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

I have been on TRT for 16 months, my hematocrit levels starting going past the max value after 2 months. I started donating blood every 2 months and levels have been perfect. I stsrted at 50mg every 3.5 days and 1/2 a anastrozol. My estrogen levels are always perfect, but my T was sometimes above max range, dropped to 40mg and brought levels to 800 range, but started getting bad back acne, so lowered it to 35. I am 51, even lowering dose, I still need to donate blood.

rotwiler said:

I have been on TRT for 16 months, my hematocrit levels starting going past the max value after 2 months. I started donating blood every 2 months and levels have been perfect. I stsrted at 50mg every 3.5 days and 1/2 a anastrozol. My estrogen levels are always perfect, but my T was sometimes above max range, dropped to 40mg and brought levels to 800 range, but started getting bad back acne, so lowered it to 35. I am 51, even lowering dose, I still need to donate blood.

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Check your ferritin?

sbstrum_MD said:

5. Beware that T → dihydrotestosterone (DHT) via 5-alpha reductase. You may wish to consider the use of a 5-alpha reductase inhibitor (5-ARI) like dutasteride (Avodart) or finasteride (Proscar). Again, measure the Biological End Point (BEP) of DHT.

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You're not going to find any support for that on this forum. None at all. That stuff is downright dangerous and should never be used by men.

Interestingly enough, my hemoglobin levels were below normal and slightly deficient on iron. Since I started TRT 5 months ago, my hemoglobin and HCT increased within midrange. So I guess this increase is a plus for me. I hope it stays at this levels with my current protocol. I do have a high total T (1,038) and free T (24) but that's where my doctor wants me due to high SHBG. I do not take aspirin, but take 3g of fish oil daily. Looking at my lab results, it is true that other blood components like platelets and WBC did not increase with my TRT protocol. Maybe Dr. Rouzier is up to something significant. Great information here in this forum. Definitely learning a lot.

Everytime I donate blood, they test to make sure iron level is high enough, so far has been normal except last time was a little higher than normal. My TRT experience started out bad, my Dr was not informed well on trt and put me on 400mg every 2 weeks, my estrogen skyrocketed to crazy levels like 160, now is 25. I do labs now on my own through online place and do local lab draw, cheaper that way and I tell my Dr my changes I make etc.

rotwiler said:

Everytime I donate blood, they test to make sure iron level is high enough, so far has been normal except last time was a little higher than normal. My TRT experience started out bad, my Dr was not informed well on trt and put me on 400mg every 2 weeks, my estrogen skyrocketed to crazy levels like 160, now is 25. I do labs now on my own through online place and do local lab draw, cheaper that way and I tell my Dr my changes I make etc.

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Ferritin is different than serum iron. Ferritin indicates body tissue stores of iron which can be depleted even if serum iron looks OK.

Having low ferritin is a contraindication to donating blood regardless of elevated HGB and HCT which can be associated with adequate or high levels of iron in the blood.

Ugh, ok, will check that next lab. Reason I was put on TRT was I did a physical in 2016 and first time my Dr checked my T level and was in 90s, he checked because I couldn't lose weight. So far in 1 year lost 71 pounds, but I have to take anastrazol or my estrogen goes up quick. 1 month into TRT I flipped out from original dose at 400mg every 2 weeks, bp went high, estrogen 5x-6x too high, anxiety, was horrible, all good now.

I agree with the advice that Vince provided as your DHT level is probably high thus causing the acne. I started out 6 years ago using 100mg of test cup per week with 1 mg of Anastrozole. Total test level was 1280 (240 - 1100) range. I was getting mild acne ( I was 55 at the time) and my DHT level was 89. I believe the range max was 79. Since then, I lowered my my dosage of test to 72 mg/wk and 0.75 mg Anastrozole which works pretty well for me. My DHT level is about 62 now. My estrogen is 22 -28 and that is good for me. If you get a script from your doctor to donate blood when Hemoglobin is over 16 or Hematocrit is over 48, you can register with the Central Blood Bank as a "Special Donor". Anytime you donate they check your hemoglobin. My Hemoglobin runs just high enough to enable the donation every 2 months. After about 2 years of using injectable testosterone, I switched to Androgel. My testosterone level dropped into the 500 range but my Hemoglobin was still over 16. I was told that eventually I won't have to donate as often but so far, that's not the case.

I, like many on this forum, have had what it seems is the normal HCT/ferritin issues with TRT. At first, my HCT/hemoglobin (HG) went through the roof. I would donate blood with my HG near the max Red Cross value of 20. Every time I donate, the HG drops about 3 points. Within a month, my HG was back up 3 points. After donating about 3 or 4 times, my iron/ferritin got depleted - but, with low iron/ferritin my HCT/HG were not increasing, so I was not having to donate blood. My HCT/HG was very stable.

