Recent Blood Work

[BigTex]

My doctor had me do blood work Monday. He didn't tell me I was going to do CMP and a CBC so I was NOT fasted. So I did my usual 10am meal of a Lean Mass shake with 120g of a carb mix with maltodextrin, oats, yams and seet potatoe sugars out of 610 calories with a 12oz of whole milk. Off I go todo blood work. So they made a mistake and put FASTED on my blood work. In fact, that was my 2nd meal of the day since 5am, I tested at 11am. I also just got started back on MK-677. So I am not at all worried about Glucose. I also started back on 500mg of metformin/d

Any way all was normal except:

Glucose - 133
ALT - 54
Red Blood Cell - NORMAL!!!! 5.65 (was 6.42)
Hemoglobin - 18.3 (was 20.2)
HTC - 53.9 (was 58.5)
Total Testosterone - 934 (was 540)
Estradiol - 64 (was 47) quite taking the anastrozol 3 months ago

My TRT is 80mg total every 10 day and I have broken that down to 40mg every 5 days with 250iu of on the 4th day. My dose was the same with the last reading of 540. But that time I tested on the day I was to inject. This time it was 2 days after my last injection.

My doctor has not reviewed the results yet. I did do a blood dump last Friday. My doctor said yesterday he wants my HTC at 45 and he will let me know the frequency of the blood dumps when he sees where we are. I was at HTC 55% the day I dumped blood.

I am happy with the 934 T reading but would still like to get back to the 100mg every 10 days that I was prescribed.

 

[Nelson Vergel]

My doctor said yesterday he wants my HTC at 45 and he will let me know the frequency of the blood dumps when he sees where we are. I was at HTC 55% the day I dumped blood.

I would be careful. Bringing hematocrit to 45 from 55 will require at least 3 donations (3 points per donation). You will probably lose iron and ferritin down to lower than "normal" levels. I would just be happy with 48-49.

 

[tareload]

Bringing hematocrit to 45 from 55

Excellent point. This doesn't seem realistic at all for BigTex given he is using exogenous Test and quite sensitive dose response WRT to RBC.

Your case is puzzling @BigTex. IIRC you visited a hematologist and no obvious red flags (hemochromatosis, etc), correct? I thought I was sensitive.

Have you considered downsizing your sizeable dietary intake of iron and see the response before going down the phlebotomy rabbit hole?

 

[Systemlord]

My doctor said yesterday he wants my HTC at 45

Your doctor wants to bleed a lot of the benefits to TRT.

My doctor had me do blood work Monday. He didn't tell me I was going to do CMP and a CBC so I was NOT fasted.

You gotta love those communication skills! I have the same problem with my doctors and in fact if I don’t remember to do my yearly PSA labs, when it comes time to refill my Jatenzo prescription, it won’t happen.

There is no communication at all.

 

[BigTex]

I would be careful. Bringing hematocrit to 45 from 55 will require at least 3 donations (3 points per donation). You will probably lose iron and ferritin down to lower than "normal" levels. I would just be happy with 48-49.

I agree.....I want to see my HTC down more but I am happy with 48-49. I have a friend that is pretty good with this stuff and he says 55 or little less is GREAT.

I am watching the iron and it was in the middle of the range. I did stop taking the iron supplements about a month ago. I also cut the DHEA supplement I was taking to see if that had an effects on Estrodiol, looks like none. Thanks for the advice!

 

[BigTex]

Excellent point. This doesn't seem realistic at all for BigTex given he is using exogenous Test and quite sensitive dose response WRT to RBC.

Your case is puzzling @BigTex. IIRC you visited a hematologist and no obvious red flags (hemochromatosis, etc), correct? I thought I was sensitive.

Have you considered downsizing your sizeable dietary intake of iron and see the response before going down the phlebotomy rabbit hole?

