phlebotomy is indicated when hematocrit exceeds 52% [6]. The link between testosterone-related erythrocytosis and thromboembolic events remains unclear [12].

References

  1. U.S. National Library of Medicine, DailyMed. Testosterone gel 1% topical (generic) prescribing information, effective 2025-09-30. Testosterone gel 1% topical prescribing information
  2. U.S. National Library of Medicine, DailyMed. AndroGel (testosterone gel) 1.62% prescribing information. DailyMed - ANDROGEL- testosterone gel
  3. Bachman E, Travison TG, Basaria S, Davda MN, Guo W, Li M, et al. Testosterone induces erythrocytosis via increased erythropoietin and suppressed hepcidin: evidence for a new erythropoietin/hemoglobin set point. J Gerontol A Biol Sci Med Sci. 2014;69(6):725-35. Testosterone induces erythrocytosis via increased erythropoietin and suppressed hepcidin: evidence for a new erythropoietin/hemoglobin set point
  4. Nackeeran S, Kohn T, Gonzalez D, White J, Ory J, Ramasamy R. The Effect of Route of Testosterone on Changes in Hematocrit: A Systematic Review and Bayesian Network Meta-Analysis of Randomized Trials. J Urol. 2022;207(1):44-51. The Effect of Route of Testosterone on Changes in Hematocrit: A Systematic Review and Bayesian Network Meta-Analysis of Randomized Trials
  5. Panahi Y, Hosseini MS, Khalili N, Naimi E, Simental-Mendía LE, Majeed M, et al. Effects of curcumin on serum cytokine concentrations in subjects with metabolic syndrome: A post-hoc analysis of a randomized controlled trial. Biomed Pharmacother. 2016;82:578-82. Effects of curcumin on serum cytokine concentrations in subjects with metabolic syndrome: A post-hoc analysis of a randomized controlled trial
  6. Basheer B, Ila V, Barros R, Mesquita F, Lopes LS, Lima VFN, et al. Management of Adverse Effects in Testosterone Replacement Therapy. Int Braz J Urol. 2025;51(3). Management of Adverse Effects in Testosterone Replacement Therapy
  7. Jahanshahi M, Khalili M, Margedari A. Naringin Chelates Excessive Iron and Prevents the Formation of Amyloid-Beta Plaques in the Hippocampus of Iron-Overloaded Mice. Front Pharmacol. 2021;12:651156. Naringin Chelates Excessive Iron and Prevents the Formation of Amyloid-Beta Plaques in the Hippocampus of Iron-Overloaded Mice
  8. Vucenik I, Shamsuddin AM. Protection against cancer by dietary IP6 and inositol. Nutr Cancer. 2006;55(2):109-25. Protection against cancer by dietary IP6 and inositol
  9. Cuomo J, Appendino G, Dern AS, Schneider E, McKinnon TP, Brown MJ, et al. Comparative absorption of a standardized curcuminoid mixture and its lecithin formulation. J Nat Prod. 2011;74(4):664-9. Comparative absorption of a standardized curcuminoid mixture and its lecithin formulation
  10. Guo M, Perez C, Wei Y, Rapoza E, Su G, Bou-Abdallah F, et al. Iron-binding properties of plant phenolics and cranberry's bio-effects. Dalton Trans. 2007(43):4951-61. Iron-binding properties of plant phenolics and cranberry's bio-effects
  11. Boots AW, Drent M, de Boer VC, Bast A, Haenen GR. Quercetin reduces markers of oxidative stress and inflammation in sarcoidosis. Clin Nutr. 2011;30(4):506-12. Quercetin reduces markers of oxidative stress and inflammation in sarcoidosis
  12. Ohlander SJ, Varghese B, Pastuszak AW. Erythrocytosis Following Testosterone Therapy. Sex Med Rev. 2018;6(1):77-85. Erythrocytosis Following Testosterone Therapy
Evidence overview for AndroGel and Erythrocytosis: Supplements With the Best Evidence