Must I donate blood while on TRT?

[madman]

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!

Most experience what we call the HONEYMOON period when first starting trt.

You are only one month in and I would be more concerned with where that dose of T (200mg/week) is going to have your TT/FT/e2 levels let alone what impact it will have on your RBCs/hemoglobin/hematocrit levels.

You were started on a very high dose which many may never need to achieve a healthy TT/FT level which will result in relief/improvement of low-t symptoms and overall well-being.

You may feel great now but when first starting trt hormones are in FLUX leading up until blood levels stabilize (6 weeks) and keep in mind that hpta is not fully shut down as it can take 2-6 weeks depending on the weekly dose of exogenous esterified T you are injecting.

When starting trt hematocrit/hemoglobin will usually increase during the first month and can take 9-12 months to reach peak levels.

Increasing doses of testosterone will also elevate HCT/hemoglobin further and even then some have issues using low doses of testosterone.

Depending on how you react to the said dose of testosterone (200mg/week) and what impact it has on driving up your RBCs/hemoglobin/hematocrit remains to be seen as you need to wait for your blood levels to stabilize (6 weeks) before blood work is done.

Even then if blood markers get pushed too high and you decide that donating blood is needed to bring it down you need to proceed with caution because although it is common for men to donate many end up making the mistake of donating too often (every 2-3 months) which is a sure-fire way to end up crashing your ferritin/iron which can be detrimental.

Healthy ferritin levels are critical regardless of serum iron.

Many can end up having IDA (iron deficiency without anemia) let alone it can negatively impact optimal thyroid function.

Iron Deficiency Without Anemia – Common, Important, Neglected

Iron Deficiency Without Anemia – Common, Important, Neglected (2019) Esa Soppi* Department of internal medicine, Eira Hospital, Laivurinkatu 29, FI-00150 Helsinki, Finland Abstract A serum ferritin concentration of

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"The development of iron deficiency anemia is a gradual process. If your body is not taking in enough iron, your body first uses the iron that is stored in tissues (i.e., ferritin) and blood levels of ferritin will begin to decrease. If not corrected, the stored iron begins to be depleted as it is used in the production of red blood cells. In the early stages of iron-deficiency, blood levels of iron can be normal while stored iron, and therefore ferritin levels, will begin to decrease.

 

[Gman86]

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.

So you’re not worried about the low ferritin? Isn’t serum iron just a measure of the iron in ur diet recently? Doesn’t it fluctuate depending on what u’ve recently eaten? I don’t see that being a good indicator of overall iron status.

 

[M.J]

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.
View attachment 9877




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.

Thanks madman for this detailed respond

 

[chrisczan]

I don’t donate because I’m an athlete and donating kills my performance for weeks. I just take 2g of IP6 at night and have never had HCT over 48. See Dante Trudel’s IG for details.

 

[Bryan_K77]

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

Unless you need above 200 mg to achieve symptom resolution, which admittedly will be a fairly small portion of people on trt. My dad needed 350 mg weekly to get 900 ng/dl and high 20’s free. Thank god he had a urologist well versed in trt and wasn’t afraid to give a higher dose

 

[Vince]

Unless you need above 200 mg to achieve symptom resolution, which admittedly will be a fairly small portion of people on trt. My dad needed 350 mg weekly to get 900 ng/dl and high 20’s free. Thank god he had a urologist well versed in trt and wasn’t afraid to give a higher dose

What's his protocol now?

 

[Bryan_K77]

He’s been on 350 mg for almost 3 years now. My dad was involved in competitive powerlifting for a couple decades, along with that was some heavy aas use. I’m not sure if prior aas abuse would require a higher trt dose, I highly doubt from a lab value standpoint, but maybe from a symptom resolution/mental standpoint.

 

[LEECHIPTURNER]

I have been on topical Testosterone (T) for 35 years. I have dealt with high HCT using blood donation about 2-4 times a year. My doctor switched me to injections, 40mg every 3 days. My HCT shot up quickly. So going back to topical. The problem is my ferritin is 13 and TIBC is 475. Exhausted pretty much all the time. So my original topical was 60mg/day; which is 420mg/week. My injection was 80mg/week. Shouldn't I just do 30mg every other day of topical? I've got to keep some level of T without doing blood donations and wrecking my iron/ferritin. Thoughts?

 

[Vince]

I don’t donate because I’m an athlete and donating kills my performance for weeks. I just take 2g of IP6 at night and have never had HCT over 48. See Dante Trudel’s IG for details.

My experiment with IP6 (Iron chelator)

My serum iron was a bit elevated during my last bloodwork and I dediced to try some IP6 (1000mg a day on VERY empty stomach with a full glass of water). After a little over 1 month my serum iron dropped by half. If I still had high HCT issues I would definitely try IP6. As an iron chelator in...

