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

Hi Guys

Blood lab turned me away for having Haemoglobin of 198. Apparently the limit is 185(Here in New Zealand)

I am currently on 80mg(split twice a week 40+40)of test cyp deep IM. Have been on this for 4 months and going well. Can't do and form of subq as gives me anxiety insomnia and gummyworm dick.

Should I lower my dose?

Latest labs below

Thanks

Prolactin 489mU/L(65-400)(taking cabergoline quarter of a 0.5mg tablet per week)
Total testosterone 22nmol/L(8.6-29)
Free testosterone 667pmol/L(220-680)
SHBG 17pmol/L(13-49)
Estradiol 143pmol/L(0-190)
Ferritin 46ug/L(30-500)
PVC 0.55 L/L(0.40-0 54)
Haemoglobin 184 g/L(125-170)
RBC 6.2x10'12/L(4.0-5.8)

____________________________________

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

---

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

---

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.

 

Tell them you want to pay cash.

From perplexity:

Men on testosterone replacement therapy (TRT) can develop elevated hematocrit (erythrocytosis), which increases the risk of blood clots and other complications. In many countries, therapeutic phlebotomy (removal of blood to reduce hematocrit) is a recognized management option if hematocrit rises above a certain threshold, usually around 54%[6].



In New Zealand, the approach is more restrictive. According to the New Zealand Blood Service (NZBS) policy, therapeutic venesection (phlebotomy) is provided for specific conditions such as hereditary haemochromatosis, polycythaemia vera, and porphyria cutanea tarda. However, the policy explicitly states:

> "Patients with high haemoglobin levels as a complication of testosterone replacement therapy do not require therapeutic venesection."[5]

This means that, in New Zealand, men who develop elevated hematocrit as a side effect of TRT are generally not eligible for therapeutic phlebotomy through the NZBS. Instead, the usual management involves adjusting the TRT dose or frequency, or temporarily discontinuing therapy, as recommended by several international guidelines[6]. Only in rare cases, and at the discretion of a specialist, might venesection be considered.

If you have further questions about managing TRT side effects in New Zealand or want to discuss alternatives, let me know!

Citations:
[1] Testosterone replacement therapy | Healthify
[2] Prescribing testosterone in ageing males - BPJ69
[3] Testosterone Replacement Therapies
[4] https://medcom.nz/wp-content/uploads/2020/05/Testosterone-Deficiency.pdf
[5] https://www.nzblood.co.nz/assets/Transfusion-Medicine/PDFs/111P012.pdf
[6] Testosterone therapy-induced erythrocytosis: can phlebotomy be justified? - PMC
[7] Testosterone Doctors in New Zealand - Excel Male TRT Forum
[8] Prescribing testosterone in ageing males - bpacnz
[9] Testosterone Replacement – Doctor 360
[10] Advanced TRT Testosterone Replacement Therapy Blood Test
[11] https://blogs.otago.ac.nz/rainbow/f...es_Patient-information-sheet_Testosterone.pdf
[12] Testosterone replacement therapy | Healthify
[13] Testosterone Replacement Therapy (TRT) by Men’s Health Clinic
[14] https://academic.oup.com/jcem/article/103/5/1715/4939465
[15] Male Hormone Replacement - Dr Bill Reeder
[16] https://biote.com/research/testosterone-in-men-a-review
[17] https://testguide.adhb.govt.nz/eguidemob/?gm=1401&gs=3
[18] Testosterone Therapy — Selfcaremen
[19] https://menshealthclinic.com/nz/treatments/testosterone-replacement-therapy/
[20] https://selfcaremen.co.nz

 

In New Zealand, men on testosterone replacement therapy (TRT) who develop elevated hematocrit and require therapeutic phlebotomy face significant restrictions:

