Systemlord
Member
My HCT is 51%, my baseline was 46%, so this idea that oral TRT doesn't increase HCT is false. I have no complaints as far as building muscle in the gym on Jatenzo.
Is it true that an elevated hematocrit level on TRT does not require blood donation?
- Thread starter t_spacemonkey
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- hematocrit
I am living proof if you over donate blood, you WILL tank your ferritin. My PCP caught it, and sent me to a hematologist. After she tried to talk me out of stopping HRT, and I refused, she agree to work with me, to try to figure out how to get some iron back without driving my HCT and HBG thru the roof. It's going to be a long process and take time. I was donating every two months, because I thought, stupidly, that if the Red Cross says its ok, it must be ok...NOT. So, we are trying to donate every three to four months, letting HCT get up to 53-53% and then donate. While not pushing iron, because doing so will in all likely hood, drive HCT up faster. She also suggested, that because my platelets are on the low side, 150K and our lab low normal is 140K, that is helpful for reducing risk, for me. So I am now at 3.5 months and due to donate. I will likely also have to reduce the T dose, which will be ok, as I am pretty high. Total is 1100, free T is twice the normal upper limit, and DHT is well over the limit too. But, for me, it did something I really wanted, it drove libido significantly. (thank you DHT). How do I feel? I feel fine. Have since the beginning, and felt a little better each time we increased the dose of T. But my hormonal doc says, we can gradually reduce if I want to. No pushing me, only my PCP is worried, even the hematologist isn't terrible worried. I have also lost 40 lbs since starting on T a year and a half ago. My lipid profile is greatly improved, as well as A1C. I have a personal goal to lose another 24lbs. My ED is greatly improved as a result of everything else, plus the other meds, and work I have done to help myself. So, I think they all know most of this, and know this kind of improvement in one's total health doesn't happen in a vacuum. They now understand why I would not give up T unless some other good reason popped up. If I can keep from crashing my ferritin, and donate every 3-4 months for the near term, then so be it.
Funny you say that..Cyp seems to wreak havoc on me in many ways compared to other esters...I get PVCs ,Thyroid issues (swelling and low Bp drops/Body temp drops )All thyroid related .. Might be the Cotton seed oil inflammatory response ..Ive used MCT oil with not as many issues ..
Also you have to understand that ferritin drops on TRT cause of erythrocytosis...When u make red blood cells in the mass amount as we tend do it sucks the ferritin dry...Ive experimanted on myself in the lab with constant bloodwork and watched it happen..I crashed ferritin bad ..Regained it fast with optiferrin C...Stuff is amazing for low ferritin..Not a shill ...
I have no idea how Drs order an iron panel and never order a ferritin level...Its so bewildering to me ...I have all my friends and family send me their bloodwork and even when I instruct them to emphasize the doctor to make sure he checks for ferritin its not in the bloodwork .....
Even hematologist who's so-call are experts in the field or should be for anemia have no idea what they're doing...
In any event I see a lot of people suffering with low ferritin that shouldn't have had to suffer because of doctors no idea what they're doing.. I would also love to know how come in iron pan include ferritin from the gate.. Makes zero sense...
I have no experience with jatenzo.. I will tell you this though Andriol was an epic failure cause it past through the liver once and gone ..I think it was long chain fatty acids they bound to the Andriol...
My opinion is double check any oral testosterone out now for C-17 alpha alkylation .... That's the only way I know you can keep test pills in the system longer... The problem is using something like this in a long-term like trt will destroy your liver over time ...
So my question would be find out why this so called new oral test actually works...
just to be clear though having platelets at 140k does nothing to help your thrombotic risk, the players for thrombotic risk are Hgb, Hct , Rbc and to a minor extent WBC, you can ask your haematologist about it if you want, in the world of polycythaemia haems most experts wont treat platelets unless over a million unless other riks or symptoms, so your at 140 or 900 will make virtually no difference to thrombotic risk
Systemlord
Member
This was my issues for years, doctors would order a total iron-binding capacity (TIBC) test or iron, which after eating something with iron will cause these to become elevated. Years earlier doctors missed the 12 and 14% iron saturation and iron at the lower limit.
There's no money in prescribing iron, no patents, no money. Countless times doctors tried to prescribe antidepressants to mask symptoms because western medicine is very poor at root cause/preventive medicine!
They prefer to mask, treat symptoms with drugs ($$$) and never bother to look for the cause, unless you're on the verge of dying. It's not a sustainable business model to cure patient's, or should I say customers.
