High HGB/HCT

[GreenMachineX]

Hey guys,
I just got a CBC done yesterday and my hemoglobin is 18.8 and hematocrit is 53.2. I can't believe this as I've lowered my dose to 6-7mg daily about 4 weeks ago from running 9-10mg daily for a couple months. When I lowered the dose, my hct was 50.8 and hgb was 17.8. I also saw on those Labs my b12 was bottom of normal so I upped the dose of that and guessing that is what pushed it up. I'm trying to donate today, but is this hct and hgb an emergency? I'll definitely get it done today or tomorrow, but how bad should I be worried?

@Cataceous @madman

I've had high hgb and hct before (I think only once my hgb was this high) and I made it obviously, but never dug in to what was really an emergency. Thanks in advance.

 

[GreenMachineX]

Also, if my hct and hgb are at this level at 6-7mg, what should I drop to?

For the compete picture above, rbc were 6.03 but it won't let me edit it.

Another thing, I'm not sure how this part works, but if I dropped dose 4 weeks ago, do the effects linger for a couple weeks so is there a chance the elevation is residual and the dosage drop effects are lagging? Or, it's cut and clear my current dose is just still too high? I'd like to get my hct down to 50 or lower...

For what it's worth, I don't think I've had symptoms of elevated hct or hgb, other than once or twice I've noticed red ears and part of face red. Hands don't seem to be any more red than normal. I did wake up dizzy in the middle of the night though last night, but could've been something else I guess. I also saw someone mention elsewhere tinnitus is from high hct which I have had for a couple weeks.

 

[GreenMachineX]

To add more weirdness, about 5 days before the labs that said my hct was 50.8 and hgb was 17.8 and rbc was 5.97, my hgb was 18.1, hct 52, and rbc 6.06. I had stopped TRT for about 3 days then resumed at 4mg a day or 2, so did my hct and hgb drop that quickly from ceasing TRT or just lab variations?

Biggest question still remains if this is an emergency hct and hgb....

 

[Cataceous]

My impression is that this isn't an emergency, but you don't want to leave it like this longer than necessary. Do you have current testosterone and SHBG measurements? It seems as though your TRT doses are small enough that testosterone shouldn't be much of a contributing factor. It is possible there is a lag in effects, but I still wouldn't have predicted this increase. Hopefully others will weigh in...

 

[GreenMachineX]

My impression is that this isn't an emergency, but you don't want to leave it like this longer than necessary. Do you have current testosterone and SHBG measurements? It seems as though your TRT doses are small enough that testosterone shouldn't be much of a contributing factor. It is possible there is a lag in effects, but I still wouldn't have predicted this increase. Hopefully others will weigh in...

Thanks. The last testosterone result was at 9mg daily and the free T was very top of range at trough. Shbg was 18. I don't have anything at this current dose.

 

[GreenMachineX]

My impression is that this isn't an emergency, but you don't want to leave it like this longer than necessary. Do you have current testosterone and SHBG measurements? It seems as though your TRT doses are small enough that testosterone shouldn't be much of a contributing factor. It is possible there is a lag in effects, but I still wouldn't have predicted this increase. Hopefully others will weigh in...

I also don't understand why my hands aren't red and anything else. And why is my rbc lower then what it was 4 weeks ago? Granted, its only slightly lower, but lower nonetheless. My blood pressure is fine too...120's to 130's over 70's. It's been way worse then that in the past. My heart rate is 60-70 resting. I'm at a loss.

 

[GreenMachineX]

A couple other things to add here...

Could the elevation be due to moving to an area 600 feet above sea level from 50' (granted this was a few months ago)?

Otherwise, since the dose drop, I can see my platelets are just a little higher and are my all my white blood cells, my cholesterol numbers look better, the hair they grows on my ears and such has slowed down, body hair slowing down, and I've lost some leg hair. Other markers of cardio health like CRP and lipoprotein A also look great. It just doesn't doesn't sense that my hgb and hct have went up!

 

[Gman86]

Idk why ur freaking out. A HCT of 53 is healthy as long as ur platelets aren’t too high. Ur BP seems fine. Men that live at elevation can average HCT levels right around 53, and not have any issues and be completely healthy. The average HCT level for men living in Potosí, Bolivia (4000 m) is around 52.7%. Imo ur level is fine right where it is, and I wouldn’t worry about it. But if ur concerned, u can obv donate blood. But most likely ur level will eventually go right back up. So I personally wouldn’t worry about it if I were u, and just enjoy life. Nothing to be concerned about from a health perspective. Ur just stressing urself out for no reason

 

[GreenMachineX]

