Blood work back from hematologist

[buggies100]

Well my hematologist finally got back to ,e today with results from my bloodwork a couple weeks ago. I was sent to him by my trt doc trying to see if there were issues behind my high red blood cells. I was always at 50 gct prior to trt, and went to 55-56 with trt. So i was tested for genetic mutations of jak2b gene, leukemia, PV and some things that hide PV. All of them came back negative, yay! He said some people just have a high rbc. We went over several studies he found that showed men on trt were fine under 56, given all other parts of the blood were in range, which mine are.
So he has released me to go back to trt dr and work out a regimen that keeps my hct in the 54 ish range. He is not a big fan of using theraputic phlebotomy as a source of keeping hct in line, such as every 8 weeks.
I see guys using way higher doseafes than i have nor could ever do. My last protocol wqs only 40 mg every 3.5 days. After a 6 weeks it shot my total T to 883 and hct to 62.1. So i am not sure where to start back. Maybe start a clomid routine to see if that will work. Will meet trt dr in a couple weeks

 

[Vince]

. We went over several studies he found that showed men on trt were fine under 56, given all other parts of the blood were in range, which mine are.

Could you post the studies, I would be interested in seeing them.

 

[Vince Carter]

You really need new Dr's this is going to be very complicated for you if you persist with their "treatment", 100mg is considered the minimum weekly dose and you're well below that and trying to steer you from donating blood is just silly.

 

[johnt]

@Vince Carter Is there really a minimum dose? If he is at 80 MG, feeling good, and labs coming back at TT 883 and I assume Free T in upper limits then that I would think is a win. I do agree that he should go to a doc that has a good understanding of TRT.

 

[Vince Carter]

As an individual he might be pretty good there with that dose but it's typically accepted that 100mg/week is the start point.

 

[buggies100]

Vince, I woild love to post studies but we were just talking kn the phone and he did not give any specific names. Though he did mention that one in particular was an older study and somebody pocked it up again and proved it true a second time. Sorry i dont have any specifics for you.

vince carter, as you can see what happened at low dose T on 3.5 day regimen, in only 6 weeks i was off the chart, it would take at least monthly phlebotomy to keep up and maybe not even then. For 3 years i was on 200 mg every two weeks. Totla T ran 400 give or take, labcorp, and i felt great. Sex at least twice a week, good gains in gym, lots of energy. 54 years old. Hct stated 55-56. The only reason i got of that regimen was concern about hct and listeneing to success stories on this site. I am sure i can not donate blood fast enough to be doing doses like i see on here unfortunaetly

 

[Moonshot]

Could you post the studies, I would be interested in seeing them.

I'm not sure since I can't access the actual studies, but it might be this one, or one of the studies it references:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2754376/

"While it is not yet clear what critical threshold is desirable, dose adjustments and/or periodic phlebotomy may be necessary to keep hematocrit below 52–55%"

Another one:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3770846/

"Guidelines indicate that a hematocrit >54% is an indication to stop TRT until the hematocrit decreases to a safe level."

 

[1Draw]

I'm not sure since I can't access the actual studies, but it might be this one, or one of the studies it references:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2754376/

"While it is not yet clear what critical threshold is desirable, dose adjustments and/or periodic phlebotomy may be necessary to keep hematocrit below 52–55%"

Another one:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3770846/

"Guidelines indicate that a hematocrit >54% is an indication to stop TRT until the hematocrit decreases to a safe level."

It would be interesting to hear from the experts here at EM their views on hematocrit levels published in this study. LabCorp ranges are 37.5 - 51.0. With Defy, if your hematocrit rises above 51, you are to immediately have a phlebotomy where this study states "phlebotomy maybe necessary to keep hematocrit below 52-55". That contradicts the ranges by LabCorp.

Interesting study and also interesting to see the high ranges from the study.

 

[Vince Carter]

LabCorps ranges, or Quest (for that matter that uses a 38.5-50.0 range). Labs cannot tell you what is good/bad...lab ranges are derived from the population that is being tested and nothing more. Its up to the patient and his Dr to interpret and apply the results. If you're only looking at lab values you're only getting a piece of the pie. For instance, labCorp thinks a TSH = 5.0 is good...it's high but it's in their range, but it's far from good for anyone that knows something about TSH.