I had the following test run at Quest and all was negative.
JAK2 V617F CASCADING REFLEX TO CALR, JAK2 EXON 12, MPL, AND CSF3R
JAK2 V617F MUTATION ANALYSIS

As Dr. Glueck stated usually these genetic disorders surface in the 1st 3 months of TRT. I have been using testosterone since 1980. It woudl be very odd for a genetic disorder to suddenly show up. I have also never had high HTC other than 50-51 with much higher doses and more than one drug.

I did cut the iron supplements about a month ago.

I found it odd the testosterone levels went from 540 to 934 since October and at the same dose. The only difference is I am splitting the from 1 to 2 in the same 10 days. You think it might have been that big of a change with timeing of the test? I can't see 40mg sending my T value up 400 points.

Do you guys think I need to worry abou the E2 value? I have never had high E2 in my life even to T values of 3000+ Not sure why it went up and I don't feel any better or worse unless I take that anastroloz.....then I feel slightly worse and the libedo crashes.

 

[BigTex]

Just looked at my dietary iron intake for the past 6 months and it is 92mg/d. Kind of over the RDA. Like I said, I have cut the iron supplement in the past few weeks.

 

[tareload]

https://journals.physiology.org/doi/epdf/10.1152/ajpendo.00184.2014

 

[tareload]

Marked erythrocytosis during treatment with sodium glucose cotransporter-2 inhibitors-report of two cases

SGLT-2 inhibitors are known to increase hematocrit. We present two cases with marked asymptomatic erythrocytosis developing after taking SGLT-2 inhibi…

www.sciencedirect.com

How can sodium-glucose cotransporter 2 inhibitors stimulate erythrocytosis in patients who are iron-deficient? Implications for understanding iron homeostasis in heart failure - PubMed

Many patients with heart failure have an iron-deficient state, which can limit erythropoiesis in erythroid precursors and ATP production in cardiomyocytes. Yet, treatment with sodium-glucose cotransporter 2 (SGLT2) inhibitors produces consistent increases in haemoglobin and haematocrit, even in...

pubmed.ncbi.nlm.nih.gov

Risk of Erythrocytosis During Concomitant Testosterone and SGLT2-Inhibitor Treatment: A Warning From Two Clinical Cases

The co-prescription of testosterone and SGLT2i in patients with hypogonadism and T2DM, conditions frequently associated, may induce erythrocytosis and should pr

academic.oup.com

Dapagliflozin Suppresses Hepcidin And Increases Erythropoiesis

AbstractContext. Dapagliflozin and other SGLT2 inhibitors are known to increase hematocrit, possibly due to its diuretic effects and hemoconcentration.Objective

academic.oup.com

 

[tareload]

Idiopathic erythrocytosis: a disappearing entity

Abstract. Erythrocytosis results when there is an increased red cell mass and thus an increased hemoglobin. The causes can be divided into primary intrinsic def

ashpublications.org

 

[tareload]

Erythrocytosis associated with hyperthyroidism: a rare case report and clinical study of possible mechanism - PubMed

Erythrocytosis may appear in patients with hyperthyroidism, and one possible mechanism is thyroid hormone-induced augmentation of HIF-1α, resulting in increased EPO levels.

pubmed.ncbi.nlm.nih.gov

 

[tareload]

Erythrocytosis in the general population: clinical characteristics and association with clonal hematopoiesis

Key Points. Erythrocytosis, only when defined using strict criteria, was associated with cardiovascular morbidity and mortality and all-cause mortality.Erythroc

ashpublications.org

 

[BigTex]

Marked erythrocytosis during treatment with sodium glucose cotransporter-2 inhibitors-report of two cases

SGLT-2 inhibitors are known to increase hematocrit. We present two cases with marked asymptomatic erythrocytosis developing after taking SGLT-2 inhibi…

www.sciencedirect.com

How can sodium-glucose cotransporter 2 inhibitors stimulate erythrocytosis in patients who are iron-deficient? Implications for understanding iron homeostasis in heart failure - PubMed

