Is high HCT inevitable on twice a week protocol?

[Arcane]

on Twice a week my HCT is 47, not out of range but creeping upward. I fear that it may hit 51+ eventually, although maybe it wont, just want to be prepared.

I was taking 50 mg every 3.5 days of Test cyp but recently changed my protocol to 25mg EOD to get a bit of stability.

Is there anyone here who injects twice a week and doesnt have high hematocrit? To the point of needed to donate blood or get a therapeutic phlebotomy?

 

[antelopers]

I've never had high hematocrit no matter what dose I was taking for TRT purposes. I think its dependent on genetics and hydration. I have a home blood monitor and my hematocrit can drastically change depending on time of day, hydration levels, etc.

 

[madman]

on Twice a week my HCT is 47, not out of range but creeping upward. I fear that it may hit 51+ eventually, although maybe it wont, just want to be prepared.

I was taking 50 mg every 3.5 days of Test cyp but recently changed my protocol to 25mg EOD to get a bit of stability.

Is there anyone here who injects twice a week and doesnt have high hematocrit? To the point of needed to donate blood or get a therapeutic phlebotomy?

I have been injecting twice-weekly (every 3.5 days) for years and run higher-end TT/FT levels although hematocrit has been driven up from pre-trt levels it is still within range (47 nmol/L).

The only time I ever had to donate was when my TT/FT levels were much higher (unintentionally) which put my RBCs/hemoglobin/hematocrit over the top end.

Lowering my overall weekly dose of T which brought my TT/FT levels back down around the top end keeps my levels to where I don't need to rely on the donating merry go round to maintain it.

Some men tend to be lucky and can run higher TT/FT levels without any issues and others may notice levels stabilize over time and then there are the ones who will always struggle.

The most effective way to avoid running into any potential issues with elevated RBCs/hemoglobin/hematocrit is to find the lowest TT/FT level you can run which allows you to maintain the beneficial effects of testosterone while at the same time minimizing/avoiding any potential side-effects.

Easier said than done as many tend to be dead set on running too high a TT/FT level and continue to go on donating to try and maintain it or just let it run higher as they see no issue with doing such!

 

[Arcane]

I have been injecting twice-weekly (every 3.5 days) for years and run higher-end TT/FT levels although hematocrit has been driven up from pre-trt levels it is still within range (47 nmol/L).

The only time I ever had to donate was when my TT/FT levels were much higher (unintentionally) which put my RBCs/hemoglobin/hematocrit over the top end.

Lowering my overall weekly dose of T which brought my TT/FT levels back down around the top end keeps my levels to where I don't need to rely on the donating merry go round to maintain it.

Some men tend to be lucky and can run higher TT/FT levels without any issues and others may notice levels stabilize over time and then there are the ones who will always struggle.

The most effective way to avoid running into any potential issues with elevated RBCs/hemoglobin/hematocrit is to find the lowest TT/FT level you can run which allows you to maintain the beneficial effects of testosterone while at the same time minimizing/avoiding any potential side-effects.

Easier said than done as many tend to be dead set on running too high a TT/FT level and continue to go on donating to try and maintain it or just let it run higher as they see no issue with doing such!

My problem is to get higher end free t, my total t enters supra-physiological ranges due to my high shbg

 

[madman]

My problem is to get higher end free t, my total t enters supra-physiological ranges due to my high shbg

Even with higher SHBG, one can still achieve a healthy FT without driving their TT too high, and even then your SHBG 45 nmol/L is far from being very high.

Top it off with the fact that you have absolutely no idea where your FT level truly sits as you never had it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best).

 

[Vince]

on Twice a week my HCT is 47, not out of range but creeping upward. I fear that it may hit 51+ eventually, although maybe it wont, just want to be prepared.

I was taking 50 mg every 3.5 days of Test cyp but recently changed my protocol to 25mg EOD to get a bit of stability.

Is there anyone here who injects twice a week and doesnt have high hematocrit? To the point of needed to donate blood or get a therapeutic phlebotomy?

My my first question would be, how long have you been on trt.? If it's been a year and your hct is only 47, there's no reason for concern.

