Hematocrit and TRT. How to have balance.

[Blackhawk]

Assuming (big assumption) altitude adaptation has similar time constant to TRT induced erythrocytosis, this reference may be of interest:

Altitude adaptation through hematocrit changes - PubMed

Adaptation takes place not only when going to high altitude, as generally accepted, but also when going down to sea level. Immediately upon ascent to high altitude, the carotid body senses the lowering of the arterial oxygen partial pressure due to a diminished barometric pressure. High altitude...

pubmed.ncbi.nlm.nih.gov

High altitude adaptation is altitude and time dependent, following the simplified equation: Adaptation=Time/Altitude where High altitude adaptation factor=Time at altitude (days)/Altitude in kilometers (km). A complete and optimal hematocrit adaptation is only achieved at around 40 days for a subject going from sea level to 3510 m in La Paz. The time in days required to achieve full adaptation to any altitude, ascending from sea level, can be calculated by multiplying the adaptation factor of 11.4 times the altitude in km. Descending from high altitude in La Paz to sea level in Copenhagen, the hematocrit response is a linear fall over 18 to 23 days.


Notice the rapid Hct descent noted upon returning to sea level. I am not aware of similar study for TRT patients.

Yes, that refers to "full adaptation", but a notable rise occurs more quickly. This was documented by altitude researchers like Drs. Houston and Hackett in the 70's-80's. I actually discussed it and other aspects of adaptation with Dr Hackett on Denali when he manned the high altitude research camp there in 1987 and at a wilderness medical conference. I taught high altitude physiology along with Wilderness Medical and Emergency care for for a wilderness guide and medicine program for 35 years.

 

[BigTex]

Why do you think you are now having issues at much lower dosages?
When I started TRT 8 years ago on 200mg/week (Dr supervised), my hct rose to 53-55, but then would settle back down to 50 from time to time, and even then I felt zero symptoms.

I am lost for an explaination. I am starting to think it is the Testosterone cypionate. I never really used this before and have always used enanthate or undeconoate.

 

[TRicker]

t's like my body rebounded too far. There may also be kidney trouble leading to this related to the cancer and chelating drugs I am/was on. My HCT reached 57.7, and remained around 54 for months even with weekly phlebotomies. I've had more than 20 phlebotomies since last spring, and for a while they were weekly.

Wow, I hope you are feeling better and kicking cancer's ass!! You've been on a rough ride, so hang tough and thanks for all the input!

 

[TRicker]

I am lost for an explaination. I am starting to think it is the Testosterone cypionate. I never really used this before and have always used enanthate or undeconoate.

Can you get enanthate or undeconoate prescribed in the US?

 

[Blackhawk]

Wow, I hope you are feeling better and kicking cancer's ass!! You've been on a rough ride, so hang tough and thanks for all the input!

Thanks for the kind wishes and encouragement.

 

[BigTex]

Can you get enanthate or undeconoate prescribed in the US?

Yes, both are prescribed. Aveed is generally only available from a doctor. Enathate is precribed and available at most pharmacies.

 

[JimGainz]

Getting back to the hematocrit question - here’s is a recent video about a TRT doc who is also a bodybuilder using Losartan to lower his HCT from 60 to 48 and now does not need to donate blood.

 

[BigTex]

Yea, I have heard people say that ARBs lower HTC and I am sure it is an individual thing. I have taken Losartan and it didn't work on lowering my BP. Also took Benicar. Telmisartin lowers my BP but has not done a thing to lower HTC. So far blood dumps have done very little.

 

[NeverSayNeverAgain]

@BigTex

I stopped, switch to Androgel for a month went back to injections and it helped my numbers a lot. I only seen a few people mention this works and it worked for me of course stopping for a month or two sucks and I packed on a ton of weight but was able to get it back off. Big difference this time was starting low and going up on dose from starting high and going down before.

 

[BigTex]

I have a friend who's doctor put him on Adrogel. His test numbers dropped from the mid 400's to 19 in a few weeks. Scares me....If this doesn't come down I think I am going to do a 4 week wash out period and see if that help.

 

[tareload]

Yes, that refers to "full adaptation", but a notable rise occurs more quickly. This was documented by altitude researchers like Drs. Houston and Hackett in the 70's-80's. I actually discussed it and other aspects of adaptation with Dr Hackett on Denali when he manned the high altitude research camp there in 1987 and at a wilderness medical conference. I taught high altitude physiology along with Wilderness Medical and Emergency care for for a wilderness guide and medicine program for 35 years.

Going back to your original statement (bold):

The increase is from erythopoesis which is called for by the Kidneys releasing EPO, and held in check by hepcidin. EPO increases due to hypoxemia, so any time the set point (HCT/HGB levels) is not met, they crank into high gear and production can increase quite dynamically. This does not take months. It happens rapidly. A well documented example, RBC, HG and HCT increase significantly in about 6 days as adaptation to lower blood oxygenation when a human goes to significantly higher altitude.

Half life (time constant = half life * ~1.44) is about 7 days in Fig. 1 of paper I posted.

So our statements are consistent. Nice summary above @Blackhawk. Thank you.

Note the very different dynamics upon returning to sea level:

 

[tareload]

Limited time resolution in this study:

Testosterone Induces Erythrocytosis via Increased Erythropoietin and Suppressed Hepcidin: Evidence for a New Erythropoietin/Hemoglobin Set Point

The mechanisms by which testosterone increases hemoglobin and hematocrit remain unclear.We assessed the hormonal and hematologic responses to testosterone administration in a clinical trial in which older men with mobility limitation were randomized to ...

www.ncbi.nlm.nih.gov

My gut tells me the time constant for TRT induced erythrocytosis may be longer than altitude induced.


