High HGB/HCT

[tareload]

One thing I don't understand is the relationship between RBCs, hemoglobin and hematocrit. If hct is hgb x3, but hematocrit is the thickness due to rbc concentration...what am I missing?

Hematocrit is the packed spun volume of whole blood that is made up of RBCs and is expressed as a percentage of total blood volume. It can be measured or calculated as Hct = (RBC × MCV)/10.

It looks like it has nothing to do with hemoglobin. According to that, my hct is on point at 53.8, or actually it should've been 53.18.
Anyone have any thoughts on that?

See this excellent review if you'd like to learn more:

A Methodical Approach to Interpreting the Red Blood Cell Parameters of the Complete Blood Count

See step 6 in particular and also some great insight into MCV, MCH, and MCHC.

Building on the other comments, please go see a trained hemologist-oncologist who has spent years studying and learning how to properly interpret CBC panels and other blood markers if you have a concern. Don't let this cause you immediate panic or anxiety. As I've shared with others, the ceiling on Hct should be considered based on your personal health history, age, inflammation status, inferred plasma viscosity. Hct on its own doesn't set your whole blood viscosity but does play a major role.

 

[GreenMachineX]

Remember that the average life of a red blood cell is 90 days, so reductions in dose take a while to reduce hematocrit. Also, dehydration, smoking and sleep apnea can make it harder to reduce hematocrit even with a low TRT dose.


Hemoglobin is contained in red blood cells, so it is are part of the equation. Hemoglobin x 3= hematocrit (unless you are not well hydrated).

How long ago did you move to a higher altitude?

What is your current total and free T?

High Hematocrit Caused by TRT: How to Lower and Manage it

Testosterone replacement therapy (TRT) is one of the most effective ways to combat low testosterone levels, but it's vital that you understand the risks associated with the treatment. As with any form

www.discountedlabs.com

Thanks. I don't have sleep apnea, don't smoke and I think pretty well hydrated at all times.

I moved to higher altitude 4 months ago.

I'm not sure my current test and free test. I need to get it done, but last known was 550 total and free was 147 (35-155) on roughly 9-10mg daily.

I think what happened was I started taking more b12, and they pushed me over the edge. But, ever since I started that, my sleep had greatly improved.

Why is my hematocrit never hgb x3 then? It's always less. This is for @readalot also.

Today test dose was right above 4mg line. About to donate. Hoping I'm not over the cut off now...

 

[Cataceous]

...
@Cataceous if my results were this at roughly 7mg per day, would dropping to 5mg make sense? Or even lower? ...

... I need to get it done, but last known was 550 total and free was 147 (35-155) on roughly 9-10mg daily.
...

These data suggest you could get away with the smaller dose. But it's only one measurement. If it's wrong on the high side then you could end up hypogonadal. There are plenty of guys with lower clearance rates who see normal serum testosterone at these lower doses. But you want to be sure you're one of them.

 

[tareload]

A HCT of 53 is healthy as long as ur platelets aren’t too high.

Ur platelets are almost low, so obv no need to be concerned about a 53 HCT when ur platelets are on the very low end of the range.

U mainly just don’t want a high HCT and high platelet count at the same time.

FYI @GreenMachineX these comments have good intent (I'm sure) but are misleading. Erythrocytosis secondary to TRT is of course not the same issue as PCV. However, there are concerns at the individual level with running Hct too high in the absence of PCV (as mentioned above and again other personal health markers must be considered in setting individual Hct ceiling).

 

[tareload]

Why is my hematocrit never hgb x3 then? It's always less. This is for @readalot also.

See the equation I just shared with you and note well the margin of error:


It is very difficult from your above posts to tabulate measured Hct and Hb values. If you share a table or your actual CBC test results it would be easier to compare calculated (rule of 3) vs measured Hct value. Typically as shown above the equation will be good to +/- 2%.

