My Dilemma

[GreenMachineX]

I would caution anyone against trying to lower their hematocrit, just for labwork. You really want to know what your day to day hematocrit is. If you chug 2 gallons of water everyday, that's fine, but don't change things for the labwork. Being at 52 for a few hours when in reality your at 55 everyday isn't a good thing. Higher hematocrit means higher blood viscosity which means higher risk of adverse events. How high is too high is subject for debate because that's a question of how much risk is too much risk? It's a judgement call. But make your judgement call based on your everyday number, not a manipulated one.

In BigTex's case, his physician is recommending a blood donation because he feels that a hematocrit of 51.9 is too much risk, knowing his history and potential to have very high hematocrit numbers if he changes his behaviour.

Good point about manipulating numbers for a single test.

 

[BigTex]

I would caution anyone against trying to lower their hematocrit, just for labwork. You really want to know what your day to day hematocrit is. If you chug 2 gallons of water everyday, that's fine, but don't change things for the labwork. Being at 52 for a few hours when in reality your at 55 everyday isn't a good thing. Higher hematocrit means higher blood viscosity which means higher risk of adverse events. How high is too high is subject for debate because that's a question of how much risk is too much risk? It's a judgement call. But make your judgement call based on your everyday number, not a manipulated one.

In BigTex's case, his physician is recommending a blood donation because he feels that a hematocrit of 51.9 is too much risk, knowing his history and potential to have very high hematocrit numbers if he changes his behaviour.

Yea, my doctor is aware I had a DVT in my right leg a year ago. Most likely it is from severe venous insufficiency but no way to put a finger on what caused it. I have to take Eliquis twice a day for the rest of my life.

 

[Gman86]

I would caution anyone against trying to lower their hematocrit, just for labwork. You really want to know what your day to day hematocrit is. If you chug 2 gallons of water everyday, that's fine, but don't change things for the labwork. Being at 52 for a few hours when in reality your at 55 everyday isn't a good thing. Higher hematocrit means higher blood viscosity which means higher risk of adverse events. How high is too high is subject for debate because that's a question of how much risk is too much risk? It's a judgement call. But make your judgement call based on your everyday number, not a manipulated one.

In BigTex's case, his physician is recommending a blood donation because he feels that a hematocrit of 51.9 is too much risk, knowing his history and potential to have very high hematocrit numbers if he changes his behaviour.

Exactly. Well said, and I agree completely. I don’t really see a point to altering numbers the day of the test only. Knowing where ur values sit on a day to day basis is obv much more valuable

 

[Gman86]

Yea, my doctor is aware I had a DVT in my right leg a year ago. Most likely it is from severe venous insufficiency but no way to put a finger on what caused it. I have to take Eliquis twice a day for the rest of my life.

Ya so u obv want to be more careful and cautious than the average guy on HRT, and err on the side of caution. So I would try to hydrate better, and see where ur RBC, HGB and HCT levels come back at on ur next blood test, and assess things from there

was just listening to a great interview where they were talking about insulin resistance, and one thing I learned that I didn’t know was that when insulin sensitivity is low, and glucose remains elevated in the blood for long periods of time, it can cause blood cells to glycate, and stick together, thus increasing the chance of blood vessels getting clogged up. Just something to consider. I’ll attach a very brief explanation of the process from Google. I’m sure u know most of the ways to reduce ur risk of having another DVT. Just don’t forget the importance of remaining as insulin sensitive as possible, amongst all the other ways that I’m sure ur trying to stay on top of

 

[Systemlord]

My doctor wanted me in September to dump blood with a 50.4 HCT

If being .4 over the ranges is the only reason your doctor wants you to dump blood, in the absence of symptoms, then you shouldn't do it.

Doctors these days are obsessed with lab ranges, more so than at anytime in the past, for treatment decisions.

 

[BigTex]

@Systemlord, it is the only reason he wants me to do it. He wants me down to about 45-47%.

 

[Systemlord]

@Systemlord, it is the only reason he wants me to do it. He wants me down to about 45-47%.

If my doctor wanted my HCT in certain range and couldn't give me a satisfactory answer why he wanted it in that range, at that point he's just my prescription pad.

 

[Gman86]

@Systemlord, it is the only reason he wants me to do it. He wants me down to about 45-47%.

