High HCT low iron

Hi,

My labs just came back and surprise, I have high HCT 57.5 and low iron 8.5 umol/l from donating. Can someone explain to my why this can't be fixed with iron supplementation? Seems like the only thing that works is lowering your T dose. I'm only at 60mg twice a week. I feel no side effects, feel great actually but I don't want to die from heart disease.

Post in thread 'Iron Supplementation Protocol to Raise Ferritin FAST While on TRT: The Vorck Protocol' Iron Supplementation Protocol to Raise Ferritin FAST While on TRT: The Vorck Protocol - Page 9 - Excel Male TRT Forum

Maybe this interests you

Funkybeats said:

Hi,

My labs just came back and surprise, I have high HCT 57.5 and low iron 8.5 umol/l from donating. Can someone explain to my why this can't be fixed with iron supplementation? Seems like the only thing that works is lowering your T dose. I'm only at 60mg twice a week. I feel no side effects, feel great actually but I don't want to die from heart disease.

Click to expand...

Made a big mistake here getting caught up on that donating blood too often merry go round to control your elevated hematocrit as it is a given you will crash your iron/ferritin which can open up another can of worms.

Where did your baseline HCT sit pre-TTh?

Most men struggling with elevated RBCs, H/H is because they are running too high a trough/steady-state FT.

Would not get to caught up on the I am only at 60 mg 2x/week (120 mg) as one can easily hit a healthy let alone high trough FT on such dose.

Need to post your labs so we know where your trough TT and more importantly trough FT sits!

Throw SHBG in there too.

Most men on therapy are injecting 100-200 mg T/week whether once weekly or split into more frequent injections as in twice-weekly (every 3.5 days), M/W/F, EOD or daily.

As I have stated numerous times on the forum over the years most men can easily hit a healthy let alone high trough FT injecting 100-150 mg/week especially when split into more frequent injections.

Yes there will always be those outliers who may need the higher-end dose 200 mg/week but it is far from common as in rare!

Such dose would have the majority OVERMEDICATED!

Also keep in mind that some men can still achieve a stellar trough FT injecting <100 mg/week.

It is easy to raise your ferritin/iron through diet or supplementation but it will not do you any favours when it comes to lowering your hematocrit.

Lowering your trough/steady-state FT would be key here let alone addresisng any other factors which can contribute to such!

Other factors such as sleep apnea, smoking, asthma, COPD can have a negative impact on hematocrit.

Throw in making sure you are well hydrated (fluids/electrolytes) days before not just the day of getting blood work done otherwise it can skew the results and you will have no idea where it truly sits.

If your results. are accurate then you need to address this as the cutoff is 55% in Canada and even then most in the know would take measures once you hit 54-55% let alone some will not want it to venture beyond 50-52%.

Ferritin will more closely correlate with hematocrit and hemoglobin. I restarted Jatenzo five days ago. 10 months ago I had a hematocrit of 57% and my ferritin was 260.

I was running normal testosterone values. I came off therapy to figure out my issues, I was overdosing on vitamin C, which is why my ferritin was so high.

My ferritin went over the normal ranges off TRT which is how I figured out my issues. I was vitamin D deficient when my ferritin was over the normal ranges. It had to be the vitamin C and stopping the vitamin C brought my ferritin to 26 after 5 months.

Now my vitamin C is slightly deficient, never felt better and my ferritin is 26 and my hematocrit prior to starting Jatenzo was 42.3. I don’t expect to have high hematocrit and hemoglobin values on Jatenzo so long as I don’t get too greedy.

Systemlord said:

Ferritin will more closely correlate with hematocrit and hemoglobin. I restarted Jatenzo five days ago. 10 months ago I had a hematocrit of 57% and my ferritin was 260.

I was running normal testosterone values. I came off therapy to figure out my issues, I was overdosing on vitamin C, which is why my ferritin was so high.

My ferritin went over the normal ranges off TRT which is how I figured out my issues. I was vitamin D deficient when my ferritin was over the normal ranges. It had to be the vitamin C and stopping the vitamin C brought my ferritin to 26 after 5 months.

Now my vitamin C is slightly deficient, never felt better and my ferritin is 26 and my hematocrit prior to starting Jatenzo was 42.3. I don’t expect to have high hematocrit and hemoglobin values on Jatenzo so long as I don’t get too greedy.

Click to expand...

The time for high Vitamin C supplementation no matter what is if you feel any kind of infection/illness coming on. Especially Liposomal Vitamin C. Vitamin C is like the ammo for your innate immune system "gun". It's interesting that it may have raised your HCT since some of us struggle with unexplained increases in HCT.

Guided_by_Voices said:

The time for high Vitamin C supplementation no matter what is if you feel any kind of infection/illness coming on. Especially Liposomal Vitamin C. Vitamin C is like the ammo for your innate immune system "gun". It's interesting that it may have raised your HCT since some of us struggle with unexplained increases in HCT.

