Is TRT dangerous?

[RumHam]

Just met with a local highly regarded endocrinologist because I wanted his take on my TRT situation. Been on TRT for 6 months and have had elevated hematocrit (54-55%) and hemoglobin (18’s) the whole time. He said what I’m doing (TRT) is dangerous and I’m at higher risk for heart attack and stoke.

It seems most medical professionals outside of TRT clinics will tell you the same thing (TRT = bad). But of course everyone within TRT clinics and communities like this say it’s safe. Not sure who to believe.

Can I safely be on TRT long term, with elevated hemoglobin and hematocrit? Nobody really knows, do they?

 

[Systemlord]

Been on TRT for 6 months and have had elevated hematocrit (54-55%) and hemoglobin (18’s) the whole time. He said what I’m doing (TRT) is dangerous and I’m at higher risk for heart attack and stoke.

In regards to your doctor's statement, the data tells a different story. The data shows the untreated group has a increase in all cause mortality and the treated group have better health outcomes.

 

[Cataceous]

The caveat on the safety of TRT is that blood work should be "ok". Although it's not settled science, there are legitimate concerns about the long-term elevation of hemoglobin/hematocrit. There are various threads here on the subject, e.g. this one. In October you mentioned you'd dropped to 160 mg per week, presumably testosterone cypionate. At an average of 16 mg testosterone per day, that's still well above the natural production range of 3-9 mg. You could cut your dose in half and still be getting more testosterone than the average healthy young man makes naturally. In short, you could probably make this issue go away if you were willing to revert to physiological dosing. Unfortunately, while dose increases feel good, dose decreases often feel bad for a fair bit of time. But it's likely to be worth it for your health in the long run.

 

[madman]

Just met with a local highly regarded endocrinologist because I wanted his take on my TRT situation. Been on TRT for 6 months and have had elevated hematocrit (54-55%) and hemoglobin (18’s) the whole time. He said what I’m doing (TRT) is dangerous and I’m at higher risk for heart attack and stoke.

It seems most medical professionals outside of TRT clinics will tell you the same thing (TRT = bad). But of course everyone within TRT clinics and communities like this say it’s safe. Not sure who to believe.

Can I safely be on TRT long term, with elevated hemoglobin and hematocrit? Nobody really knows, do they?

Regarding those struggling with high hematocrit here is my reply from another thread:

When using exogenous T RBCs/hemoglobin/hematocrit will increase within the 1st month and can take up to 9-12 months to reach peak levels.

T formulation, the dose of T, genetics (polymorphism of the AR), age all play a role in the impact a trt protocol will have on blood markers (RBCs/hemoglobin/hematocrit).

Other factors such as sleep apnea, smoking can have a negative impact on hematocrit.

Injectable T has been shown to have a greater impact on increasing HCT compared to transdermal T.

3–18% with transdermal administration and up to 44% with injection.

In most cases when using injectable T high supra-physiological peaks post-injection and overall T levels (running too high TT/FT level) will have a big impact on increasing HCT.

Manipulating injection frequency by injecting more frequently using lower doses of T resulting in minimizing the peak--->trough and maintaining more stable levels may lessen the impact on HCT but it is not a given.

As again running very high TT/FT levels will have a stronger impact on driving up HCT.

Although injectables have been shown to have a greater impact on HCT you can see even when using a transdermal formulation that maintains stable serum concentrations that the impact it has on HCT is DEPENDANT ON THE DOSE AND SERUM LEVEL OF T.

Using higher doses of transdermal T and achieving higher TT/FT levels will have a great impact on HCT levels.

How high an FT level you are running is critical.

It is a given that most men on trt struggling with elevated RBCs/hemoglobin/hematocrit are running too high an FT level.

Sure some men are more sensitive than others as they may still struggle with elevated blood markers when running lower T levels but it is far from common and many may already have an underlying health issue contributing to such.

If you are struggling with such blood markers then in most cases finding the lowest FT level you can run while still maintaining the beneficial effects may very well be the solution.

Easier said than done as many men on trt tend to do better running higher-end FT levels within reason.

Mind you some are lucky and never have an issue or levels tend to stabilize over time.

Others will continue to struggle until the cows come home.

Unfortunately too many are caught up in running absurdly high trough FT levels due to the herd mentality spewed on the bro forums and gootube!



post #6

TRT Accelerates Artery Plaque Buildup

I read this article today that is concerning. https://www.cardiosmart.org/news/2017/3/testosterone-treatment-accelerates-artery-plaque-buildup

www.excelmale.com

*the clinical significance of a hematocrit >54% is unknown




Hematocrit

*Some authors recommend that TTh be discontinued if hematocrit is >54%, which may be reasonable while baseline hematocrit level >50% is a relative contraindication for starting testosterone therapy. However, these recommendations are based on assumptions – the clinical significance of a hematocrit >54% is unknown