How to Respond to Very High Hematocrit

[buggies100]

Good afternoon all. I hope everyone's new year is moving along fine.
I have, as posted last week, a very high hematocrit level, in the range of 59-60!!!! I had been running 55-56 for 2 years and my dr never said it was an issue. Thanks for that!! So i went from 200mg every two weeks to 40 mg every 3.5 days. So my T shot thru the roof, up to 883 and of course Hct went with it. Not really sure why lower dose more frequently did that. Anyway, I have a dr appt with obsidian men's health wed, two urologists who specialize in mens health. It is a concierge service.
I am off T for 10 days now and not due for another blood draw till early march. Of course ai m beginning to crash a bit now. My LH at the beginning of all this in sept 2013 was 1.2, so I was not a high producer.
So what type of protocol would you guys think I should be on I am really concerned about taking any T at the moment. Just wanted some other opinions before I meet new dr

 

[Vince]

I think your protocol of 40mg every 3 1/2 day is fine. I would also consider adding in HCG and of course get your high hematocrit down.

 

[Vettester Chris]

Donating to the blood bank always keeps mine in check, along with ferritin and iron serum, which is genetically problematic for me.

 

[buggies100]

I will look to add hcg when i speak with new dr, and speak to him about clomid or tamox. Inam afraid i can take no more T cyp at this point with such high hct. Apparently the 40 mg every 3.5 days is not so fine, as it sent my T way higher than the 200 every two weeks did. Kinda comfounding, lower dose raised total T to 883 and free t to 33
So if i do no T u til i can get this hct in control, is hcg and clomid the route i must take?

 

[buggies100]

Yeah i hear ya and agree. Unfortunately red cross will not take blood at this level and o ly let me do theraputic every 4 weeks. Dropping 2-3 points per time will not get me down to 50 for naother 4 months! Yikes!

 

[Nelson Vergel]

I would get three therapeutic phlebotomies by giving 1 unit per month for 3 months while taking iron plus vitamin C after the second draw. Then retest CBC and iron a week after the 3rd phlebotomy. You will need your doctor to call in an order to your local blood center.

I would not get off TRT or start nolvadex. I would also add a baby aspirin per day plus 1000 mg of Omega 3's.

If your blood pressure is high, it would probably be good to take:

Can Losartan decrease high hematocrit caused by testosterone replacement?

 

[ratbag]

[FONT=&quot]Has anyone read this article by Neal Rouzier, M.D?


ERYTHROCYTOSIS VS PCV (Polycythemia Vera)​[/FONT]​

[FONT=&quot]

NEAL ROUZIER, M.D.

This is in response to your inquiry about elevated red blood cell counts that are quite common, almost universal, in those who take testosterone. It is more prevalent in those taking injectable testosterone and less so in those using the creams or gels. Most physicians become concerned about this elevation of hemoglobin because they associate this elevation with a blood condition which causes hyperviscosity (thick blood) and potential strokes. However, this is definitely not the case with you or in those that take testosterone and have elevated red blood cell counts. The two conditions are commonly confused with each other, yet they are entirely different in their cause, treatment, and outcomes.

The condition that you have acquired is termed erythrocytosis and is simply an increase in the red blood cells due to increased production of a kidney hormone called erythropoietin. This is the same phenomenon that occurs when cyclists use Epogen or Procrit (erythropoietin) to raise their blood counts to enhance their endurance. This is also the same process that causes people who live at high altitude to have an increase in red blood cell counts. People who live at altitude have the same physiologic increase in red blood cell counts as you and we never worry about them. This is because it is a physiologic (not harmful) increase in only red blood cells, not in any other cells or clotting factors. Treatment is not necessary for anyone with erythrocytosis that lives at altitude as it does not cause any problem whatsoever and it is quite beneficial. Millions of people worldwide live at high altitude and have blood counts higher than yours and no treatment is necessary nor is there ever any harm. In fact athletes train at high altitudes to raise their blood counts to increase their exercise endurance at sea level. It gives them an advantage. People with chronic lung problems (COPD) also have high blood counts and we never treat them as their response is physiologic (normal, expected, and not harmful) in order for the blood to carry more oxygen.