Click to expand...

My immune system is borderline overactive without vitamin C, I never get sick. I have high histamine levels. I sneezed a couple of times every night every day of my life.

madman said:

Made a big mistake here getting caught up on that donating blood too often merry go round to control your elevated hematocrit as it is a given you will crash your iron/ferritin which can open up another can of worms.

Where did your baseline HCT sit pre-TTh?

Most men struggling with elevated RBCs, H/H is because they are running too high a trough/steady-state FT.

Would not get to caught up on the I am only at 60 mg 2x/week (120 mg) as one can easily hit a healthy let alone high trough FT on such dose.

Need to post your labs so we know where your trough TT and more importantly trough FT sits!

Throw SHBG in there too.

Most men on therapy are injecting 100-200 mg T/week whether once weekly or split into more frequent injections as in twice-weekly (every 3.5 days), M/W/F, EOD or daily.

As I have stated numerous times on the forum over the years most men can easily hit a healthy let alone high trough FT injecting 100-150 mg/week especially when split into more frequent injections.

Yes there will always be those outliers who may need the higher-end dose 200 mg/week but it is far from common as in rare!

Such dose would have the majority OVERMEDICATED!

Also keep in mind that some men can still achieve a stellar trough FT injecting <100 mg/week.

It is easy to raise your ferritin/iron through diet or supplementation but it will not do you any favours when it comes to lowering your hematocrit.

Lowering your trough/steady-state FT would be key here let alone addresisng any other factors which can contribute to such!

Other factors such as sleep apnea, smoking, asthma, COPD can have a negative impact on hematocrit.

Throw in making sure you are well hydrated (fluids/electrolytes) days before not just the day of getting blood work done otherwise it can skew the results and you will have no idea where it truly sits.

If your results. are accurate then you need to address this as the cutoff is 55% in Canada and even then most in the know would take measures once you hit 54-55% let alone some will not want it to venture beyond 50-52%.

Click to expand...

Hey, thanks for the reply. My baseline HCT before TRT was 50.5 then 53.5 after three months of therapy, then 57.5 after six months. I was likely a little dehydrated for the last test. My hemoglobin and red blood counts seems around the same or slightly lower then when I was at 53.5. I do have OSA but use a CPAP every night. My total test is 33.9 nmol/l and free test is 934 pmol/l. SBHG was not tested. The only thing I can think is to reduce my test to 50mg twice per week. Will I need to donate again to bring the 57.5 HCT down?

Thanks for the help!

Funkybeats said:

Hey, thanks for the reply. My baseline HCT before TRT was 50.5 then 53.5 after three months of therapy, then 57.5 after six months. I was likely a little dehydrated for the last test. My hemoglobin and red blood counts seems around the same or slightly lower then when I was at 53.5. I do have OSA but use a CPAP every night. My total test is 33.9 nmol/l and free test is 934 pmol/l. SBHG was not tested. The only thing I can think is to reduce my test to 50mg twice per week. Will I need to donate again to bring the 57.5 HCT down?

Thanks for the help!

Click to expand...

Your hematocrit was already above the top-end of the reference range (49-50%) depending on lab used (Lifelabs or Dynacare) pre-TTH so it was a given that it would be driven up much higher when using injectable esterified T especially when running too high a trough/steady-state FT level.

*The Endocrine Society uses a hematocrit threshold of >50% as a relative contraindication to initiating TT and >54% as an indication to discontinue treatment [1].

You are hitting a high trough TT high 900s let alone what is more critical here is your trough FT is high!

Not sure if your labs were done at Dynacare or Lifelabs so I will post the reference ranges for TT/FT.

You are hitting a high trough TT 977.7 ng/dL (33.9 nmol/L) Lifelabs reference range (Male 8.4-28.8 nmol/L) or Dynacare reference range (Male 7.6-31.4 nmol/L) and more importantly a high trough FT 934 pmol/L Lifelabs reference range (Male ≤10-49 196-636 pmol/L) or Dynacare reference range (160-699 pmol/L).


Your FT was calculated using the linear law-of-mass action Vermeulen (cFTV).







Also need to keep in mind that your peak TT and more importantly FT will be higher!

Of course you could donate again to try and lower your RBCs, H/H but it will only be a temporary fix and you have already crash your iron/ferritin due to your frequent blood donations.

The simple fix here would be bringing down your trough/steady-state FT!

Keep in mind it will take time for your hematocrit to drop down as the lifespan of RBCs 120 days.

As I have stated numerous times on the forum over the years, patience is key when tweaking a protocol (decreasing/increasing T dose)!

