TRAVERSE Anemia Substudy: TRT, Hemoglobin, and Energy in Men With Low T

Last reviewed 2026-10-04 by Jack Mayeux, APRN, FNP. This page is clinical content and is reviewed on a regular schedule.

Medically reviewed by Jack Mayeux, FNP

In men with low T and anemia, testosterone corrected the anemia more often than placebo, and hemoglobin changes tracked with energy.

This article walks through the JAMA Netw Open (2023) (https://doi.org/10.1001/jamanetworkopen.2023.40030) paper in plain English: what was studied, what changed, what the limits are, and what it does not prove. Full citation and DOI link (https://doi.org/10.1001/jamanetworkopen.2023.40030) are at the end, with a PubMed record (https://pubmed.ncbi.nlm.nih.gov/37889486/).

What the study found

This randomized, placebo-controlled study was nested within the TRAVERSE trial at 316 US sites. It included 5,204 men aged 45 to 80 with two testosterone levels below 300 ng/dL, symptoms of low T, and heart disease or elevated heart risk. Of these, 815 had anemia at baseline, and men used testosterone gel or placebo gel.

Anemia was corrected in 41.0% of testosterone-treated men vs 27.5% on placebo at 6 months, and 45.0% vs 33.9% at 12 months, and fewer non-anemic men developed anemia on testosterone. Changes in hemoglobin tracked with changes in energy. The difference narrowed by 48 months, and red-cell counts need monitoring on TRT.

Key finding (from the study record): Anemia corrected in 41.0% vs 27.5% at 6 mo and 45.0% vs 33.9% at 12 mo (P=.002); fewer non-anemic men developed anemia on TRT. Hemoglobin changes tracked with energy.

How the study was done

• Design: RCT nested in TRAVERSE • Who was studied: 5,204 men 45-80 with hypogonadism (815 anemic) • Journal / year: JAMA Netw Open (2023) • First author: Pencina KM et al.

From the abstract: IMPORTANCE: Testosterone deficiency causes mild anemia. Whether testosterone replacement therapy (TRT) can correct anemia or prevent the development of anemia in men with hypogonadism remains incompletely understood. OBJECTIVE: To assess the efficacy of TRT in correcting anemia in men with hypogonadism and anemia, and reducing the risk of developing anemia in those without anemia.

What it means — and what it does not

Useful takeaway: In men with low T and anemia, testosterone corrected the anemia more often than placebo, and hemoglobin changes tracked with energy.

Limits and caveats: Hypogonadal men with CV risk; gel. Hemoglobin rising is also why hematocrit must be monitored (erythrocytosis risk). Benefit narrowed by 48 months (44.6% vs 39.2%).

This evidence can inform a conversation with a licensed provider. It is not a guarantee of similar results for you, and it is not a recommendation to start, stop, or change any medication on your own.

Related research we cite

• Association of Testosterone Levels With Anemia in Older Men: A Controlled Clinical Trial (https://doi.org/10.1001/jamainternmed.2016.9540) — JAMA Intern Med (2017); also on PubMed (https://pubmed.ncbi.nlm.nih.gov/28241237/). Takeaway: In older men with low T and unexplained anemia, more than half were no longer anemic after a year of testosterone vs about 1 in 5 on placebo.

How this connects to care

A2Z serves men in Utah with telehealth evaluation, labs, and provider-guided plans when appropriate. The TRT program is $149/month and includes initial labs only. Tadalafil and enclomiphene, sermorelin, and tirzepatide (compounded, not FDA-approved) are separate products.

Relevant pages on this site:

• TRT program (https://a2ztrt.com/trt)

FAQ

What did this study actually find?

In men with low T and anemia, testosterone corrected the anemia more often than placebo, and hemoglobin changes tracked with energy. The design was: RCT nested in TRAVERSE. Population: 5,204 men 45-80 with hypogonadism (815 anemic).

Does this mean I should start treatment?

No. Research informs care; it does not prescribe it. A licensed provider reviews your symptoms, labs, and history before any decision. Results vary.

What are the main limits of this evidence?

Hypogonadal men with CV risk; gel. Hemoglobin rising is also why hematocrit must be monitored (erythrocytosis risk). Benefit narrowed by 48 months (44.6% vs 39.2%).

Why monitor blood counts on TRT?

Testosterone can raise red-cell production. That may help anemia in some men, but hematocrit that rises too far is a known risk and is monitored.

Keep reading

• TRAVERSE Sexual Function Study: Libido Without Erectile Benefit (https://a2ztrt.com/post/traverse-libido) • TRT and Insulin Sensitivity in Men With Type 2 Diabetes (https://a2ztrt.com/post/testosterone-insulin-sensitivity) • What Is a Normal Testosterone Level, Really? (https://a2ztrt.com/post/what-is-a-normal-testosterone-level) • Can You Drink Alcohol on TRT? What Men Should Know (https://a2ztrt.com/post/can-you-drink-alcohol-on-trt)

Reference

Pencina KM et al. Efficacy of Testosterone Replacement Therapy in Correcting Anemia in Men With Hypogonadism: A Randomized Clinical Trial. JAMA Netw Open. 2023. https://doi.org/10.1001/jamanetworkopen.2023.40030 (https://doi.org/10.1001/jamanetworkopen.2023.40030) · PubMed 37889486 (https://pubmed.ncbi.nlm.nih.gov/37889486/).

Next step

Start a free consult in Utah (https://a2ztrt.com/contact). Bring your questions — including anything this study raised for you.

The TRT program is $149/month and includes initial labs only. Tadalafil and enclomiphene, sermorelin, and tirzepatide (compounded, not FDA-approved) are separate products.

Talk to a licensed provider. Results vary. Not medical advice.