Must I donate blood while on TRT?

[JRoop]

Hello! I'm on my first month of TRT and loving it! My doctor suggested I donate blood about 3 months in, but that may not be an option. I had hep several years ago and have been cured, but I'm sure I still have the antibodies. My question is what can I do to help with hematocrit since I may not be able to donate regularly? Any feedback anyone can provide will be greatly appreciated! Thank you!

 

[chris@]

I donate and it helps keep my Hematocrit down. I’m on 150mg coumpound cream. If you cant donate then get your doc to write you a phlebotomy prescription and they will essentially take it and dispose of it. You will probably have to pay a fee. Locally I’ve heard it’s around $90 here in NorCal.

 

[Vince]

Keep your dose of testosterone low. Higher levels of T contribute to higher levels of HCT.

 

[JRoop]

I donate and it helps keep my Hematocrit down. I’m on 150mg coumpound cream. If you cant donate then get your doc to write you a phlebotomy prescription and they will essentially take it and dispose of it. You will probably have to pay a fee. Locally I’ve heard it’s around $90 here in NorCal.

Oh that's really helpful! Thank you!

 

[JRoop]

Keep your dose of testosterone low. Higher levels of T contribute to higher levels of HCT.

I'm on 200mg now. I'll definitely keep an eye on it. Thank you! Also, I've noticed you provide a lot of valuable insight on this board. I always appreciate your comments.

 

[Vince]

I'm on 200mg now. I'll definitely keep an eye on it. Thank you! Also, I've noticed you provide a lot of valuable insight on this board. I always appreciate your comments.

I would consider cutting your dose in half. There’s really no reason to inject 200 mg of testosterone weekly.

 

[Henry]

You shouldn't have to donate blood while on TRT. Think about it, young men in their 20's, at the highest levels of TRT in their lives, don't have to donate blood. If your HGB and HCT are climbing, then you need to lower your dose. I've been on TRT for over 6 years and never had to donate. My HCT and HGB has been rock solid and hasn't changed since I got on.

 

[chris@]

You shouldn't have to donate blood while on TRT. Think about it, young men in their 20's, at the highest levels of TRT in their lives, don't have to donate blood. If your HGB and HCT are climbing, then you need to lower your dose. I've been on TRT for over 6 years and never had to donate. My HCT and HGB has been rock solid and hasn't changed since I got on.

I agree but in my case alcohol consumption (and diet) as a moderate drinker I think has a significant impact on Hematocrit and also estrogen. The only time I’ve had bad bloods is when I was hitting the wine a little more than I should. Before you say it, I know.... “don’t drink alcohol while on TRT”. Hydration has also played a big part in my hematocrit results. Im not talking about drinking a couple glasses of water the day before your blood draws. I mean sustained hydration and paying attention to your water intake. I typically, until this year, fly approx 150K miles for business a year. I can get really dehydrated if not very careful. This has been reflected in my blood work at times.

 

[Henry]

I agree but in my case alcohol consumption (and diet) as a moderate drinker I think has a significant impact on Hematocrit and also estrogen. The only time I’ve had bad bloods is when I was hitting the wine a little more than I should. Before you say it, I know.... “don’t drink alcohol while on TRT”. Hydration has also played a big part in my hematocrit results. Im not talking about drinking a couple glasses of water the day before your blood draws. I mean sustained hydration and paying attention to your water intake. I typically, until this year, fly approx 150K miles for business a year. I can get really dehydrated if not very careful. This has been reflected in my blood work at times.

This is great that you know the contributors so now, you can fix those and hopefully, it can resolve the HCT, HGB and E2 issues.

 

[M.J]

I donate and it helps keep my Hematocrit down. I’m on 150mg coumpound cream. If you cant donate then get your doc to write you a phlebotomy prescription and they will essentially take it and dispose of it. You will probably have to pay a fee. Locally I’ve heard it’s around $90 here in NorCal.

I was under the impression that cream won’t increase HCT. your saying it does ?

 

[TestOneTwo]

I'm on 200mg now. I'll definitely keep an eye on it. Thank you! Also, I've noticed you provide a lot of valuable insight on this board. I always appreciate your comments.

