RBC won't lower, what else could it be?

[Gianluca]

Last year my RBC started to go up for no apparent reason with no changes in TRT dose, I have seen it in December of 2022 at 5.9 with HGB at 18.7

At the beginning of this year I started to lower my Test dose from 180 to 140mg weekly. Again 3 months ago I went from 140 to 126mg weekly, along with that I did a therapeutic phlebotomy.

I was expecting to see a in range CBC, since I went from 180mg to 126mg Test dose with a therapeutic phlebotomy in between as well. CBC came back almost identical with RBC at 5.88 and HGB at 18.8, I still can't believe it.

The only thing I have changed last year was using a new (better) CPAP machine, and coincidently that is where I started to see my RBC rising. I find it unusual and not likely to be the cause though, as even during the 2019, 2020 and half of 2021 I was not using any CPAP at all, and with the same dose and similar diet my RBC was within the range. I don't believe the new CPAP is causing any obstruction during the night, I also check my HR during sleep, nothing abnormal with it.

I regularly eat red meat, but I have since 2019, but more since 2020. I started HCG 3 weeks ago, nothing else new.

Thoughts?

 

[captain]

I was using CPAP and got a smart watch that records levels. My levels are lower with CPAP than without it. All I found was you may be fighting against the CPAP. I lost weight and no longer use it.

 

[Gianluca]

I was using CPAP and got a smart watch that records levels. My levels are lower with CPAP than without it. All I found was you may be fighting against the CPAP. I lost weight and no longer use it.

I don’t even think I need it anymore either. I was diagnosed with a mild sleep apnea during the 2017, I used the macchine for a little bit that year and maybe during the 2018, but couldn’t get used to it, then I didn’t touch it till 2 years ago when GF told me I was snoring.

I was hoping it would make a difference in my adrenal recovery and improve sleep, but I’m not sure it did. I’ll try not to use it for a week and see if there is any changes in sleep patterns.

 

[Cataceous]

I wouldn't dismiss the hypothesis that excess testosterone is contributing to the problem until you've tried physiological dosing for a sustained period. Even 126 mg TC/week provides double the average production of healthy young men. The absence of symptoms of excess for a period of time is not a guarantee about the future, and you also can't assume linear behavior.

 

[Systemlord]

So while you lowered the Test dosage, your body was still replacing the lost red blood cells at higher rate than normal, because of the loss of oxygen from the phlebotomy.

If you wait a little longer for your red blood cell production to level out, you may find your overall red blood cell level lower on this new lower Test dosage.

 

[Gianluca]

I wouldn't dismiss the hypothesis that excess testosterone is contributing to the problem until you've tried physiological dosing for a sustained period. Even 126 mg TC/week provides double the average production of healthy young men. The absence of symptoms of excess for a period of time is not a guarantee about the future, and you also can't assume linear behavior.

The reason I started to lower my dose was indeed to get closer to physiologic dosing of Test CYP

My levels were never too high though, even at 140mg on EOD protocol TT at 700 with FT at 26 ng/dl (equilibrium ultrafiltration).

126mg weekly on EOD, TT at 500 and unfortunately, I didn't get back the FT but I have calculated an estimate of about 18 ng/dl using TruT calculator, which is similar to the results of years ago on same dose on M/W/F protocol with Direct FT method.

I still scratching my head, going from 180mg to 126 that is 54mg less, and not seeing any reduction in RBC after months doesn't make sense. Even if it still too much testosterone I would have seen some sort of reduction in the RBC I believe.

I do not discard your opinion though, and I appreciate the input here.

 

[Gianluca]

So while you lowered the Test dosage, your body was still replacing the lost red blood cells at higher rate than normal, because of the loss of oxygen from the phlebotomy.

If you wait a little longer for your red blood cell production to level out, you may find your overall red blood cell level lower on this new lower Test dosage.

When I donated I was at 40mg less of my dose, my body should have replaced red blood cell at a lesser degree already. Plus the additional 14mg dose reduction 3 months ago.