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[LEECHIPTURNER]

My experiment with IP6 (Iron chelator)

My serum iron was a bit elevated during my last bloodwork and I dediced to try some IP6 (1000mg a day on VERY empty stomach with a full glass of water). After a little over 1 month my serum iron dropped by half. If I still had high HCT issues I would definitely try IP6. As an iron chelator in...

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Thanks, Vince. I have iron anemia. But, my hematocrit is high. So I need to destroy RBCs, not get rid of iron. Does the IP6 nuke RBCs?

 

[Bryan_K77]

I have been on topical Testosterone (T) for 35 years. I have dealt with high HCT using blood donation about 2-4 times a year. My doctor switched me to injections, 40mg every 3 days. My HCT shot up quickly. So going back to topical. The problem is my ferritin is 13 and TIBC is 475. Exhausted pretty much all the time. So my original topical was 60mg/day; which is 420mg/week. My injection was 80mg/week. Shouldn't I just do 30mg every other day of topical? I've got to keep some level of T without doing blood donations and wrecking my iron/ferritin. Thoughts?

You can’t accurately try to convert dosages from topical to injectable a and vice versa, more variables with transdermals. One person might absorb 70% of the topical T and someone else might only absorb 10% and that can change over time. Either way, the topical MUST be used at least once per day if it’s your primary therapy and most use it twice daily to achieve steady state levels.

 

[madman]

You can’t accurately try to convert dosages from topical to injectable a and vice versa, more variables with transdermals. One person might absorb 70% of the topical T and someone else might only absorb 10% and that can change over time. Either way, the topical MUST be used at least once per day if it’s your primary therapy and most use it twice daily to achieve steady state levels.

The absorption would be around 9-13% at best with the transdermal (standard application) method.

The only way you would be getting much higher absorption is with the scrotal application.

 

[Bryan_K77]

The absorption would be around 9-13% at best with the transdermal (standard application) method.

The only way you would be getting much higher absorption is with the scrotal application.

True, I was referring to scrotal application. I understand some don’t apply to the scrotum to achieve lower dht levels

 

[DDawg]

Tha is for all of the I for gentlemen, especially the scientific docs presented above.
ive been in T therapy for about 8 months and wasn’t really feeling any better after the first few injecrions (i felt really good initially! Even my coworkers mentioned I had a upbeat appearance and flow about me, even other dudes noticed!) Got my blood levels tested and doc said my HCT was high. I usually run dehydrated all the time any way so I tried drinking more water, taking baby aspirin (I should have been doing that over 40 any way right?) Finally tried my first blood donation! OMG! I feel fricken FANTASTIC! I instantly felt lighter, more energy and relieved! I can’t wait to donate again! Anybody else feel this good after donation and lowering HCT levels?!?! I should have done this three months ago!

 

[M.J]

I can’t understand how would any one donate blood for me at least, I lose ferritin very quickly even one time every 3 or 6 month is enough to take Ferrite very down.

 

[Gman86]

I can’t understand how would any one donate blood for me at least, I lose ferritin very quickly even one time every 3 or 6 month is enough to take Ferrite very down.

Where was ur ferritin before donating?

 

[Gman86]

Tha is for all of the I for gentlemen, especially the scientific docs presented above.
ive been in T therapy for about 8 months and wasn’t really feeling any better after the first few injecrions (i felt really good initially! Even my coworkers mentioned I had a upbeat appearance and flow about me, even other dudes noticed!) Got my blood levels tested and doc said my HCT was high. I usually run dehydrated all the time any way so I tried drinking more water, taking baby aspirin (I should have been doing that over 40 any way right?) Finally tried my first blood donation! OMG! I feel fricken FANTASTIC! I instantly felt lighter, more energy and relieved! I can’t wait to donate again! Anybody else feel this good after donation and lowering HCT levels?!?! I should have done this three months ago!

What was ur HCT before donating?

Did u just do the regular donation or power red where they take I think double the amount of blood?

 

[FDV70]

I can’t understand how would any one donate blood for me at least, I lose ferritin very quickly even one time every 3 or 6 month is enough to take Ferrite very down.

you need to proceed with caution because although it is common for men to donate many end up making the mistake of donating too often (every 2-3 months) which is a sure-fire way to end up crashing your ferritin/iron which can be detrimental.

I wanted to let everyone know that this problem has literally been solved now (ferritin can be recovered in a few days, brough to pre-donation level). I posted the answer in another forum here; here's the link:

Raising ferritin FAST (a how-to, not a question)

Hi all, I started TRT in 2001 and have been giving blood over the years and have always had issues with recovering my ferritin. Long story short, I got tired of waiting for others to do the research, so I did it myself, created a protocol, hired a hematologist in May 2021 who thought it could...

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