That’s a mighty dose. Is that weekly? Bi-weekly? A bad protocol can raise HCT. Also surprised you’re already feeling great. Typically it needs at the very least about 6 weeks to start feeling something and more like 12 to actually be able to judge the protocol by how you feel and by your bloodwork. If you only go after how you feel, well someone on 500mg will also confirm they feel awesome but bloodwork may indicate that this level can’t be sustained for long without running into serious issues.

 

[chris@]

I was under the impression that cream won’t increase HCT. your saying it does ?

I can only speak for myself but my Hemocrit was at 56.5 and now 46.2 after 30 days of grapefruit seed extract, sustained hydration, and donating a pint of blood. Please remember everyone’s physiology is different. How you apply TRT, alcohol intake, hydration and even weightlifting can contribute to high HCT. I feel great and am Taking better care of myself.

note: previous to this high HCT experience I have not had a problem with HCT. Scrotal application was the only thing I changed in regards to application. I was putting it on my shoulders. The result was over double the total and bio available. But it came with high HCT and Estradiol. This is why folks here say it takes a long time to get dialed in and I agree. I’ve reduced my scrotal amount to half of what I was using and going under my arms for the remainder of the dose. I’ll update when I get my next result in a few months.

 

[M.J]

I can only speak for myself but my Hemocrit was at 56.5 and now 46.2 after 30 days of grapefruit seed extract, sustained hydration, and donating a pint of blood. Please remember everyone’s physiology is different. How you apply TRT, alcohol intake, hydration and even weightlifting can contribute to high HCT. I feel great and am Taking better care of myself.

note: previous to this high HCT experience I have not had a problem with HCT. Scrotal application was the only thing I changed in regards to application. I was putting it on my shoulders. The result was over double the total and bio available. But it came with high HCT and Estradiol. This is why folks here say it takes a long time to get dialed in and I agree. I’ve reduced my scrotal amount to half of what I was using and going under my arms for the remainder of the dose. I’ll update when I get my next result in a few months.

how is libido ? That’s the main issue, I want to try the cream just to see if libido get higher.

 

[chris@]

I haven’t ever had any libido or ED issues. Early 50’s and still wake up with wood most
mornings. It’s all mental for me as the physiology of my libido is in order. I will tell you that with (cream) scrotal application you can bounce your numbers really high and for some including me that can cause varying degrees of anxiety. Anxiety is a major distraction from life including sex life so your mileage may vary....

 

[M.J]

I haven’t ever had any libido or ED issues. Early 50’s and still wake up with wood most
mornings. It’s all mental for me as the physiology of my libido is in order. I will tell you that with (cream) scrotal application you can bounce your numbers really high and for some including me that can cause varying degrees of anxiety. Anxiety is a major distraction from life including sex life so your mileage may vary....

Thanks for the info, where do you apply your cream ? Is it one time or two ?

unfortunately for me we don’t have cream anymore in the market I have to get that from outside somehow.

 

[Wilson7]

Erythrocytosis is a function of dosing, route of administration, age and genetics. I've been on HRT since I was in my early 30's, now 62. I didn't have issues with high HCT until I was in my late 40's. Switched to a gel that was both expensive and ineffective, after two years my HCT still went up. I feel better on higher dosing and sc TC. Elevated HCT goes with the territory, I get therapeutic phlebos every 10 - 12 weeks or when my HCT > 52%. If at some point you add nandrolone to the mix, it will drive it even faster. For many guys cutting the dose to get around the HCT elevation gets you to a point where the HCT and not how you feel is dictating dosing, makes no sense. How you feel dictates dosing, address the HCT with phlebos. Get an H/H test done every 3 months or so. If you get to HCT >52%, donate or get a phlebo. Figure out how long it takes for you to get back to 52% and then you'll know the frequency for donations. Lastly, we don't really know what risk elevated HCT plays when it is a function of HRT. Guys that live at altitude and are on HRT have HCT close to 60% and do just fine. The association with negative health events (stroke and DVT) are likely multifactorial. If you are already at risk for a clot, adding in HRT may or may not raise that risk. We need more data, HRT erythrocytosis is not polycythemia vera, hypoxia driven (COPD), etc. Different mechanisms and likely different outcomes.