• New Zealand Blood Service (NZBS) Policy: Therapeutic venesection (phlebotomy) is generally only provided for specific conditions such as hereditary haemochromatosis, polycythaemia vera, and porphyria cutanea tarda5. Elevated hematocrit due to TRT (testosterone-induced erythrocytosis) is not an approved indication for therapeutic phlebotomy under NZBS25.
• Referral Process: All patients needing therapeutic phlebotomy must be referred in writing by a physician or general practitioner, with detailed medical information included25. However, unless you have one of the specific approved diagnoses (e.g., hereditary haemochromatosis), your referral for TRT-induced erythrocytosis will not normally be accepted by NZBS25.
• Hospital-Based Options: If you are not eligible for NZBS venesection, you may be referred to your local hospital for assessment and possible management by a specialist2. Hospital-based therapeutic phlebotomy may be considered in rare cases at the discretion of a hospital physician, particularly if your hematocrit is dangerously high and other interventions (like adjusting TRT dosage) are not effective.
• Alternative Management: Most men with high hematocrit on TRT in New Zealand will be managed by adjusting their TRT dose, changing the delivery method, or temporarily stopping therapy, as recommended by international guidelines3.

Summary Table: Access to Therapeutic Phlebotomy for TRT-Induced High Hematocrit in NZ

Pathway	Eligibility for TRT-Induced Polycythemia?	Notes
NZBS Donor Centre	No	Only for approved conditions25
Hospital/Specialist Referral	Rare, case-by-case	Specialist discretion, not guaranteed2
Blood Donation	Not recommended for therapeutic use	May not be accepted if high hematocrit

What to do:

• Discuss with your doctor about adjusting your TRT or exploring other causes of high hematocrit.
• If your hematocrit is dangerously high, your doctor can refer you to a hospital specialist for further assessment.

Would you like more details on managing high hematocrit while on TRT, or information about alternative options in New Zealand?

Citations:​

1. Testosterone replacement therapy | Healthify
2. https://www.nzblood.co.nz/assets/Transfusion-Medicine/PDFs/111I025.pdf
3. High Hematocrit on TRT? Here's How to Reduce It.
4. https://medcom.nz/wp-content/uploads/2020/05/Testosterone-Deficiency.pdf
5. https://www.nzblood.co.nz/assets/Transfusion-Medicine/PDFs/111P012.pdf
6. Testosterone Doctors in New Zealand - Excel Male TRT Forum
7. Therapeutic Phlebotomy Service
8. Therapeutic Venesection | Test
9. https://www.liebertpub.com/doi/10.1089/andro.2021.0019
10. Advanced TRT Testosterone Replacement Therapy Blood Test
11. Therapeutic Phlebotomy for Testosterone-Induced Polycythemia - PubMed
12. https://www.awanuilabs.co.nz/south/...5/2020/05/Venesection-Covid19-limitations.pdf
13. Management of hematocrit levels for testosterone replacement patients, a narrative review - PubMed
14. https://testosteroneclinic.co.nz
15. https://www.nzblood.co.nz/become-a-donor/am-i-eligible/detailed-eligibility-criteria/
16. Prescribing testosterone in ageing males - bpacnz
17. Sodium-glucose co-transporter 2 (SGLT2) inhibitors and potential risk for polycythaemia
18. https://selfcaremen.co.nz
19. Testosterone therapy-induced erythrocytosis: can phlebotomy be justified? - PMC

 

Tell them you want to pay cash.

From perplexity:

Men on testosterone replacement therapy (TRT) can develop elevated hematocrit (erythrocytosis), which increases the risk of blood clots and other complications. In many countries, therapeutic phlebotomy (removal of blood to reduce hematocrit) is a recognized management option if hematocrit rises above a certain threshold, usually around 54%[6].

In New Zealand, the approach is more restrictive. According to the New Zealand Blood Service (NZBS) policy, therapeutic venesection (phlebotomy) is provided for specific conditions such as hereditary haemochromatosis, polycythaemia vera, and porphyria cutanea tarda. However, the policy explicitly states:

> "Patients with high haemoglobin levels as a complication of testosterone replacement therapy do not require therapeutic venesection."[5]

This means that, in New Zealand, men who develop elevated hematocrit as a side effect of TRT are generally not eligible for therapeutic phlebotomy through the NZBS. Instead, the usual management involves adjusting the TRT dose or frequency, or temporarily discontinuing therapy, as recommended by several international guidelines[6]. Only in rare cases, and at the discretion of a specialist, might venesection be considered.

