High hematocrit risk

[Goddar]

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.

Mine was 45-47 before start trt, and during this 3 years it increased to 52-54. Now i feel calmer because as i can see there is no evidence between high Hto and diseases. But im going to check if daily pins reduces the hto, because i dont feel any physiological advantage of having a higher hto.

 

[phalloguy100]

Mine was 45-47 before start trt, and during this 3 years it increased to 52-54. Now i feel calmer because as i can see there is no evidence between high Hto and diseases. But im going to check if daily pins reduces the hto, because i dont feel any physiological advantage of having a higher hto.

Well, if it ain't broke, don’t fix it.

 

[madman]

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.

No shit sherlock!

You very well know where the f**k I stand on this!

Abe!

*Implication - 54% is an arbitrary cut-off

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


Might want to throw this in there too!

*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

High Testosterone on only 80mg/week - Page 3 - ExcelMale Forum. TRT, Hormones, Peptides, Men’s Health

I'm somewhat confused. I had not been feeling great - as though my levels have been off. My cypionate schedule is 40mg (0.2 ml) on Sundays and Thursdays. So, I went in for a blood test on Thursday before my next injection: Testosterone - 907 ng/dL Estradiol (Sensitive) - 18.7...

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ABSTRACT The relative proportional increase of the elderly population within many countries will become one of the most significant social transformations of the twenty-first century and, for the first time in history, persons aged 65 or above outnumbered children under five years of age...

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I posted this thread in 20f**king21!

Based on assumptions!

Key f**king point here!

*Some authors recommend that TTh be discontinued if hematocrit is >54%, which may be reasonable while baseline hematocrit level >50% is a relative contraindication for starting testosterone therapy. However, these recommendations are based on assumptions – the clinical significance of a hematocrit >54% is unknown




Hematocrit

*Some authors recommend that TTh be discontinued if hematocrit is >54%, which may be reasonable while baseline hematocrit level >50% is a relative contraindication for starting testosterone therapy. However, these recommendations are based on assumptions – the clinical significance of a hematocrit >54% is unknown

*The lack of increase in cardiovascular events with elevated hematocrit may be due to the fact that T acts as a vasodilator and has anti-atherosclerotic effects [223]. In addition, testosterone is able to decrease plasma concentrations of procoagulatory substances such as fibrinogen and PAI-1 as well as Factor XII [224] Isolated hematocrit elevations can be the result of insufficient fluid intake on a hot day. Only repeated measures of hematocrit >54% should be followed by concomitant administration of aspirin, bleeding, therapeutic phlebotomy, and/or discontinuation of TTh until hematocrit declines below 54%. After normalization of hematocrit levels, TTh can be continued with a reduced dosage

*Periodic hematological assessment is, however, indicated, i.e. before TTh, then 3–4 months and 12 months in the first year of treatment, and annually thereafter. Although it is not yet clear what upper limit of hematocrit level is clinically desirable, dose adjustments may be necessary to keep hematocrit below 52–54%

*Men with significant erythrocytosis (hematocrit >52%), severe untreated obstructive sleep apnea, or untreated severe congestive heart failure should not be started on treatment with TTh without prior resolution of the co-morbid condition.

 

[madman]

Mine was 45-47 before start trt, and during this 3 years it increased to 52-54. Now i feel calmer because as i can see there is no evidence between high Hto and diseases. But im going to check if daily pins reduces the hto, because i dont feel any physiological advantage of having a higher hto.

My uro is considered one of the top in Canada.

He is considered the pioneer when it comes to subcutaneous T therapy and has treated 1000s of men for almost 2 decades.

Did one of the first pilot studies using subcutaneous T injections.




