Brief Answer:
testosterone stimulates erythropoeitin.Keep hemoglobin below 17.

Detailed Answer:
Hello sir, I did review your concern.

Testosterone is a steroid compound. It has a erythropoeitin stimulating efffect. Hence in return the Erythropeitin causes stimulation of redblood cell precursors proliferation leading to polycythemia. Generally, a hemoglobin above 18.5 in males for chronic long term periods as seen in polycythemia vera can cause thrombotic attacks, headache, dizziness, weakness, vertigo ans stroke like phenomenon.

For treatment of high hemoglobin if it causes the above mentioned symptoms, the recommendations these days are phlebotomy(removal of blood from veins at regular interval to keep hemoglobin between 14-16) and hydroxyurea in adequate doses. If you do not have any history of bleeding low dose aspirin can help prevent thrombotic attacks.

I would not recommend nattokinase, since there is lack of evidence or any controlled trials on that and there are reports that nattokinase and aspirin when combined can cause dangerous bleeding.

Also, I would recommend to review your need of taking exogenous testosterone as unless medically indicated it is not good for overall health due to its potential sideeffects on liver, gonads and blood system.
So all in all I would recommend you to consult your doctor and aim at keep hemoglobin below 17 and review low dose aspirin use if you do not have any past bleeding history. I would not recommend nattkinase.

I hope this helps sir.
let me know if you have any more questions or concerns,
Wish you all the best.
sincerely,
Dr Parth Desai

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Brief Answer:
Erythrocytosis is secondary condition as opposed to polycythemia vera.

Detailed Answer:
Hello
Thank you for your reply. Classically all those causes of increased hemoglobin or RBC count that are not due to the primary bone marrow myeloproliferative disorder(known these days as polycythemia vera due to mutation in a gene known as JAK2STAT) are known as erythrocytosis. It can be due to chronic smoking, living on high altitudes, chronic hypoxia, steroid intake, some weird hemoglobin types and so on.
The basic difference from polycythemia vera is that if you remove the cause the rbc count and hemoglobin level will fall down and hence it is known as erythrocytosis. Where as polycythemia vera is a primary bone marrow slow growing malignancy which is a matter of concern and needs to be addressed differently apart from decreasing the blood count to reduce temporary symptoms.

The most important thing is whether you are having symptoms of headache, dizziness, stroke like attacks and pruritis at that high hemoglobin levels. If yes, there is treatment that is indicated either in form of phlebotomies plus hydroxyurea or removing the cause.
Ofcourse for Polycythemia vera, there are other treatments that need to be taken to prevent progression of the disease.

So your condition is not to worry about in terms of progressing into something bad as far as bone marrow is considered. but proper treatment for high rbc and viscous blood needs to be addressed anyways.

I hope this helps sir.
let me know if you have any more questions or concerns.
Wish you all the best.
sincerely
Dr Parth Desai.

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