If you have further questions about managing TRT side effects in New Zealand or want to discuss alternatives, let me know!

Citations:
[1] Testosterone replacement therapy | Healthify
[2] Prescribing testosterone in ageing males - BPJ69
[3] Testosterone Replacement Therapies
[4] https://medcom.nz/wp-content/uploads/2020/05/Testosterone-Deficiency.pdf
[5] https://www.nzblood.co.nz/assets/Transfusion-Medicine/PDFs/111P012.pdf
[6] Testosterone therapy-induced erythrocytosis: can phlebotomy be justified? - PMC
[7] Testosterone Doctors in New Zealand - Excel Male TRT Forum
[8] Prescribing testosterone in ageing males - bpacnz
[9] Testosterone Replacement – Doctor 360
[10] Advanced TRT Testosterone Replacement Therapy Blood Test
[11] https://blogs.otago.ac.nz/rainbow/f...es_Patient-information-sheet_Testosterone.pdf
[12] Testosterone replacement therapy | Healthify
[13] Testosterone Replacement Therapy (TRT) by Men’s Health Clinic
[14] https://academic.oup.com/jcem/article/103/5/1715/4939465
[15] Male Hormone Replacement - Dr Bill Reeder
[16] https://biote.com/research/testosterone-in-men-a-review
[17] Test Guide Mobile
[18] https://selfcaremen.co.nz/testosteronetherapy
[19] https://menshealthclinic.com/nz/treatments/testosterone-replacement-therapy/
[20] https://selfcaremen.co.nz

Thanks for the information Nelson, I guess I'm dropping my dose then...

 

New Zealand has some elevations reaching 12,000 ft, so it would be helpful if you posted your altitude because high hemoglobin at sea level on TRT and living at high altitude also while on TRT may not present with the same vascular conditions within the body.

I find I can tolerate high hemoglobin only when my ferritin is <80.

How's your blood pressure?

If I go down to say 60mg a wk split, should I skip a dose to bring my Hemoglobin down?

 

If I go down to say 60mg a wk split, should I skip a dose to bring my Hemoglobin down?

There's no possible way anyone could answer your question with any degree of certainty.

 

There's no possible way anyone could answer your question with any degree of certainty.

Cool' I think I'll just stay where I am then as I feel good for the most part

 

Hi Guys

Blood lab turned me away for having Haemoglobin of 198. Apparently the limit is 185(Here in New Zealand)

I am currently on 80mg(split twice a week 40+40)of test cyp deep IM. Have been on this for 4 months and going well. Can't do and form of subq as gives me anxiety insomnia and gummyworm dick.

Should I lower my dose?

Latest labs below

Thanks

Prolactin 489mU/L(65-400)(taking cabergoline quarter of a 0.5mg tablet per week)
Total testosterone 22nmol/L(8.6-29)
Free testosterone 667pmol/L(220-680)
SHBG 17pmol/L(13-49)
Estradiol 143pmol/L(0-190)
Ferritin 46ug/L(30-500)
PVC 0.55 L/L(0.40-0 54)
Haemoglobin 184 g/L(125-170)
RBC 6.2x10'12/L(4.0-5.8)

Your weekly T dose is <100 mg/week.

80 mg/week split (40 mg every 3.5 days).

Although your TT 22 nmol/L (634.5 ng/dL) is far from high with a lowish SHBG 17 nmol/L your FT would still be healthy as you would be hitting a cFTV 18.9 ng/dL.

Free & Bioavailable Testosterone calculator

Most healthy young males would be hitting a cFTV 13-15 ng/dL and this is a short-lived daily peak to boot.

How many days post-injection were labs done?