We will see, Luckly I have enough ferritin and can donate some blood

 

[FunkOdyssey]

Do you have an oura ring? Very useful to measure your blood oxygen and report on apnea episodes. It would give you the data you need around how well you're breathing with and without the CPAP.

 

[tareload]

I wouldn't dismiss the hypothesis that excess testosterone is contributing to the problem until you've tried physiological dosing for a sustained period. Even 126 mg TC/week provides double the average production of healthy young men. The absence of symptoms of excess for a period of time is not a guarantee about the future, and you also can't assume linear behavior.

Testosterone Suppresses Hepcidin in Men: A Potential Mechanism for Testosterone-Induced Erythrocytosis

Testosterone suppresses the iron regulatory peptide hepcidin in men, and this effect is more pronounced in older men who also experience greater erythrocyt

academic.oup.com

Table 2

 

[tareload]

Not linear in the least.

Further examination of the data shows a decent exponential relationship (x-axis in log form below). Very high slope below 100 mg/week Test ester). See Fig. 2. If you took that data and did separate curves for old vs young it would be even more instructive.

We are all very fortunate to have @Cataceous here.

Another anecdote. I have methodically tracked my Hct in the last year after going from 60 mg/week up to current 180 mg/week in 20 mg intervals. After passing 120 mg/week I observed no further elevation in Hct. So these data would suggest you essentially ride for free after some threshold FT level. There is no free lunch with androgen abuse but this is about as close as you can get it appears.

Including my standard pitch for aspirin/clotting protection should you decide to use "higher dosing".

Thank you for reading @FunkOdyssey . Bless you.

 

[tareload]

What do you conclude from Table 1?

Fig. 2?

 

[Keepfit1]

Last year my RBC started to go up for no apparent reason with no changes in TRT dose, I have seen it in December of 2022 at 5.9 with HGB at 18.7

At the beginning of this year I started to lower my Test dose from 180 to 140mg weekly. Again 3 months ago I went from 140 to 126mg weekly, along with that I did a therapeutic phlebotomy.

I was expecting to see a in range CBC, since I went from 180mg to 126mg Test dose with a therapeutic phlebotomy in between as well. CBC came back almost identical with RBC at 5.88 and HGB at 18.8, I still can't believe it.

The only thing I have changed last year was using a new (better) CPAP machine, and coincidently that is where I started to see my RBC rising. I find it unusual and not likely to be the cause though, as even during the 2019, 2020 and half of 2021 I was not using any CPAP at all, and with the same dose and similar diet my RBC was within the range. I don't believe the new CPAP is causing any obstruction during the night, I also check my HR during sleep, nothing abnormal with it.

I regularly eat red meat, but I have since 2019, but more since 2020. I started HCG 3 weeks ago, nothing else new.

Thoughts?

Reds can take a while to adjust to a change in dose, allegidly reds have a 120 day cycle, the alternative is to get a haematologist to check you for Jak2 to see if you have primary polycythaemia, I have it , you probably dont but one last thing to check if still concerned

 

[Gianluca]

Do you have an oura ring? Very useful to measure your blood oxygen and report on apnea episodes. It would give you the data you need around how well you're breathing with and without the CPAP.

I don't, I use an apple watch though. Although mine doesn't show the oxygen level, I can see the HR which never rise more than about 60, then there is a respiration rate report, which is normal. Years ago when I was diagnosed with a mild sleep apnea, I believe my HR would rise at about 80/90 during sleep.

I know the oxygen meter would be the best indicator though.

 

[Gianluca]

Testosterone Suppresses Hepcidin in Men: A Potential Mechanism for Testosterone-Induced Erythrocytosis

Testosterone suppresses the iron regulatory peptide hepcidin in men, and this effect is more pronounced in older men who also experience greater erythrocyt

academic.oup.com

Table 2
View attachment 36102

This is interesting, thanks for posting. I really would have thought the more Test the more the RBC goes up. We can see how above 50mg things get a little nastier, just where we may get into a supraphysiological dosing.