Systemlord
Member
Jatenzo is FDA approved, clinical trials show it's safe for the liver.
My Experience On Jatenzo (Oral TRT) Log
I wanted to start a thread detailing my personal experience with Jatenzo (oral TRT) which is remarkable in how quickly it has shown results when compared with injections. The first week on Jatenzo was very pleasant unlike my experience after dosing changes on injections, all with minimal swings...
www.excelmale.com
Well I have no faith in the FDA for anything other than corruption...Jatenzo is FDA approved, clinical trials show it's safe for the liver.
My Experience On Jatenzo (Oral TRT) Log
I wanted to start a thread detailing my personal experience with Jatenzo (oral TRT) which is remarkable in how quickly it has shown results when compared with injections. The first week on Jatenzo was very pleasant unlike my experience after dosing changes on injections, all with minimal swings...
Systemlord
Member
Well then there's the clinical trials.
Canadian_ride&dive
New Member
Forget about Hematorcrit. Its a percentage that can change with dehydration. Watch your HEMOGLOBIN levels. If they get too high (above 185) you are at risk of clots. Hematocrit is a useless reading.
Canadian_ride&dive
New Member
If you’re struggling with high hemoglobin (185+) then you need to do 2 things: spread your dose out over 2-3 injections not one, and likely lower your dose for a while (ie 150 down to 100) and monitor for a few months. If it normalizes slowly increase your dose 10mg every month and watch to see where it starts increasing hemoglobin levels. Stop taking iron supplements as that. An increase hemoglobin levels as well. Also get checked for sleep apnea that can also raise baseline hemoglobin
I would value your opinion! Are there any reported case studies of HRT patients, with cardiac events or strokes and high HCB and or HCT? I am not discounting the theory or ideas that exist of the risk, but many of the patients who may have had high HCT or HBG or both, may have had other underlying conditions or health issues that were just as important to consider. Basically, I am asking if this is a theoretical risk, or a real risk? That is not to say it's not important if it's more theoretical at this time. There are good points to be made on both sides, and it could well be, that some physicians are very interested in seeing the ability to prescribe TRT don't want to risk seeing a rise in stroke or heart attack victims, from HRT, even if the risk is just theoretical. I doubt anyone would do a large clinical trial, because it could be considered unethical if it truly puts patients at risk of very serious events in half the study patients. But there should, given all the patients on TRT, be plenty of case reports of bad events happening in TRT patients, IF they are actually seeing them. Has anyone seen any case reports? I can't find them.Most doctors in the know would not recommend donating or lowering your T dose unless your hematocrit hits 52-54%.
Yes, there are some who prefer not letting it get too far past the top-end reference range but again whether one is experiencing any negative sides comes into play.
54% is considered the cut-off!
This sums it up and this is coming from one who would be considered the father of testosterone!
This is f**KING GOLD!
* No need to intervene unless hct>54%
* If >54% would definitely do something
View attachment 39203
Testosterone Replacement and Erythrocytosis
Management of erythrocytosis during TRT
Dear Editor, Testosterone is the primary sex hormone and anabolic steroid in men. It is a widely used drug which is used by males as an anabolic–androgenic steroid but it is also the cornerstone in treatment of both hypogonadal men and transgender people. This letter will focus on the use of...
post #13
Low Testosterone in Men: Recommendations on the diagnosis, treatment and monitoring
Take-home points
*The clinical significance of a hematocrit >54% is unknown
*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%
madman
Super Moderator
Khera sums it up here!
Dr. Khera (41:47-43:02) and Dr. Mulhall (43:02-43:58)
post #41
New Perspectives in the Diagnosis and Management of Hypogonadism
Only at Nelson's domain. Enjoyed this one. Dr. Khera and Dr. Mulhalll, are two giants in the field here!
www.excelmale.com
,,
Am I missing something here? these are not case reports, they are clearly the leading thought leaders, expressing concerns, and I get and don't dismiss that, because the potential adverse events are very serious. But, I didn't see where they can or are pointing to unequivocal data, or even case reports of people who suffered these potential events that fit the concerns, that is, on HRT, with increased hemoglobin and or Hematocrit as the main factors that likely drove a heart attack or stroke. it seems they are warning about the prospects, cautiously so, as medicine often does, but without any evidence that there really is a problem. It may be that it's true, and without knowing for sure, it's a big risk to take. I am surprised if it really is this much concern, that these patients with events haven't been reported to the respective societies, and or the FDA. These are the events that would typically with any meds drive more study, and warnings. having said that, do I want to take the risk? No. Thats why I was giving blood...too much it seems. So now I have backed down the dosing, and am slowly recovering iron levels, while trying not to lower the T dose so much that I lose the benefits. it's difficult to balance.Khera sums it up here!