Many patients with heart failure have an iron-deficient state, which can limit erythropoiesis in erythroid precursors and ATP production in cardiomyocytes. Yet, treatment with sodium-glucose cotransporter 2 (SGLT2) inhibitors produces consistent increases in haemoglobin and haematocrit, even in...

pubmed.ncbi.nlm.nih.gov

Risk of Erythrocytosis During Concomitant Testosterone and SGLT2-Inhibitor Treatment: A Warning From Two Clinical Cases

The co-prescription of testosterone and SGLT2i in patients with hypogonadism and T2DM, conditions frequently associated, may induce erythrocytosis and should pr

academic.oup.com

Dapagliflozin Suppresses Hepcidin And Increases Erythropoiesis

AbstractContext. Dapagliflozin and other SGLT2 inhibitors are known to increase hematocrit, possibly due to its diuretic effects and hemoconcentration.Objective

academic.oup.com

I am certainly not taking any kind fo SGLT-2 inhibitors. I think I will go back to taking my morning asprin and toss this tylenol. Asprin in the morning and ibuprofin in the evening. Aspring helped my pain levels well. While my metabolism is high, my thyroid levels are normal.

 

[tareload]

I am certainly not taking any kind fo SGLT-2 inhibitors. I think I will go back to taking my morning asprin and toss this tylenol. Asprin in the morning and ibuprofin in the evening. Aspring helped my pain levels well. While my metabolism is high, my thyroid levels are normal.

I was trying to think of any other factors which could be at play besides the testosterone. I do 325 mg aspirin and 200 mg ibuprofen every AM lately.

Given your history your Hct response seems to have really amplified in last few years?

 

[ajax31]

He’s been taking iron supplements. I’d like hear when he started them in relation to the higher hematocrit and the dosage.

 

[tareload]

He’s been taking iron supplements. I’d like hear when he started them in relation to the higher hematocrit and the dosage.

Great point. I was not aware BigTex was taking Fe supplement along with the prodigious intake he receives from food.

As George Carlin used to say....Holy Sh*t folks .

 

[BigTex]

I was trying to think of any other factors which could be at play besides the testosterone. I do 325 mg aspirin and 200 mg ibuprofen every AM lately.

Given your history your Hct response seems to have really amplified in last few years?

I agree it is confusing. This is the least amount of testosterone I have ever taken in the 42+ years I have been using anabolic steroids. Never had problems. Now that I am "officially" on the TRT thing I start having issues. What has changed? Age? Test cypionate.....I have not used that since the 1980's. Atthis point I am afraid to alter anything. I want to keep everythign as consistant as possible and see what happens.

I took two ibuprofen this morning and will take 2 asprin tonight.

 

[BigTex]

He’s been taking iron supplements. I’d like hear when he started them in relation to the higher hematocrit and the dosage.

The high HTC came long before the supplements. It was after my 2nd blood dump when I got concerned about iron levels. After I saw they were fine I quit taking them all to together. But I eat a lot of food therefore I get more dietary iron that the RDA allows. But I have done that all my life. 5000 cals a day is low for me since I use to be up close to 10,000.

 

[tareload]

Just looked at my dietary iron intake for the past 6 months and it is 92mg/d. Kind of over the RDA.

That is a f ton. Here's mine on 5000 kcal/day:

Increasing your muscle mass during a rigorous weight loss diet?

Hypoenergetic diet–induced weight loss results in ∼20–30% of mass lost as lean body mass (LBM), with the remaining mass lost from adipose tissue. So normally you can expect for every 10 pounds of body weight you lost to also lost 2-3 pounds of muscle tissue. However, is there a way to avoid...

www.excelmale.com

Are you planning an experiment to significantly reduce your dietary iron intake?

 

[BigTex]

Not really. @readalot, I am a very maticulous person meaning I am also very habitual. I eat the same foods at the same time and have for years. I change very little. If I need more calories, I eat more of it. So it is not diet. I also do not eat vegetables at all. I hate them so I have to supplement. 1 centrum silver (walmart brand) for old people every day solves the problem.

Here is yesterdays diet