Elevated hematocrit and hemoglobin, not all physicians have the same opinion ..........

[Another Great Day]

About 2 weeks ago I had my labs drawn at Labcorp and I was surprised that my hemoglobin and hematocrit were this elevated with a 786 testosterone level. Each week I take a total of 90 mg/ml of cypionate by taking daily subcutaneous injections. My recent labcorp labs:

Blood Pressure 122/72
Hemoglobin: 18.7 range: 13.0-17.7
Hematocrit: 56.7 range: 37.5-51.0
platelet: 157 range: 150-450
ferritin: 161 range: 30-400
Testosterone total: 786.7 range: 264.0- 916

Providers with different thoughts.
A week ago I paid a visit to my local ED because based upon these labs and an unusual pain in my calf I thought I had a DVT. I showed the ED provider my labs and commented on my elevated Hct and Hb. She looked at the labs and said those are not high and she moved on to another topic. After 4 1/2 hours in the ED I learned that I did not have DVT.

Today I followed up with my primary care doctor. Again, I showed him the labs, and he too said, those are not very high and he said that my testosterone was not that high.

This goes against what I thought was "correct" for many years.......

I am a patient at a well known HRT clinic. In the past when my Hct and Hb would be elevated at these levels I would receive an urgent email with an order for therapeutic phlebotomy along with instructions to take large amounts of fish oil.

My question: Are my current Hct and Hb levels so high that it warrants therapeutic phlebotomy and do these providers simply have different opinions on what is "high" or am I missing something?

 

[Systemlord]

My question: Are my current Hct and Hb levels so high that it warrants therapeutic phlebotomy and do these providers simply have different opinions on what is "high" or am I missing something?

When I was on TRT, I hematocrit of 57%. My endocrinologist freaked out and ordered monthly phlebotomies. After a little more than a year, the hematologist at the infusion center who reviews everyone’s blood pressure readings, hemoglobin and hematocrit for the infusion center contacted my endocrinologist.

The hematologist asked my doctor, why are you choosing to phlebotomize this man? My blood pressure numbers were <120/60. With increased testosterone, nitric oxide increases and expands the vasculature, expanding, widening of the veins to account for the increase in viscosity.

The hematologist is the authority on the matter. Some men will have issues with hematocrit at 52% while others won’t and we don’t know why. One could argue the man that does have issues may already have some type of vascular damage or maybe lacks the adaptation to deal with the thicker blood.

 

[Nelson Vergel]

My order for phlebotomy is good for 2 years at the local Houston blood bank. I don't need a physician to tell me when to give blood. It would be your decision unless you require a new order every time.

 

[madman]

About 2 weeks ago I had my labs drawn at Labcorp and I was surprised that my hemoglobin and hematocrit were this elevated with a 786 testosterone level. Each week I take a total of 90 mg/ml of cypionate by taking daily subcutaneous injections. My recent labcorp labs:

Blood Pressure 122/72
Hemoglobin: 18.7 range: 13.0-17.7
Hematocrit: 56.7 range: 37.5-51.0
platelet: 157 range: 150-450
ferritin: 161 range: 30-400
Testosterone total: 786.7 range: 264.0- 916

Providers with different thoughts.
A week ago I paid a visit to my local ED because based upon these labs and an unusual pain in my calf I thought I had a DVT. I showed the ED provider my labs and commented on my elevated Hct and Hb. She looked at the labs and said those are not high and she moved on to another topic. After 4 1/2 hours in the ED I learned that I did not have DVT.

Today I followed up with my primary care doctor. Again, I showed him the labs, and he too said, those are not very high and he said that my testosterone was not that high.

This goes against what I thought was "correct" for many years.......

I am a patient at a well known HRT clinic. In the past when my Hct and Hb would be elevated at these levels I would receive an urgent email with an order for therapeutic phlebotomy along with instructions to take large amounts of fish oil.

My question: Are my current Hct and Hb levels so high that it warrants therapeutic phlebotomy and do these providers simply have different opinions on what is "high" or am I missing something?

The man considered the father of testosterone!

Dr. Abraham Morgentaler

What's that Abe?

*54% is a useful,reasonable upper limit of acceptability


Come again, say it ain't so Abe!

* NO NEED TO INTERVENE unless HCT >54%








What do the other governing bodies have to say?

*hematocrit of ≥54% appears to be consistent threshold to discontinuing or reducing treatment utilized by major urologic governing bodies, while the evidence for this specific cutoff is lacking

My doctor is one of the top uros in Canada and as stated previously the cutoff is 55% in Canada as per the CUA (Canadian Urological Association) guidelines for Testosterone Therapy

If one has no underlying health issues and is not experiencing any sides he is not too concerned with a hematocrit that falls within 50-55% but tends to recommend donating blood 52-55% or in some cases lowering the T dose and bringing down the FT.


*Canadian guidelines cite 55% as the safe upper limit


*The Endocrine Society uses a hematocrit threshold of >50% as a relative contraindication to initiating TT and >54% as an indication to discontinue treatment [1]. The European Association of Urology (EAU) guidelines on hypogonadism also state that the hematocrit should not exceed 54%, while recent Canadian guidelines cite 55% as the safe upper limit [15, 40]. The AUA guidelines on testosterone deficiency define polycythemia as a hematocrit of 52% and recommend stopping or reducing treatment if the hematocrit reaches 54% [14]








Sit back and dwell on this one!

*There is no evidence that an increase of haematocrit up to and including 54% causes any adverse effects. If the haematocrit exceeds 54% there is a testosterone independent, but weak associated rise in CV events and mortality [79, 177-179]. Any relationship is complex as these studies were based on patients with any cause of secondary polycythaemia, which included smoking and respiratory diseases. There have been no specific studies in men with only testosterone-induced erythrocytosis


============

Look over my reply in post #42

Post in thread 'High Testosterone on only 80mg/week'

Jun 22, 2024

Based on the comments you made here about a hematocrit of below 54 being safe are you willing to stand liable for giving out this false information if the OP has a stroke or heart attack?

Also please enlighten us on where you attended medical school and where you got your degree in endocrinology?

If you are having to give blood to reduce the hematocrit, you are not on "TRT" you are taking a small steroid cycle and calling it TRT.

As for my advice to the poster, I know personally of two people I have given similar advice to, both had strokes under the age of fifty. One with a...

• madman

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