Idk why ur freaking out. A HCT of 53 is healthy as long as ur platelets aren’t too high. Ur BP seems fine. Men that live at elevation can average HCT levels right around 53, and not have any issues and be completely healthy. The average HCT level for men living in Potosí, Bolivia (4000 m) is around 52.7%. Imo ur level is fine right where it is, and I wouldn’t worry about it. But if ur concerned, u can obv donate blood. But most likely ur level will eventually go right back up. So I personally wouldn’t worry about it if I were u, and just enjoy life. Nothing to be concerned about from a health perspective. Ur just stressing urself out for no reason

Thanks for the reply. Is the 18.8 hgb not a problem either? That did give me peace of mind, but I'm still trying to figure out where some of my other symptoms are from. My platelets are 198, from range 140-400. I'm still going to donate and reduce dosage though. I wonder if e2 is too high also. Noticing some water weight and libido is gone. In the other hand, my knees are cracking quite a bit. Need to run it all again I guess.

 

[Gman86]

Thanks for the reply. Is the 18.8 hgb not a problem either? That did give me peace of mind, but I'm still trying to figure out where some of my other symptoms are from. My platelets are 198, from range 140-400. I'm still going to donate and reduce dosage though. I wonder if e2 is too high also. Noticing some water weight and libido is gone. In the other hand, my knees are cracking quite a bit. Need to run it all again I guess.

Ur platelets are almost low, so obv no need to be concerned about a 53 HCT when ur platelets are on the very low end of the range. 18.8 HGB would equal around a 56.4 HCT when we use the multiply HGB by 3 to get HCT rule. And a 56.4 HCT is getting up to the point where u need to start considering trying to lower it a little. But even a HCT of 56.4 might not be an issue for a lot of people, especially if they had a platelet level like urs. U mainly just don’t want a high HCT and high platelet count at the same time. ur test dose is already so low that I wouldn’t continue to lower it. I would just donate blood if ur concerned at all, then wait a bit and get everything retested. And the night before and obv the day of getting ur labs done make sure to hydrate very well. Don’t just drink plain water either. That will go right through u. U need to add quality salt and ideally electrolytes to ur water to actually absorb the water. Just adding quality salt should do the trick tho. Everytime I drink water I always add some Celtic salt to it. Another thing u could do is add some coconut water to ur water, or just drink coconut water straight up. That should definitely help hydrate u. Here’s an amazing video mostly about salt and how to actually hydrate ur body and cells. Most people drink a bunch of water, but aren’t actually hydrating themselves. I personally only drink carbonated mineral water. If u like seltzer water, that’s the best way to go. Has natural minerals in it that helps u actually absorb it into ur cells

 

[GreenMachineX]

Ur platelets are almost low, so obv no need to be concerned about a 53 HCT when ur platelets are on the very low end of the range. 18.8 HGB would equal around a 56.4 HCT when we use the multiply HGB by 3 to get HCT rule. And a 56.4 HCT is getting up to the point where u need to start considering trying to lower it a little. But even a HCT of 56.4 might not be an issue for a lot of people, especially if they had a platelet level like urs. U mainly just don’t want a high HCT and high platelet count at the same time. ur test dose is already so low that I wouldn’t continue to lower it. I would just donate blood, then wait a bit and get everything retested. And the night before and obv the day of getting ur labs done make sure to hydrate very well. Don’t just drink plain water either. That will go right through u. U need to add quality salt and ideally electrolytes to ur water to actually absorb the water. Just adding quality salt should do the trick tho. Everytime I drink water I always add some Celtic salt to it. Another thing u could do is add some coconut water to ur water, or just drink coconut water straight up. That should definitely help hydrate u. Here’s an amazing video mostly about salt and how to actually hydrate ur body and cells. Most people drink a bunch of water, but aren’t actually hydrating themselves. I personally only drink carbonated mineral water. If u like seltzer water, that’s the best way to go. Has natural minerals in it that helps u actually absorb it into ur cells

Thanks. I'm still going to drop dose a little. The reason for my dose as it is was because at 9mg daily my free T was very top of range in the trough, so I have a lot of room to move down. I also believe I'm having high e2 symptoms. Those are emotions out of control, muscle weakness/cramps, calf swelling (raising above my heart reduces it back down), zero libido and frightened turtle syndrome, bloat all over like chest/love handles/face, constant tinnitus... I'm just thinking with where my free T is at, if I'm having high E symptoms and elevated hct, lowering test dose is the simplest answer, right? I looked up hrt in women and found all those side effects.

Either way, my numbers still aren't an emergency is what it sounds like to you...helps me keep calm. Just gotta make it until tomorrow.

How much does 1 blood donation lower hct and hgb?

