Hematocrit: How Doctors Respond

[SkyWarn]

I am curious if anyone has ever had their doctor pull them off TRT because of high hematocrit.

 

[CoastWatcher]

While that can certainly happen, a doctor who understands androgen management would be very unlikely to take such drastic action given the fact that hematocrit and hemoglobin are typically kept in check through phlebotomies when certain thresholds are reached. Remember, I'm speaking of doctors who can play this game.

Patients, however, are another story. There are men who discontinue TRT because phlebotomies become more than they can deal with. We have members who, discouraged, discuss abandoning hormone replacement because the donation of blood regularly isn't something they can or want to do.

Hopefully, some first-hand accounts will be posted.

 

[mooseman109]

My original Dr pulled me off after 3 years. However, my hct was 62.3!

 

[Vince Carter]

You hear it on the forum on rare occasion but it's not very common to happen as it's easily dealt with as Coastwatcher said.

 

[SkyWarn]

My original Dr pulled me off after 3 years. However, my hct was 62.3!

62? wow. How did you feel at that number? Any noticeable sides? When I was 56 I felt stress and had a mild headache, but I wonder how much of that was just my imagination.

 

[AndyP]

I was a 47 before starting trt (gel) and this increased to 51 so treated with a phylobotomy. Since going on ED injections this has now stabilized back at 47 so I’m a happy bunny. The thought of regular blood letting wasn’t great but it was something I was prepared to live with.

I was suffering pressure headaches at 51 but my E2 was also high. I think the risks of being just over 50 are overblown but it does feel better being under

 

[SkyWarn]

I was a 47 before starting trt (gel) and this increased to 51 so treated with a phylobotomy. Since going on ED injections this has now stabilized back at 47 so I’m a happy bunny. The thought of regular blood letting wasn’t great but it was something I was prepared to live with.

I was suffering pressure headaches at 51 but my E2 was also high. I think the risks of being just over 50 are overblown but it does feel better being under

Yea when I donate I always feel so much better the next day. Its hard to describe the feeling, but I don't think its imaginary. Its similar to that feeling right after a you take a huge dump lol.

 

[Vince]

When I used to have to donate blood, I always feel better after donating. After I donated, even though they told me not to I will go ahead and workout. I always feel good.

 

[DragonBits]

Well, I do pass out if I give blood.

Interesting experience, it happened twice. I am fine after giving blood, when I get up from the gurney and start to walk, OK. but then they want you to sit down and rehydrate. When I sit down again, I pass out cold. Last time (a couple of decades ago) I passed out twice. Once after sitting down, they laid me on the floor and pumped my legs, I got up and passed out again. After resting on the gurney for a while and drinking some OJ, I was OK. I would be curious what my blood pressure was at the time?

I suspect it was because I was chronically dehydrated from not drinking water and mostly drinking diet soda/tea/coffee. But I don't know for sure, I have not been able to "retest" the theory. Since then I drink lots of water and hardly any soda.

 

[SkyWarn]

Well, I do pass out if I give blood.

Interesting experience, it happened twice. I am fine after giving blood, when I get up from the gurney and start to walk, OK. but then they want you to sit down and rehydrate. When I sit down again, I pass out cold. Last time (a couple of decades ago) I passed out twice. Once after sitting down, they laid me on the floor and pumped my legs, I got up and passed out again. After resting on the gurney for a while and drinking some OJ, I was OK. I would be curious what my blood pressure was at the time?

I suspect it was because I was chronically dehydrated from not drinking water and mostly drinking diet soda/tea/coffee. But I don't know for sure, I have not been able to "retest" the theory. Since then I drink lots of water and hardly any soda.

So it sounds like you haven't given blood in years. How do you keep your hematocrit in check?

 

[DragonBits]

So it sounds like you haven't given blood in years. How do you keep your hematocrit in check?

I use testosterone undecanoate in castor oil every 10-12 weeks, it doesn't cause a dramatic rise in HCT (but in 7& of men, it still happens). My HCT rose from a low of 40 to a high of 47.5.

-------------------------------------------------------------------------
FYI. % of men that get a rise of HCT greater than 50% on different T protocols.

Testosterone cypionate or enanthate
(short-acting injectable)100-200 mg IM every week
67% get a rise over 50%

Testosterone undecanoate (long-acting injectable)1000 mg, 12 weeks
7% get a rise over 50%

Transdermal gel 50-100 mg every day(sachets)
Testosterone 20-80 mg every day (dosing pump)
13% get a rise over 50%

Pellets Crystalline testosterone 75 mg/pellet implanted, 10-14 pellets every 3-6 month
35% get a rise over 50%.
------------------------------------------------------

As you can see, HCT is most frequent in men that use either TC / TE. The forum suggest if you change your dose to more frequent injections of a smaller amount, you reduce your side effects.