Keep in mind If your labs were done at true trough (84 hrs post-injection) then your peak TT and more importantly FT will be even higher.

Were you well hydrated (fluids/electrolytes) days before having blood work done?

If not I would retest before jumping to any conclusions let alone lowering your T dose!

When it comes to your protocol (dose of T/injection frequency) and what trough FT level you are hitting if blood markers are healthy you are not experiencing any sides and you feel good overall then I would see no issue with changing anything,

If your RBCs, hemoglobin and hematocrit are elevated due to running too high a trough/steady-state FT and you are expereincing sides then the most sensible move would be to lower your trough FT.

My reply from an older thread!

Again if one has no underlying health issues and is not experiencing any negative sides most in the know specializing in testosterone therapy would not fret if the patient's hematocrit falls within 50-54%.

Yes some will be more cautious and take measures once hematocrit hits 52%.

Most of the endos are sticklers and hesitate once your hematocrit gets over the top end and prefer to keep patients levels no higher than 50%.

Post in thread 'High Testosterone on only 80mg/week'

Jun 22, 2024

Based on the comments you made here about a hematocrit of below 54 being safe are you willing to stand liable for giving out this false information if the OP has a stroke or heart attack?

Also please enlighten us on where you attended medical school and where you got your degree in endocrinology?

If you are having to give blood to reduce the hematocrit, you are not on "TRT" you are taking a small steroid cycle and calling it TRT.

As for my advice to the poster, I know personally of two people I have given similar advice to, both had strokes under the age of fifty. One with a...

• madman

• 

 

Hi Guys

Blood lab turned me away for having Haemoglobin of 198. Apparently the limit is 185(Here in New Zealand)

I am currently on 80mg(split twice a week 40+40)of test cyp deep IM. Have been on this for 4 months and going well. Can't do and form of subq as gives me anxiety insomnia and gummyworm dick.

Should I lower my dose?

Latest labs below

Thanks

Prolactin 489mU/L(65-400)(taking cabergoline quarter of a 0.5mg tablet per week)
Total testosterone 22nmol/L(8.6-29)
Free testosterone 667pmol/L(220-680)
SHBG 17pmol/L(13-49)
Estradiol 143pmol/L(0-190)
Ferritin 46ug/L(30-500)
PVC 0.55 L/L(0.40-0 54)
Haemoglobin 184 g/L(125-170)
RBC 6.2x10'12/L(4.0-5.8)

Post in thread 'High Testosterone on only 80mg/week'

Jun 22, 2024

Based on the comments you made here about a hematocrit of below 54 being safe are you willing to stand liable for giving out this false information if the OP has a stroke or heart attack?

Also please enlighten us on where you attended medical school and where you got your degree in endocrinology?

If you are having to give blood to reduce the hematocrit, you are not on "TRT" you are taking a small steroid cycle and calling it TRT.

As for my advice to the poster, I know personally of two people I have given similar advice to, both had strokes under the age of fifty. One with a...

• madman

• 

Luckily I have been able to stick with my protocol over the years.

8 years in and still going strong.

Blood work is stellar and yes I have always run a high-end trough TT/FT.

Those beloved injections (150 mg T) split twice-weekly strictly sub-q.

Yes my hematocrit hovers 50-52% and I feel great overall no sides

 

If I go down to say 60mg a wk split, should I skip a dose to bring my Hemoglobin down?

The most effective and fast way to decrease hematocrit without blood donation is taking an ARB like losartan or others.

Thread 'Can Losartan decrease high hematocrit caused by testosterone replacement?'

Apr 19, 2015

Recently I had a really bad cold with a severe cough. It was so bad my doc put me on a bunch of stuff to reduce inflammation in my Bronchial and some cough trigger pills. He also had me stop using Lisinopril. It's one side affect in a drip and cough. I didn't take Lisinopril for BP, I toke it for migraines. So once my cold died and my cough settled he put me on Losartan(ARB). It's very similar to Lisinopril but the process in which it relaxes the blood vessels is a little different. Well today I went in for my 2 month blood donation. Well my hemoglobin was 15. It hasn't been that low since...