Canadian Urological Association guideline on testosterone deficiency in men 2021

Hematocrit

*Canadian guidelines cite 55% as the safe upper limit

High Testosterone on only 80mg/week - Page 3 - ExcelMale Forum. TRT, Hormones, Peptides, Men’s Health

I'm somewhat confused. I had not been feeling great - as though my levels have been off. My cypionate schedule is 40mg (0.2 ml) on Sundays and Thursdays. So, I went in for a blood test on Thursday before my next injection: Testosterone - 907 ng/dL Estradiol (Sensitive) - 18.7...

www.excelmale.com

 

[LabTracker]

Is the 54% hematocrit cutoff primarily based on data from generally unhealthy individuals, whose poor lifestyle choices lead to elevated hematocrit levels, rather than those specifically on TRT?

I wonder if the risk factors in the statistics are influenced by unhealthy people raising their HCT through lifestyle-related factors.

 

[Systemlord]

Is the 54% hematocrit cutoff primarily based on data from generally unhealthy individuals, whose poor lifestyle choices lead to elevated hematocrit levels, rather than those specifically on TRT?

I wonder if the risk factors in the statistics are influenced by unhealthy people raising their HCT through lifestyle-related factors.

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.

You must have missed my post. So in order words the 54% cut off was chosen out of thin air due to a lack of data.

 

[LabTracker]

Yeah I understood that, maybe I phrased my question wrong. I'm not claiming anything anyone saying here is wrong... I'm just wondering if any research involving high hematocrit and it's risks is based more on general unhealthy lifestyle and its effects, rather than specifically the hct rising because of trt.

 

[Dog427]

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

A lot who are not helpful for you because they simply do not know about the subject. Which is ok but not the Docs to take advice from.

 

[Nelson Vergel]

Click:

High Hematocrit and Testosterone Replacement Therapy:​

What Every Man on TRT Needs to Know About Blood Thickening​

 

[Phil Goodman]

Click:

High Hematocrit and Testosterone Replacement Therapy:​

What Every Man on TRT Needs to Know About Blood Thickening​

This was a great write up! And I didn’t even know you have a Substack, so I’ll have to keep an eye on that.

Again, I think that was a very thorough and nuanced article so good job on that… but one aspect that I think it missed(unless I just overlooked it) is the hydration angle. That’s another thing to consider for guys trying to keep it within a healthy range. However, I would say that some people tend to overstate that aspect and give off the impression that any increase in hematocrit can be offset by simply hydrating better. That clearly isn’t the case and I think is just a convenient out for people who want to keep their head in the sand on that front… but it should be considered a tool available for helping with the issue(just not a complete fix most of the time).



And for me personally I’ve noticed that there are more variations in levels than most people realize. I know I’ve shared my experiences here with getting a test on Friday and a test the following Monday and seeing a few point difference between the two… with Monday being lower. This was despite the fact that I had made a point to hydrate during the week for my Friday test and had alcohol both days of the weekend which should’ve made me more dehydrated. Still haven’t come up with a good theory to explain the difference other than the blood lost from it being taken for the test on Friday… but that small amount shouldn’t explain a drop like that.


On the hematocrit topic, I think another interesting thing I would like to see studied more is - what causes some people on oral t to have such a large jump? While most people see a much smaller rise from oral t, th small number of people who see a large jump raise the average so much that the average increase for oral t is actually higher than from injectable. So what is the mechanism in those outliers that causes such a huge jump? That’s also something I haven’t really heard of a good theory for.



Anyway… those are just some things off the top of my head on the topic, but again I think the article was really well done for the most part.

 

[Melody68]

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 XXXXX the uncertain risks then continue. Otherwise consider that many men see better overall results when testosterone is reduced to physiological levels.

It appears, Cataceous, that you DO have to keep repeating that lower T doses are often effective and better for you. I notice the OP has tried many things except the obvious - reducing the dose.

I had high hematocrit problems at one time. Then I had a TIA, perhaps related, perhaps not, no one knows. But it scared me so I decided to cut my T down to the lowest dose that still fulfilled my goals, which were mainly fighting fatigue and poor body composition. I now take only 63mg/week, feel and look quite well, and have the added benefit of bringing my hematocrit back in line, usually 50 or under. "Reduction" is NOT A DIRTY WORD!