New Zealand does not let me give blood to decrease high hematocrit on TRT

Hi Guys

Blood lab turned me away for having Haemoglobin of 198. Apparently the limit is 185(Here in New Zealand)

I am currently on 80mg(split twice a week 40+40)of test cyp deep IM. Have been on this for 4 months and going well. Can't do and form of subq as gives me anxiety insomnia and gummyworm dick.

Should I lower my dose?

Latest labs below

Thanks

Prolactin 489mU/L(65-400)(taking cabergoline quarter of a 0.5mg tablet per week)
Total testosterone 22nmol/L(8.6-29)
Free testosterone 667pmol/L(220-680)
SHBG 17pmol/L(13-49)
Estradiol 143pmol/L(0-190)
Ferritin 46ug/L(30-500)
PVC 0.55 L/L(0.40-0 54)
Haemoglobin 184 g/L(125-170)
RBC 6.2x10'12/L(4.0-5.8)

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The New Zealand Blood Service (NZBS) explicitly says that erythrocytosis caused by testosterone-replacement therapy (TRT) is not an accepted indication for its therapeutic venesection (phlebotomy) programme. In the words of the NZBS Haemochromatosis & Therapeutic Venesection Policy, section 3 (Polycythaemia / Erythrocytosis):

“Patients with high haemoglobin levels as a complication of testosterone replacement therapy do not require therapeutic venesection.” nzblood.co.nz

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What that means in practice​

Topic	NZBS position
Referral to NZBS therapeutic venesection clinic	Referrals based solely on TRT-induced high Hb/Hct will be declined. NZBS regards dose adjustment, route change, or temporary cessation of testosterone as the appropriate management.
Alternative venues	If a man on TRT truly needs phlebotomy (e.g., very high Hct > 0.54 that cannot be controlled by modifying therapy), this must be arranged in a hospital service or privately—not through NZBS donor centres.
Ordinary blood donation	Men on TRT may donate blood as regular donors provided they meet all standard criteria (age, health, medications, Hb 130-185 g/L, Hct < 0.54, etc.). Donation under those rules is not considered “therapeutic” and is limited to the usual 12-week interval.
When NZBS does offer venesection	Accepted indications are hereditary haemochromatosis, polycythaemia rubra vera (PRV) and some other primary erythrocytoses, and porphyria cutanea tarda. Other conditions are only considered on a case-by-case basis with supporting evidence. nzblood.co.nz

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Practical takeaway for clinicians & patients on TRT​

1. First step is endocrine review – lowering the testosterone dose, switching from injections to transdermal formulations, or lengthening injection intervals usually resolves the elevated haematocrit.
2. Reserve venesection for rare cases where haematocrit remains dangerously high despite optimising therapy and alternative causes have been excluded; organise this via hospital haematology, not NZBS.
3. Do not send TRT patients to NZBS claiming “therapeutic blood donation” – the referral will be declined and valuable capacity diverted from patients with recognised indications.

 

@JayD

I have attached the letter for download.

Draft advocacy letter to NZBS​

Date: [Insert date]
To: Dr [Name], Medical Director
New Zealand Blood Service

Subject: Request to add testosterone-induced erythrocytosis to NZBS therapeutic venesection programme

Dear Dr [Name],

I am writing as a New Zealand resident undergoing testosterone-replacement therapy (TRT) for clinically diagnosed hypogonadism. TRT has restored my quality of life, but like many men on treatment it has also raised my haematocrit. My most recent full-blood-count showed a haematocrit of [XX] %, above the internationally accepted safety threshold of 0.50-0.54 %.

1 . International safety guidance​

• The Endocrine Society’s 2018 Clinical Practice Guideline recommends withholding or adjusting TRT and/or performing phlebotomy when haematocrit exceeds 54 %, noting the eight-fold rise in erythrocytosis risk above that level. [1]
• The American Urological Association likewise advises “hold TRT if HCT > 50 % and reinstate at a lower dose once normalised.” [2]
• European Urology and other reviews confirm that regular phlebotomy is a proven, low-risk method to control TRT-induced erythrocytosis. [3, 4]

Elevated haematocrit increases blood viscosity and the odds of thrombo-embolic events; therapeutic venesection lowers viscosity by ~3 % per 450 mL unit removed. [5]

2 . Established practice in the United States​

• Carter BloodCare operates an FDA-approved variance programme offering no-cost phlebotomies every 2–8 weeks for TRT patients, and can even transfuse collected units if the donor meets standard eligibility. [6, 7]
• The American Red Cross performs over 10 000 therapeutic apheresis procedures annually, including for testosterone-related polycythaemia. [8]
• These services follow AABB Standard 5.6.7.1, which differentiates therapeutic draws from standard allogeneic donations yet allows use of the blood if all criteria are met. [9]

3 . Gap in current NZBS policy​

Section 3.1 of NZBS Policy 111P012 (“Haemochromatosis & Therapeutic Venesection”) currently states that “patients with high haemoglobin levels as a complication of testosterone replacement therapy do not require therapeutic venesection.” [10] This leaves TRT patients ineligible for NZBS venesection clinics even when their haematocrit exceeds evidence-based safety limits, forcing them to seek more costly or less convenient private options.

4 . Requested action​

I respectfully ask NZBS to:

1. Add testosterone-induced secondary erythrocytosis to the list of accepted indications for therapeutic venesection, alongside polycythaemia vera and hereditary haemochromatosis.
2. Adopt the US threshold (HCT ≥ 0.54 or clinician-directed ≥ 0.50) and minimum interval (14 days) used by centres such as Carter BloodCare.
3. Allow units collected from otherwise eligible TRT donors to enter the allogeneic supply, further securing New Zealand’s blood inventory.

