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Therapeutic phlebotomy may be indicated for hemochromatosis, polycythemia vera, porphyria cutanea tarda, and polycythemia secondary to arterio-venous fistulae, cyanotic congenital heart disease or cor pulmonale. Polycythemia is sometimes called erythrocytosis, but the terms are not synonymous, because polycythemia refers to any increase in red blood cells, whereas erythrocytosis only refers to a documented increase of red cell mass. http://www.eclinpath.com/hematology/polycythemia/. Testosterone therapy does not need blood letting because it is not related to a genetic condition called haemochromatosis which can be caused by high iron levels, excessively thick blood volume. Polycythemia Vera is a disease confused with healthy increases in Red Blood Cell counts. The use of bio identical testosterone will increase red blood cell counts, yet it is not harmful, as compared to the disease condition Polycythemia Vera which thickens the blood dangerously. Increased red cell mass with testosterone therapy is safe, as those living at high altitude or using Cyclic variations in adaptive conditioning (CVAC), or those with COPD. We do not worry nor do we do blood letting because people benefit from high blood cell count as it carries more oxygen when needed. The use of testosterone or high altitude will naturally increase red cell mass because this builds up a good reserve of blood cells in case a man was in a fight and lost blood, he would be able to survive blood loss from injury. This is healthy erythrocytosis, which is only an increase in red cell mass. Most men on testosterone therapy will have an increase in red blood cell mass which is healthy and safe and does not require blood letting. We use https://docnutrients.com/shop/testro-genin/ as an effective way to improve health with bio identical hormones. It is important to note, many men or woman using testosterone often by coincidence on a high animal protein diet which will increase the risk of stroke or heart attack due to the added LDL cholesterol that can clog arteries. Jeffrey Life MD is an advocate of a plant protein based diet when using bio identical hormone intervention to prevent the risk of cardiovascular events while gaining the benefits of healthy circulation and building lean body mass. https://www.youtube.com/watch?v=BWMB0JLrdAw Actually the excess fat in the typical keto or Atkins or high fat american diet will increase the thickness of the blood forcing the production of more hemoglobin, which increases blood pressure and the risk of heart disease. 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