Anabolic Steroids & High Hematocrit

Hematocrit is the measure of the proportion of red blood cells in your blood. With more red blood cells, your blood becomes thicker and can carry more oxygen. While this might help athletes perform better for a short time, it also makes your blood flow slower and increases the risk of blood clots, heart attacks, or strokes. This post will explore the implications of elevated hematocrit levels and discuss potential strategies to mitigate these risks.

What is Hematocrit

Hematocrit (HCT) is expressed as a percentage and indicates how much of the total blood volume is taken up by red blood cells (RBC). For instance, if you have a hematocrit level of 45%, that means 45% of your blood volume is composed of red blood cells, while the remaining 55% is made up of other components like plasma (the liquid part), white blood cells, and platelets.

A healthy hematocrit range varies by age and sex. In general, for adult men, it's around 38-52%, and for women, it's about 35-47%. The level can give important clues about your overall health. For example, a high level could suggest dehydration or a condition like polycythemia (too many red blood cells).

Why Steroids Increase RBC

Red blood cells are primarily created in our bone marrow. Steroids stimulate this production through two mechanisms:

  • Increased Erythropoietin Production: Anabolic steroids indirectly increase the production of red blood cells by stimulating the production of erythropoietin, a hormone that promotes the production of red blood cells in bone marrow.
  • Direct Bone Marrow Stimulation: Testosterone directly stimulates the bone marrow to produce more red blood cells.

Implications of Elevated Hematocrit

Elevated hematocrit levels, secondary polycythemia, can have various implications for health. Here’s an overview:

  • Increased Risk of Thrombosis: The primary concern with high hematocrit levels is the increased risk of thrombosis (blood clots). Blood clots can obstruct blood vessels, leading to severe complications such as strokes, heart attacks, or pulmonary embolism. These conditions can be life-threatening and require immediate medical attention.
  • Cardiovascular Strain: Elevated hematocrit thickens the blood, which makes it harder for the heart to pump it through the body. This increased workload can lead to hypertension (high blood pressure) and other cardiovascular issues, potentially worsening existing heart conditions or precipitating new ones.
  • Organ Damage: High hematocrit can reduce the efficiency of blood flow to vital organs, potentially leading to organ damage. Organs like the kidneys and brain rely on a steady, efficient blood supply to function properly, and compromised blood flow can lead to organ dysfunction or failure.


Symptoms of elevated hematocrit can vary depending on the severity of the condition and the rate at which hematocrit levels rise.

Mild Elevation (45-50% in Women, 50-54% in Men):

  • Symptoms: Mild elevations often cause no symptoms or very subtle ones, such as slight fatigue or mild headaches. Many individuals may not notice any changes and discover elevated levels only through routine blood tests.

Moderate Elevation (51-55% in Women, 55-60% in Men):

  • Symptoms: As levels increase, symptoms become more noticeable. These can include dizziness, headaches, fatigue, and a feeling of fullness in the head or face. Visual disturbances, such as blurry vision or seeing flashes of light, may start to occur.

High Elevation (Above 55% in Women, Above 60% in Men):

  • Symptoms: At these levels, symptoms are more severe and can significantly impact daily activities. These include pronounced headaches, frequent dizziness, chest pain, difficulty breathing, and a noticeable reddening of the skin. There might be numbness or tingling in the extremities due to poor circulation.
  • Increased Risk: There is a higher risk of thrombotic events (like deep vein thrombosis or pulmonary embolism), hypertension, and complications related to reduced blood flow to critical organs.

Very High Levels (Above 60%):

  • Symptoms: These are critical levels where the blood becomes markedly thicker. Symptoms include severe headaches, intense itching (especially after exposure to hot water), chest pain, heart palpitations, and major visual disturbances. There can also be confusion or changes in mental status due to reduced cerebral blood flow.
  • Emergency Situations: At very high levels, the risk of life-threatening blood clots and cardiovascular events (such as heart attacks and strokes) is significantly increased. Immediate medical attention is required.

Lowering HTC / RBC

Lowering hematocrit levels involves several targeted approaches. These methods aim to reduce the concentration of red blood cells and mitigate associated health risks.

Discontinuation of Steroids: The first and most obvious step is to stop using anabolic steroids, as they are a direct cause of increased red blood cell production.

Phlebotomy: Regularly scheduled phlebotomy, or therapeutic blood removal, such as through donating blood is a common and effective method to directly reduce hematocrit levels. Note: It’s important to check with Canadian Blood Service to ensure you are eligible. Those on certain medications such as Finasteride, Dutasteride, and Accutane (isotretinoin) may cause birth defects if the blood is transfused to a pregnant woman.

Hydration: Dehydration can exacerbate high hematocrit levels. Increasing water intake can help dilute the blood, thus lowering the hematocrit. This is particularly important for those who may not be adequately hydrated.


  • Aspirin: Taking low-dose aspirin may be recommended to reduce the risk of blood clots, although this should be done under medical advice to avoid potential side effects like gastrointestinal bleeding.
  • Angiotensin-converting enzyme (ACE) inhibitors or Angiotensin II receptor blockers (ARBs): These medications can also help reduce hematocrit levels and manage blood pressure, especially in those who have developed hypertension from steroid use.

Grapefruit & Seed Extract (Naringin): Grapefruit has been shown to lower elevated hematocrits in some studies.

Regular Exercise: Engaging in regular cardiovascular exercise can help improve heart health and blood circulation, which is beneficial for managing elevated hematocrit.

Dietary Adjustments: Reducing iron intake can help manage hematocrit levels since iron is crucial for red blood cell production. This involves limiting high-iron foods such as red meat and liver.

Monitoring and Regular Testing

Regular blood tests, including complete blood counts (CBC), play a vital role in monitoring hematocrit levels and fine-tuning treatment approaches. For instance, frequent blood donations without accompanying blood work can lead to a significant drop in iron and ferritin levels, potentially resulting in anemia. Thus, consistent testing is crucial to verify that hematocrit levels are normalizing and that the chosen interventions are successful.

Disclaimer: This blog post is intended for educational purposes only and should not be taken as medical advice. Always consult your healthcare provider for personal health concerns.