Nice schematic to go along with Blackhawk's excellent and pithy summary above.

 

[tareload]

Comparison of the Effects of Testosterone Gels, Injections, and Pellets on Serum Hormones, Erythrocytosis, Lipids, and Prostate‐Specific Antigen

 

[gerardo]

Why in the world you even have to ask the question?

It should be a no-brainer.

If you don't understand and don't know how to answer it would be better for you to keep quiet with your ignorance. This here is a forum and the experiences can serve other people less intelligent than you.

 

[JimGainz]

Over the past 5 years on TRT I have tried every injection frequency imaginable in a effort to dial in HCT and Estradiol. Looking back at my logs (I keep detailed notes on my protocol and bloodwork) the only time I didn’t have to donate blood was when I was doing once per week injections.

my current protocol is 80mg Testosterone once every 6 days along with 120mg of Nandrolone every 6 days (the compounds are injected 3 days apart so it’s Testoserone >>>3days ( nandrolone)>>>>3 days (testosterone)>>>>3 days (nandrolone) etc.

I switched to this about a month ago and feel fantastic. I’ll get bloods done in a few months to check numbers but regardless I plan to stay on once per week (roughly) testosterone injections. I never followed the logic of keeping numbers stable with frequent injections. our bodies were made for hormone variability - not constant levels. I took a similar approach to my Thyroid (T3) - instead of taking 5 small doses throughout the day, I take a small dose upon waking and then two larger doses spaced farther apart. Feel better doing it this way as well.


A lot of guys do better on frequent dosing, or subq injections (probably the majority on this forum) so I’m not knocking that protocol - I was not one of them.

FWIW Dr Rand Mclain, a well known TRT expert said in a video that the majority of his patients feel better on weekly dosing (and switched back after trying more frequent dosing protocols) and felt splitting a Testosterone dose is just chasing numbers - The guy has had thousands of patients over the years so that’s quite a lot of men switching back to weekly.

 

[S1W]

Over the past 5 years on TRT I have tried every injection frequency imaginable in a effort to dial in HCT and Estradiol. Looking back at my logs (I keep detailed notes on my protocol and bloodwork) the only time I didn’t have to donate blood was when I was doing once per week injections.

my current protocol is 80mg Testosterone once every 6 days along with 120mg of Nandrolone every 6 days (the compounds are injected 3 days apart so it’s Testoserone >>>3days ( nandrolone)>>>>3 days (testosterone)>>>>3 days (nandrolone) etc.

I switched to this about a month ago and feel fantastic. I’ll get bloods done in a few months to check numbers but regardless I plan to stay on once per week (roughly) testosterone injections. I never followed the logic of keeping numbers stable with frequent injections. our bodies were made for hormone variability - not constant levels. I took a similar approach to my Thyroid (T3) - instead of taking 5 small doses throughout the day, I take a small dose upon waking and then two larger doses spaced farther apart. Feel better doing it this way as well.


A lot of guys do better on frequent dosing, or subq injections (probably the majority on this forum) so I’m not knocking that protocol - I was not one of them.

FWIW Dr Rand Mclain, a well known TRT expert said in a video that the majority of his patients feel better on weekly dosing (and switched back after trying more frequent dosing protocols) and felt splitting a Testosterone dose is just chasing numbers - The guy has had thousands of patients over the years so that’s quite a lot of men switching back to weekly.

Subjectively, how do you think this protocol (80 T + 120 ND) would compare to one in which dosages were reversed (120 T+ 80 ND)?

 

[JimGainz]

Subjectively, how do you think this protocol (80 T + 120 ND) would compare to one in which dosages were reversed (120 T+ 80 ND)?

I think it would be fine. 80 mg of nandrolone is great for most guys - I was a mess with decades of injuries and needed more. I’ll probably run it at 180 mg for a few weeks keeping the Test dose the same. Testosterone does not need to be higher than nandrolone to avoid libido issues or deca dick despite what has become common practice. personally, going back to a once every 6 day Testosterone dose has increased my libido to the highest it’s been in years - even running nandrolone. It’s good to play to safe and start lower to find your minimum effective dose - but my point is don’t be afraid to bump the nandrolone if your joints need it.

 

[JYD21]

I think it would be fine. 80 mg of nandrolone is great for most guys - I was a mess with decades of injuries and needed more. I’ll probably run it at 180 mg for a few weeks keeping the Test dose the same. Testosterone does not need to be higher than nandrolone to avoid libido issues or deca dick despite what has become common practice. personally, going back to a once every 6 day Testosterone dose has increased my libido to the highest it’s been in years - even running nandrolone. It’s good to play to safe and start lower to find your minimum effective dose - but my point is don’t be afraid to bump the nandrolone if your joints need it.

I do see a lot of guys anecdotally that not only felt better with less frequent injects (once or twice a week), but their H/H, RBC, and E2 levels went down on labs.

I realize what plotters and studies may show, but also good to consider the qualitative data out there from personal experiences.

 

[Marcel]

That research suggests that more frequent injections are better. However, even 20 mg EOD can be too much for some guys. That's 7 mg per day of testosterone, above the average production for healthy young men. I've experimented with taking half as much and still did not see a return of hypogonadal symptoms. If testosterone is causing high hematocrit then there must be a dose low enough where this doesn't occur. If this dose is so low that benefits are lost then I hypothesize that creating diurnal variation in serum testosterone levels may help.

Hi, what dose are you on?

 

[Cataceous]

Hi, what dose are you on?

3.2 mg of testosterone enanthate and 2.4 mg testosterone propionate per day. The testosterone content is equivalent to about 6.2 mg of testosterone cypionate per day or 44 mg per week. Nominal peak serum testosterone from this is about 700 ng/dL.