Your physician is confusing your erythrocytosis with a blood disorder called Polycythemia Vera (PCV). This is a harmful blood condition that causes an increase in clotting which leads to strokes and blood clots. The difference is that erythrocytosis only causes increased red blood cells and no harm. PCV causes an increase in platelets which causes increased clotting. More importantly, PCV is associated with a defect in the blood vessel wall which stimulates the clotting cascade of thrombosis in addition to increased platelets. These two entities together cause an increased risk of blood clots and stroke thereby requiring treatment by phlebotomy or blood donation to lower blood counts and prevent the complications of PCV.

PCV is classically defined as an increase in red blood cells, white blood cells, platelets, splenomegaly, and clotting disorders. You do not have this nor are you at risk for this. In addition, the literature clearly demonstrates that testosterone causes erythrocytosis only and not PCV. Testosterone administration has never been associated with any risk of clotting or stroke in any of the studies over the last forty years. Therefore the erythrocytosis requires no treatment. You have the same erythrocytosis that people have who live at altitude and you should receive the same treatment as they do, which is nothing. If your physician is uncomfortable with this, then he can refer you to a hematologist who will hopefully understand this very well. If your physician or you are still concerned, then the treatment is simply to donate blood which is the only necessary treatment for PCV, which you do not have.

Although this explanation was technical, it was intended as such so that you could pass this information along to your physician.

Neal Rouzier, M.D. 760-320-4292
​

[/FONT]

 

[CoastWatcher]

Has anyone read this article by Neal Rouzier, M.D?


ERYTHROCYTOSIS VS PCV (Polycythemia Vera)​​

NEAL ROUZIER, M.D.

This is in response to your inquiry about elevated red blood cell counts that are quite common, almost universal, in those who take testosterone. It is more prevalent in those taking injectable testosterone and less so in those using the creams or gels. Most physicians become concerned about this elevation of hemoglobin because they associate this elevation with a blood condition which causes hyperviscosity (thick blood) and potential strokes. However, this is definitely not the case with you or in those that take testosterone and have elevated red blood cell counts. The two conditions are commonly confused with each other, yet they are entirely different in their cause, treatment, and outcomes.

The condition that you have acquired is termed erythrocytosis and is simply an increase in the red blood cells due to increased production of a kidney hormone called erythropoietin. This is the same phenomenon that occurs when cyclists use Epogen or Procrit (erythropoietin) to raise their blood counts to enhance their endurance. This is also the same process that causes people who live at high altitude to have an increase in red blood cell counts. People who live at altitude have the same physiologic increase in red blood cell counts as you and we never worry about them. This is because it is a physiologic (not harmful) increase in only red blood cells, not in any other cells or clotting factors. Treatment is not necessary for anyone with erythrocytosis that lives at altitude as it does not cause any problem whatsoever and it is quite beneficial. Millions of people worldwide live at high altitude and have blood counts higher than yours and no treatment is necessary nor is there ever any harm. In fact athletes train at high altitudes to raise their blood counts to increase their exercise endurance at sea level. It gives them an advantage. People with chronic lung problems (COPD) also have high blood counts and we never treat them as their response is physiologic (normal, expected, and not harmful) in order for the blood to carry more oxygen.

Your physician is confusing your erythrocytosis with a blood disorder called Polycythemia Vera (PCV). This is a harmful blood condition that causes an increase in clotting which leads to strokes and blood clots. The difference is that erythrocytosis only causes increased red blood cells and no harm. PCV causes an increase in platelets which causes increased clotting. More importantly, PCV is associated with a defect in the blood vessel wall which stimulates the clotting cascade of thrombosis in addition to increased platelets. These two entities together cause an increased risk of blood clots and stroke thereby requiring treatment by phlebotomy or blood donation to lower blood counts and prevent the complications of PCV.

PCV is classically defined as an increase in red blood cells, white blood cells, platelets, splenomegaly, and clotting disorders. You do not have this nor are you at risk for this. In addition, the literature clearly demonstrates that testosterone causes erythrocytosis only and not PCV. Testosterone administration has never been associated with any risk of clotting or stroke in any of the studies over the last forty years. Therefore the erythrocytosis requires no treatment. You have the same erythrocytosis that people have who live at altitude and you should receive the same treatment as they do, which is nothing. If your physician is uncomfortable with this, then he can refer you to a hematologist who will hopefully understand this very well. If your physician or you are still concerned, then the treatment is simply to donate blood which is the only necessary treatment for PCV, which you do not have.