 

[Gman86]

Erythrocytosis is a function of dosing, route of administration, age and genetics. I've been on HRT since I was in my early 30's, now 62. I didn't have issues with high HCT until I was in my late 40's. Switched to a gel that was both expensive and ineffective, after two years my HCT still went up. I feel better on higher dosing and sc TC. Elevated HCT goes with the territory, I get therapeutic phlebos every 10 - 12 weeks or when my HCT > 52%. If at some point you add nandrolone to the mix, it will drive it even faster. For many guys cutting the dose to get around the HCT elevation gets you to a point where the HCT and not how you feel is dictating dosing, makes no sense. How you feel dictates dosing, address the HCT with phlebos. Get an H/H test done every 3 months or so. If you get to HCT >52%, donate or get a phlebo. Figure out how long it takes for you to get back to 52% and then you'll know the frequency for donations. Lastly, we don't really know what risk elevated HCT plays when it is a function of HRT. Guys that live at altitude and are on HRT have HCT close to 60% and do just fine. The association with negative health events (stroke and DVT) are likely multifactorial. If you are already at risk for a clot, adding in HRT may or may not raise that risk. We need more data, HRT erythrocytosis is not polycythemia vera, hypoxia driven (COPD), etc. Different mechanisms and likely different outcomes.

Awesome explanation. Just curious, do u check ur ferritin levels at all? I would imagine that getting phlebotomized that often would tank ur iron stores. And imo, as long as platelets aren’t elevated, which are what we can measure to check our clotting risk, I personally don’t think HCT should be as feared as it is. My platelets are always on the low end of the range, so I personally don’t worry about HCT until it gets around 55. But if a guy has a moderate to high platelet count, I may err more on the side of caution. But I always see people talk about HCT when they’re talking about clotting risks, but it’s really platelets that are the main factor when it comes to clotting. Obv we have to take multiple labs and factors into consideration tho like u said.

 

[Wilson7]

I check ferritin about twice a year, always low end of normal. I go back and forth with my hematologist about ferritin. Yes it is the indicator of iron stores but my blood iron is usually at the higher end, everything else is fine. Platelets always the low end of normal, I take an aspirin EOD, celebrex daily for my joints. In COPD, hypoxia induced erythrocytosis, obesity and not HCT 43.6% vs 53.5% is the driver for DVT.

 

[chris@]

Thanks for the info, where do you apply your cream ? Is it one time or two ?

unfortunately for me we don’t have cream anymore in the market I have to get that from outside somehow.

I apply ~35mg to the scrotum and ~115mg under my arm once a day in the morning. The evening application doesn’t work for me. I have always had a hard time sleeping and the evening dose is brutal on ability to get restful sleep. I’ve tried and it’s a no go.

 

[madman]

I was under the impression that cream won’t increase HCT. your saying it does ?

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.

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).

Does hematocrit keep increasing after testosterone steady state? How often to check?

Hello guys, I’ve been on TRT for about 4 months and I just recently got my blood lab results. Everything looks good, but I did noticed my hemoglobin and hematocrit did increase to 15 and 45 respectively. Are they going to keep increasing? My doctor wants to check me at 6 month intervals now and...

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Erythrocytosis Following Testosterone Therapy


Proposed direct and indirect effects of T on erythropoiesis.

Effects of T formulation

Of the available T formulations, short-acting IM injections (TC and TE) have the highest incidence of erythrocytosis (approaching 40%).14 Recent studies support a unified hypothesis in which T formulation, dose, and pharmacokinetics collectively determine the risk of erythrocytosis by establishing the duration of supraphysiologic T levels.52 T formulations that result in stable serum concentrations (pellets, transdermal gels and patches, and extended-release IM TU) result in a low incidence of erythrocytosis that is dependent on dose and serum level and independent of duration of therapy.11, 52, 67 The relation of individual T formulations and associated effects on average T levels and incidence of erythrocytosis are presented in Table 1.



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 dependent 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.




Conclusions

Erythrocytosis is often a limiting variable in patients on TTh. Direct and indirect effects related to supraphysiologic T levels are believed to mediate the effects on erythrocytosis. The true mechanism of erythrocytosis and its role in thromboembolic events remain unclear, although some data support an increased risk of CV events resulting from T-induced erythrocytosis. Large multicenter randomized controlled trials are required to study TTh, its effects on Hb and Hct, and the clinical significance of treatment-induced increases in red blood cell mass.