How fast can hematocrit rise?

[johndoesmith]

On 5/20 I had a hematocrit of 44 39-51 range, and a change in protocol on 5/23. I increased to 140mg per week, 60mg every 3 days. Along with the addition of HCG 500 IU twice per week, so total of 1000 IU of HCG per week.

I had a CBC on 6/29, showing an increase of hematocrit to 48.9 38.5-50 range.

I am probably going to run labs sometime in the first week of august. I don't want my hematocrit to go too high, seeing as I had a near 5 point increase in the first month.

I also don't want to preemptively donate blood and not know if maybe I just stabilize at 48.9, and never needing to donate blood which would be good.

So is there much risk of being over range by waiting another 2-3 weeks or so to run labs? I am hoping Dr saya sees this.

 

[PAUL-E]

I would also like to know I don't think you need to freak out(not saying you are) but in the meantime take your fish oil and drink plenty of water.

 

[trt4me]

I've read that it can rise and then stabilize so I would give it a chance and test again.

 

[johndoesmith]

I've read that it can rise and then stabilize so I would give it a chance and test again.

Yeah that's what I recall reading too, can't really remember WHERE I read that. My intuition along with the fact that I use defy and they have all of my labs, tells me that it probably won't go TOO high if anything. I assume if I was on a dangerous track, they'd let me know, and to get a test or just go donate blood.

 

[Dr Justin Saya MD]

Johndoesmith - you still have quite a bit of room on the HCT from a safety perspective. I wouldn't get too anxious, but continue to monitor.

BTW, there is nothing wrong with presumptively donating blood (even if not absolutely necessary)...there's always shortages and it could save a life ;-)

 

[Vince Carter]

On 5/20 I had a hematocrit of 44 39-51 range, and a change in protocol on 5/23. I increased to 140mg per week, 60mg every 3 days. Along with the addition of HCG 500 IU twice per week, so total of 1000 IU of HCG per week.

I had a CBC on 6/29, showing an increase of hematocrit to 48.9 38.5-50 range.

I am probably going to run labs sometime in the first week of august. I don't want my hematocrit to go too high, seeing as I had a near 5 point increase in the first month.

I also don't want to preemptively donate blood and not know if maybe I just stabilize at 48.9, and never needing to donate blood which would be good.

So is there much risk of being over range by waiting another 2-3 weeks or so to run labs? I am hoping Dr saya sees this.

I dont' see HCT as some sort of crisis, per se, sure it needs monitored and treated with donation (or phlebotomy) but I just don't think that it's something to worry over, and Dr Saya points out that you're still well within ranges. There is SOME indication that over time HCT can stabilize for men on HRT, I think I myself am seeing some indications of that (I have pending results now) that will further verify. But after having high HCT (55.6) and donating three times (every 59 days), my last few CBCs showed a now much steadier HCT with no need to donate.

 

[johndoesmith]

Johndoesmith - you still have quite a bit of room on the HCT from a safety perspective. I wouldn't get too anxious, but continue to monitor.

BTW, there is nothing wrong with presumptively donating blood (even if not absolutely necessary)...there's always shortages and it could save a life ;-)

Okay that's great to hear. I'm new to all of this, learning as I go, and maybe it's the low t habits but I tend to worry a little bit. It is getting better with testosterone, the "urgency" isn't there as much, so it feels like more a habit that I have to worry about things.

I will keep that in mind about blood donation! Always try to help out when I can.

Vince carter: That's good to hear, I wasn't sure, so I asked. I was pretty confident that 48 isn't a big deal, but that 56 or so IS! Getting other people's opinions here makes me feel better about waiting a bit.

 

[Weasel]

Making sure you stay well hydrated will also lower the number on labs. If don't drink any water before my fasting labs, my HCT comes back a couple points higher than if I go in well hydrated.

 

[Nelson Vergel]

Here is the only study that showed a hematocrit graph using 125 mg per week of testosterone enanthate injections (they gave a group finasteride to see if blocking DHT may suppress hematocrit increase, which it did not).

Hematocrit increased from an avg of around 43 to 48 after 6 months. This is lower than what we see in the field but shows that hematocrit can indeed level off.



Abstract
Testosterone (T) stimulates erythropoiesis and regulates iron homeostasis. However, it remains unknown whether the (type II) 5α-reduction of T to dihydrotestosterone (DHT) mediates these androgenic effects, as it does in some other tissues. Our purpose was to determine whether inhibition of type II 5α-reductase (via finasteride) alters red blood cell (RBC) production and serum markers of iron homeostasis subsequent to testosterone-enanthate (TE) administration in older hypogonadal men. Sixty men aged ≥60 yr with serum T <300 ng/dl or bioavailable T <70 ng/dl received treatment with TE (125 mg/wk) vs. vehicle paired with finasteride (5 mg/day) vs. placebo using a 2 × 2 factorial design. Over the course of 12 mo, TE increased RBC count 9%, hematocrit 4%, and hemoglobin 8% while suppressing serum hepcidin 57% (P < 0.001 for all measurements). Most of the aforementioned changes occurred in the first 3 mo of treatment, and finasteride coadministration did not significantly alter any of these effects. TE also reduced serum ferritin 32% (P = 0.002) within 3 mo of treatment initiation without altering iron, transferrin, or transferrin saturation. We conclude that TE stimulates erythropoiesis and alters iron homeostasis independently of the type II 5α-reductase enzyme. These results demonstrate that elevated DHT is not required for androgen-mediated erythropoiesis or for alterations in iron homeostasis that would appear to support iron incorporation into RBCs.

http://ajpendo.physiology.org/content/307/5/E456

 

[PAUL-E]

Nelson are there any similar graphs comparing estrogen and hematocrit?

