What did @the.tudca.king actually say?
The creator claims that face flushing on testosterone replacement therapy (TRT) comes down to two culprits: elevated estrogen levels and high hematocrit or hemoglobin. He says testosterone "remotizes" (converts to) estrogen, which can cause water retention and flushing. He also says testosterone increases red blood cell production, which thickens the blood, raises vascular pressure, and produces a flushed face. He then pitches a "hemoglobin product" as a fix for the hematocrit issue.
The core physiological framework here is not wrong. But the framing is incomplete in ways that could matter to someone dealing with a real symptom on a regulated medication.
Does the science back this up?
Mostly, yes, but with important caveats. Estrogen's role in fluid retention is well-established, and erythrocytosis from exogenous testosterone is one of the most documented side effects in the literature.
On the estrogen side, testosterone does aromatize to estradiol via the CYP19A1 enzyme. Elevated estradiol can contribute to fluid retention through aldosterone-related pathways, and some men report facial flushing as part of that picture. However, the direct clinical evidence linking estradiol elevation specifically to facial flushing in TRT patients is thin. It is plausible, but it is not a well-studied, confirmed mechanism in controlled trials.
On the hematocrit side, the evidence is much stronger. Testosterone-induced erythrocytosis is real and common. A review by Bachman et al. (2010, Journal of Clinical Endocrinology and Metabolism) found hematocrit elevations above 50% in a significant subset of TRT patients. Increased blood viscosity from elevated hematocrit does raise peripheral vascular resistance, which can plausibly cause flushing and warmth in the face. This part of the explanation holds up.
What did they get wrong (or right)?
They got the hematocrit mechanism right. That is the more clinically documented of the two pathways, and pointing people toward blood work monitoring is genuinely good advice.
The estrogen explanation is shakier. Saying estrogen "can allow you to hold water and lead to something like this" is speculative when applied specifically to facial flushing. Water retention from estrogen tends to be systemic, not localized to facial appearance in the way flushing presents. The creator conflates two different symptoms: edema and vasodilation-driven flushing. Those are not the same thing, and lumping them together without distinction is misleading.
The word "remotizes" is clearly a mispronunciation of aromatizes, which is worth noting not to mock the creator, but because the mechanism of aromatization is something TRT patients genuinely need to understand correctly.
More concerning: recommending a "hemoglobin product" without context, without blood work results in hand, and without any clinical nuance is a red flag. Elevated hematocrit on TRT is managed through phlebotomy, dose adjustment, or hydration, not over-the-counter supplements. No supplement has strong clinical evidence for reducing testosterone-induced erythrocytosis.
What should you actually know?
If you are flushing on TRT, the hematocrit angle is worth taking seriously, but you need actual numbers from a lab, not a supplement. Hematocrit above 54% is generally considered the threshold where clinical intervention is warranted, per Endocrine Society guidelines. Your prescribing provider should be monitoring this at baseline and periodically during treatment.
Other causes of flushing that this video ignores entirely include direct vasodilatory effects of testosterone itself, injection site reactions, changes in blood pressure, and in some cases, polycythemia vera, a separate condition that TRT can unmask. Flushing can also be unrelated to TRT entirely.
The estrogen theory is not something you should act on without an actual estradiol lab value. Trying to suppress estrogen without evidence of elevation can cause its own problems, including joint pain, low libido, and mood issues. Estrogen management in TRT requires lab-guided decisions, not symptom guessing.
- Get a complete blood count and estradiol panel before assuming either cause.
- Discuss any persistent flushing with your prescribing provider, not a TikTok comment section.
- Do not purchase supplements to address a hematocrit problem that has not been confirmed by blood work.