High hematocrit risk

[Goddar]

Hey guys ! Im a new member

Ive been on trt during 3 years, 100-140mg/w cyp test. Hematocrit always high ( between 52-55). Plaqueta and hemoglobinas always on range. Despite my trt doctor sayd there is no problem, i prefer to mantain as low as possible. Ive try to do lot of things ( grapefruit, apnea study, pin e3d, increase water amount, stop smoking). 2 months ago y started to donate blood, but i realized the next month my hematocrit come Back as before. Now im putting 20mg test Daily subq, nattokinase and next week im going to retest again. My concern is if there are real risk on this Numbers and if somebody experienced some. Im very confused becAuse ive been looking lots of studies and there are oposite theories about hematocrit and diferents diseases ( vte, strokes, etc ). Ive also noticed and increase in the size of my veins

 

[Systemlord]

Ive also noticed and increase in the size of my veins

Testosterone increases nitric oxide, nitric oxide, expands the veins to account for the thicker blood.

The nitric oxide regulates vascular tone and blood flow.

i prefer to mantain as low as possible.

That’s like saying, you prefer lower testosterone, higher, hemoglobin, and hematocrit are one of the many benefits of TRT.

What happens when you go to high elevation is your testosterone spikes and hematocrit and hemoglobin increase.

Athletes train at high altitude to take advantage of the higher hematocrit and hemoglobin. If you keep these blood parameters as low as possible, you lose out on the benefits.

 

[Jerajera]

I don't think out of range Hct is without dangers. I can't remember the studies but I'm pretty sure the idea that people who live in altitude and have higher Hct levels aren't more likely to suffer from cardiac events is actually not correct.

Also, yes you will derive some benefits from higher Hct levels. Guys taking EPO have much greater cardio capacity, but they also have to get up at night and get on a bike when an alarm goes off to tell them they're going to die if they don't move around. Something can give you benefits in some ways and still shorten your lifespan, or be negative in other ways to a degree that makes the overall trade off not worth it.

For me, daily injections definitely lower Hct when using injectable Test (I think @Vince also said he was able to stop donating blood when he moved to daily injections). Keep in mind though that subQ doesn't work for everyone; I'm not sure what the mechanisms are but my TT/FT levels are much lower on subQ and E2 levels significantly higher, and that's after giving the protocol 8 weeks on the exact same dosage.

This is a very common complaint, so personally I would change only one parameter at a time and do daily injections IM on the same dosage and see what happens. Keep in mind it might take a while for Hct numbers to reflect that change, I would say at least a couple of months.

 

[Goddar]

I don't think out of range Hct is without dangers. I can't remember the studies but I'm pretty sure the idea that people who live in altitude and have higher Hct levels aren't more likely to suffer from cardiac events is actually not correct.

Also, yes you will derive some benefits from higher Hct levels. Guys taking EPO have much greater cardio capacity, but they also have to get up at night and get on a bike when an alarm goes off to tell them they're going to die if they don't move around. Something can give you benefits in some ways and still shorten your lifespan, or be negative in other ways to a degree that makes the overall trade off not worth it.

For me, daily injections definitely lower Hct when using injectable Test (I think @Vince also said he was able to stop donating blood when he moved to daily injections). Keep in mind though that subQ doesn't work for everyone; I'm not sure what the mechanisms are but my TT/FT levels are much lower on subQ and E2 levels significantly higher, and that's after giving the protocol 8 weeks on the exact same dosage.

This is a very common complaint, so personally I would change only one parameter at a time and do daily injections IM on the same dosage and see what happens. Keep in mind it might take a while for Hct numbers to reflect that change, I would say at least a couple of months.

Thanks ! But i think there are Lot of people on trt who have an out of range Hct durante years, dont know if that affect then in some medical issues. Now ive been putting pin daily, but did you hct low when you switch to a daily doses without doing anything else?

 

[Goddar]

Testosterone increases nitric oxide, nitric oxide, expands the veins to account for the thicker blood.

The nitric oxide regulates vascular tone and blood flow.


That’s like saying, you prefer lower testosterone, higher, hemoglobin, and hematocrit are one of the many benefits of TRT.

What happens when you go to high elevation is your testosterone spikes and hematocrit and hemoglobin increase.

Athletes train at high altitude to take advantage of the higher hematocrit and hemoglobin. If you keep these blood parameters as low as possible, you lose out on the benefits.

I don't think out of range Hct is without dangers. I can't remember the studies but I'm pretty sure the idea that people who live in altitude and have higher Hct levels aren't more likely to suffer from cardiac events is actually not correct.