 

[johndoesmith]

Nelson are there any similar graphs comparing estrogen and hematocrit?

I read the study, and it doesn't give you the levels of testosterone or estradiol during treatment. It does give a rather confusing graph correlating changes in T and E2 to changes in HCT, HGB, and ferritin.

Although directly regarding E2 and HCT I copied this from the study:

"Interestingly, we also observed that TE administration elevated circulating E2 and BioE2 and that the magnitude of change in E2 was correlated to the increases in RBC count and HGB. These findings raise the possibility that estrogens may mediate several of the effects we observed. In this regard, estrogen has been shown to suppress hepcidin, and an estrogen response element is present in the promoter region of the hepcidin gene (20, 21). However, we find it highly unlikely that E2 mediated the erythropoietic effects of T given that T administration results in elevated RBC count and HGB in aromatase-deficient men (30) and that RBC count and HGB are elevated following T plus letrozole (a potent aromatase inhibitor) treatment in boys with constitutional delay of puberty (19). Similarly, preclinical evidence from our laboratory indicates that trenbolone (a nonaromatizable and non-5&#945;-reducible T analog) and TE elevate HGB in an identical manner in orchiectomized rats (26, 36). Together, these results demonstrate that aromatase activity is not necessary for androgen-stimulated erythropoiesis, although the possibility remains that the suppression of hepcidin was at least partially influenced by the elevated E2 following TE administration."

So it seems that E2 doesn't, according to this study, although I am not certain I am understanding this study completely.

 

[trt1]

Be weary of these Hematocrit lab values from labcorp especially is you tend to drink a great deal of water. On 5/10/17 I had some labs done via labcorp and my hematocrit came in at 47.7 and I only had 1 glass of water that day. I could feel the blood/sludge moving around my body.

On 5/19/17 my hematocrit came in from the finger prick test at 54 and this was after a whole blood donation on 4/27/17. Before trt my hematocrit was 45. Some dr's see you are within the range and say everything is fine even if you are on the high side of the range. I can feel my blood getting too thick and that's when you should donate.

By the time your labs indicate they are too high you will either have to come off your maintenance dose to experience relief of serious symptoms. I was on 120 mg cypionate weekly and 500 iu HCG twice a week.

I'm now currently just dosing 10 mg a day because when my hct was too high I felt like I was going to die and a 50 mg dose every 3.5 days brought my symptoms back with a vengeance, I rushed myself to urgent care twice in 3 weeks and every time they ran the cbc my HCT RBC and Hemo #'s were in the range. I suspect partially due to me over hydrating because I knew what was up and water appeared to provide a tiny bit of relief.

I have since donated on 5/19/17 when my HCT was 54 and then donated on 5/24 and my hemoglobin was 16.3. If it is in fact true that HCT is 3 times hemoglobin my 5/19 donation brought me down around 5 points. I still didn't feel much relief after that donation and plan on doing one more donation on 6/2/17 before having ferratin checked and beginning a maintenance phlebotomy every 2 months.

After my 5/24 donation I still feel as if my blood was a bit viscous. Makes me realize that many of these anti aging clinics dont know their ass from 3rd base when they prescribe 200 mg cypionate a week considering the average man produces 4-7 mg of test a day, that's around 3-5 times physiological doses and with HCG on top of that its even more.

On the bright side I seem to be experiencing more libido on 70-90 mg a week than I ever did on 120,140 and 200 a week and I no longer need an AI, sometimes Ill just take a micro dose because it allows me to last longer in the sack, prior to this I was battling my AI dose with my T just trying to keep my libido up.

I was deathly afraid of phlebotomy before trt and now its as easy as watching a rerun of columbo.

Bottom line, if its becomes harder to breathe and you feel as if your blood has become too viscous and you have trouble thinking and feel pressure in your head I would suggest an immediate cbc test without hydrating too much before hand for accurate results. And if your hematocrit is over 48-49 I would consider either lowering your dose or donating blood or double rbc's before you start to experiencing some hellish like symptoms that I wouldn't wish on my worst enemy. Everyone obviously is different but this happened to me around my 8 month mark of trt and it has been almost a show stopper for me.

 

[user_joe]

If it's early on in treatment I don't see any need to donate if you are in range, even if it's tops of the range assuming no symptoms. If mentally it's just bugging you no harm in just donating once and keeping an eye on it. That's what I did as I was unsure. It all settled down as it does for most. I still go in 2-3x/year. I'll donate if it's over 47 since my dr picked 46 as ideal. I've had to leave bc hct did not increase at all more than once. Never any ill effects though from donating.

 

[trt1]

I concur, I felt a plethora of symptoms from barely being able to play hoops due to being out of breath which never happens to feeling the blood move about my body in a sludge like manner. I never would have tried phlebotomy unless I was symptomatic. You can tell when something is out of whack on treatment.

 

[Vince]

I've never felt any symptoms from high or low hematocrit. I do work out daily and I'm on my feet all day, maybe it's because my levels never been high enough to feel symptoms?

 

[trt1]

Probably never hot high enough. I have ridden my bicycle up 14,000 foot mountains in Colorado with no issues before trt and the out of breath feeling I have experienced on trt at times will occur from just walking to my kitchen at times when my blood is out of whack. Cannot wait for this to stabilize. Strangely feel better on 60-70 mg a week since I experienced symptoms, libido is stronger than 120! Just need to levels to get low enough to do cardio again comfortably, can barely jog with high HCT, hemo and RBC levels that 3 phlebotomy's in 1 month haven't fully resolved.