Low Total T; High Hematocrit - Where to go from here?

[JuiceBoxHero]

Hi everyone! Long time reader, first time poster.

I started TRT about 20 weeks ago. After my most recent blood test, my urologist wanted me to consider stopping. However, I'm debating moving to a person that only focuses on TRT. But before I jump to that route, I'm curious about my most recent blood work.

46 y/o male; 100mg Test C wk split into two injections SubQ every 4 days in the AM.
Blood work was completed at 9a on injection day.

Total T: 578 ng/dl
Free T: 130.1 pg/ml
Dihydrotesosterone: 69 H ng/dl
Hemoglobin: 17.7 H g/dl
Hematocrit: 53.5 H
Estradiol: 47 H pg/ml
Prolactin: 108 ng/ml
PSA Total: 0.66

I do a daily BP test in the morning and I hover around 118/80.

The total T seems low for a higher Hematocrit and Hemoglobin. My physique has changed, but I have pretty bad acne on my scalp and back and a few cystic acne spots on my face. I'm noticing some hair thinning as well (photos show it). My wife says I tend to blow up a bit at the kids more quickly. But I do feel more energetic and less brain foggy.

I'm not interesting in stopping, but wondering where to move forward? I was thinking about doing 3 injections per week instead of 2. But everything I've read says my total should be higher - in the 800s.

I could use any advance before deciding to pay a lot more for a TRT focused clinic.

Best

 

[Nelson Vergel]

Do you know what your hematocrit was before starting TRT? If it was over 50, you may have sleep apnea (assuming that you don’t smoke)

Get some Nizoral shampoo and also some coal tar shampoo for your scalp. Using each one of consecutive days for two weeks and then stay on the Nizoral 3 times per week.

Try to minimize chocolate and milk products for a while to decrease acne. You can wash your face also with Nizoral.

 

[JuiceBoxHero]

Do you know what your hematocrit was before starting TRT? If it was over 50, you may have sleep apnea (assuming that you don’t smoke)

Get some Nizoral shampoo and also some coal tar shampoo for your scalp. Using each one of consecutive days for two weeks and then stay on the Nizoral 3 times per week.

Try to minimize chocolate and milk products for a while to decrease acne. You can wash your face also with Nizoral.

Prior to starting (May 8, 2025):
Total T: 384 ng/dl
Free T: 53 pg/ml
Hemoglobin: 15.5 H g/dl
Hematocrit: 47 H
Estradiol: 20 H pg/ml
Prolactin: 6.5 ng/ml
PSA Total: 0.48

I did my own lab work on July 30, 2025
Total T: 501 ng/dl
Free T: 110.7 pg/ml
Hemoglobin: 15.6 H g/dl
Hematocrit: 49.8 H
Estradiol: 24 H pg/ml (ultra sensitive this time though)
Prolactin: 6.5 ng/ml
PSA Total: 0.48

Copied from above (Oct 8, 2025)
Total T: 578 ng/dl
Free T: 130.1 pg/ml
Dihydrotesosterone: 69 H ng/dl
Hemoglobin: 17.7 H g/dl
Hematocrit: 53.5 H
Estradiol: 47 H pg/ml
Prolactin: 10.8 ng/ml
PSA Total: 0.66

I was thinking about this last night. I'm wondering how dehydrated I was going into the appointment. I usually chug a lot of water before going, but this time I decided to just live my normal routine. But if that's the case, my numbers might just be high until I chug water.

Since I'm doing 50mg every 4 days (subq), I was going to propose to my doctor that I go 30mg every 3 days (subq) and do more blood work in 8 weeks. I'm hoping that will help bring things down and maybe tame the acne a little bit.

I have actually been using Nioxin shampoo 5 days a week and Nizoral 2 days a week for about 15 years now. I always had this fear of thinning hair. But using the Nizoral on the face might not be a bad idea. I didn't realized it helped acne until recently. My doctor did prescribe a Benzyl Peroxide body wash that I'm going to try as well.

My diet isn't as dialed in as it should be so that's good advice about reducing dairy - and hell probably sugar too. I'm on a minimum Retatrutide dose and it makes me hungrier than ever.

I have done a couple sleep studies over the years and they all come back with very mild when on my back but non-existant when on my side - positional sleep apnea. I sometimes wear a device to keep my on my side, but I'm an active sleeper and fight the hell out of it.

I actually got a CPAP provided to me a month ago but have been struggling to use it for more than an hour a night. I'm trying to dial it in. A major problem - TRT has caused the libido to skyrocket - making a move on my wife in the middle of the night with a mask on has been 100% unsuccessful. Pick your battles I guess.

Anyway, I'm hoping increasing the frequency and reducing the dose a little might help.