Can't control hematocrit even on low dose??

[paul22]

Hoping I can get some insight on why I am unable to control my hematocrit levels on low dose TRT. A bit of background:

-Healthy and fit 32 year old male. Cardio 7 days a week. Lifting 5 days a week.

-Underwent 3 years of various fertility treatments due to low test and sperm count. Which included fixing varicose vein both sides, clomid 25mg per day hcg 1500 iu 3 times a week 1 mg Arimidex ed.

-was able to have healthy child via IVF w/ wife

-Switched to TRT to avoid returning to low T symptoms. dose test c 40mg every 3.5d. hcg 1500 iu 3 times a week .5 mg arimidex every 3.5 days

-3 month follow up showed total T 1326 and e at 28. CBC showed hematocrit at 49.2

-Follow up 2 months later showed test 805 e 26 hematocrit 50.6

-Donated blood hematocrit decreased 48.7

-hematocrit has been steadily increasing over the past 8 months.

I have been self monitoring monthly my hematocrit and donating as needed. Hematocrit creeps up to 52ish on blood test after 2 months. The frequency of my donations has increased to every 1.5 months now. I cant seem to keep hematocrit under control even on this relatively low dose. Blood pressure elevates slightly in the weeks before donation then returns to normal following donation.
Local doctors don’t seem to have a plan to fix besides stopping treatment which I am dreading because I hate to go back to the way I was. But I am completely out of ideas on how to stop this rise. To continue to donate at this frequency I risk crashing iron.

Any thoughts?

 

[Vince]

I wonder if you stop donating blood how high would your HCT go. Some doctors let their patients HCT rise to 52 before donating. Maybe yours will only go to 50 or 51?

 

[J2048b]

these are just suggestions as im no doctor nor is anything to be looked at as doctors advice:

ask for a script from ur doc for a phlebo with electrolytes, this may help really aide in hydration which will help in regards to thick blood....

instead of doseing test e3d, try dosing every day, it has helped some reduce hematocrit as well as hemaglobin, u devide the dosage up every day say mond-frid, and pin sub q about 5mlg -10 mlg per day, as opposed to a full 40 mlg at once...e3.5d

why so much hcg? ive never gone over 500 iu's per week ever! and my total test was well above 1400....

also why so much arimidex?

i know everyone is different,

my old schedule when i was at the peak of trt:

sunday hcg 250 iu's
monday 200 mlg test cyp
wed .5 arimidex
friday 250 iu hcg

felt the best had everything dialed in.... e was usually between 20-29
total test usually above 1000

havent ran it like this in years as i age moderation takes hold....

 

[Nelson Vergel]

Do you smoke (anything) or have sleep apnea?

 

[paul22]

Non smoker or drinker.

I dont know about sleep apnea. I rarely snore and am not overweight.

Looking back over past labs when I was on clomid and hcg for fertility reasons my hematocrit fluctuated between 47-49

 

[HealthMan]

What is you FT? That HCG dosage might be the culprit. Cause a very large spike in T

 

[mooseman109]

If my hct is below 52 i am thrilled. I started to inject daily. I beliece it has helped lower my hct, but nothing of any major significance. Looks like i will be able to get by on 3-4 months between donations. I do 10mg/ day. My free T stays 11-14,total T 600 ish

 

[paul22]

Latest labs has FT at 27.91 with reference range of 5-21
FT% is 3.48 with reference range of 1.50-4.20

 

[J2048b]

im not over weight, i have sleep apnea

i guess i snore because ive been told i do, but just cause ur not over weight doesnt mean u cant have sleep apnea

 

[Pringle]

Non smoker or drinker.

I dont know about sleep apnea. I rarely snore and am not overweight.

Looking back over past labs when I was on clomid and hcg for fertility reasons my hematocrit fluctuated between 47-49

In my earlier post today I shared my experience with my inability to control my polycythemia. I tried everything from lowering injection amounts, going to daily injections, over hydration, etc. I was diagnosed with severe sleep apnea 90 days ago and have been on CPAP since. All my CBC lab values have significantly dropped over the past 90 days and all now in normal ranges with no phlebotomy assistance. I am not overweight, 51 years old, 5’8 and 175lbs. I train 5-6 days a week. I Had no idea I had apnea, was a “hunch” my doc investigated. May be worth an evaluation....it was for me!

 

[Systemlord]

Daily injections significantly lowered my HCT, not that it was ever a problem. Any doctor freaking out over 50% HCT doesn't understand that this isn't do to an underlying medical problem, it is a side effect of TRT and isn't dangerous in the sense it will cause blood clotting, it won't.

There are other medical conditions where doctor do see high HCT levels, this is why doctors are freaking out, because they are treating this as polycythemia vera.

 

[HealthMan]

Latest labs has FT at 27.91 with reference range of 5-21
FT% is 3.48 with reference range of 1.50-4.20

You could try to aim for low 20 FT see if it helps

 

[jsmith21896]

Daily injections significantly lowered my HCT, not that it was ever a problem. Any doctor freaking out over 50% HCT doesn't understand that this isn't do to an underlying medical problem, it is a side effect of TRT and isn't dangerous in the sense it will cause blood clotting, it won't.

There are other medical conditions where doctor do see high HCT levels, this is why doctors are freaking out, because they are treating this as polycythemia vera.