Ya that’s just too low while on HRT. U’d have to keep ur total test level in hypogonadal range to maintain a HCT in that range. Unless u were donating blood every other month, which I doubt would be healthy for ur iron levels and iron stores

 

[FunkOdyssey]

Ya that’s just too low while on HRT. U’d have to keep ur total test level in hypogonadal range to maintain a HCT in that range. Unless u were donating blood every other month, which I doubt would be healthy for ur iron levels and iron stores

I agree. BigTex seems like a guy that would probably sit around 45-47% with no TRT. Chasing that range would be a race to the bottom in terms of T levels and well-being.

Tell your doc to stop setting impossible goals for you and let you live your best high HCT life.

 

[Gman86]

I agree. BigTex seems like a guy that would probably sit around 45-47% with no TRT. Chasing that range would be a race to the bottom in terms of T levels and well-being.

Tell your doc to stop setting impossible goals for you and let you live your best high HCT life.

Exactly. Around a 50% HCT level is not only totally fine, but optimal, for most men, imo.

 

[BigTex]

Ya that’s just too low while on HRT. U’d have to keep ur total test level in hypogonadal range to maintain a HCT in that range. Unless u were donating blood every other month, which I doubt would be healthy for ur iron levels and iron stores

Strangely enough he is fine with the test being high. Yea, I am not going to be donating blood on a regular basis. He always assures me he only makes suggestions that I am the final decision. I am fine with 51.9 or anything below 54%

 

[Gman86]

Strangely enough he is fine with the test being high. Yea, I am not going to be donating blood on a regular basis. He always assures me he only makes suggestions that I am the final decision. I am fine with 51.9 or anything below 54%

I feel the same. 54% is around where I wouldn’t want my HCT to go any higher as well. Ideally I personally like to see my HCT in the 49-52/53 range. Luckily my HCT has been hovering around 51%.

 

[DorianGray]

Say, @BigTex, if you don't mind my asking, what was your Ferritin?

 

[BigTex]

200mcg/L (24-336mcg/L)

 

[testiculus]

@Systemlord, it is the only reason he wants me to do it. He wants me down to about 45-47%.

Defensive medicine unfortunately has become standard practice. If he doesn't make that recommendation he risks loosing his license if he's ever investigated by the medical board. Of course a HCT that low for BigTex would only be acheivable off TRT or with weekly blood donations.

 

[testiculus]

One other point to make, risk at given HCT varies by person. Age and genetics both affect how much risk a particular HCT presents. While 54% is generally viewed as a threshold one shouldn't go over (due to exponentially increasing risk above 54%), the risk of a 54% HCT at the age of 25 is not the same as at age 65. So as one gets older, to maintain constant risk you would need to gradually lower your HCT level. How much lower? Who knows? Just be aware of the age effect and factor that into your decisions.

 

[Systemlord]

While 54% is generally viewed as a threshold one shouldn't go over (due to exponentially increasing risk above 54%)

Glenn Cunningham, when asked by Dr. Abraham Morgenthaler, where did you come up with 54%? His answer was we actually don't have much data to say anything but we had to pick a number and it seemed like a reasonable number.

 

[BigTex]

Glenn Cunningham, when asked by Dr. Abraham Morgenthaler, where did you come up with 54%? His answer was we actually don't have much data to say anything but we had to pick a number and it seemed like a reasonable number.

Great way to make medical standards. Just pick a number out of air and make it apply. Same with blood pressure recommendations.

 

[Systemlord]

There are over 80 million people that live higher than 2,500 meters and they develop a secondary erythrocytosis. Men in parts of Bolivia have a normal range of HCT from 45-61%.

These men are not at an increased risk of thrombotic events nor do they have to undergo phlebotomies to manage their hematocrit.

 

[testiculus]

There are over 80 million people that live higher than 2,500 meters and they develop a secondary erythrocytosis. Men in parts of Bolivia have a normal range of HCT from 45-61%.

These men are not at an increased risk of thrombotic events nor do they have to undergo phlebotomies to manage their hematocrit.

This is a great example of the genetic varability of risk from elevated HCT that I was talking about. Those who have lived at high elevations for generations develop genetic adaptations and don't suffer adverse effects from the elevated HCT. Of course, those of us whose ancestors lived at sea level don't have these adapations and have a different risk profile.