*It has to be noted that the largest increase in hematocrit levels is seen in the first year after initiation of testosterone therapy. On the other hand it is expected that a decrease can take a similar amount of time. Especially when taking into account that the lifespan of a erythrocyte is 120 days. Hence, interventions to lower hematocrit levels should be evaluated after 6 months and a decrease can be expected until 1 year after the intervention.












Look over post #4!


* OSA by itself is believed to cause erythrocytosis via hypoxemia [25]. Combined with TT, it is possible that the effects on erythrocytosis may be compounded, either through higher metabolic requirements with elevated testosterone, changes in response to hypoxia, and physiologic changes to the airways

* Patients with obstructive sleep apnea, advanced age, obesity, type II diabetes mellitus, elevated baseline hematocrit (>50%), and those who live in high altitudes are at higher risk of developing erythrocytosis after TT [32]

* The percentage increase in hematocrit continues to increase in a linear dose-dependent fashion [38]. Side effects of secondary erythrocytosis resulting from hyperviscosity include paresthesias, blurred vision, fatigue, and headaches [39]

*The Endocrine Society uses a hematocrit threshold of >50% as a relative contraindication to initiating TT and >54% as an indication to discontinue treatment [1]. The European Association of Urology (EAU) guidelines on hypogonadism also state that the hematocrit should not exceed 54%, while recent Canadian guidelines cite 55% as the safe upper limit [15, 40]. The AUA guidelines on testosterone deficiency define polycythemia as a hematocrit of 52% and recommend stopping or reducing treatment if the hematocrit reaches 54% [14]

*The upper limit of normal for hematocrit in most laboratory reference ranges in healthy adult males is 54%, which is where this value is likely derived

*The major limitation to using these studies is that they involve population sampling, and do not investigate men on testosterone. Regardless, a hematocrit of ≥54% appears to be the consistent threshold to discontinuing or reducing treatment utilized by major urologic governing bodies, while the evidence for this specific cutoff is lacking

*Therapeutic phlebotomy is one way in which patients may “treat” erythrocytosis. Phlebotomy is a mainstay of treatment in PCV and there are no absolute contraindications [48]

*Phlebotomy is effective in the management of erythrocytosis in patients with PV in reducing thromboembolic events and this benefit may be conferred onto patients with secondary erythrocytosis secondary to TT, though there is no high-quality evidence to support this claim

*There are no evidence-based guidelines that outline the frequency or volume of phlebotomy protocols in patients receiving TT

*Whether or not phlebotomy has a role to play in the management of secondary polycythemia deserves further study

*At this point, phlebotomy appears to be a safe approach to reducing hematocrit but physicians should be aware that it may not be sufficient in reducing hematocrit levels on a long-term basis

madman said:

Your hematocrit was already above the top-end of the reference range (49-50%) depending on lab used (Lifelabs or Dynacare) pre-TTH so it was a given that it would be driven up much higher when using injectable esterified T especially when running too high a trough/steady-state FT level.

*The Endocrine Society uses a hematocrit threshold of >50% as a relative contraindication to initiating TT and >54% as an indication to discontinue treatment [1].

You are hitting a high trough TT high 900s let alone what is more critical here is your trough FT is high!

Not sure if your labs were done at Dynacare or Lifelabs so I will post the reference ranges for TT/FT.

You are hitting a high trough TT 977.7 ng/dL (33.9 nmol/L) Lifelabs reference range (Male 8.4-28.8 nmol/L) or Dynacare reference range (Male 7.6-31.4 nmol/L) and more importantly a high trough FT 934 pmol/L Lifelabs reference range (Male ≤10-49 196-636 pmol/L) or Dynacare reference range (160-699 pmol/L).


Your FT was calculated using the linear law-of-mass action Vermeulen (cFTV).





Also need to keep in mind that your peak TT and more importantly FT will be higher!

Of course you could donate again to try and lower your RBCs, H/H but it will only be a temporary fix and you have already crash your iron/ferritin due to your frequent blood donations.

The simple fix here would be bringing down your trough/steady-state FT!

Keep in mind it will take time for your hematocrit to drop down as the lifespan of RBCs 120 days.

As I have stated numerous times on the forum over the years, patience is key when tweaking a protocol (decreasing/increasing T dose)!

*It has to be noted that the largest increase in hematocrit levels is seen in the first year after initiation of testosterone therapy. On the other hand it is expected that a decrease can take a similar amount of time. Especially when taking into account that the lifespan of a erythrocyte is 120 days. Hence, interventions to lower hematocrit levels should be evaluated after 6 months and a decrease can be expected until 1 year after the intervention.








Look over post #4!