I have a similar experience. I was dosing .20ml (40mg) eod and at my last blood draw in Nov. my hct was 53. I donated a double red at the end of Dec., when the blood bank tested it, they said it was 56, I had them check again after the donation and it was 53. So you're saying that having high hct due to trt really isn't a thing to worry about? I have since lowered my dose a little to .16 eod to hopefully lower it or at least not raise it any more.

 

[vood13]

Get tested for sleep apnea. I had the same experience chasing my hematocrit with phlebotomy with no success. Before TRT I was tested and had mild obstructive sleep apnea (10 events per hour). About 1 year into TRT, I woke up with my heart in atrial fibrillation caused by severe OSA (54 events per hour). Got put on a CPAP and now have stable hematocrit and a lot more energy. Definitely something to look into.

 

[Nelson Vergel]

Sleep Apnea Is Associated With Polycythemia in Hypogonadal Men on Testosterone Replacement Therapy


Background
Polycythemia (erythrocytosis) is a known side effect of testosterone (T) replacement therapy (TRT) and appears to correlate with maximum T levels. There is also a well-established association between obstructive sleep apnea (OSA) and the development of polycythemia, which confers additional long-term cardiovascular morbidity. Synergy between TRT and OSA in the development of polycythemia remains poorly understood.

Aim
The objective of this study was to retrospectively assess the relationship of OSA and secondary polycythemia in hypogonadal men receiving TRT.

Methods
We performed a retrospective chart review of all men treated by a single provider from 2015 to 2019 for the diagnosis of hypogonadism. Patients who developed a hematocrit of 52% or greater were classified as having polycythemia. OSA was identified via clinical documentation or use of nocturnal continuous positive airway pressure. Demographics, laboratory values, treatment details, and comorbidities were recorded. Data were reported as mean ± SD for parametric variables and median [interquartile range] for non-parametric values.

Outcome
The primary outcome of this study was the association between OSA and polycythemia in hypogonadal men on TRT.

Results
474 men were included in this study. 62/474 (13.1%) men met the criteria for the diagnosis of polycythemia with a median hematocrit of 53.6 [interquartile range 52.6, 55.5]. Univariate analysis demonstrated a strong positive association between polycythemia and the concomitant diagnosis of OSA in hypogonadal men (P = .002). Even after correcting for age, body mass index (BMI), and peak T levels in the multivariate analysis (P = .01), this relationship remained significant with an odds ratio of 2.09 [95% CI 1.17, 3.76]. 37 men on TRT with polycythemia and OSA were included in the final cohort with a mean age of 59.2 ± 11.4 years, mean BMI of 32.4 ± 6.0, and median time from TRT initiation to polycythemia diagnosis of 3 years. All patients diagnosed with OSA were prescribed continuous positive airway pressure with poor compliance noted in 52.8% of men. 37.8% were managed via phlebotomy and 59.5% were managed via dose de-escalation of TRT. In hypogonadal men on TRT with polycythemia, BMI was the only risk factor strongly associated with OSA (P = .013).

Clinical Translation
In hypogonadal men (particularly those with elevated BMI) on TRT who develop secondary polycythemia, a diagnosis of OSA should be strongly considered.

Strengths & Limitations
This is a single provider retrospective study and further studies are needed to assess generalizability.

Conclusions
In this retrospective single-center cohort, the development of polycythemia in hypogonadal men on TRT was associated with an increased prevalence of OSA.

Lundy SD, Parekh NV, Shoskes DA. Obstructive Sleep Apnea Is Associated With Polycythemia in Hypogonadal Men on Testosterone Replacement Therapy. J Sex Med 2020

 

[Duece12345]

Throw me in the non-obese, non-snorer, in-shape but still have sleep apnea category.

 

[Cataceous]

I don't know why nobody mentions the obvious in these cases: the testosterone dose is too high. If trough serum testosterone is 800 ng/dL then the peak is probably 20-30% higher. The average male at his prime has peak testosterone around 600-700 ng/dL. His average level is maybe 500-600 and trough is perhaps 400-500. We couldn't all have had above-average testosterone in our natural states, so why are we surprised when we get side effects from boosting testosterone above what's normal for us?

 

[BigBamBoo]

At 50 years old my natural TT is 550-600. But due to my high SHBG, my free T is around 9-10.

I have labs from about 12+ years ago and my TT was 750. Did not know there was a FT or SHBG test back then.

Our youngest son (21 yo) who is very athletic has a TT of 900+, SHBG 23, and FT at 19 at his last blood test.
I had both my sons get tested early in their lives so they can have a baseline to look back at as they age.

We have a doctor friend who says sleep apnea has been the “thing” for awhile now.
She says pretty much ANYONE who gets tested will be diagnosed with it.

One thing that has lowered my HCT, improved my lipids, etc., has been intermittent fasting.
I only eat between 3:00pm and 8:00pm. The results have been amazing for me.

Everyone is different and finding what works for YOU can be a challenging journey.

 

[Duece12345]

Only five hrs a day for food! I wish i could do that. I would end up eating my arm off.

 

[BigBamBoo]

The first couple of weeks is the hardest.

After that it gets easier.

You can start by just cutting out breakfast and then work up from their.

If you want more info, just PM so we don’t highjack this thread.

But it has proven to lower HCT, lipids, etc.