TRT side effects and hematocrit: what the evidence says

What did @trtstrong actually say?

The creator described two common TRT side effects, elevated blood pressure and high hematocrit, and walked through how he's managed both. He acknowledged pre-existing elevated blood pressure before starting TRT, which is worth noting. His past approach included therapeutic phlebotomy (blood donation) and low-dose aspirin. His current approach is a pivot: he's now taking a supplement called Hemaflow by Leviathan Nutrition, which he found on TikTok, in the hope of "reducing if not doing away with" his blood pressure medication and the need for blood donations.

That last part is where this video goes from personal testimony to something clinically concerning. He's not just sharing a product. He's framing a dietary supplement as a potential replacement for a prescribed antihypertensive medication. He does tell viewers to "do your own research," but the overall message is clear: click the link, this product might replace your meds.

Does the science back this up?

On the core side effects, yes. The evidence is solid. But on Hemaflow as a clinical intervention, there is essentially nothing peer-reviewed to evaluate.

TRT-associated erythrocytosis, meaning elevated hematocrit, is one of the most consistently documented side effects of testosterone therapy. A 2021 review by Bhasin et al. in the New England Journal of Medicine confirmed that hematocrit rises above 54% occur in a meaningful proportion of TRT users, particularly with injectable testosterone, and that therapeutic phlebotomy is the standard management approach. The creator's description of blood "like sludge" is informal, but it maps onto real concerns about increased blood viscosity and potential cardiovascular risk.

Blood pressure elevation on TRT is also real, though the magnitude is debated. A 2023 randomized controlled trial (Lincoff et al., NEJM) found no significant increase in major cardiovascular events in TRT users, but blood pressure monitoring remains standard of care. The aspirin mention is a separate issue. Routine aspirin for cardiovascular risk reduction without a specific indication is no longer recommended by most major guidelines, including the American College of Cardiology.

What did they get wrong (or right)?

Credit where it's due: the creator is honest that he had elevated blood pressure and borderline hematocrit before TRT. That kind of disclosure matters because it reframes TRT as a potential aggravating factor rather than a guaranteed cause. He also correctly identifies therapeutic phlebotomy as the primary management tool for high hematocrit, and that aligns with clinical guidelines from the American Urological Association.

Where this falls apart is the Hemaflow pivot. The product is marketed specifically for TRT users managing hematocrit and blood pressure, but there is no published clinical trial data on this formulation. The creator has been on it for a short time and has no outcome data to share. Presenting it as a reason to potentially stop a prescribed blood pressure medication is not "do your own research" territory. That is a medical decision that requires a provider.

The aspirin recommendation is also a quiet misstep. Aspirin as a general blood-thinning precaution for TRT users is not supported by current guidelines and carries real bleeding risk.

What should you actually know?

If you are on TRT and your hematocrit is climbing, the conversation needs to happen with your prescribing provider, not a TikTok comment section. Hematocrit above 54% is a standard threshold for dose adjustment or treatment pause under AUA guidelines. Therapeutic phlebotomy works, but it needs to be monitored because repeated donations can cause iron deficiency, which the body compensates for by producing even more red blood cells, potentially worsening the problem over time.

Blood pressure management on TRT is similarly individualized. If you need an antihypertensive, stopping it based on a supplement you found through a TikTok Shop link is a genuinely bad idea. Supplements can have real ingredient effects, but they are not FDA-reviewed for efficacy or safety in the way medications are, and their ingredient quality is not guaranteed.

• Get your hematocrit and blood pressure checked regularly if you are on TRT. Every 3 to 6 months is a common interval.
• Do not stop or taper a prescribed blood pressure medication without telling your doctor.
• Therapeutic phlebotomy is legitimate, but monitor iron levels if you are doing it frequently.
• Aspirin is not a standard or recommended tool for managing TRT-related blood viscosity.
• No supplement currently has peer-reviewed evidence demonstrating it reduces TRT-related erythrocytosis or replaces antihypertensives.

Is there a conflict of interest here?

Yes, and it's not subtle. The video is tagged with TikTok Shop, the creator is tagging the brand directly, and there is a purchase link in the description. That does not automatically make the product harmful, but it means this video is fundamentally an advertisement wrapped in a personal health story. The "do your own research" disclaimer does not change the commercial structure of the content. Viewers should weigh that context heavily before making any health decisions based on what they watched.