Also, yes you will derive some benefits from higher Hct levels. Guys taking EPO have much greater cardio capacity, but they also have to get up at night and get on a bike when an alarm goes off to tell them they're going to die if they don't move around. Something can give you benefits in some ways and still shorten your lifespan, or be negative in other ways to a degree that makes the overall trade off not worth it.

For me, daily injections definitely lower Hct when using injectable Test (I think @Vince also said he was able to stop donating blood when he moved to daily injections). Keep in mind though that subQ doesn't work for everyone; I'm not sure what the mechanisms are but my TT/FT levels are much lower on subQ and E2 levels significantly higher, and that's after giving the protocol 8 weeks on the exact same dosage.

This is a very common complaint, so personally I would change only one parameter at a time and do daily injections IM on the same dosage and see what happens. Keep in mind it might take a while for Hct numbers to reflect that change, I would say at least a couple of months.

rhe

The problem is that there are lot of doctors who advocate to keep the hay under 50, and i prefer not to take risk

 

[Systemlord]

The problem is that there are lot of doctors who advocate to keep the hay under 50, and i prefer not to take risk.

That's called having cold feet, being ignorant, performance anxiety, playing it safe. These types of doctors aren't up to date on the medical literature.

The doctors that are in the know, have the confidence to allow higher HCT and HGB in the absence of symptoms because they know what they're doing.

If I was a doctor and didn't know anything about hematocrit and hemoglobin, I would play it safe because I don't want to lose my medical license for causing harm to my patient.

 

[Systemlord]

Does a high hematocrit change your blood's clotting profile? High altitude vs TRT.

Does having a high hematocrit mean your blood is more likely to clot? This study looks at a city where people with the highest hematocrit in the world live and work.

www.excelmale.com

 

[Cataceous]

That's called having cold feet, being ignorant, performance anxiety, playing it safe. These types of doctors aren't up to date on the medical literature.

The doctors that are in the know, have the confidence to allow higher HCT and HGB in the absence of symptoms because they know what they're doing.

If I was a doctor and didn't know anything about hematocrit and hemoglobin, I would play it safe because I don't want to lose my medical license for causing harm to my patient.

You've had the benefit of all the research provided by @readlot/@tareload and yet absorbed none of it? What about Dr. Saya's cautionary statements on the subject? Symptoms may not appear until it's too late. Elevated HCT/Hgb can lead to excessive blood viscosity, to the extent that long-term exposure may cause harm.

Why must a practitioner be cautious? When was the last time you had your plasma viscosity measured?​

​

[My concern is] more the LONGTERM vascular consequences. ... If we look at simple fluid dynamics and the laws of physics, thicker fluid (blood) inside of a pipe (vessel) = higher pressure (blood pressure). I've seen this countless times in patients requiring blood donation or therapeutic phlebotomy -- BP drops, sometimes dramatically, afterwards and generally remains at the lower levels until (if/when) HCT rises again.​

 

[Systemlord]

You've had the benefit of all the research provided by @readlot/@tareload and yet absorbed none of it? What about Dr. Saya's cautionary statements on the subject? Symptoms may not appear until it's too late. Elevated HCT/Hgb can lead to excessive blood viscosity, to the extent that long-term exposure may cause harm.

Why must a practitioner be cautious? When was the last time you had your plasma viscosity measured?​

​

[My concern is] more the LONGTERM vascular consequences. ... If we look at simple fluid dynamics and the laws of physics, thicker fluid (blood) inside of a pipe (vessel) = higher pressure (blood pressure). I've seen this countless times in patients requiring blood donation or therapeutic phlebotomy -- BP drops, sometimes dramatically, afterwards and generally remains at the lower levels until (if/when) HCT rises again.​

I'm providing information based on the context of @Goddar statement that a lot of doctors will not allow HCT over 50% (small elevation) when other lab ranges goes all the way to 52% and the cut off being 54%.

Can agree that this is an over reaction on the part of doctors?

My blood pressure remained the same after my blood donations. Doctors apply same strategy for everyone treating everyone the same rather than as an individual whether we're talking about testosterone or hematocrit.

There's little to no critical thinking or analytical thought process in providing care these days.

 

[Cataceous]

I'm providing information based on the context of @Goddar statement that a lot of doctors will not allow HCT over 50% (small elevation) when other lab ranges goes all the way to 52% and the cut off being 54%.

Can agree that this is an over reaction on the part of doctors?
...