 

[SkyWarn]

I use testosterone undecanoate in castor oil every 10-12 weeks, it doesn't cause a dramatic rise in HCT (but in 7& of men, it still happens). My HCT rose from a low of 40 to a high of 47.5.

-------------------------------------------------------------------------
FYI. % of men that get a rise of HCT greater than 50% on different T protocols.

Testosterone cypionate or enanthate
(short-acting injectable)100-200 mg IM every week
67% get a rise over 50%

Testosterone undecanoate (long-acting injectable)1000 mg, 12 weeks
7% get a rise over 50%

Transdermal gel 50-100 mg every day(sachets)
Testosterone 20-80 mg every day (dosing pump)
13% get a rise over 50%

Pellets Crystalline testosterone 75 mg/pellet implanted, 10-14 pellets every 3-6 month
35% get a rise over 50%.
------------------------------------------------------

As you can see, HCT is most frequent in men that use either TC / TE. The forum suggest if you change your dose to more frequent injections of a smaller amount, you reduce your side effects.

Interesting! I wonder why more men don't simply use testosterone undecanoate. Are there any drawbacks compared to cyp? I wouldn't mind the less frequent injections

 

[mooseman109]

62? wow. How did you feel at that number? Any noticeable sides? When I was 56 I felt stress and had a mild headache, but I wonder how much of that was just my imagination.

I was very short of breath on any activity. No headaches or flushed face. BP was raised about 10 points on each end. I was at 56-57 for a couple years and could not tell. I stay at 51-53 and can not tell at all. I notice no difference at all after a donation. We are all different, but if platelets are low and all else is good, I do not think HCT in mid 50's is a thing. Certainly low 50's no big deal. Folks who live at elevation have high HCT and they are fine. Juts my 2 cents, but I have consulted with 2 hematologists regarding this issue and that is basically what they said.

 

[AndyP]

I think the strange thing is also the complete lack of predictability. My raising 4 points on gel (13% get a rise) but back to baseline on injections (67% get a rise) shows this. You would expect it to be the other way round just looking at the statistics. Both were daily applications so the stability of dosing is only one of many factors. Testing is the only way to find out what works for you as an individual.

 

[DragonBits]

Interesting! I wonder why more men don't simply use testosterone undecanoate. Are there any drawbacks compared to cyp? I wouldn't mind the less frequent injections

Broadly, you can break up the reasons for medical choices into 4 categories.

Financial: We are all victims of the medical / industrial complex, doctors just as much as patients. Some of the smartest people in the world work hard to figure you how to get consumers to pay as much they can get. But I think this often drives suboptimal choices.

Regulatory: Regulations are either created out of safety concerns, or financial issues masquerading as safety issues.

Psychological: Men like to tinker, there isn’t a lot of tinkering with TU and perceptions can be ingrained.

Medical: Real issues related to the protocol.

FINANCIAL: TU in castor oil is Nebido, roughly about $140 cash pay for 4 ML outside of the USA. But it isn’t approved in the USA. Endo Pharmaceuticals got the approval for Aveed, I used to trade biotech stocks and followed them. They claimed safety concerns and got TU 3 ml ampule approve. They did it that way so they could solely control the product in the US market, reap all the profits and charge what they wanted to, cash pay is ~ $1,176 for 3 ML. Same exact product, just 1 ML less product.

The only TU product a US based doctor can prescribe is Aveed. Most clinics like Defy don’t take insurance, those of us that are low T but not below 264 mg/dl Total T aren’t going to get a regular doctor that needs to work with insurance to approve their choice to even prescribe testosterone, and if by chance you do find a doctor willing to prescribe Aveed, insurance won’t pay for it.

If insurance covers it, great, but I doubt TRT clinics / doctors will get a lot of patients to self-pay that sort of money. And there is no profit for a compounding pharmacy in that situation.

MEDICAL ISSUES: I never get a high HCT, only inject every 3 months. It is an IM injection into the glute, not the easiest to do.

3 days after injection, and for ~ 18 days, you get fairly high levels of TT, FT and E2. At day 16 I measured 1380 TT, FT 28 and E2 56. It starts to decline and level off after that. At 109 days post injection I measured 690 TT, FT 20 and E2 20.


