Minimizing Erythrocytosis w/ gels, pills, compounded dissolvables, daily injections?

[AndrewP]

I am currently on Natesto and while it works it is ultimately insufficient w/ a peak testosterone only around 400. I have covered studies on gels and pill options and it appears that pills are a very good approach with the softest effect on hematocrit. There is some debate in the literature and I am not certain if daily injections are comparatively so bad. It seems that estrogen control and lower average testosterone have the best effect. I see no reason to have high T at night so I am looking into these options. Compounded options like buccal testosterone and oral testosterone add even more complexity.

It took a couple years to figure out what was going on - low ferritin (10) from TRT has been the cause of debilitating fatigue that nearly caused me to drop out of my PhD program! I must find a way to seriously reduce erythrocytosis or MUST stop TRT. Any help you can provide is greatly appreciated!!! I am hoping for a value between 700 and 1000. My natural T is ~260 at 38. Qs:

Which pill formulation is strongest? Pill formulations seem... weak..
Are gels and daily injections comparable per their effects on RBC production?
How about compounded options like buccal or sublingual?
Any other thoughts?

I am also thinking about SHBG and estrogen control as a way to reduce production

Thank you!

UPDATE:
An update. I got on Kyzatrex and although I don't know its effects on ferritin I can confirm that it causes a HUGE increase in testosterone.

I was prescribed 4x 200mg (maximum dose) to be taken 2 times per day.

The peak (4 hours) after the first dose but before the second sent me to 2640 total testosterone. This is after taking 2, 200mg capsules with 2 eggs and a heavy dose of olive oil after 1 week of consistent dosing. I have no other T active as I have been off injections for a while and had been using nasal testosterone in its place.

I have since cut this in half taking 1 in the morning and 1 in the afternoon at 3 PM. Will report back.

 

[Systemlord]

I must find a way to seriously reduce erythrocytosis or MUST stop TRT.

What do you consider seriously worrying erythrocytosis?

I'm on Jatenzo, oral testosterone undecanoate, @237 mg twice daily and normally have a 51% hematocrit. Whether or not this is considered secondary erythrocytosis is open to debate, being that ranges, depending on the lab company, could be, 50, 51, and 52%.

In the clinic trials for Kyzatrex, there were no cases of secondary erythrocytosis.

It took a couple years to figure out what was going on - low ferritin (10) from TRT

Same here, took almost 3 years to figure out TRT drags my ferritin levels down to 24 from a healthy 100+.

 

[AndrewP]

What do you consider seriously worrying erythrocytosis?

I'm on Jatenzo, oral testosterone undecanoate, @237 mg twice daily and normally have a 51% hematocrit. Whether or not this is considered secondary erythrocytosis is open to debate, being that ranges, depending on the lab company, could be, 50, 51, and 52%.

In the clinic trials for Kyzatrex, there were no cases of secondary erythrocytosis.


Same here, took almost 3 years to figure out TRT drags my ferritin levels down to 24 from a healthy 100+.

What lab values are you getting and what is your ferritin holding at?

Yep, when I saw a lab of 156 ferretin that was incidently taken in years prior to TRT compared to 12, I knew .

 

[Systemlord]

What lab values are you getting and what is your ferritin holding at?

Recently ferritin is 222 and hematocrit 58.5 and hemoglobin 18.9. I was vitamin D deficient during this lab draw and dehydrated. I was having to supplement more iron due to the low vitamin D (completely unaware, needed more vitamin D, not more iron) and expect things to return to normal soon.

Previously, ferritin was 98 and hematocrit 51% and hemoglobin 17.9. My ferritin <100 is optimal as people with ferritin 100> have decreased life expectancy.

A ferritin of 20-100 is optimal for maximum life expectancy.

 

[AndrewP]

That's fantastic! What are you getting for Total T, free T, E, SHRB... ?

 

[AndrewP]

What do you consider seriously worrying erythrocytosis?

I'm on Jatenzo, oral testosterone undecanoate, @237 mg twice daily and normally have a 51% hematocrit. Whether or not this is considered secondary erythrocytosis is open to debate, being that ranges, depending on the lab company, could be, 50, 51, and 52%.

In the clinic trials for Kyzatrex, there were no cases of secondary erythrocytosis.


Same here, took almost 3 years to figure out TRT drags my ferritin levels down to 24 from a healthy 100+.

If you have ever been on T injections than based on research you will have a more or less permanently increased baseline hematocrit. It takes at least a year of no exogenous T to revert to your earlier baseline


For me, anything 53 or below I think is totally fine.

