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

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Kaliman911

Member
Gman86 said:
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.
Click to expand...
That's what they briefly touched bases on. That the risk of blood clotting is not cause by the red blood cell count, but by higher platelet count. According to the conversation, TRT does not increase platelet count. Here is a link about thrombocytopenia:

https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0062958/
 
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K

Kaliman911

Member
madman

madman

Super Moderator
Blackhawk said:
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.
Click to expand...

I believe this is the man he may have been referring to.

 
madman

madman

Super Moderator
Blackhawk said:
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.
Click to expand...

 
H

halclyon

New Member
High hemacrat

Gman86 said:
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.
Click to expand...

Bern on topical T for a year now and labs keep showing Hem at 51-54%Normal is 50%. My T levels also rose from pre-T treatment sub normal levels of mid 200s to high or above normal levels

My endocrinologist became alarmed as he feared that high density of red blood corpuscles in my blood put me (I’m 83) at risk for stroke. My Endocrinologist kept lowering my T dosage by 1/4 three times trying to lower the Hemacrat but it stayed at 51 until in Getmany where I teach half the year my German doc drew 500 ml of blood twice in two months. That finally lowered my Hem and T From high to just barely normal. He’s happy with that. Ny US endocrinologist does not like to have his patients draw blood but prefers to lower the T dose which did not work for me.

An interesting thread as they always are when they are so relevant to us personally.
 
M

ManOnMission

Member
Ive been on TRT for 5 years. I stabilized once I stopped donating blood and doing the Yo Yo of Ferritin, Iron, T levels, Hema and Hemo. My levels are pretty consistent at 18 hemo and 52 for hema the past 1.5 years. I stopped donating about 1.5 years ago. My testosterone level is always in the 500-600 range. I watch platelets..which are always at the middle of the range. Unscientific observation: I think where people run into more occurrences of issues is when they try to push T levels into the 900+ range from what Ive seen. Im a 49 year old male, exercise 4-5 days per week, mostly cardio.
 
T

timk

Member
FWIW... My hematocrit lowered since I've reduced my dose from 200mg weekly to 50mg weekly. I also feel a lot better on a lower dose.
 
H

Hammer

Member
Based on my experience since I started try 6 years ago, my H/H went from pre TRT levels of 14.7/45 to as high as 18.2/54. I donate blood every two months and I take baby aspirin as well as (3) 980 mg fish oils caps per day. At the higher H/H levels, I was injecting intramuscular once per week. I took Virgil Nelson's advice and divided my dosage in half and injected twice per week with a insulin syringe in my shoulders. Since making the with, my H/H averages 16+ and my hematocrit about 46. My H/H levels were taken one day post injection for the last three blood tests. I still donate every two months to be on the safe side. If you embark on the daily aspirin routine, you might want to get an aspirin sensitivity test done to insure that your stomach can handle it. I don't think many people have adverse reactions to 81mg/day of aspiring but everyone is different. Good luck!
 
M

ManOnMission

Member
I do 120 mg per week. Shot of 60 mg on Monday and 60 mg on Thursday. I also do baby aspirin and fish oil along with vitamins. Im also on Thyroid, HCG and DHEA.
 
Blackhawk

Blackhawk

Member
Hammer said:
Based on my experience since I started try 6 years ago, my H/H went from pre TRT levels of 14.7/45 to as high as 18.2/54. I donate blood every two months and I take baby aspirin as well as (3) 980 mg fish oils caps per day.

At the higher H/H levels, I was injecting intramuscular once per week. I took Virgil Nelson's advice and divided my dosage in half and injected twice per week with a insulin syringe in my shoulders. Since making the with, my H/H averages 16+ and my hematocrit about 46.

My H/H levels were taken one day post injection for the last three blood tests. I still donate every two months to be on the safe side. If you embark on the daily aspirin routine, you might want to get an aspirin sensitivity test done to insure that your stomach can handle it. I don't think many people have adverse reactions to 81mg/day of aspiring but everyone is different. Good luck!
Click to expand...

So what do you now attribute your lower HGB/HCT levels to, donating every two months or the change in injection frequency?

And, how's your ferritin?
 
H

Hammer

Member
My ferritin is fine. My H/H levels came down 2 months after I started the injections twice per week. They have been consistently between 16.1 and 16.5 on the hemoglobin and hematocrit approximately 3x the hemoglobin. I've been donating blood for about 5.5 years and have only noticed the reduction in H/H after changing my injection schedule. I'm even considering converting to a 3x/week injection schedule to see if it puts me in the normal range.
 