I did gain water weight during those 18 days, then it all went away in 2-3 days. My blood pressure went up also, then went down. I could take an AI, in the past I didn’t really notice the water weight though I did record that my BP went up in Jan 2014, now I think it was elevated E2. I keep a spread sheet, but don’t always record or check BP.

You can’t really fine tune TU/Nebido/Aveed. You can raise your T higher by using a gel/cream or injectable TC + TU, it works well if you are at 690 TT and want higher. Not so easy to lower TT/FT, though I think there are supplements that do lower FT, not many really want to lower FT. Lower FT and you lower E2..


I think the longer cycle of when your E2 is elevated is an advantage, it’s not up and down every X days, it goes up and gradually falls over 12 weeks, likely reaches a better spot after 3 weeks. I am thinking one can use an AI during the first two weeks and it will work well and easier to figure out a dose if the higher E2 is a concern. But it does down naturally so one could just wait. But once you pass 3 weeks your T/E2 is in a pretty sweet spot fpr 9 weeks.

So IMO the disadvantaged of Aveed is that I don’t think any TRT clinic prescribes it, it isn’t a money maker for a compounding pharmacy, it’s very expensive if you can’t get insurance to cover it and you can’t easily tinker with the levels, at least not if the same way you can with TC. BUT for me at least, I don't need to tinker with the levels. My SHBG is about 40, I am not sure if your SHBG is very low or very high you will get the same results.

Another disadvantage a doctor might consider, once you first inject Nebido/Aveed/TU, your T levels will be high for at least 8-10 weeks after the first injection. If for some reason higher T is causing a problem, you are stuck for a couple of months.

For me, ~$50 a month for Nebido is reasonable, if I had to pay $380+ a month for Aveed (keep in mind you need to inject Aveed more often than Nebido which I haven’t factored in), I would elect either a cream/gel or frequent TC injections. You get more side effects with TC, but it’s far cheaper than in those circumstances that I have outlined with Aveed. If Nebido needs to be imported into the USA by some means. Mexico has Nebido, Canada does not. BTW, I have seen generic TU for sale in other esters from Chinese markets, it isn't going to work the same way, but it will be similar, but you are getting into the gray market with unknown risks.

 

[SkyWarn]

Broadly, you can break up the reasons for medical choices into 4 categories.

Financial: We are all victims of the medical / industrial complex, doctors just as much as patients. Some of the smartest people in the world work hard to figure you how to get consumers to pay as much they can get. But I think this often drives suboptimal choices.

Regulatory: Regulations are either created out of safety concerns, or financial issues masquerading as safety issues.

Psychological: Men like to tinker, there isn’t a lot of tinkering with TU and perceptions can be ingrained.

Medical: Real issues related to the protocol.

FINANCIAL: TU in castor oil is Nebido, roughly about $140 cash pay for 4 ML outside of the USA. But it isn’t approved in the USA. Endo Pharmaceuticals got the approval for Aveed, I used to trade biotech stocks and followed them. They claimed safety concerns and got TU 3 ml ampule approve. They did it that way so they could solely control the product in the US market, reap all the profits and charge what they wanted to, cash pay is ~ $1,176 for 3 ML. Same exact product, just 1 ML less product.

The only TU product a US based doctor can prescribe is Aveed. Most clinics like Defy don’t take insurance, those of us that are low T but not below 264 mg/dl Total T aren’t going to get a regular doctor that needs to work with insurance to approve their choice to even prescribe testosterone, and if by chance you do find a doctor willing to prescribe Aveed, insurance won’t pay for it.

If insurance covers it, great, but I doubt TRT clinics / doctors will get a lot of patients to self-pay that sort of money. And there is no profit for a compounding pharmacy in that situation.

MEDICAL ISSUES: I never get a high HCT, only inject every 3 months. It is an IM injection into the glute, not the easiest to do.

3 days after injection, and for ~ 18 days, you get fairly high levels of TT, FT and E2. At day 16 I measured 1380 TT, FT 28 and E2 56. It starts to decline and level off after that. At 109 days post injection I measured 690 TT, FT 20 and E2 20.


I did gain water weight during those 18 days, then it all went away in 2-3 days. My blood pressure went up also, then went down. I could take an AI, in the past I didn’t really notice the water weight though I did record that my BP went up in Jan 2014, now I think it was elevated E2. I keep a spread sheet, but don’t always record or check BP.

You can’t really fine tune TU/Nebido/Aveed. You can raise your T higher by using a gel/cream or injectable TC + TU, it works well if you are at 690 TT and want higher. Not so easy to lower TT/FT, though I think there are supplements that do lower FT, not many really want to lower FT. Lower FT and you lower E2..