No, it's not as though there's a sharp cutoff below which there's no danger. Being at top-of-range may well harm some individuals in the long run. Until there are routine measurements of blood viscosity and a better understanding of the risks it's not unreasonable for a doctor to object to these levels, particularly if they represent a marked increase over a previous healthy baseline.

...
There's little to no critical thinking or analytical thought process in providing care these days.

The lack of critical thinking lies in rationalizing elevated HCT/Hbg caused by excessive testosterone use. Do I have to keep repeating that 6-7 mg of testosterone is the typical daily production for healthy young men? Not intending to pick on you, OP, but you're taking double this, 14 mg per day. If the perceived benefits of higher testosterone use trump the uncertain risks then continue. Otherwise consider that many men see better overall results when testosterone is reduced to physiological levels.

 

[Gman86]

I'm providing information based on the context of @Goddar statement that a lot of doctors will not allow HCT over 50% (small elevation) when other lab ranges goes all the way to 52% and the cut off being 54%.

Can agree that this is an over reaction on the part of doctors?

My blood pressure remained the same after my blood donations. Doctors apply same strategy for everyone treating everyone the same rather than as an individual whether we're talking about testosterone or hematocrit.

There's little to no critical thinking or analytical thought process in providing care these days.

Preach brotha. Like I’ve said in many other posts, common sense and critical thinking skills are key, when trying to make sense of things in life, and in this case particularly, whether or not a HCT of 50%+ should warrant a person to either donate blood/ get phlebotomized, or lower their androgens.

Think the opposed opinions on this subject come mostly from differing opinions on how each HCT percentage affects blood viscosity, as well as differing opinions on what negative effects may, or may not come from the increased blood viscosity, at different HCT percentages.

Pretty sure there’s a middle ground here tho, like there usually always is with things. And each case is going to be different. So there’s no way to ever make generalized recommendations/ paramaters, when it comes to certain HCT percentages, imo. Unless we’re talking about extremely high HCT levels. Like say 60%. Don’t think many people/ doctors would think a HCT of 60% isn’t something to be concerned with. Think the percentages in contention are probably around 50-55%, for most people/ doctors. I personally don’t think many guys have to worry about a HCT level of 55% or less, but again, I would still personally prefer to assess each person individually before making an accurate recommendation. Would mainly have to look at platelets, whether they’re metabolically healthy or not, whether they’re insulin resistant or not, iron status, and vital signs. But for most guys, as a general rule of thumb, I personally wouldn’t be too worried about a HCT level of say 53-54% or less. Above that I personally would like to fully assess the person to give any sort of recommendation of lowering androgens and/ or needing to donate blood/ get phlebotomized. Not that I’m a doctor or anything lol. Just my views if I were one, and I was managing a patient with above average HCT levels

But if I was a doctor, the patient would have to be pretty damn metabolically compromised/ have some type of clotting/ platelet disorder for me to be concerned with a HCT of 50. Imo that’s a pretty perfect HCT level for most guys

 

[Goddar]

thanks everbody for the repost!

Im trying to lower because there is no problem for me to have a lower Numbers. The next week ill do my blood test after some weeks with daily pink. Ive donated 2 times ( Jun and Aug ) and first time after a month my hto come back as before ( 54)

Do all you guys after the trt increased the size and amount of visible veins ? Thats my arm, and ice never had this vascularity.

 

[Phil Goodman]

thanks everbody for the repost!

Im trying to lower because there is no problem for me to have a lower Numbers. The next week ill do my blood test after some weeks with daily pink. Ive donated 2 times ( Jun and Aug ) and first time after a month my hto come back as before ( 54)

Do all you guys after the trt increased the size and amount of visible veins ? Thats my arm, and ice never had this vascularity.

From what I’ve read (and your results seem to also indicate), donating blood is no longterm solution. And there is a legit possibility that it will make it worse, as you are priming your body to stay in a state of elevated production. Of course it went back up….because you lost a pint of blood so the first thing your body says is “oh shit we need to make more blood as fast as possible”.


I think @Gman86 nailed it again with his post above. People get way too fixated on an individual metric and specifically, a very specific range of that metric. If your hematocrit is slightly elevated and all other metrics are good or great then it is likely not worth worrying about. Our bodies are capable of adapting to a lot more than most people think. For people who live at higher elevations and have higher hematocrit numbers, do they freak out and donate blood all the time or do they realize their body has adapted to the environment? If you live a healthy lifestyle while maintaining a decent-good diet, exercise, and have good sleep hygiene then you’ll likely have good blood pressure and be fine for the most part. Sure there are outliers, but for the vast majority of people, if you are otherwise healthy then a slightly raised hematocrit level is not much of a concern.


