How to Respond to Very High Hematocrit

ratbag said:

Has anyone read this article by Neal Rouzier, M.D?


ERYTHROCYTOSIS VS PCV (Polycythemia Vera)​​

NEAL ROUZIER, M.D.

This is in response to your inquiry about elevated red blood cell counts that are quite common, almost universal, in those who take testosterone. It is more prevalent in those taking injectable testosterone and less so in those using the creams or gels. Most physicians become concerned about this elevation of hemoglobin because they associate this elevation with a blood condition which causes hyperviscosity (thick blood) and potential strokes. However, this is definitely not the case with you or in those that take testosterone and have elevated red blood cell counts. The two conditions are commonly confused with each other, yet they are entirely different in their cause, treatment, and outcomes.

The condition that you have acquired is termed erythrocytosis and is simply an increase in the red blood cells due to increased production of a kidney hormone called erythropoietin. This is the same phenomenon that occurs when cyclists use Epogen or Procrit (erythropoietin) to raise their blood counts to enhance their endurance. This is also the same process that causes people who live at high altitude to have an increase in red blood cell counts. People who live at altitude have the same physiologic increase in red blood cell counts as you and we never worry about them. This is because it is a physiologic (not harmful) increase in only red blood cells, not in any other cells or clotting factors. Treatment is not necessary for anyone with erythrocytosis that lives at altitude as it does not cause any problem whatsoever and it is quite beneficial. Millions of people worldwide live at high altitude and have blood counts higher than yours and no treatment is necessary nor is there ever any harm. In fact athletes train at high altitudes to raise their blood counts to increase their exercise endurance at sea level. It gives them an advantage. People with chronic lung problems (COPD) also have high blood counts and we never treat them as their response is physiologic (normal, expected, and not harmful) in order for the blood to carry more oxygen.

Your physician is confusing your erythrocytosis with a blood disorder called Polycythemia Vera (PCV). This is a harmful blood condition that causes an increase in clotting which leads to strokes and blood clots. The difference is that erythrocytosis only causes increased red blood cells and no harm. PCV causes an increase in platelets which causes increased clotting. More importantly, PCV is associated with a defect in the blood vessel wall which stimulates the clotting cascade of thrombosis in addition to increased platelets. These two entities together cause an increased risk of blood clots and stroke thereby requiring treatment by phlebotomy or blood donation to lower blood counts and prevent the complications of PCV.

PCV is classically defined as an increase in red blood cells, white blood cells, platelets, splenomegaly, and clotting disorders. You do not have this nor are you at risk for this. In addition, the literature clearly demonstrates that testosterone causes erythrocytosis only and not PCV. Testosterone administration has never been associated with any risk of clotting or stroke in any of the studies over the last forty years. Therefore the erythrocytosis requires no treatment. You have the same erythrocytosis that people have who live at altitude and you should receive the same treatment as they do, which is nothing. If your physician is uncomfortable with this, then he can refer you to a hematologist who will hopefully understand this very well. If your physician or you are still concerned, then the treatment is simply to donate blood which is the only necessary treatment for PCV, which you do not have.

Although this explanation was technical, it was intended as such so that you could pass this information along to your physician.

Neal Rouzier, M.D. 760-320-4292
​

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ratbag said:

Thanks Coastwatcher, that link doesn't work. I don't agree either with his ignoring estradiol or his views on AI's but he's not the first person to discuss polycemia vs erythrocytosis. I myself was sent for blood donations because my HCT was too high but what we didn't see was my platelets were low and my clotting is very low as a result. I've donated blood a few times and my HCT goes right back up there like before except now my iron is too low and this makes me hypothyroid. So I believe most TRT users think that high HCT infers that they have polycemia with high platelets.

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