 

[tjlab]

I feel your pain. I just lowered my weekly dose to 80-90mg divided into 2 injections. I am convinced, but have no data to support, that when test levels remain high - hematocrit goes up. So far, 120mg weekly IM injected once weekly, has been the highest I could go without giving blood every 2 months. I kind of feel like I am an outcast since it seems like almost everyone on here injects bi weekly or daily and runs around with super high levels and everything stays in range. Find a dosage that works and let me know.

Well my hematologist finally got back to ,e today with results from my bloodwork a couple weeks ago. I was sent to him by my trt doc trying to see if there were issues behind my high red blood cells. I was always at 50 gct prior to trt, and went to 55-56 with trt. So i was tested for genetic mutations of jak2b gene, leukemia, PV and some things that hide PV. All of them came back negative, yay! He said some people just have a high rbc. We went over several studies he found that showed men on trt were fine under 56, given all other parts of the blood were in range, which mine are.
So he has released me to go back to trt dr and work out a regimen that keeps my hct in the 54 ish range. He is not a big fan of using theraputic phlebotomy as a source of keeping hct in line, such as every 8 weeks.
I see guys using way higher doseafes than i have nor could ever do. My last protocol wqs only 40 mg every 3.5 days. After a 6 weeks it shot my total T to 883 and hct to 62.1. So i am not sure where to start back. Maybe start a clomid routine to see if that will work. Will meet trt dr in a couple weeks

 

[Mountain Man]

I just got my bloodwork and had a recent exam. I am a patient by Dr Morganthaler in Boston. My hematocrit was 50, the top number "in range" for Quest. Morganthaler's view is that since I am feeling great and BP is consistently 120/80 range, there is no need for concern. It seems he is not a numbers guy, but more concerned with how you feel. it seems keeping hematocrit down is somewhat controversial. There is a thread here from Dr John Crissler that implies that high hematocrit is not that big a deal.

My protocol from Morganthaler is pretty basic, 100 test cyp 1 time per week. His conservative approach works well for me and I'm ten months into TRT.I guess finding a doctor you trust, stay in touch with him, do bloodwork and discuss is the way to proceed.

I do wonder if I could be even better with a more aggressive protocol, but the doctor's opinion was, "You are having a great response and your numbers are in range. Why change?"

 

[Vince]

Hematocrit may stabilize after long term testosterone replacement
https://www.excelmale.com/forum/sho...lize-after-long-term-testosterone-replacement

 

[Mountain Man]

I also think that cardiovascular risk can be minimized if a guy is working his cardiovascular conditioning 3 times per week, even if hematocrit is a little high. Some of the original studies that showed a link between cardiac issues and TRT were flawed for this reason.

Maybe cardio is the X factor in this. Athletes that train at altitude have high hematocrit and great cardio. If one is working out and doing the supplemental work, numbers may not tell the whole story.

 

[tjlab]

Hey mountain man, what is trough level and what day do you draw to check?

I just got my bloodwork and had a recent exam. I am a patient by Dr Morganthaler in Boston. My hematocrit was 50, the top number "in range" for Quest. Morganthaler's view is that since I am feeling great and BP is consistently 120/80 range, there is no need for concern. It seems he is not a numbers guy, but more concerned with how you feel. it seems keeping hematocrit down is somewhat controversial. There is a thread here from Dr John Crissler that implies that high hematocrit is not that big a deal.

My protocol from Morganthaler is pretty basic, 100 test cyp 1 time per week. His conservative approach works well for me and I'm ten months into TRT.I guess finding a doctor you trust, stay in touch with him, do bloodwork and discuss is the way to proceed.

I do wonder if I could be even better with a more aggressive protocol, but the doctor's opinion was, "You are having a great response and your numbers are in range. Why change?"

 

[tjlab]

I agree as I do 30-45 minutes 3-4 a week plus 5-6 days of strength training. I really think that platelets have a lot to do with increased risk. I take 6g of fish oil daily.

100mg / weekly worked for me but my trough was 500TT. 120mg a week got it to 650TT. You may wanna try 120mg, but anymore than that u will probably need to give blood and get on an AI.

 

[Mountain Man]

Hey mountain man, what is trough level and what day do you draw to check?

This was the trough day.( the lowest point of the injection's benefits)

I also do fish oil 2400/day.