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Donating Blood on Testosterone Replacement Therapy 

By Rick Collins, Esq.

 

 

Q: I’m on prescribed testosterone replacement therapy. Can I donate blood to lower my blood volume and hematocrit?

           

A: According to the American Red Cross, every two seconds someone in the United States needs blood. More than 38,000 blood donations are needed every day and a single car accident victim can require as many as 100 pints of blood. Patients diagnosed with cancer and other diseases can require frequent blood transfusions. Just one donation can save up to three lives. A “phlebotomy” takes only 10 or 15 minutes and is safe and sterile. You can research the process1 and the need2 online. Being a blood donor is something good to do for the sake of others.

           

Not everyone can donate blood. You must be in good general health, weigh at least 110 pounds, and be at least 16 years old. Before donating, you will be asked confidential health questions including whether you have “ever used injectable drugs, including anabolic steroids, unless prescribed by a physician.” If you’ve illegally used injectable steroids, sorry, you’re ineligible. You also must have normal hematocrit and hemoglobin levels. Hematocrit level is the percentage of red blood cells (RBCs) in your blood. Hematocrit below the normal range means too few RBCs – anemia; above the normal range may indicate conditions like polycythemia or erythrocytosis. Hemoglobin is a protein that enables RBCs to transport oxygen. Before you donate blood, your finger is pricked to make sure your hematocrit or hemoglobin levels are normal.

           

Now, let’s talk about medically prescribed testosterone replacement therapy (TRT). Even medical doses may cause an increase in RBCs, higher blood viscosity, and greater clotting risk. Some physicians recommend treating this by donating blood on a regular basis, although there is some question as to whether frequent blood donations are sufficient to keep hematocrit levels down.3 Donation for this purpose would require a doctor’s approval and be categorized as a “therapeutic phlebotomy.” But while this procedure could benefit the TRT patient, what about the safety of the blood for transfusion recipients? Concerns about the safety of blood from a TRT patient led to a policy of throwing away the blood products collected. Therapeutic phlebotomy offered no benefit to the people needing transfusions, so donors had to pay for the procedure – a cost as high as $500.

           

That changed in 2014, when a therapeutic phlebotomy exception was added to the Code of Federal Regulations to allow blood centers to accept the blood of TRT patients.4 The variance permits “individuals on prescription testosterone to donate blood and blood components more frequently than every eight weeks without examination or certification of health by physician at time of donation, provided the donor is referred with a prescription by a physician containing instructions regarding frequency of phlebotomy and hematocrit/hemoglobin limits and to be exempt from placing special labeling about the donor’s disorder on the blood components.” However, because there are still unknowns about TRT, only the RBCs collected may be distributed for transfusion, not the plasma and platelet components.

 

It seemed a shame to throw away blood safely collected at a blood collection center,” an article on the subject recently observed, “but [blood centers were] pressed routinely to do just that. … Until now, [TRT patients were charged] when they came to the blood center with a doctor’s prescription to have blood drawn. Now they can donate blood like any other donor.”5

           

Except that most blood centers don’t ask donors if they are on TRT, so they won’t know to use only the RBCs for distribution and not the plasma and platelets. As they may be unaware of the FDA variance, the ethical thing to do is to advise them that you’re on TRT. They should then accept your donation but only use the RBCs for distribution. The better practice would be for blood centers to add a question about TRT to their donation forms. Hopefully that will happen soon.

 

Things get trickier if you are on TRT and donating at the express direction of your physician. If you tell the blood center about TRT but not that your doctor directed a phlebotomy, they should draw your blood and use only the RBCs for distribution. But if you tell them you are on TRT and that your doctor directed a phlebotomy, your donation will be refused because the assumption is that you have high hematocrit. That assumption may be false, as your doctor’s “direction” may be merely a recommendation of a healthy practice, not because of a problem. It’s been reported that some centers will consider a doctor-directed phlebotomy of a TRT patient to only be a temporary bar to a blood draw (as brief as one day). More likely, the blood center would declare you ineligible other than through a doctor-approved, self-pay therapeutic phlebotomy, which may not be fair. This may be frustrating to TRT donors, but, of course, the safety of the blood supply is most important.

 

Two functional points: schedule any blood donations for just prior to your next injection to limit the loss of circulating anabolic factors (free and total testosterone) and be aware that frequent phlebotomies can deplete iron stores, reducing endurance performance for cross-training athletes.

 

Rick Collins, Esq., CSCS [https://rickcollins.com/] is the lawyer who members of the bodybuilding community and dietary supplement industry turn to when they need legal help or representation. [© Rick Collins, 2019. All rights reserved. For informational purposes only, not to be construed as legal or medical advice.]

 

References:

 

1. nybloodcenter.org/donate-blood/become-donor/donation-process]

 

2. www.redcrossblood.org/donate-blood/how-to-donate/how-blood-donations-help/blood-needs-blood-supply.html

 

3. www.ncbi.nlm.nih.gov/pubmed/28150363

 

4. www.fda.gov/media/111933/download; 21 CFR 640.120(27)(o)

 

5. www.ocala.com/article/LK/20160104/News/604146717

 

 

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