I think the longer cycle of when your E2 is elevated is an advantage, it’s not up and down every X days, it goes up and gradually falls over 12 weeks, likely reaches a better spot after 3 weeks. I am thinking one can use an AI during the first two weeks and it will work well and easier to figure out a dose if the higher E2 is a concern. But it does down naturally so one could just wait. But once you pass 3 weeks your T/E2 is in a pretty sweet spot fpr 9 weeks.

So IMO the disadvantaged of Aveed is that I don’t think any TRT clinic prescribes it, it isn’t a money maker for a compounding pharmacy, it’s very expensive if you can’t get insurance to cover it and you can’t easily tinker with the levels, at least not if the same way you can with TC. BUT for me at least, I don't need to tinker with the levels. My SHBG is about 40, I am not sure if your SHBG is very low or very high you will get the same results.

Another disadvantage a doctor might consider, once you first inject Nebido/Aveed/TU, your T levels will be high for at least 8-10 weeks after the first injection. If for some reason higher T is causing a problem, you are stuck for a couple of months.

For me, ~$50 a month for Nebido is reasonable, if I had to pay $380+ a month for Aveed (keep in mind you need to inject Aveed more often than Nebido which I haven’t factored in), I would elect either a cream/gel or frequent TC injections. You get more side effects with TC, but it’s far cheaper than in those circumstances that I have outlined with Aveed. If Nebido needs to be imported into the USA by some means. Mexico has Nebido, Canada does not. BTW, I have seen generic TU for sale in other esters from Chinese markets, it isn't going to work the same way, but it will be similar, but you are getting into the gray market with unknown risks.

Thanks for such a detailed response. The high levels in the first few weeks were very similar for me when I was on Pellets. Unfortunately I didn't stay with the pellets long enough to know if it helped with hematocrit. The literature suggests pellets have a lower risk of raising Hematocrit. Its almost tempting to give those a whirl again. The only reason I quit was because I didn't like the "procedure"

 

[[email protected]]

I am curious if anyone has ever had their doctor pull them off TRT because of high hematocrit.

A couple times. I simply said no, I like being a functional human being, I’ll just donate blood.

 

[[email protected]]

Broadly, you can break up the reasons for medical choices into 4 categories.

Financial: We are all victims of the medical / industrial complex, doctors just as much as patients. Some of the smartest people in the world work hard to figure you how to get consumers to pay as much they can get. But I think this often drives suboptimal choices.

Regulatory: Regulations are either created out of safety concerns, or financial issues masquerading as safety issues.

Psychological: Men like to tinker, there isn’t a lot of tinkering with TU and perceptions can be ingrained.

Medical: Real issues related to the protocol.

FINANCIAL: TU in castor oil is Nebido, roughly about $140 cash pay for 4 ML outside of the USA. But it isn’t approved in the USA. Endo Pharmaceuticals got the approval for Aveed, I used to trade biotech stocks and followed them. They claimed safety concerns and got TU 3 ml ampule approve. They did it that way so they could solely control the product in the US market, reap all the profits and charge what they wanted to, cash pay is ~ $1,176 for 3 ML. Same exact product, just 1 ML less product.

The only TU product a US based doctor can prescribe is Aveed. Most clinics like Defy don’t take insurance, those of us that are low T but not below 264 mg/dl Total T aren’t going to get a regular doctor that needs to work with insurance to approve their choice to even prescribe testosterone, and if by chance you do find a doctor willing to prescribe Aveed, insurance won’t pay for it.

If insurance covers it, great, but I doubt TRT clinics / doctors will get a lot of patients to self-pay that sort of money. And there is no profit for a compounding pharmacy in that situation.

MEDICAL ISSUES: I never get a high HCT, only inject every 3 months. It is an IM injection into the glute, not the easiest to do.

3 days after injection, and for ~ 18 days, you get fairly high levels of TT, FT and E2. At day 16 I measured 1380 TT, FT 28 and E2 56. It starts to decline and level off after that. At 109 days post injection I measured 690 TT, FT 20 and E2 20.


I did gain water weight during those 18 days, then it all went away in 2-3 days. My blood pressure went up also, then went down. I could take an AI, in the past I didn’t really notice the water weight though I did record that my BP went up in Jan 2014, now I think it was elevated E2. I keep a spread sheet, but don’t always record or check BP.

