Does hematocrit keep increasing after testosterone steady state? How often to check?

Kaliman911 · Mar 8, 2018

Hello guys, I’ve been on TRT for about 4 months and I just recently got my blood lab results. Everything looks good, but I did noticed my hemoglobin and hematocrit did increase to 15 and 45 respectively. Are they going to keep increasing? My doctor wants to check me at 6 month intervals now and not sure if my A1C will change too much on those 6 months. She also told me to take a baby aspirin. Doesn’t fish oil do the same? Thin the blood? I take plenty of that. I will appreciate any info and guidance. Thanks.

CoastWatcher · Mar 8, 2018

Kaliman911 said:
Hello guys, I've been on TRT for about 4 months and I just recently got my blood lab results. Everything looks good, but I did noticed my hemoglobin and hematocrit did increase to 15 and 45 respectively. Are they going to keep increasing? My doctor wants to check me at 6 month intervals now and not sure if my A1C will change too much on those 6 months. She also told me to take a baby aspirin. Doesn't fish oil do the same? Thin the blood? I take plenty of that. I will appreciate any info and guidance. Thanks.

Your Hct and Hgb may well continue to rise during the course of TRT. It is, for many, the cost of a ticket to the TRT show. Should that be the case, therapeutic phlebotomy is a procedure that can deal with it. There is a great deal of information on this topic available here on the Forum, including the attached.

How to Manage Increased Blood Thickness (Hematocrit) Caused by Testosterone Replacement Therapy

Vince · Mar 8, 2018

Fish oil and aspirin both will make your blood more slippery, helps reduce the effects of high HCT. After 2 years of trt my HCT finally has stabilized, I still have my levels checked regularly. Because I have a fear of high HCT levels, but after a full year of not donating blood my HCG levels have not gone over 47.9.

captain · Mar 8, 2018

I thought levels tend spike then drop back over time after you first start TRT. I think they can spike again with dose increases. Dr. Crisler says you may not need to donate. http://www.drjohncrisler.com/trt-and-phlebotomy.html He seems to be the only one that's said much about it. I know there was a heated debate about it one time on a forum and not much has been said after that.

Kaliman911 · Mar 8, 2018

captain said:
I thought levels tend spike then drop back over time after you first start TRT. I think they can spike again with dose increases. Dr. Crisler says you may not need to donate. http://www.drjohncrisler.com/trt-and-phlebotomy.html He seems to be the only one that's said much about it. I know there was a heated debate about it one time on a forum and not much has been said after that.

Thats great info to know. It's prett recent too, Feb 2017. Thanks!

HealthMan · Mar 8, 2018

Testosterone suppresses hepcidin. The higher the dosage the higher the suppression and impact on hematocrit.

Testosterone Suppresses Hepcidin in Men: A Potential Mechanism for Testosterone-Induced Erythrocytosis
Testosterone Suppresses Hepcidin in Men: A Potential Mechanism for Testosterone-Induced Erythrocytosis

Either donate blood and make sure you have a full iron panel including ferritin on a regular basis. Or reduce dosage. Or both.

CoastWatcher · Mar 8, 2018

Kaliman911 said:
Thats great info to know. It's prett recent too, Feb 2017. Thanks!

It is certainly a contentious point.

Vince · Mar 8, 2018

Even with very high testosterone levels my HCT was at 47.9 I do know how different we all are
I took a peak at my Labs
I took a peek at my Labs

Kaliman911 · Mar 8, 2018

CoastWatcher said:
It is certainly a contentious point.

The discussion about high platelets being the main concern, instead of hmgb/HCT is interesting. Will have to do more research. In the discussion platelets are not increased by TRT.

madman · Mar 9, 2018

Kaliman911 said:
Hello guys, I’ve been on TRT for about 4 months and I just recently got my blood lab results. Everything looks good, but I did noticed my hemoglobin and hematocrit did increase to 15 and 45 respectively. Are they going to keep increasing? My doctor wants to check me at 6 month intervals now and not sure if my A1C will change too much on those 6 months. She also told me to take a baby aspirin. Doesn’t fish oil do the same? Thin the blood? I take plenty of that. I will appreciate any info and guidance. Thanks.

When starting trt hematocrit/hemoglobin will usually increase during the first month and can take 9-12 months to reach peak levels.

Increasing dose of testosterone will also elevate HCT/hemoglobin further and even than some have issues using low doses of testosterone.

madman · Mar 9, 2018

Kaliman911 said:
Hello guys, I've been on TRT for about 4 months and I just recently got my blood lab results. Everything looks good, but I did noticed my hemoglobin and hematocrit did increase to 15 and 45 respectively. Are they going to keep increasing? My doctor wants to check me at 6 month intervals now and not sure if my A1C will change too much on those 6 months. She also told me to take a baby aspirin. Doesn't fish oil do the same? Thin the blood? I take plenty of that. I will appreciate any info and guidance. Thanks.