I have enclosed copies of the relevant Endocrine Society and AUA guidelines, the AABB standard, and the Carter BloodCare TRT phlebotomy enrolment form for your consideration. I would be grateful for an opportunity to discuss this proposal with NZBS clinicians or policy staff, and I am willing to participate in any pilot programme that may be required.

Thank you for your time and for NZBS’s continued commitment to donor and patient safety.

Yours sincerely,

[Name]
[Address]
[NHI or DOB]
[Phone / Email]

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References for NZBS (attach or link as endnotes)​

1. Endocrine Society Clinical Practice Guideline, JCEM 2018 – monitoring & 54 % rule MediRequestsOxford Academic
2. AUA Guideline summary – hold TRT if HCT > 50 % ASH Publications
3. European Urology Focus review on TRT-erythrocytosis management European Urology Focus
4. Bioscientifica review: phlebotomy as practical option Bioscientifica
5. The Blood Project educational brief on TRT & erythrocytosis The Blood Project
6. Carter BloodCare TRT programme overview Carter BloodCare
7. Carter BloodCare enrolment/prescription form Carter BloodCare
8. American Red Cross therapeutic-apheresis service description Red Cross Blood
9. AABB Standards (5.6.7.1) regarding therapeutic phlebotomy mabbweb.org
10. NZBS Policy 111P012, clause 3.1 – current exclusion of TRT cases NZ Blood

 

New Zealand should adopt the US guidelines and stop discriminating and putting men's health at risk.

Thread 'How U.S. Blood Banks Handle Therapeutic Phlebotomy for Men on Testosterone Replacement Therapy (TRT)'

Yesterday at 5:32 PM

How U.S. Blood Banks Handle Therapeutic Phlebotomy for Men on Testosterone Replacement Therapy (TRT)
Blood centers have had to adapt their policies because the polycythemia/erythrocytosis that often accompanies TRT creates both medical need (frequent blood removal) and regulatory challenges (how to label and use that blood). Key “special considerations” now in place fall into four broad areas:

Area	Typical Blood-bank Practice	Why It Matters
...

• Nelson Vergel
• blood banks therapeutic phlebotomy trt blood donation guidelines
• Replies: 2
• Forum: Testosterone Side Effect Management

 

New Zealand should adopt the US guidelines and stop discriminating and putting men's health at risk.

Thread 'How U.S. Blood Banks Handle Therapeutic Phlebotomy for Men on Testosterone Replacement Therapy (TRT)'

Yesterday at 5:32 PM

How U.S. Blood Banks Handle Therapeutic Phlebotomy for Men on Testosterone Replacement Therapy (TRT)
Blood centers have had to adapt their policies because the polycythemia/erythrocytosis that often accompanies TRT creates both medical need (frequent blood removal) and regulatory challenges (how to label and use that blood). Key “special considerations” now in place fall into four broad areas:

Area	Typical Blood-bank Practice	Why It Matters
...

• Nelson Vergel
• blood banks therapeutic phlebotomy trt blood donation guidelines
• Replies: 2
• Forum: Testosterone Side Effect Management

Thanks very much Nelson I will submit a letter

 

I would try daily/more frequent injections of Test to deal with Hct.

As far as sensitivity, i think most guys will experience a loss of it without hCG or/and Preg/DHEA supplementation after a few years on TRT.

I personally never had issues with erections but my sensitivity goes down significantly without hCG, no question.

As far as poor reactions to hCG, daily injections are also a good thing to try. Start low (50iu/day) and go from there. Even 50iu/day makes a difference even if that ends up being all you can withstand without significant E2 side effects.

I tried Pregnenolone and DHEA and got side effects like mild anxiety and insomnia and this was on the lowest dose I could find. Daily subq injections ended in ***** worm dick which was absolutely horrible.

My libido itself is actually stronger than pre TRT, Just need to figure out the sensitivity and hardness thing out. Everything else on TRT has been excellent.

My prolactin only stays in range now with a quarter of a cabergoline tablet per week

 

Thanks very much Nelson I will submit a letter

Show it to your doctor and engage other men in New Zealand on TRT

 

I tried Pregnenolone and DHEA and got side effects like mild anxiety and insomnia and this was on the lowest dose I could find. Daily subq injections ended in ***** worm dick which was absolutely horrible.

My libido itself is actually stronger than pre TRT, Just need to figure out the sensitivity and hardness thing out. Everything else on TRT has been excellent.

My prolactin only stays in range now with a quarter of a cabergoline tablet per week

For Preg/DHEA I would recommend trying sublingual administration. Nootropics Depot and Douglas Labs are reputable companies making small dose disolvable tablets (5mg). Not sure whether they ship to NZ though.

Sublingual administration bypasses (not completely, but to a large degree) first pass metabolism through the liver, which consequently gives you a higher DHEA to DHEA-S ratio, meaning you'll end up with less of the metabolites (which include E2, in my opinion responsible for a lot of issues on TRT past a certain threshold and depending on individual sensitivity).

The above is not true for oral administration of those neurosteroids, even if micronized. There's a possibility that "lipid matrix" technology allows oral Preg/DHEA to bypass liver metabolism to some degree, but there's no research at all behind the products of the companies who claim to implement that method, so buyer beware and I would stick with sublingual personally.

It's fairly common anecdotally for subQ injections of Testosterone to not work well, and you'll find evidence of that on this forum from guys who are typically pretty good at keeping track of protocols and running labs. There's also plenty of guys on reddit and other forums who've run into the same issue.
So if you try ED injections again, I would definitely stick to IM. Big difference in my experience, both subjectively and on labs.

For whatever reason Test levels (both TT and FT) end up significantly lower, and E2 significantly higher than on IM injections. Don't know why on paper, but paper is just paper; at some point you have to pay attention to anecdotal evidence also.