Although, I felt fine with low ferritin, my GP and defy recommended iron supplementation. After a month on iron supplements, my iron levels are now on the high side of normal and I am on the HCT/HG express train again. I am having to donate blood every month to keep things below HG of 20. My present defy protocol is 70mg Tcyp along with 0.15 anastrazole and 500 IU of HCG every 3.5 days.

It is pretty clear to me that iron/ferritin level modulates my HCT/HG production dramatically. I'm hoping to get my iron/ferritin level back near the low side of the normal range which should stop my wild HCT/HG swings. Then, hopefully, I can donate blood 2-3 times a year to keep things under control.

It would be very nice if high HCT/HG as a result of TRT wasn't an issue.

I seem to feel better after blood donations. Might be a placebo effect but toward the 2 month mark I feel tired. Actually except for first few weeks, TRT has never given me better energy, just better feeling mentally and easier to lose weight even on the small dose I take. I have worked graveyard shift since 1992, so think that is more my tired issue since I am getting older.

rotwiler I agree.
When I give blood I always feel better as my HCT would go down around 5 points.
But as it came back up over the 50 mark, which was pretty quick, I started feeling tired all over again.
I miss trt for reasons already stated above and would love to figure out the HCT deal
but I think for those of us who can't the risk may be greater.

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.

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My hemoglobin and hematocrit and rbc did what seems similar to all the others. Increased, I donated 5 or 6 times. Now it stays pretty normal without donations.

Maybe the others will chime in on the lab frequency, but especially if you are new to TRT, 6 months seems too long to go without follow up labs. Also, check your bp regularly and keep a log. You didn't mention your age.

my experience with HCT so far, started trt was checked at 6 weeks ( 150mg once a week ) told doc i wanted to inject twice a week, dose increased to 80mg twice a week, was checked at 6 weeks HCT 53, dose decreased to 60mg twice a week, 1st blood donation, went back for another donation 2 months later, hct back to 53, went back in approx. 2 months 51, went back in 9-10 weeks 49, next time i waited 3 months, had hct checked and is at 47, so seems to be stabilizing now.

j4ever said:

my experience with HCT so far, started trt was checked at 6 weeks ( 150mg once a week ) told doc i wanted to inject twice a week, dose increased to 80mg twice a week, was checked at 6 weeks HCT 53, dose decreased to 60mg twice a week, 1st blood donation, went back for another donation 2 months later, hct back to 53, went back in approx. 2 months 51, went back in 9-10 weeks 49, next time i waited 3 months, had hct checked and is at 47, so seems to be stabilizing now.

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That's what we all hope for, stabilizing HCT. For me it took two years and then my HCT finally stabilized. Now for the past year the blood center constantly calls me and ask me to donate but I haven't for over a year now.

AlexM said:

My hemoglobin and hematocrit and rbc did what seems similar to all the others. Increased, I donated 5 or 6 times. Now it stays pretty normal without donations.

Maybe the others will chime in on the lab frequency, but especially if you are new to TRT, 6 months seems too long to go without follow up labs. Also, check your bp regularly and keep a log. You didn't mention your age.

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I am 43. Blood pressure has been a bit elevated, but it has been like that even before TRT. I believe it is more affected by my diet. I eat a lot of carbs and fluid shifts may be causing higher blood pressure. When I was following a ketogenic diet, my blood pressure was perfect. Right now is about 145/85. Before TRT, my hemoglobin was actually below range. Ferritin was a tad low too. TRT improved that. I would be worried about donating because of the ferritin levels. 6 months does seem a bit long for the next blood work. However, my doc would get my labs sooner if I need to. I think I will check my HCT and hemoglobin on my own in between.

yeah they will do that, I always get an automated message, even with it staying in range, I might go in 1-2 times a year and make a donation, hopefully it would help someone and it gives me an excuse to eat cookies, I just don't want to have to get a therapeutic donation every couple of months.

I meant RDW is off a little, rbc is fine.

j4ever said:

yeah they will do that, I always get an automated message, even with it staying in range, I might go in 1-2 times a year and make a donation, hopefully it would help someone and it gives me an excuse to eat cookies, I just don't want to have to get a therapeutic donation every couple of months.

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I also thought about donating twice a year, just to help people in need of blood. Before trt I did donate occasionally.

I donate every 2 months, is next to my work, easy and takes about 40 minutes total, but keeps my levels great.

rotwiler said:

I donate every 2 months, is next to my work, easy and takes about 40 minutes total, but keeps my levels great.

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I did that straight for 2 years donating every 8 weeks, I just got tired of donating that often. I'm happy my HCT finally stabilized.