As an allopathic-trained physician practicing hematology and oncology, I am always interested in reading Dr. Warren Slaten’s articles, as I often will learn new information about alternative therapies that I may not be familiar with. However, in his most recent article, “Testosterone: Benefits and Misconceptions” (March 4, 2021), there are several statements that I feel are inaccurate.

Dr. Slaten writes that while testosterone increases red blood cell count, this does not pose an increased risk of blood clots. While the potential risk of cardiac events in those taking testosterone is not clear (the FDA does have a warning of possible increased risk due to conflicting data), it is important to understand the difference between arterial events (where the clot is in the arteries, causing heart attacks or stroke) and venous events such as deep vein thrombosis in the legs or lungs.

It is well established that increased red blood cell count is a direct risk factor for developing venous blood clots. Furthermore, the assertion by Dr. Slaten that the risk for clots in polycythemia vera patients is due to increased platelet count is simply incorrect, as these patients are at increased risk of clots regardless of the platelet count. Finally, while it would be ideal to think the high red blood cell count in those taking testosterone is due to “increased oxygen utilization,” the exact mechanism is not clear and is more likely due to how the testosterone hormone directly signals the body to increase red blood cell production.

For those who are considered appropriate candidates for testosterone replacement, the recommendation is to monitor blood counts and to either consider reducing the dose of testosterone, or stopping completely, if the red blood cell count rises above a set level.