• Steelballs
• Replies: 44
• Forum: Testosterone Side Effect Management

 

The most effective and fast way to decrease hematocrit without blood donation is taking an ARB like losartan or others.

Thread 'Can Losartan decrease high hematocrit caused by testosterone replacement?'

Apr 19, 2015

Recently I had a really bad cold with a severe cough. It was so bad my doc put me on a bunch of stuff to reduce inflammation in my Bronchial and some cough trigger pills. He also had me stop using Lisinopril. It's one side affect in a drip and cough. I didn't take Lisinopril for BP, I toke it for migraines. So once my cold died and my cough settled he put me on Losartan(ARB). It's very similar to Lisinopril but the process in which it relaxes the blood vessels is a little different. Well today I went in for my 2 month blood donation. Well my hemoglobin was 15. It hasn't been that low since...

• Steelballs
• Replies: 44
• Forum: Testosterone Side Effect Management

What is the most effective shallow IM dosing regimen to help lower high RBC’s, H&H? Is it ED, EOD or E3.5 days? I know everyone responds differently, but has anyone had success with one protocol vs another. I have read that 2x week may be beneficial. Any insights provided are appreciated.

 

Your hematocrit is probably 54 and you are taking a relatively lower dose. I would not worry too much. Make sure next time you get blood drawn that you are well hydrated. Some guys say narigin supplements help.

How to Lower High Hematocrit on TRT

Discover effective strategies on how to lower high hematocrit and red blood cell count while on testosterone. Explore tips and techniques on our blog to manage high hematocrit levels.

www.discountedlabs.com

 

Your weekly T dose is <100 mg/week.

80 mg/week split (40 mg every 3.5 days).

Although your TT 22 nmol/L (634.5 ng/dL) is far from high with a lowish SHBG 17 nmol/L your FT would still be healthy as you would be hitting a cFTV 18.9 ng/dL.

Free & Bioavailable Testosterone calculator

View attachment 51786

Most healthy young males would be hitting a cFTV 13-15 ng/dL and this is a short-lived daily peak to boot.

How many days post-injection were labs done?

Keep in mind If your labs were done at true trough (84 hrs post-injection) then your peak TT and more importantly FT will be even higher.

Were you well hydrated (fluids/electrolytes) days before having blood work done?

If not I would retest before jumping to any conclusions let alone lowering your T dose!

When it comes to your protocol (dose of T/injection frequency) and what trough FT level you are hitting if blood markers are healthy you are not experiencing any sides and you feel good overall then I would see no issue with changing anything,

If your RBCs, hemoglobin and hematocrit are elevated due to running too high a trough/steady-state FT and you are expereincing sides then the most sensible move would be to lower your trough FT.

My reply from an older thread!

Again if one has no underlying health issues and is not experiencing any negative sides most in the know specializing in testosterone therapy would not fret if the patient's hematocrit falls within 50-54%.

Yes some will be more cautious and take measures once hematocrit hits 52%.

Most of the endos are sticklers and hesitate once your hematocrit gets over the top end and prefer to keep patients levels no higher than 50%.

Post in thread 'High Testosterone on only 80mg/week'

Jun 22, 2024

Based on the comments you made here about a hematocrit of below 54 being safe are you willing to stand liable for giving out this false information if the OP has a stroke or heart attack?

Also please enlighten us on where you attended medical school and where you got your degree in endocrinology?

If you are having to give blood to reduce the hematocrit, you are not on "TRT" you are taking a small steroid cycle and calling it TRT.

As for my advice to the poster, I know personally of two people I have given similar advice to, both had strokes under the age of fifty. One with a...

• madman

• 

Bloods were taken early morning round 730am. I inject 8am Monday morning and 8 pm Thursday night.

I may of had a glass of water before the injection I'm not too sure.

Sorry if it's a dumb question but how did you arrive at 100mg a week

IM just wondering if the Hemoglobin, RBC, PCV will all stabilise (come down) after I've been on TRT for a year or so? Is that a thing?