 

[Systemlord]

That's fantastic! What are you getting for Total T, free T, E, SHRB... ?

988 ng/dL peak within 2 hours, 489 ng/dL at 6 hours, 289 ng/dL at 12 hours. SHBG is 20-24, Free T at 28 ng/dL peak, 12.9 ng/dL at midpoint.

For me, anything 53 or below I think is totally fine.

You don't sound sure about that, is this an idea rather than a cold hard fact?

The cutoffs for TRT for hematocrit is 54%, even this is an arbitrary number. Secondary erythrocytosis has never been proven to be harmful in healthy individuals. Secondary erythrocytosis may be a problem for people with comorbid conditions.

The majority of studies looking at high hematocrit being harmful are those with polycythemia vera, a cancer of the bone marrow that causes clotting.

So it's not hard to understand why doctors associate high hematocrit with harm.

My own doctors comments about my 58.5% hematocrit after speaking with a hematologist ->

I can’t tell you at what level of hematocrit is too high for you, but this is pretty high. I’d recommend at least monthly monitoring of your levels at least for the Hgb/Hct.

 

[AndrewP]

988 ng/dL peak within 2 hours, 489 ng/dL at 6 hours, 289 ng/dL at 12 hours. SHBG is 20-24, Free T at 28 ng/dL peak, 12.9 ng/dL at midpoint.


You don't sound sure about that, is this an idea rather than a cold hard fact?

The cutoffs for TRT for hematocrit is 54%, even this is an arbitrary number. Secondary erythrocytosis has never been proven to be harmful in healthy individuals. Secondary erythrocytosis may be a problem for people with comorbid conditions.

You are correct. 55 is a high limit for me based on research. I have hit 57 in the past. Key to me is ferratin level maintenance and dropping testosterone levels at night.

I am thinking that a low daily dose of Enclomiphene may be able to "break through" oral T because of the low trough value.

I really good balance between tradeoffs would be to to pair Oral with Enclo and bump my LH to 5 to 7 to get a baseline natural. Or, low dose daily HCG and oral. This would prevent E & T levels from dropping too low at night.

 

[magnus68]

You are correct. 55 is a high limit for me based on research. I have hit 57 in the past. Key to me is ferratin level maintenance and dropping testosterone levels at night.

I am thinking that a low daily dose of Enclomiphene may be able to "break through" oral T because of the low trough value.

I really good balance between tradeoffs would be to to pair Oral with Enclo and bump my LH to 5 to 7 to get a baseline natural. Or, low dose daily HCG and oral. This would prevent E & T levels from dropping too low at night.

How do you keep your Ferritin up?

 

[AndrewP]

How do you keep your Ferritin up?

The hills and valley of oral T vs a steady state suppose to stop blood thickening and the process begin altered RBC production that causes low ferretin... I'm theory...

 

[AndrewP]

An update. I got on Kyzatrex and although I don't know its effects on ferritin I can confirm that it causes a HUGE increase in testosterone.

I was prescribed 4x 200mg (maximum dose) to be taken 2 times per day.

The peak (4 hours) after the first dose but before the second sent me to 2640 total testosterone. This is after taking 2, 200mg capsules with 2 eggs and a heavy dose of olive oil after 1 week of consistent dosing. I have no other T active as I have been off injections for a while and had been using nasal testosterone in its place.

I have since cut this in half taking 1 in the morning and 1 in the afternoon at 3 PM. Will report back.

 

[madman]

An update. I got on Kyzatrex and although I don't know its effects on ferritin I can confirm that it causes a HUGE increase in testosterone.

I was prescribed 4x 200mg (maximum dose) to be taken 2 times per day.

The peak (4 hours) after the first dose but before the second sent me to 2640 total testosterone. This is after taking 2, 200mg capsules with 2 eggs and a heavy dose of olive oil after 1 week of consistent dosing. I have no other T active as I have been off injections for a while and had been using nasal testosterone in its place.

I have since cut this in half taking 1 in the morning and 1 in the afternoon at 3 PM. Will report back.

Who is the idiot treating you?

This is ridiculous.

The starting dose is 200 mg twice daily.

Some may eventually need to be titrated to a higher daily dose to achieve high levels but the majority would never need the maximum dose to achieve a healthy let alone high peak TT/FT level.

400 mg twice daily is overkill for most.


*The recommended starting dose is 200 mg orally twice daily, once in the morning and once in the evening. Take KYZATREX with food.

KYZATREX® (oral testosterone undecanoate) now available in all states across the US

https://www.excelmale.com/forum/threads/testosterone-update-on-oral-products.27963/

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