And you should also consider that the levels can fluctuate pretty substantially throughout the day/week based on various factors. I recently did a little bit of a test recently since my annual physical lined up with my bloodwork for defy. Did bloodwork for defy on a Friday(which is the day I would expect my numbers to be best due to maximum hydration, no drinking during the week, eating cleaner, etc.). My hematocrit was 53.5. Everything else was well within range and looked great other than alkaline phospatase which is almost always elevated for me and has been for years. It just runs in the family and I don’t even worry about it anymore because again, basically all of my marker are great. Including blood pressure which is very good(110-120 over mid 70s every time). Then I turned around and did my bloodwork for my GP on Monday morning. I thought these numbers would be worse due to drinking on the weekend for football season and eating worse food(higher sodium, etc.). That Monday morning my hematocrit was 50.8. So almost a 3 point difference between that Friday and that Monday. But the main point is that everything else looked really good. Again, fixating on one metric and insisting it be at a very specific point is an approach that fails to look at the big picture. Human bodies are extremely adaptable when you take care of them. So if you are healthy overall then there are other things you could focus on that would improve your life more than fixating on one metric…especially when that fixation results in you dumping blood out of your body every few months.

 

[Gman86]

From what I’ve read (and your results seem to also indicate), donating blood is no longterm solution. And there is a legit possibility that it will make it worse, as you are priming your body to stay in a state of elevated production. Of course it went back up….because you lost a pint of blood so the first thing your body says is “oh shit we need to make more blood as fast as possible”.


I think @Gman86 nailed it again with his post above. People get way too fixated on an individual metric and specifically, a very specific range of that metric. If your hematocrit is slightly elevated and all other metrics are good or great then it is likely not worth worrying about. Our bodies are capable of adapting to a lot more than most people think. For people who live at higher elevations and have higher hematocrit numbers, do they freak out and donate blood all the time or do they realize their body has adapted to the environment? If you live a healthy lifestyle while maintaining a decent-good diet, exercise, and have good sleep hygiene then you’ll likely have good blood pressure and be fine for the most part. Sure there are outliers, but for the vast majority of people, if you are otherwise healthy then a slightly raised hematocrit level is not much of a concern.


And you should also consider that the levels can fluctuate pretty substantially throughout the day/week based on various factors. I recently did a little bit of a test recently since my annual physical lined up with my bloodwork for defy. Did bloodwork for defy on a Friday(which is the day I would expect my numbers to be best due to maximum hydration, no drinking during the week, eating cleaner, etc.). My hematocrit was 53.5. Everything else was well within range and looked great other than alkaline phospatase which is almost always elevated for me and has been for years. It just runs in the family and I don’t even worry about it anymore because again, basically all of my marker are great. Including blood pressure which is very good(110-120 over mid 70s every time). Then I turned around and did my bloodwork for my GP on Monday morning. I thought these numbers would be worse due to drinking on the weekend for football season and eating worse food(higher sodium, etc.). That Monday morning my hematocrit was 50.8. So almost a 3 point difference between that Friday and that Monday. But the main point is that everything else looked really good. Again, fixating on one metric and insisting it be at a very specific point is an approach that fails to look at the big picture. Human bodies are extremely adaptable when you take care of them. So if you are healthy overall then there are other things you could focus on that would improve your life more than fixating on one metric…especially when that fixation results in you dumping blood out of your body every few months.

Well said. Definitely agree with all of the above. And very interesting and helpful anecdote about the 3 point difference in ur HCT level Friday to Monday. I already knew HCT is based greatly on hydration level, and figured that hydration status could result in difference up to 3-4 points, but it’s always good to see real life examples reinforce theoretical ideas. Definitely ironic tho that u figured ur hct would be worse, based on ur diet that weekend, and it ended up coming back 3 points lower lol

And I cannot agree more, in regards to how adaptive the human body can be. It’s the reason why 99.99% of all living species have died off, and we’ve been a species for as long as we have. It’s because our bodies are extremely adaptive. Most, if not all, species that are alive today are extremely adaptive. Again, it’s why they’re here as well.

 

[Systemlord]

Do all you guys after the trt increased the size and amount of visible veins ? Thats my arm, and ice never had this vascularity.

Nitric oxide expands the veins to count for the thicker blood.

 

[phalloguy100]

I started getting prominent veins after adding cialis to TRT…. So it probably does have something to do with NO production.