Dr. Khera (41:47-43:02) and Dr. Mulhall (43:02-43:58)
post #41
New Perspectives in the Diagnosis and Management of Hypogonadism
Only at Nelson's domain. Enjoyed this one. Dr. Khera and Dr. Mulhalll, are two giants in the field here!
,,
The burden of proof must be on those making the claim that it's benign to have blood parameters outside of the normal ranges for long periods of time. Don't expect to see RCTs anytime soon. Would such studies even get past an ethics committee?
Donating? Yes. Donating every two months to keep HCT and hemoglobin in high normal range is not helpful for most. Why not? Because the elevated levels of HCT and hemoglobin being produced by your body, use up iron, and donating takes more ferritin and therefore iron out of your body. You will deplete your iron reserves by donating too much or too often. That's where I am. Now I have to walk a tightrope, lower T dose, slowly replace the iron over time (it took nearly a year of donating every two months to deplete it) so I don't risk spiking the HCT levels even higher. Not a good place to be.
I was hoping there were some known case studies to support the idea that hematocrit or hemoglobin above a certain level, was known or shown to be a problem. I am not saying those against controlling these two parameters are right. I am just surprised given the many patients these days using HRT, with erythrocytosis being perhaps one of, if not the most common side effect at least in older men, that there have not been reported events. I think, it would be smart for everyone to take a step back, and rephrase the question and issue. It's not a KNOWN or PROVEN risk, it is a theoretical risk, but one which could carry SEVERE consequences including death. Having been thru getting adequate treatment for hypothyroidism, and the fact that even many endocrinologists don't want to stray from the therapeutic windows created by lab results of unhealthy people, who simply have not been diagnosed as hypothyroid and therefore called "normal" and still feeling very sluggish, in the middle of that range, I am a little skeptical when the community wants to label a certain number as normal, and a tick or so above, is abnormal. We had to push my T3 levels above the normal range, and then, finally, without hand shaking, no increase in BP, no increase in heart rate, no detectable side effects, then I got relief. There is a word for this in the medical community, and they don't like it when you repeat it, it's called "cookbook" medicine. it basically means just follow a lab test keep patients all the same in the given lab range, and don't question them about how they feel or symptoms. I truly hope this is not what's happening, because that is the same attitude that docs used to claim someone with HRT at 300 was "normal" and should not be treated. Personally, for now at least, I am reducing my dosing to try to bring my HCT down a little over time, and rebuild my iron reserves from over donating simply because the theoretical risk of a severe consequence is concerning to me. Everyone needs to make their own assessment based on their willingness to assume some risk, and their docs willingness to treat.
FunkOdyssey
Seeker of Wisdom
It seems to me men on TRT are dying of cardiovascular events all the time. They would have to be -- there are probably millions of men on TRT, including old men, and old men die of heart disease. The studies that have been done are reassuring in that the mortality rates of men on TRT are not significantly different than men not on TRT, and the men studied would include a large number of men with elevated HCT because that's what TRT often does.
What do you think happens when a guy on TRT with an elevated HCT dies of a heart attack? You think the alarms would be raised and papers would be published in journals in response? I don't think anything happens at all. I'm not sure why you think we would find out about it. It must happen multiple times a day, every single day.
Last edited:
sbstrum_MD
Member
First of all, the hemoglobin and hematocrit are telling you the same thing. So if you call the Hgb normal, then the HCT is normal. Hgb x 3 essentially = hematocrit; or viceversa, HCT/3 ≈ HGB.
Your HCT of 50.4 ≈ Hgb 16.8. I would not consider that normal nor would I consider a HCT of 50% normal. As a board-certified internist and medical oncologist, I would not advise the patient undergo phlebotomy for that level of HCT. First, the patient may be dehydrated and that is causing ↑. It might be a lab gliche that needs retesting. But if the patient. had symptoms of hyperviscosity, then a phlebotomy would be indicated, assuming that exogenous testosterone administration is continued. A normal PLT (platelet) count is 150-250. I would not be concerned about a value of 283. My conclusion: assuming the patient did not have symptoms of hyperviscosity, such as headache, fatigue, blurred vision and/or paresthesias, I would advise the patient to ensure adequate hydration and repeat the CBC in two-four weeks.
-- Stephen B. Strum, MD, FACP
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