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Is There A Connection Between Low-T And Anemia?

Last Updated: August 28, 2025
anemia

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
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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
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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.

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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.

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
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There is also risk associated with testosterone replacement therapy, including acne, sleep apnea increased estradiol, gynecomastia, 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.

Conclusion

As you address the concerns of low testosterone and its connection to anemia, consider the benefits of Enclomiphene. Available at Invigor Medical, Enclomiphene can help manage hormone levels effectively, potentially improving symptoms of anemia associated with low testosterone. This treatment offers a strategic approach to enhance your overall health and hormonal balance. Buy Enclomiphene today to start seeing improvements in your energy levels and overall vitality.

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Frequently Asked Questions

Can low testosterone cause anemia?

Low testosterone levels have been associated with anemia, particularly in men. Testosterone plays a role in stimulating erythropoiesis, the process of red blood cell production in bone marrow. Therefore, low testosterone levels may contribute to decreased red blood cell production, leading to anemia.

Can testosterone affect iron levels?

Testosterone can affect iron levels indirectly by influencing erythropoiesis. As testosterone stimulates red blood cell production, it may also influence the utilization and regulation of iron in the body. However, the relationship between testosterone and iron levels is complex and may vary based on individual factors and underlying health conditions.

Does testosterone regulate red blood cells?

Testosterone does play a role in regulating red blood cell production. It stimulates the production of erythropoietin, a hormone produced by the kidneys that stimulates the bone marrow to produce red blood cells. Therefore, adequate testosterone levels are essential for maintaining healthy red blood cell counts.

What can cause anemia besides low iron?

Anemia can be caused by various factors besides low iron levels. These include deficiencies in other nutrients like vitamin B12 and folate, chronic diseases such as kidney disease or cancer, bone marrow disorders, chronic inflammation, genetic conditions like sickle cell anemia or thalassemia, and certain medications or treatments like chemotherapy. It’s essential to identify the underlying cause of anemia to determine the appropriate treatment approach.

Written by

Leann Poston M.D.
Leann Poston M.D.
Licensed Physician and Medical Content Reviewer
Dr. Leann Poston is a licensed physician in the state of Ohio who holds an M.B.A. and an M. Ed. She is a full-time medical communications writer and educator who writes and researches for Invigor Medical. Dr. Poston lives in the Midwest with her family. She enjoys traveling and hiking. She is an avid technology aficionado and loves trying new things.

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Leann Poston M.D.
Leann Poston M.D.
Licensed Physician and Medical Content Reviewer
Dr. Leann Poston is a licensed physician in the state of Ohio who holds an M.B.A. and an M. Ed. She is a full-time medical communications writer and educator who writes and researches for Invigor Medical. Dr. Poston lives in the Midwest with her family. She enjoys traveling and hiking. She is an avid technology aficionado and loves trying new things.

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