You can’t really fine tune TU/Nebido/Aveed. You can raise your T higher by using a gel/cream or injectable TC + TU, it works well if you are at 690 TT and want higher. Not so easy to lower TT/FT, though I think there are supplements that do lower FT, not many really want to lower FT. Lower FT and you lower E2..


I think the longer cycle of when your E2 is elevated is an advantage, it’s not up and down every X days, it goes up and gradually falls over 12 weeks, likely reaches a better spot after 3 weeks. I am thinking one can use an AI during the first two weeks and it will work well and easier to figure out a dose if the higher E2 is a concern. But it does down naturally so one could just wait. But once you pass 3 weeks your T/E2 is in a pretty sweet spot fpr 9 weeks.

So IMO the disadvantaged of Aveed is that I don’t think any TRT clinic prescribes it, it isn’t a money maker for a compounding pharmacy, it’s very expensive if you can’t get insurance to cover it and you can’t easily tinker with the levels, at least not if the same way you can with TC. BUT for me at least, I don't need to tinker with the levels. My SHBG is about 40, I am not sure if your SHBG is very low or very high you will get the same results.

Another disadvantage a doctor might consider, once you first inject Nebido/Aveed/TU, your T levels will be high for at least 8-10 weeks after the first injection. If for some reason higher T is causing a problem, you are stuck for a couple of months.

For me, ~$50 a month for Nebido is reasonable, if I had to pay $380+ a month for Aveed (keep in mind you need to inject Aveed more often than Nebido which I haven’t factored in), I would elect either a cream/gel or frequent TC injections. You get more side effects with TC, but it’s far cheaper than in those circumstances that I have outlined with Aveed. If Nebido needs to be imported into the USA by some means. Mexico has Nebido, Canada does not. BTW, I have seen generic TU for sale in other esters from Chinese markets, it isn't going to work the same way, but it will be similar, but you are getting into the gray market with unknown risks.

$140 for 3ml? Wow.

 

[DragonBits]

$140 for 3ml? Wow.

btw, Nebido is ~$140 for 4 ml, which lasts 12 weeks. The internet reported price of aveed is ~ $1,176 for 3 M, it's recommended to be injected every 10 weeks.

 

[Simon7]

I use testosterone undecanoate in castor oil every 10-12 weeks, it doesn't cause a dramatic rise in HCT (but in 7& of men, it still happens). My HCT rose from a low of 40 to a high of 47.5.

-------------------------------------------------------------------------
FYI. % of men that get a rise of HCT greater than 50% on different T protocols.

Testosterone cypionate or enanthate
(short-acting injectable)100-200 mg IM every week
67% get a rise over 50%

Testosterone undecanoate (long-acting injectable)1000 mg, 12 weeks
7% get a rise over 50%

Transdermal gel 50-100 mg every day(sachets)
Testosterone 20-80 mg every day (dosing pump)
13% get a rise over 50%

Pellets Crystalline testosterone 75 mg/pellet implanted, 10-14 pellets every 3-6 month
35% get a rise over 50%.
------------------------------------------------------

As you can see, HCT is most frequent in men that use either TC / TE. The forum suggest if you change your dose to more frequent injections of a smaller amount, you reduce your side effects.

@DragonBits , thank you for that very informative post about the differences of HCT rises via different Testosterone delivery systems. I live outside the US and I've tried both Nebido and transdermal gel but as I have low SHBG the T gets quickly flushed out of my system. What enables me to sustain continuous high T levels is bi weekly SUBQ T enanthate injections, which are absorbed slower via the SUBQ tissue. However the T enanthate does raise my HCT, requiring me to donate blood three times a year.

I wonder if the Nebido 1000mg/4ml dose can be split up used in bi weekly SUBQ injections of say 50mg each, thus lasting 10 weeks, similar to what I do with my T ethanoate ampule. The Nebido instructions state:

"As with all oily solutions, Nebido must be injected strictly intramuscularly and very slowly (over two minutes). Pulmonary microembolism of oily solutions can in rare cases lead to signs and symptoms such as cough, dyspnoea, malaise, hyperhidrosis, chest pain, dizziness, paraesthesia, or syncope. These reactions may occur during or immediately after the injection and are reversible. The patient should therefore be observed during and immediately after each injection in order to allow for early recognition of possible signs and symptoms of pulmonary oily microembolism. Treatment is usually supportive, e.g. by administration of supplemental oxygen.

Suspected anaphylactic reactions after Nebido injection have been reported."

The question is given the above warning of Pulmonary microembolism is would it be safe to home administer Nebido via SUBQ. Unless a medical authority says it is safe I would not attempt it. Perhaps @Dr Justin Saya MD can chime in?