 

[Arcane]

Even with higher SHBG, one can still achieve a healthy FT without driving their TT too high, and even then your SHBG 45 nmol/L is far from being very high.

Top it off with the fact that you have absolutely no idea where your FT level truly sits as you never had it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best).

I just purchased the equilibrium dialysis, will be using it from now on. Based on my previous results, what would you guess my free T actually sits at? higher or lower than what my last blood test determined

My my first question would be, how long have you been on trt.? If it's been a year and your hct is only 47, there's no reason for concern.

4 months. My hct was 44 before trt

 

[madman]

I just purchased the equilibrium dialysis, will be using it from now on. Based on my previous results, what would you guess my free T actually sits at? higher or lower than what my last blood test determined


4 months. My hct was 44 before trt

As Vince stated there should be no issues with having hematocrit 47 nmol/L let alone I would not be concerned if it were in the low 50s unless one was experiencing symptoms.

Most doctors in the know would not recommend donating unless one was experiencing negative symptoms or HCT >54 nmol/L.



3.7.6 Erythrocytosis

Elevated hematocrit is the most common side effect of testosterone therapy. Stimulation of erythropoiesis is a normal biological action, which enhances the delivery of oxygen to testosterone sensitive tissues (e.g. striated, smooth, and cardiac muscle). Any elevation above the normal range for hematocrit usually becomes evident between three and twelve months after testosterone therapy initiation. However, polycythemia can also occur after any subsequent increase in testosterone dose, switching mode of formulation from topical to parenteral administration, and if there is the development of comorbidity, which can be linked to an increase in hematocrit (e.g. respiratory or hematological diseases).

There is no evidence that an increase of hematocrit up to and including 54% causes any adverse effects on health. If the hematocrit exceeds 54% there is testosterone independence, but a weakly associated rise in CV events and mortality [72, 153-155]. Any relationship is complex as these studies were based on subjects with any cause of secondary polycythemia, which included smoking and respiratory diseases. There have been no specific studies including men with only testosterone-induced erythrocytosis.

Three large studies have not shown any evidence that testosterone therapy is associated with an increased risk of venous thromboembolism [156, 157]. However, one study showed that increased risk was observed peaking at six months after initiation of testosterone therapy, then declining over the subsequent period [158]. No study reported whether or not there was a monitoring of the hematocrit, testosterone, and/or E2 levels. High endogenous testosterone or E2 levels have not been associated with a greater risk of venous thromboembolism [159]. In one study venous thromboembolism was reported in 42 cases and 40 of these had a diagnosis of an underlying disorder of thrombophilia (including Factor V Leiden deficiency, prothrombin mutations, homocystinuria) [160]. In an RCT of testosterone therapy in men with chronic stable angina, there were no adverse effects on coagulation, by assessment of tissue plasminogen activator or plasminogen activator inhibitor-1 enzyme activity or fibrinogen levels [161]. A meta-analysis of RCTs of testosterone therapy reported that cases of venous thromboembolism were frequently related to underlying undiagnosed thrombophilia-hypofibrinolysis disorders [71].

With testosterone therapy, an elevated hematocrit is more likely to occur if the baseline level is toward the upper limit of normal prior to initiation of therapy. Added risks for a raised hematocrit on testosterone therapy include factors, such as smoking or respiratory conditions at baseline. Higher hematocrit values are more common on parenteral rather than topical formulations. In men with pre-existing CVD extra caution is advised with a definitive diagnosis of hypogonadism before initiating testosterone therapy and monitoring of testosterone as well as the hematocrit over treatment.

*An elevated hematocrit in the absence of any co-morbidities or acute cardiovascular or venous thromboembolism can be managed by a reduction in testosterone dose, change in formulation, or if the elevated hematocrit is very high by venesection (500 mL) and repeated if necessary, with usually no need to stop the testosterone therapy.




Regarding your FT and comparing blood work it should only be done when using the same lab, same assay (most accurate).

Testing your FT using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration is the only way to know where your FT level truly sits.

With a TT 1300 ng/dl and SHBG 45 nmol/L your FT will most likely be high.