Is the haematopoietic effect of testosterone mediated by erythropoietin? The results of a clinical trial in older menhttp://onlinelibrary.wiley.com/doi/10.1111/j.2047-2927.2012.00009.x/full

Testosterone alters iron metabolism and stimulates red blood cell production independently of dihydrotestosteroneTestosterone alters iron metabolism and stimulates red blood cell production independently of dihydrotestosterone

Testosterone Induces Erythrocytosis via Increased Erythropoietin and Suppressed Hepcidin: Evidence for a New Erythropoietin/Hemoglobin Set Point
Testosterone Induces Erythrocytosis via Increased Erythropoietin and Suppressed Hepcidin: Evidence for a New Erythropoietin/Hemoglobin Set Point

Effects of Graded Doses of Testosterone on Erythropoiesis in Healthy Young and Older Men
Effects of Graded Doses of Testosterone on Erythropoiesis in Healthy Young and Older Men

Tommy Wall · Mar 10, 2018

The interesting debate reg to donate or not was very interesting for many of us but unfortunately and aruptly ended up in status quo. This kinds of different opinions are good and healthy. And I think different opinions should be welcome on a forum like this one.

Smokin Joe · Mar 10, 2018

The discussion about high platelets being the main concern, instead of hmgb/HCT is interesting. Will have to do more research. In the discussion platelets are not increased by TRT.

Kaliman911,
What was the discussion around platelets-I missed something.
My platelets are low (100,000-117,000)Idiopathic Thrombo Cytopenia.
My immune system eats em up as fast my marrow produces.
My HCT rises rapidly on TRT-from 45 to 51 in 4 to 5 months which is why I have
consistently stopped trt.

Blackhawk · Mar 10, 2018

Side issue for me and others here, phlebotomy decreases ferritin stores as well as hematocrit. Be sure to monitor if you get into a blood donation schedule.

Gman86 · Mar 10, 2018

Was anyone on here with high HCT experiencing side effects from it, or were just afraid of the number being high?

Vince · Mar 10, 2018

Gman86 said:
Was anyone on here with high HCT experiencing side effects from it, or were just afraid of the number being high?

The only thing I fear with high HCT the chance of blood clogs. I also believe that it may cause high blood pressure.

madman · Mar 10, 2018

Abstract
Introduction
A rapid increase in awareness of androgen deficiency has led to substantial increases in prescribing of testosterone therapy (TTh), with benefits of improvements in mood, libido, bone density, muscle mass, body composition, energy, and cognition. However, TTh can be limited by its side effects, particularly erythrocytosis. This review examines the literature on testosterone-induced erythrocytosis and polycythemia.

Aim
To review the available literature on testosterone-induced erythrocytosis, discuss possible mechanisms for pathophysiology, determine the significance of formulation, and elucidate potential thromboembolic risk.

Methods
A literature review was performed using PubMed for articles addressing TTh, erythrocytosis, and polycythemia.

Main Outcome Measures
Mechanism, pharmacologic contribution, and risk of testosterone-induced erythrocytosis.

Results
For men undergoing TTh, the risk of developing erythrocytosis compared with controls is well established, with short-acting injectable formulations having the highest associated incidence. Potential mechanisms explaining the relation between TTh and erythrocytosis include the role of hepcidin, iron sequestration and turnover, erythropoietin production, bone marrow stimulation, and genetic factors. High blood viscosity increases the risk for potential vascular complications involving the coronary, cerebrovascular, and peripheral vascular circulations, although there is limited evidence supporting a relation between TTh and vascular complications.

Conclusion
Short-acting injectable testosterone is associated with greater risk of erythrocytosis compared with other formulations. The mechanism of the pathophysiology and its role on thromboembolic events remain unclear, although some data support an increased risk of cardiovascular events resulting from testosterone-induced erythrocytosis.

Ohlander SJ, Varghese B, Pastuszak AW. Erythrocytosis Following Testosterone Therapy. Sex Med Rev 2018;6:77–85.

https://www.sciencedirect.com/science/article/pii/S2050052117300410?via=ihub

madman · Mar 10, 2018

Proposed direct and indirect effects of T on erythropoiesis.

Blackhawk · Mar 10, 2018

captain said:
I thought levels tend spike then drop back over time after you first start TRT. I think they can spike again with dose increases. Dr. Crisler says you may not need to donate. http://www.drjohncrisler.com/trt-and-phlebotomy.html He seems to be the only one that's said much about it. I know there was a heated debate about it one time on a forum and not much has been said after that.

This talk is encouraging, I would like to follow up, but I could not understand the name of the presenter Crisler referred to, nor find any reference on the Age medical management website. Does anyone have this reference material? I want to see the presenters research references.

Gman86 · Mar 10, 2018

Forgot about the increased risk for clots. Blood pressure you can monitor, but increased blood viscosity isn’t really something you can monitor very easily.

Does hematocrit keep increasing after testosterone steady state? How often to check?

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