Bodybuilders’ intense training and physical development raise questions about their hemoglobin levels. Hemoglobin is the iron-containing protein in red blood cells that transports oxygen from the lungs to tissues. A higher concentration of this protein can improve oxygen delivery, benefiting muscular performance and recovery. This article explores the physiological adaptations from training and the pharmacological factors that influence a bodybuilder’s blood profile and elevated hemoglobin readings.
The Baseline: Hemoglobin and Healthy Ranges
Hemoglobin (Hb) and hematocrit (HCT) are two measurements used to assess the oxygen-carrying capacity of the blood. Hemoglobin is the direct measure of the oxygen-transport protein, expressed in grams per deciliter (g/dL) of blood. Hematocrit is the percentage of total blood volume that is made up of red blood cells, which is typically calculated to be about three times the hemoglobin value.
For adult males, the generally accepted healthy hemoglobin range is approximately 13.5 to 17.5 g/dL, while for adult females, the range is slightly lower, typically between 12.0 and 15.5 g/dL. Levels above these reference ranges are collectively termed erythrocytosis, which denotes an abnormally high concentration of red blood cells. When this elevation is particularly pronounced or involves an increase in other blood cell lines, it may be referred to as polycythemia.
Exercise-Induced Hemoconcentration
Intense physical activity, such as resistance training, can cause an immediate, temporary rise in hemoglobin and hematocrit, known as acute hemoconcentration. This occurs because water leaves the bloodstream and moves into the working muscle tissues, causing a fluid shift rather than the creation of new red blood cells. The resulting temporary decrease in plasma volume concentrates existing blood components, making readings appear higher immediately after the workout.
This post-exercise increase is transient, with plasma volume typically returning to normal within a few hours of recovery. Chronic resistance training alone does not induce dramatically high resting hemoglobin levels. Athletes engaged in high-volume training, especially endurance work, often experience an increase in overall plasma volume, which can dilute the blood slightly. This dilution sometimes leads to a reading termed “sports anemia” or pseudoanemia, despite the athlete having a greater total red blood cell mass.
Pharmacological Influences on Red Blood Cell Production
The most significant driver of unnaturally high hemoglobin and hematocrit levels in some bodybuilders is the use of performance-enhancing compounds. Anabolic Androgenic Steroids (AAS), synthetic derivatives of testosterone, directly influence red blood cell production, known as erythropoiesis. These compounds stimulate the kidneys to increase the synthesis and release of erythropoietin (EPO).
EPO is a hormone that signals the bone marrow to produce more red blood cells. The resulting increase in red blood cells raises the amount of hemoglobin circulating in the blood, often pushing levels above the normal physiological range. Testosterone derivatives also enhance this process by suppressing hepcidin, a hormone regulating iron absorption, thereby increasing the iron available for new red blood cell creation.
Certain AAS, such as oxymetholone, were historically prescribed for treating severe anemia due to their powerful erythropoietic effects. Exogenous erythropoietin itself is also sometimes misused to maximize oxygen-carrying capacity. This pharmacological pathway is the primary reason some bodybuilders present with extremely elevated blood cell profiles that require clinical concern.
Health Risks Associated with Elevated Hemoglobin
When hemoglobin and hematocrit levels become excessively high, the primary health concern is increased blood viscosity. Blood with a high concentration of red blood cells becomes physically thicker, making it harder for the heart to pump through the circulatory system. This increased workload contributes to cardiovascular strain and hypertension.
The thickening of the blood significantly elevates the risk of forming blood clots, known as thrombosis. These clots can block blood vessels, leading to serious events such as stroke, heart attack, or pulmonary embolism. The risk is amplified in individuals who are dehydrated or have pre-existing cardiovascular issues.
Regular monitoring of blood parameters, including a complete blood count (CBC), is necessary for those with elevated hemoglobin, especially users of pharmacological agents. To mitigate the dangers of hyperviscosity, therapeutic phlebotomy is sometimes performed. This medical procedure involves removing a unit of blood to reduce the red blood cell mass and decrease the risk of thrombotic complications.