New Zealand does not let me give blood to decrease high hematocrit on TRT

[Nelson Vergel]

I really think all of you guys on TRT in New Zealand should start a letter writing campaign.

In Aotearoa New Zealand the rules about who can and cannot give blood are drafted and maintained by the New Zealand Blood Service (NZBS | Te Ratonga Toto o Aotearoa), the Crown entity that collects, tests and distributes the nation’s blood supply. NZBS’s medical and scientific team periodically reviews the scientific evidence and overseas practice, then updates the “Donor Selection Criteria” and the Transfusion Medicine Handbook accordingly. Wikipedianzblood.co.nz

Because donor‐eligibility rules are considered a safety-critical part of a “biological medicine”, any material change must be cleared by Medsafe – the medicines-regulatory arm of the Ministry of Health that enforces the Medicines Act 1981. NZBS therefore submits its proposed criteria to Medsafe, which can approve, request modifications or reject them; only after Medsafe approval do the new rules take effect. nzblood.co.nz www.aabb.orgnzblood.co.nz

So, in practical terms:

1. NZBS decides the clinical details of donor-eligibility guidelines.
2. Medsafe signs off those guidelines to ensure they meet national regulatory safety standards.

Together these two bodies determine the blood-donation rules that apply in New Zealand.

 

[Nelson Vergel]

The New Zealand Blood Service (NZBS) explicitly says that erythrocytosis caused by testosterone-replacement therapy (TRT) is not an accepted indication for its therapeutic venesection (phlebotomy) programme. In the words of the NZBS Haemochromatosis & Therapeutic Venesection Policy, section 3 (Polycythaemia / Erythrocytosis):

“Patients with high haemoglobin levels as a complication of testosterone replacement therapy do not require therapeutic venesection.” nzblood.co.nz

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What that means in practice​

Topic	NZBS position
Referral to NZBS therapeutic venesection clinic	Referrals based solely on TRT-induced high Hb/Hct will be declined. NZBS regards dose adjustment, route change, or temporary cessation of testosterone as the appropriate management.
Alternative venues	If a man on TRT truly needs phlebotomy (e.g., very high Hct > 0.54 that cannot be controlled by modifying therapy), this must be arranged in a hospital service or privately—not through NZBS donor centres.
Ordinary blood donation	Men on TRT may donate blood as regular donors provided they meet all standard criteria (age, health, medications, Hb 130-185 g/L, Hct < 0.54, etc.). Donation under those rules is not considered “therapeutic” and is limited to the usual 12-week interval.
When NZBS does offer venesection	Accepted indications are hereditary haemochromatosis, polycythaemia rubra vera (PRV) and some other primary erythrocytoses, and porphyria cutanea tarda. Other conditions are only considered on a case-by-case basis with supporting evidence. nzblood.co.nz

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Practical takeaway for clinicians & patients on TRT​

1. First step is endocrine review – lowering the testosterone dose, switching from injections to transdermal formulations, or lengthening injection intervals usually resolves the elevated haematocrit.
2. Reserve venesection for rare cases where haematocrit remains dangerously high despite optimising therapy and alternative causes have been excluded; organise this via hospital haematology, not NZBS.
3. Do not send TRT patients to NZBS claiming “therapeutic blood donation” – the referral will be declined and valuable capacity diverted from patients with recognised indications.

 

[Nelson Vergel]

@JayD

Draft advocacy letter to NZBS​

Date: [Insert date]
To: Dr [Name], Medical Director
New Zealand Blood Service

Subject: Request to add testosterone-induced erythrocytosis to NZBS therapeutic venesection programme

Dear Dr [Name],

I am writing as a New Zealand resident undergoing testosterone-replacement therapy (TRT) for clinically diagnosed hypogonadism. TRT has restored my quality of life, but like many men on treatment it has also raised my haematocrit. My most recent full-blood-count showed a haematocrit of [XX] %, above the internationally accepted safety threshold of 0.50-0.54 %.

1 . International safety guidance​

• The Endocrine Society’s 2018 Clinical Practice Guideline recommends withholding or adjusting TRT and/or performing phlebotomy when haematocrit exceeds 54 %, noting the eight-fold rise in erythrocytosis risk above that level. [1]
• The American Urological Association likewise advises “hold TRT if HCT > 50 % and reinstate at a lower dose once normalised.” [2]
• European Urology and other reviews confirm that regular phlebotomy is a proven, low-risk method to control TRT-induced erythrocytosis. [3, 4]

Elevated haematocrit increases blood viscosity and the odds of thrombo-embolic events; therapeutic venesection lowers viscosity by ~3 % per 450 mL unit removed. [5]

2 . Established practice in the United States​

• Carter BloodCare operates an FDA-approved variance programme offering no-cost phlebotomies every 2–8 weeks for TRT patients, and can even transfuse collected units if the donor meets standard eligibility. [6, 7]
• The American Red Cross performs over 10 000 therapeutic apheresis procedures annually, including for testosterone-related polycythaemia. [8]
• These services follow AABB Standard 5.6.7.1, which differentiates therapeutic draws from standard allogeneic donations yet allows use of the blood if all criteria are met. [9]

3 . Gap in current NZBS policy​

Section 3.1 of NZBS Policy 111P012 (“Haemochromatosis & Therapeutic Venesection”) currently states that “patients with high haemoglobin levels as a complication of testosterone replacement therapy do not require therapeutic venesection.” [10] This leaves TRT patients ineligible for NZBS venesection clinics even when their haematocrit exceeds evidence-based safety limits, forcing them to seek more costly or less convenient private options.

4 . Requested action​

I respectfully ask NZBS to:

1. Add testosterone-induced secondary erythrocytosis to the list of accepted indications for therapeutic venesection, alongside polycythaemia vera and hereditary haemochromatosis.
2. Adopt the US threshold (HCT ≥ 0.54 or clinician-directed ≥ 0.50) and minimum interval (14 days) used by centres such as Carter BloodCare.
3. Allow units collected from otherwise eligible TRT donors to enter the allogeneic supply, further securing New Zealand’s blood inventory.

I have enclosed copies of the relevant Endocrine Society and AUA guidelines, the AABB standard, and the Carter BloodCare TRT phlebotomy enrolment form for your consideration. I would be grateful for an opportunity to discuss this proposal with NZBS clinicians or policy staff, and I am willing to participate in any pilot programme that may be required.

Thank you for your time and for NZBS’s continued commitment to donor and patient safety.

Yours sincerely,

[Name]
[Address]
[NHI or DOB]
[Phone / Email]

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References for NZBS (attach or link as endnotes)​

1. Endocrine Society Clinical Practice Guideline, JCEM 2018 – monitoring & 54 % rule MediRequestsOxford Academic
2. AUA Guideline summary – hold TRT if HCT > 50 % ASH Publications
3. European Urology Focus review on TRT-erythrocytosis management European Urology Focus
4. Bioscientifica review: phlebotomy as practical option Bioscientifica
5. The Blood Project educational brief on TRT & erythrocytosis The Blood Project
6. Carter BloodCare TRT programme overview Carter BloodCare
7. Carter BloodCare enrolment/prescription form Carter BloodCare
8. American Red Cross therapeutic-apheresis service description Red Cross Blood
9. AABB Standards (5.6.7.1) regarding therapeutic phlebotomy mabbweb.org
10. NZBS Policy 111P012, clause 3.1 – current exclusion of TRT cases NZ Blood