Although this explanation was technical, it was intended as such so that you could pass this information along to your physician.

Neal Rouzier, M.D. 760-320-4292
​

Rouzier and and his positions have been discussed extensively here at EM.

His positions, that hematocrit and estradiol do not merit monitoring, puts him at odds with the leading physicians in the field of androgen replacement therapy. One can, of course, choose to accept his arguments, but in doing so it would seem a great risk is being entertained.

 

[ratbag]

Thanks Coastwatcher, that link doesn't work. I don't agree either with his ignoring estradiol or his views on AI's but he's not the first person to discuss polycemia vs erythrocytosis. I myself was sent for blood donations because my HCT was too high but what we didn't see was my platelets were low and my clotting is very low as a result. I've donated blood a few times and my HCT goes right back up there like before except now my iron is too low and this makes me hypothyroid. So I believe most TRT users think that high HCT infers that they have polycemia with high platelets.

 

[CoastWatcher]

Thanks Coastwatcher, that link doesn't work. I don't agree either with his ignoring estradiol or his views on AI's but he's not the first person to discuss polycemia vs erythrocytosis. I myself was sent for blood donations because my HCT was too high but what we didn't see was my platelets were low and my clotting is very low as a result. I've donated blood a few times and my HCT goes right back up there like before except now my iron is too low and this makes me hypothyroid. So I believe most TRT users think that high HCT infers that they have polycemia with high platelets.

I understand your position, and was, perhaps, guilty of seeing his name and criticizing him for something other than what you were drawing attention to. I do understand the distinction you make - and you have to deal with in terms of your health - but feel Dr. Rouzier can cause a lot of men untold medical grief. I hope your situation is well monitored.

 

[PAUL-E]

I agree with nelson not coming off and adding the fish oil but I would bump it up to 3000-4000mg every day. I take 4000MG every day

https://www.youtube.com/watch?v=WjdbvAXw4Xw

 

[buggies100]

Thanks Ratbag for the article and Coastwatcher for your comments as well. I saw my new trt dr today. It is a men's health clinic in northern Virginia staffd by two urologists who specialize in mens issues. He basically said the same thing, although was not comfortable with hct being over 60. Especially combined with the fact sine it has been that high i quickly gwr shoet of breath, which is something new. I tyipcally run 55 give or take and have no issue with shortness of breath. My platletts, wbc, and rdw are all great.
So since i am so high, he wants me to see a hematolgist to make sure there is no underlying cause for high rbc. My rbc has bee just above normal for years, way before startint TRT. Fair enough. His advice was to stay off T until we can get some labs back for the hematologist to look at. I can suffer thru the low t sruff for a few weeks. If there are no underlying problems the hemotologist will write up a phlebotomy schedule and program and we will proceed to adjust until it fits.
At least I have a direction

 

[ratbag]

That video is somewhat misleading because he states that people who train or live in high altitude create more red blood cells and it's useful for training and aerobic status. But what he didn't say is that is the definition of erythrocytosis. Where as polycemia is about too many platelets and the blood gets thick and clots too easily. I've learned that donating blood doesn't really solve the problem because your HCT goes right back to where it was very quickly. Unless of course you lower the amount of testosterone you take.

I now look at my platelets and I don't concern myself with my HCT being too high. My platelets are low and my blood is thin so my MD says I'm fine and not to worry over it. BTW. my HCT is 53. I have no shortness of breath and I feel well. However what Dr. Rouzier states is consistent with my health. His claim is that TRT causes erythrocytosis and NOT polycemia and this poses no problem for TRT users. You have polycemia when your platelets count is too high. Rouzier simply claims that TRT does not induce polycemia (too many platelets). TRT only causes erythrocytosis. In my case this is true.

I sense that most TRT users believe that high HCT means that your blood is too thick and that it is polycemia and therefore you must donate blood to fix it.