* OSA by itself is believed to cause erythrocytosis via hypoxemia [25]. Combined with TT, it is possible that the effects on erythrocytosis may be compounded, either through higher metabolic requirements with elevated testosterone, changes in response to hypoxia, and physiologic changes to the airways

* Patients with obstructive sleep apnea, advanced age, obesity, type II diabetes mellitus, elevated baseline hematocrit (>50%), and those who live in high altitudes are at higher risk of developing erythrocytosis after TT [32]

* The percentage increase in hematocrit continues to increase in a linear dose-dependent fashion [38]. Side effects of secondary erythrocytosis resulting from hyperviscosity include paresthesias, blurred vision, fatigue, and headaches [39]

*The Endocrine Society uses a hematocrit threshold of >50% as a relative contraindication to initiating TT and >54% as an indication to discontinue treatment [1]. The European Association of Urology (EAU) guidelines on hypogonadism also state that the hematocrit should not exceed 54%, while recent Canadian guidelines cite 55% as the safe upper limit [15, 40]. The AUA guidelines on testosterone deficiency define polycythemia as a hematocrit of 52% and recommend stopping or reducing treatment if the hematocrit reaches 54% [14]

*The upper limit of normal for hematocrit in most laboratory reference ranges in healthy adult males is 54%, which is where this value is likely derived

*The major limitation to using these studies is that they involve population sampling, and do not investigate men on testosterone. Regardless, a hematocrit of ≥54% appears to be the consistent threshold to discontinuing or reducing treatment utilized by major urologic governing bodies, while the evidence for this specific cutoff is lacking

*Therapeutic phlebotomy is one way in which patients may “treat” erythrocytosis. Phlebotomy is a mainstay of treatment in PCV and there are no absolute contraindications [48]

*Phlebotomy is effective in the management of erythrocytosis in patients with PV in reducing thromboembolic events and this benefit may be conferred onto patients with secondary erythrocytosis secondary to TT, though there is no high-quality evidence to support this claim

*There are no evidence-based guidelines that outline the frequency or volume of phlebotomy protocols in patients receiving TT

*Whether or not phlebotomy has a role to play in the management of secondary polycythemia deserves further study

*At this point, phlebotomy appears to be a safe approach to reducing hematocrit but physicians should be aware that it may not be sufficient in reducing hematocrit levels on a long-term basis

Click to expand...

So looks like I've made a rookie mistake here. I have reduced my dosage to 100mg a week, I think I'll try 3 times a week to reduce the peak TT and FT. If that doesn't bring it back in range I will reduce to 80mg. In the article you posted it says HCG derived testosterone increases are not correlated to increased HCT. If I can't get the test in the box would HCG mono therapy be an option? My lab is LifeLabs.

Funkybeats said:

So looks like I've made a rookie mistake here. I have reduced my dosage to 100mg a week, I think I'll try 3 times a week to reduce the peak TT and FT. If that doesn't bring it back in range I will reduce to 80mg. In the article you posted it says HCG derived testosterone increases are not correlated to increased HCT. If I can't get the test in the box would HCG mono therapy be an option? My lab is LifeLabs.

Click to expand...

Your only options when it comes to formulations which will have minimal impact on hematocrit would be nasal T gel (Natesto) and the newer oral TU formulations (Jatenzo, Tlando or Kyzatrex).

Unfortunately as of now the only oral TU formulation available in Canada is the generic oral TU which has replaced the grandfather of oral T (Andriol) which had been available for. decades up until it was discontinued in 2018.

Keep in mind we may have the option to use the newer versions of oral TU Kyzatrex or Tlando which are available in the US as Marius Pharmaceuticals and Verity Pharmaceuticals are currently seeking approval from Health Canada!

Crossing my fingers that Health Canada approves both of the newer oral TU formulations as it will open up another door for many men suffering from hypogonadism let alone the ones already on T therapy that are struggling with side-effects from running too high a trough/steady-state FT level!










8. Side effects of HCG treatment

Since HCG treatment raises serum testosterone levels, it can lead to similar side effects as seen in direct TRT, including gynecomastia, high blood pressure, acne, hair loss and raises in estrogen potentially leading to gynecomastia. However, unlike supplementation with supraphysiological doses of testosterone as seen in doping, physiological serum testosterone increases triggered by HCG supplementation only rarely result in side effects (Table 2). Moreover, as compared to TRT, HCG treatment seems to have fewer side effects with regard to affecting hematocrit, estradiol, prostate volume, and PSA increases [15]. Interestingly, serum testosterone seems to peak at 72 hours post HCG injection and significantly correlates with estradiol peaks observed 24 hours after injection [38]. Therefore similar to TRT, even though not in line with guidelines, ancillary drugs such as aromatase inhibitors, selective estrogen receptor modulators, or 5α-reductase inhibitors are used off-label in some rare cases of severe side effects due to increased serum estradiol or DHT levels. However, as opposed to TRT, HCG does not increase the risk of infertility but rather improves fertility. It is currently unknown if long-term administration of HCG can lead to side effects such as gonadotropin resistance. (Table 2).