 

[GreenMachineX]

These data suggest you could get away with the smaller dose. But it's only one measurement. If it's wrong on the high side then you could end up hypogonadal. There are plenty of guys with lower clearance rates who see normal serum testosterone at these lower doses. But you want to be sure you're one of them.

I did have some other results confirming those levels though.

 

[GreenMachineX]

See the equation I just shared with you and note well the margin of error:


It is very difficult from your above posts to tabulate measured Hct and Hb values. If you share a table or your actual CBC test results it would be easier to compare calculated (rule of 3) vs measured Hct value. Typically as shown above the equation will be good to +/- 2%.

Here are the full results.

 

[tareload]

Some more reference material for you:

Daily Injections to Manage Hematocrit - Not Working

Yes, I think I know what Hct is. And no, it isn’t the % of hemoglobin in plasma. It is the volume percentage of red blood cells in whole blood. Contrary to your statement above, dehydration will affect both Hct and Hgb. Here’s a good reference for you to read: Hemoglobin (Hb) is the...

forums.t-nation.com

Note the RMSE (error) on this correlation wasn't shared but you can see that while the best-fit line has excellent correlation, there is still some differences between the data vs the model fit.

 

[Cataceous]

I did have some other results confirming those levels though.

The 5 mg dose then should put you at around half of the free testosterone seen with the 10 mg dose, about 70-80 pg/mL on the Quest scale. If this is the case then it's a reasonable experiment if you can stick with it for a couple months. It's still possible to feel hypogonadal in the transition, because it's a significant drop. But the hope is to resolve the side effects of excess and be closer to what's natural for you.

 

[tareload]

Here are the full results.

Here's what I summarized from your above posts:

Hb measured	calc Hct (3x Hb)	Hct measured	Difference	MCHC
18.8​	56.4​	53.2​	3.2​	0.353​
17.8​	53.4​	50.8​	2.6​	0.350​
18.1​	54.3​	52​	2.3​	0.348​

Now go back to the article I shared with you:

Your MCHC is not exactly 33.3333333333.......%. The rule of 3 assume MCHC of 1/3 (33.3333333......%). Yours is actually ~35% and consistent. Hence, your deviation from the rule of 3 is to be expected and your MCHC is within the reference range. The more your MCHC differs from 1/3 and the higher your Hb, the more your measured Hct will deviate from rule of 3 above.

If you want some practice examples here's the applicable parts of my last two CBCs:

How do the calculated rule of 3 Hcts differ from the measured values?

 

[GreenMachineX]

The 5 mg dose then should put you at around half of the free testosterone seen with the 10 mg dose, about 70-80 pg/mL on the Quest scale. If this is the case then it's a reasonable experiment if you can stick with it for a couple months. It's still possible to feel hypogonadal in the transition, because it's a significant drop. But the hope is to resolve the side effects of excess and be closer to what's natural for you.

Gotcha. Then that's what I'll do. I'm OK with trough being exactly midrange. My health is most important. Just finished donating! Hgb at Red Cross was 19.2 so I was close to cut off. Perfect timing for a dose reduction.

Here's what I summarized from your above posts:

Hb measured	calc Hct (3x Hb)	Hct measured	Difference	MCHC
18.8​	56.4​	53.2​	3.2​	0.353​
17.8​	53.4​	50.8​	2.6​	0.350​
18.1​	54.3​	52​	2.3​	0.348​

Now go back to the article I shared with you:
View attachment 19933

Your MCHC is not exactly 33.3333333333%. It's ~35% and consistent. Hence, your variation from the rule of 3 is to be expected and your MCHC is within the reference range.

Wait, so was my hematocrit actually 53 or 56 then? Or is the difference not that big of a deal, its more that it's just too high in general? I'm a little confused.

 

[GreenMachineX]

Post to all...just finished donating. Blood pressure was 122/78...lowest ever at a Red Cross and in line with all current readings. Hgb was 19.2 so getting close to cut off. Praise God the meter was reading correctly today (I've seen their meter be an entire hemoglobin point off before).