 

[GreenMachineX]

Also, found this:

https://www.liebertpub.com/doi/10.1089/15270290152608534

"Male hematocrit averaged 52.7% and hemoglobin averaged 17.3 m/dL whole blood. The corresponding female values were 48.3% and 15.8 g/dL whole blood, respectively. The range of normal values was 45% to 61% for hematocrit and 13 to 21 g/dL for hemoglobin in the men and 41% to 56% for hematocrit and 12 to 19 g/dL for hemoglobin in the women. These data indicate that hematocrit values above 61% in men or 56% in women and hemoglobin values above 21 g/dL whole blood in men or 19 g/dL whole blood in women are outside the normal range."

Those numbers are crazy high. So what we are saying is if those people aren't at increased risk, then why would TRT patients be, if only the cause of the erythrocytosis is different and everything else equal?

Still donating...still don't want my levels this high, but interesting discussion and helps me not freak out.
Could moving from 50' elevation to 600' elevation make this worse as well?

 

[Systemlord]

And why is my rbc lower then what it was 4 weeks ago? Granted

Your HCT isn't static and is always fluctuating.

Were you hydrated when you drew those labs?

 

[GreenMachineX]

Your HCT isn't static and is always fluctuating.

Were you hydrated when you drew those labs?

Yes. I always drink plenty per day and keep my urine a light yellow, but not quite clear.

 

[GreenMachineX]

One thing I don't understand is the relationship between RBCs, hemoglobin and hematocrit. If hct is hgb x3, but hematocrit is the thickness due to rbc concentration...what am I missing?

 

[Cataceous]

Dr. Says has a lengthy post in which he discuses why elevated hemoglobin/hematocrit may be problematic. "My take: as I've said before, it is not concern for MI, DVT that presents itself to me with TRT-induced erythrocytosis, but more the LONGTERM vascular consequences." For him the issue is higher blood pressure and wear and tear on the vasculature.

@readalot has contributed a great deal on this subject, as in this thread, for example. "Although some may suggest erythrocytosis (Hct > 52%) is benign, [a] plethora of literature and basic physics would indicate otherwise."

 

[GreenMachineX]

Dr. Says has a lengthy post in which he discuses why elevated hemoglobin/hematocrit may be problematic. "My take: as I've said before, it is not concern for MI, DVT that presents itself to me with TRT-induced erythrocytosis, but more the LONGTERM vascular consequences." For him the issue is higher blood pressure and wear and tear on the vasculature.

@readalot has contributed a great deal on this subject, as in this thread, for example. "Although some may suggest erythrocytosis (Hct > 52%) is benign, [a] plethora of literature and basic physics would indicate otherwise."

He's probably right about the long term effects, but I'm just glad to see another doctor also say that what I've got isn't an emergency today. Anxiety is coming back. Whatever is causing this insane anxiety, I've gotta figure out. Need as much reassurance as I can get over the next 15 hours until my donation appointment.

 

[GreenMachineX]

Also, from ScienceDirect:

Hematocrit is the packed spun volume of whole blood that is made up of RBCs and is expressed as a percentage of total blood volume. It can be measured or calculated as Hct = (RBC × MCV)/10.

It looks like it has nothing to do with hemoglobin. According to that, my hct is on point at 53.8, or actually it should've been 53.18.
Anyone have any thoughts on that?

 

[GreenMachineX]

Your HCT isn't static and is always fluctuating.

Were you hydrated when you drew those labs?

Now that I think about it, I have reduced my water intake a little. I used to drink 1.5 gallons per day, urine was always clear, but recently felt like that was just too much. But still, for the most part, my urine is light yellow (except when I wake up in the morning). Are you thinking that falsely elevated the hgb?

@Nelson Vergel Do you have any thoughts on any of this?

@Cataceous if my results were this at roughly 7mg per day, would dropping to 5mg make sense? Or even lower? I'm still perplexed that my rbc is basically the same as 1 month ago but hgb so much higher...the more I think about it, the more I think the indicators of high test side effects don't match up to these levels. I'm not breaking out, skin isn't really any greasier, platelets and wbc are higher than 6 months ago (TRT suppresses this correct?). Clearly something isn't right though because my sleep isn't great, it's definitely better though then 1 month ago), and anxiety hits at the same time every day. I have a few good hours per day. Today I'm using 5mg, erring to the 4mg side a little.

 

[Nelson Vergel]

@Nelson Vergel Do you have any thoughts on any of this?

Remember that the average life of a red blood cell is 90 days, so reductions in dose take a while to reduce hematocrit. Also, dehydration, smoking and sleep apnea can make it harder to reduce hematocrit even with a low TRT dose.

It looks like it has nothing to do with hemoglobin. According to that, my hct is on point at 53.8, or actually it should've been 53.18.
Anyone have any thoughts on that?

Hemoglobin is contained in red blood cells, so it is are part of the equation. Hemoglobin x 3= hematocrit (unless you are not well hydrated).

How long ago did you move to a higher altitude?

What is your current total and free T?

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