A couple of medical societies advise not to even start TRT with hematocrit above 50 (I think one says 52 and other 54). The risks are too high. Lookup testosterone guidelines from American Urological Association and from the Endocrine Society. They explain what the risks are of having high hematocrit, and the role of TRT in it.

Mine is usually 40-47.

 

[Systemlord]

A couple of medical societies advise not to even start TRT with hematocrit above 50 (I think one says 52 and other 54).

I think each case should have the pros and cons weighed because if someone is really bad off, you have to weigh what's worse, the higher hematocrit of the lower testosterone.

Quality of life matters.

Men like me are going to fall through the cracks. If I need TRT one day and I fit this scenario, I only need Total T between 100-200 to fully benefit.

I remember once I was on 13 mg EOD and that was the time I had the strongest libido on TRT.

Just saying.

 

[madman]

Hey guys ! Im a new member

Ive been on trt during 3 years, 100-140mg/w cyp test. Hematocrit always high ( between 52-55). Plaqueta and hemoglobinas always on range. Despite my trt doctor sayd there is no problem, i prefer to mantain as low as possible. Ive try to do lot of things ( grapefruit, apnea study, pin e3d, increase water amount, stop smoking). 2 months ago y started to donate blood, but i realized the next month my hematocrit come Back as before. Now im putting 20mg test Daily subq, nattokinase and next week im going to retest again. My concern is if there are real risk on this Numbers and if somebody experienced some. Im very confused becAuse ive been looking lots of studies and there are oposite theories about hematocrit and diferents diseases ( vte, strokes, etc ). Ive also noticed and increase in the size of my veins

Some key points here!


*There is no compelling evidence that testosterone therapy or testosterone therapy-associated erythrocytosis are associated with increased risk of cardiovascular events or venous thromboembolism

*However, clinical practice guidelines generally recommend intervention if hematocrit of ≥54% while taking testosterone therapy; interventions include stopping testosterone therapy altogether, changing the dose or route of administration or instituting a phlebotomy regimen

Note: 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.




post #2/3

Secondary Polycythemia

https://emedicine.medscape.com/article/205039-overview?form=fpf Practice Essentials In secondary polycythemia, the number of red blood cells (RBCs) is increased as a result of an underlying condition. Secondary polycythemia would more accurately be called secondary erythrocytosis or...

www.excelmale.com

*Erythrocytosis can lead to increased blood viscosity.

*While primary erythrocytosis has been well established as a risk factor for thromboembolic events, the risk of secondary erythrocytosis related to testosterone therapy is less clear.

*In a meta-analysis of all randomized controlled trials for testosterone therapy and cardiovascular risk, the existing evidence was not found to support a causal role between testosterone therapy and adverse CV events when hypogonadism is appropriately diagnosed and treated. However, none of these trials evaluated secondary polycythemia as a potential independent risk factor for these adverse events.

*There are no randomized or prospective studies that have documented a direct relationship between testosterone therapy-related erythrocytosis and thromboembolic events.




*Testosterone has a dose-dependent stimulating effect on erythropoiesis.

*Erythrocytosis is the most common dose-limiting effect of testosterone therapy.

*Erythrocytosis confers an increased blood viscosity and potential (though unproven) increased risk of thromboembolic events.

 

[madman]

I think each case should have the pros and cons weighed because if someone is really bad off, you have to weigh what's worse, the higher hematocrit of the lower testosterone.

Quality of life matters.

Men like me are going to fall through the cracks. If I need TRT one day and I fit this scenario, I only need Total T between 100-200 to fully benefit.

I remember once I was on 13 mg EOD and that was the time I had the strongest libido on TRT.

Just saying.

I only need Total T between 100-200 to fully benefit.

Pure f**king nonsense!

7 years on this forum and still clueless!

 

[Systemlord]

Note: 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.

Glenn Cunningham. Dr. Abraham Morgantaler, asked him both on stage and in person where did you come up with 54% cut off? His answer was we actually don't have much data to say anything but we had to pick a number and it seemed like a reasonable number.

With a secondary erythrocytosis there is an increase in blood volume which enlarges the vascular bed, decreases peripheral resistance and increases cardiac output. Therefore, in a secondary erythrocytosis optimal oxygen transport with increased blood volume occurs at a higher hematocrit value than with a normal blood volume. A moderate increase in hematocrit may be beneficial despite the increased viscosity.


There are over 80 million people that live higher than 2,500 meters and they develop a secondary erythrocytosis. Men in parts of Bolivia for instance have a normal range of HCT from 45-61%. These men are not at an increased risk of thrombotic events nor do they have to undergo phlebotomies to manage their hematocrit.