One thing I want to point out, I heard this from Nelson the first-time years ago, that after starting TRT some men experience a rise in HCT, which eventually would level out months after that. If I'm not reading this incorrectly, hepcidin comes back up at week 20




Peraphs I really need to wait a couple of more months to see a difference in RBC.

 

[Blackhawk]

Never knew until I used a recording SPO2 monitor.

Amazon.com

I have no obstructive apnea, but my SPO2 was averaging 87% with drops into the 70s until I got on supplemental Oxygen while sleeping. Now 97% on 1.5 liters per minute with no drops below 90. Unless I move to sea level, I am on O2 for sleep forever.

My sleep doc loves that I have one like this and can provide serial charts for any changes in protocol. I had to go through ruling out obstructive apnea to get where I am now. I have mild CNS apnea, which CPAP made worse. I was able to run these SPO2 charts with all available combinations: just room air, just CPAP, CPAP with O2, Just O2 at varying LPM.

The damn thing though, is i am still having trouble with HGB/HCT. My T dose is so low, It is probably due to being out of whack after several years of transfusional dependent anemia. My hematologist thinks that my system did not reset correctly to the norm. My EPO was off the charts during anemia, and once hematopoetic stem cells kicked in I rebounded hard and stayed there, overproducing RBCs. I'd be interested in another EPO blood test at this point

 

[Gianluca]

Never knew until I used a recording SPO2 monitor.

Amazon.com

I have no obstructive apnea, but my SPO2 was averaging 87% with drops into the 70s until I got on supplemental Oxygen while sleeping. Now 97% on 1.5 liters per minute with no drops below 90. Unless I move to sea level, I am on O2 for sleep forever.

My sleep doc loves that I have one like this and can provide serial charts for any changes in protocol. I had to go through ruling out obstructive apnea to get where I am now. I have mild CNS apnea, which CPAP made worse. I was able to run these SPO2 charts with all available combinations: just room air, just CPAP, CPAP with O2, Just O2 at varying LPM.

The damn thing though, is i am still having trouble with HGB/HCT. My T dose is so low, It is probably due to being out of whack after several years of transfusional dependent anemia. My hematologist thinks that my system did not reset correctly to the norm. My EPO was off the charts during anemia, and once hematopoetic stem cells kicked in I rebounded hard and stayed there, overproducing RBCs. I'd be interested in another EPO blood test at this point

thanks, this is good info. You just convinced me to buy a SPO2 sleep meter. It makes me think the new CPAP could have made things worse then for me as well, the SPO2 meter will tell. I really started to see the RBC going up since the new machine

 

[Blackhawk]

thanks, this is good info. You just convinced me to buy a SPO2 sleep meter. It makes me think the new CPAP could have made things worse then for me as well, the SPO2 meter will tell. I really started to see the RBC going up since the new machine

Hope it provides data as useful as it has for me!

 

[Mastodont]

View attachment 36103

What do you conclude from Table 1?

Fig. 2?

View attachment 36104

Conclusion...you should opt for 300mg a week when you are young

 

[Wilson7]

Do you have an oura ring? Very useful to measure your blood oxygen and report on apnea episodes. It would give you the data you need around how well you're breathing with and without the CPAP.

Looking into to an Oura ring, do you find it helpful? I wear a home holter and PAC activity many times spikes between 10p and 2a. My dentist suggested the Oura to track HRV, SO2 and sleep cycles. Would have to use my little finger, only one that fits and I'm not fat.

 

[FunkOdyssey]

Looking into to an Oura ring, do you find it helpful? I wear a home holter and PAC activity many times spikes between 10p and 2a. My dentist suggested the Oura to track HRV, SO2 and sleep cycles. Would have to use my little finger, only one that fits and I'm not fat.

They make the ring in a range of sizes. When you order they send you a sizing kit first and wait for you to choose a ring size before sending the actual ring.

Yes it is very helpful. You will learn how all kinds of lifestyle factors impact your sleep, HR, HRV, SpO2, body temperature, and breathing rate. I would never give mine up now.

One of the first things I recommend you do once you get an oura ring is have several drinks before bed one night and behold the trainwreck that occurs.