Doctor: NO phlebotomy once 52% reached - O.K. to use leeches?

Re-Ride

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Hi, Doc will discontinue hcg and will also not prescribe any alternate such as cyp once hematocrit reaches the upper limit of 52%. He specifically does not believe in phlebotomy -ever-. I am now at 50.5% in my 5th month of hcg mono.

I posted my labs in the appropriate thread but got no reply.

My choices as I see them are:

(1) discontinue all HRT cold turkey

(2) Leeches

(3) blood letting at home; not eligible to donate

Anything else?

Serum t goals:

the end: "I don't play the numbers game"

mine: a minimum of 600 or whatever allows me to be minimally functional. At 199 last winter I was writing my will.

Please do not suggest another doc, Defy ect. I can only use Medicare. I have over 20 years of letting doctors manage my endocrine levels. It's the same story everywhere. None agree with anything on this site.

Who has experience with 2, or 3 above? Are these options safe? Will they work?
_____
edit: I still hold this endo in high regard. My appointments have not been rushed. He's thorough. Perhaps he's expecting the hematocrit to level off or has something else in mind. I don't see him simply abandoning my care. Still, it is difficult to understand why therapeutic phlebotomy would be off the table.
 
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I did discuss serum T goals with this endo at the onset. He liked the initial result but now he's saying that he doesn't believe in playing the numbers. I'm no longer sure what an appropriate goal is for me. To heck with muscle tone, I'll settle on enough energy to get through the day. Where I'm at now, ~550, gets me through the day. Can't see quitting.
 
I guess his decision will make you look for another doctor. This kind of things upsets the hell out of me!!

Nelson, I'd be extremely grateful if you will look at my recent labs. No where on this site have I seen ultra-high free T like mine. There are other issues as well. You may not have answers but any input is appreciated as these values seem highly atypical.

I will watch the hematocrit and get it resolved one way or another.

edit: I like this endo. He's usually reasonable. He is open to review of studies. I did not want to press the issue yesterday.
 
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New office visit today. 150 mi round trip to the Big City. 2nd visit with my new doc who may become my primary. He was incredibly thorough discussing every aspect of my care which involves much more than HRT (hCG mono). He did not like the hematocrit level and agrees that therapeutic phlebotomy is appropriate on HRT. I thought I was leaving with a phlebotomy order. Instead I got a referral to a hematologist. Argh! In fairness I should choose to be under this new primary's care for HRT. He is properly expecting the endo to deal with the hemoatocrit. I will re-check in a few weeks then see what the endo says. I did receive a message fro the endo indicating that he wishes to review any literature have on thyroid "ratio theory". That's encouraging and an example of why I'm not quick to look elsewhere.

Q: What steps can I take to reduce the hematocrit naturally? Exercise, diet?
 
I think the only thing that can bring it down is phlebotomy. I'm also ineligible to donate so I have to pay out of pocket to have it done ($150 each time). Wishing I could learn to do it on my own...can't be that damn hard.
 

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Lakshman KM, Kaplan B, Travison TG, Basaria S, Knapp PE, Singh AB, LaValley MP, Mazer NA, Bhasin S. The effects of injected testosterone dose and age on the conversion of testosterone to estradiol and dihydrotestosterone in young and older men. J Clin Endocrinol Metab. 2010 Aug;95(8):3955-64.

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