S

sbstrum_MD

Member
I am a MD of many decades duration. My focus is on prostate cancer and I was one of the 1st docs in the USA to use androgen deprivation therapy and soon after wrote about Androgen Deprivation Syndrome (ADS) and published in 1997 a paper on AAD (anemia of androgen deprivation). So, yes, testosterone deficiency leads to anemia and the use of testosterone can ↑ the red blood cell mass in the form of elevation of hematocrit (HCT). And most of the comments on this thread are quite accurate for lay persons so I congratulate all. Hemoglobin x 3 is ≈ HCT. I find the HCT more reliable then testing for Hgb (hemoglobin) but both are always included on the CBC (complete blood count) report as well as what are called red blood cell (RBC) indices (measurements of size of the red blood cell (mean cell volume or MCV) and mean cell hemoglobin concentration or MCHC. When the MCV starts to fall that is an indicator that you may be becoming iron deficient from the blood donations (depending on your diet and how much iron is in it). Some fine points for anyone:

1. The working testosterone is the free testosterone and sometimes the total testosterone is misleading. So if you have to order one versus the other, the free is more biological valuable.

2. Hematocrit levels above 50% start to worry me about a risk for a stroke or CVA or thrombosis anywhere. If your normal baseline HCT is 42 then I would titrate my use of testosterone treatment with the HCT and the free testosterone.

3. Patients with a disease called polycythemia rubra vera (called a myeloproliferative disease) often make too many RBCs and have a risk of thrombosis and sometimes bleeding. Those patients often donate blood to reduce their red blood cell mass + avoid iron in order to make themselves iron deficient so that they can't keep producing RBCs. I mention the info in the above lines since using aspirin (ASA) or anything that make ↓ platelet stickiness/aggregation might bite you in the butt if you have a tendency to bleed rather than thrombus. Often it is an issue of what you are taking re meds and supplements + any underlying disease that makes you prone to clot or to bleed.

4. Those on testosterone supplementation should be mindful of aromatization to estradiol and the need for an aromatase inhibitor to prevent gynecomastia. I have found that anastrozole (Arimidex) at 0.5 mg twice a week is usually fine to block aromatase. But measure E2 (estradiol) in your labs.

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.

6. Lastly, be aware that high normal or elevated E2 will stimulate prolactin production which will suppress dopamine. You want dopamine. Why →

Dopamine actions:
1) Decrease sensitivity of AR (androgen receptor) via prolactin decrease
2) Improve mental clarity as a result of dopamine increase
3) Enhance anti-angiogenesis via dopamine increase
4) Increase libido via dopamine increase

Stephen B. Strum, MD, FACP
 
Blackhawk

Blackhawk

Member
sbstrum_MD said:
I am a MD of many decades duration. My focus is on prostate cancer and I was one of the 1st docs in the USA to use androgen deprivation therapy and soon after wrote about Androgen Deprivation Syndrome (ADS) and published in 1997 a paper on AAD (anemia of androgen deprivation). So, yes, testosterone deficiency leads to anemia and the use of testosterone can ↑ the red blood cell mass in the form of elevation of hematocrit (HCT). And most of the comments on this thread are quite accurate for lay persons so I congratulate all. Hemoglobin x 3 is ≈ HCT. I find the HCT more reliable then testing for Hgb (hemoglobin) but both are always included on the CBC (complete blood count) report as well as what are called red blood cell (RBC) indices (measurements of size of the red blood cell (mean cell volume or MCV) and mean cell hemoglobin concentration or MCHC. When the MCV starts to fall that is an indicator that you may be becoming iron deficient from the blood donations (depending on your diet and how much iron is in it). Some fine points for anyone:

1. The working testosterone is the free testosterone and sometimes the total testosterone is misleading. So if you have to order one versus the other, the free is more biological valuable.

2. Hematocrit levels above 50% start to worry me about a risk for a stroke or CVA or thrombosis anywhere. If your normal baseline HCT is 42 then I would titrate my use of testosterone treatment with the HCT and the free testosterone.

3. Patients with a disease called polycythemia rubra vera (called a myeloproliferative disease) often make too many RBCs and have a risk of thrombosis and sometimes bleeding. Those patients often donate blood to reduce their red blood cell mass + avoid iron in order to make themselves iron deficient so that they can't keep producing RBCs. I mention the info in the above lines since using aspirin (ASA) or anything that make ↓ platelet stickiness/aggregation might bite you in the butt if you have a tendency to bleed rather than thrombus. Often it is an issue of what you are taking re meds and supplements + any underlying disease that makes you prone to clot or to bleed.

4. Those on testosterone supplementation should be mindful of aromatization to estradiol and the need for an aromatase inhibitor to prevent gynecomastia. I have found that anastrozole (Arimidex) at 0.5 mg twice a week is usually fine to block aromatase. But measure E2 (estradiol) in your labs.

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.

6. Lastly, be aware that high normal or elevated E2 will stimulate prolactin production which will suppress dopamine. You want dopamine. Why →

Dopamine actions:
1) Decrease sensitivity of AR (androgen receptor) via prolactin decrease
2) Improve mental clarity as a result of dopamine increase
3) Enhance anti-angiogenesis via dopamine increase
4) Increase libido via dopamine increase

Stephen B. Strum, MD, FACP
Click to expand...

Thanks for your input, nice to have your synopsis. The dopamine info is new to me!

Controversies exist regarding polycythemia vera vs erytrocytosis from testosterone therapy. There are strong claims by some doctors that higher HGB/HCT does not equal the thrombosis risk without platelet elevation. Please let us know your thoughts about this.
 
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