Thanks for the info

 

Bloods were taken early morning round 730am. I inject 8am Monday morning and 8 pm Thursday night.

I may of had a glass of water before the injection I'm not too sure.

Sorry if it's a dumb question but how did you arrive at 100mg a week

IM just wondering if the Hemoglobin, RBC, PCV will all stabilise (come down) after I've been on TRT for a year or so? Is that a thing?

Thanks for the info

You tested at ttue trough so your peak TT and more importantly FT will be higher.

Need to be hydrated (fluids/electrolytes) days before going for blood work otherwise when testing hematocrit your resuts can be skewed.

Yes drinking fluids and taking in some sodium pre donation is common but if you are already dehydrated due to not taking in enough fluid/electrolytes well in advance than your results will be skewed!

I stated that you were injecting <100 mg/week just to point out that you are still achieving a very healthy FT injecting less than the common starting dose.

When first starting TTh or tweaking a protocol (increasing dose of T) hematocrit will start rising within the 1st month and can take anywhere from 6-9 months or in some cases up to a year to reach peak levels.

Levels tend to stabilize over time but there are many who still struggle with high levels especially the men caught up on riunning too high a trough/steady-state FT level let alone those who had high-end hematocrit pre-TTh or underlying issues contributing to such.

 

Hi Guys

Blood lab turned me away for having Haemoglobin of 198. Apparently the limit is 185(Here in New Zealand)

I am currently on 80mg(split twice a week 40+40)of test cyp deep IM. Have been on this for 4 months and going well. Can't do and form of subq as gives me anxiety insomnia and gummyworm dick.

Should I lower my dose?

Latest labs below

Thanks

Prolactin 489mU/L(65-400)(taking cabergoline quarter of a 0.5mg tablet per week)
Total testosterone 22nmol/L(8.6-29)
Free testosterone 667pmol/L(220-680)
SHBG 17pmol/L(13-49)
Estradiol 143pmol/L(0-190)
Ferritin 46ug/L(30-500)
PVC 0.55 L/L(0.40-0 54)
Haemoglobin 184 g/L(125-170)
RBC 6.2x10'12/L(4.0-5.8)

Hi there ,


- Did you hydrate enough before the bloodwork ? As going in dehydrated can give false readings ( higher than normal ).

 

Hi there ,


- Did you hydrate enough before the bloodwork ? As going in dehydrated can give false readings ( higher than normal ).

I probably didn't as was first thing in the morning around 730am. I do drink around 2 Litres of liquid a day

 

Quick up date

I dropped my dose to 30mg+30mg per week since putting up this post. I have not really noticed a difference from my previous dose. Just in the last few weeks I have developed lower sensitivity and weaker erections. Has anyone else experienced this on Test cypionate at around 8 months in?. I have read a lot of guys on Reddit getting erectile dysfunction at around 1 year on TRT and having to come off or use HCG if they can tolerate it. Is it a case of increasing or decreasing injection frequency?(Increasing my actual mg dose Is a no go due to sides)Is it the ester? Do I need to add HCG? (which did not agree with me the first time I tried it, and Kisspeptin skyrocketed my prolactin) I tried half a Viagra but it just made my nose stuffy, my face red and gave me a bit of a headache, don't really feel I actually got anything out of it strangely.

Is there guys out there in there late 40's that get rock hard erections and brilliant sensitivity on T alone? I was fine in that department before TRT

 

I would try daily/more frequent injections of Test to deal with Hct.

As far as sensitivity, i think most guys will experience a loss of it without hCG or/and Preg/DHEA supplementation after a few years on TRT.

I personally never had issues with erections but my sensitivity goes down significantly without hCG, no question.

As far as poor reactions to hCG, daily injections are also a good thing to try. Start low (50iu/day) and go from there. Even 50iu/day makes a difference even if that ends up being all you can withstand without significant E2 side effects.

 

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.

 

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

---

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

---

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.