 

[tareload]

Gotcha. Then that's what I'll do. I'm OK with trough being exactly midrange. My health is most important. Just finished donating! Hgb at Red Cross was 19.2 so I was close to cut off. Perfect timing for a dose reduction.

Wait, so was my hematocrit actually 53 or 56 then? Or is the difference not that big of a deal, its more that it's just too high in general? I'm a little confused.

53.2 on the first row (+/- the typical 1% error on the machine). Go with the measured value. The rule of 3 is an approximation with the big assumption I outlined above. The deviation is ok and expected. Take some deep breaths and try to relax. Stress will kill you and I'll try to follow my own advice (I don't do a very good job of following it).

 

[tareload]

Blood pressure was 122/78...

Very nice pulse pressure and congrats.

 

[tareload]

What was your Hb/Hct before TRT and what were your pre-TRT serum numbers (TT/SHBG)?

cRP before and after TRT?

CMP before vs after?

 

[tareload]

Can Hemoglobin-Hematocrit Relationship Be Used to Assess Hydration Status? | Hosti Hayuanta | Cermin Dunia Kedokteran

MCHC...the lurking number when comparing "rule of 3 calculated Hct" (3*Hb) vs measured Hct.

 

[tareload]

@GreenMachineX

Daily Injections to Manage Hematocrit - Not Working

Thank you for bringing this up. As one would expect, there is a distribution of responses to TRT [Hct and inflammation status (–> plasma viscosity) and hence whole blood viscosity response, NO production,…]. So you better know where you are on each of the distributions. Some guys...

forums.t-nation.com

In case you want even more fun:

Erythrocytosis | eClinpath

Erythrocytosis is defined as an increase in red blood cell (RBC) mass, usually absolute, and is also associated with an increased hematocrit (HCT) and hemoglobin concentration. Although some use the term polycythemia interchangeably with erythrocytosis, the two are not synonymous. Polycythemia...

eclinpath.com

 

[GreenMachineX]

What was your Hb/Hct before TRT and what were your pre-TRT serum numbers (TT/SHBG)?

cRP before and after TRT?

CMP before vs after?

I honestly don't recall any before TRT numbers because it was so long ago. I do recall when I was put on TRT the second time my total T was around 150 I believe.

Current CRP is <.2, which is perfect I think? CMP will take more time to post so I'll do that a bit later.

 

[GreenMachineX]

Hey guys, is it dangerous to take supplements or prescriptions after a blood donation? For example, I use theanine and lemon balm a lot for anxiety and sleep. Will those drop my blood pressure too much or hit me harder? I've read of people drinking coffee after blood donation and getting quite jittery after it, like tolerance was completely reset.

 

[GreenMachineX]

@GreenMachineX

Daily Injections to Manage Hematocrit - Not Working

Thank you for bringing this up. As one would expect, there is a distribution of responses to TRT [Hct and inflammation status (–> plasma viscosity) and hence whole blood viscosity response, NO production,…]. So you better know where you are on each of the distributions. Some guys...

forums.t-nation.com

In case you want even more fun:

Erythrocytosis | eClinpath

Erythrocytosis is defined as an increase in red blood cell (RBC) mass, usually absolute, and is also associated with an increased hematocrit (HCT) and hemoglobin concentration. Although some use the term polycythemia interchangeably with erythrocytosis, the two are not synonymous. Polycythemia...

eclinpath.com

Thanks. Interesting thread. I see some guys claiming hgb is more important than hct when it comes to viscosity. They are related I see to a certain extent, but it sounds like to them my hgb of 18.8 or 19.2 at the red cross is more dangerous then the hct of 53.8. I'm laying here in bed and can here my heart beat in my ears when I'm laying on my side. It's freaking me out still.

Should I be taking aspirin?

Also, does it take hemoglobin to drop 2-3 months like it does red blood cells? They are 2 different things it seems, so curious to know what happens there.