Testosterone injection frequency and it’s effect on hematocrit

[liftingheavy220]

Hello everyone,

I’ve been on TRT for over a year now and I’ve had some trouble with my hematocrit and RBCs getting too high. I’ve had to donate blood about 3 times and every time I do my ferritin drops pretty dramatically. I’d like to avoid donating blood so frequently or at least because I have to.

I have been on testosterone dosages as high as 250mg and as low as 150mg a week. 250mg was too much and I would have trouble sleeping and my hematocrit would get high fast. At 150mg my hematocrit would be at a healthy range but my testosterone would be in the 700s and I wouldn’t feel as great.

I’ve tried daily dosing but found that it raised my hematocrit even higher than twice weekly. Is there any way that I can keep my testosterone in the 900-1100 range without raising my hematocrit? Since I’ve started testosterone I’ve been doing a minimum of two shots a week. Would going to once a week lower my hematocrit?

If anyone has had success with being able to lower their hematocrit while keeping their total T in a high normal range please share how you did it.

 

[CoastWatcher]

These issues, hematocrit and hemoglobin, are far too often the price of a ticket to the TRT follies. Sometimes men stabilize spontaneously; we have members who acheved stability by lowering dose and increasing their injection frequency. Some men have to continue donating blood and some never have a problem.

Where does your SHBG sit? I ask because it will determine how well you respond to a once weekly injection schedule (regardless of Hct and Hgb issues).

 

[liftingheavy220]

These issues, hematocrit and hemoglobin, are far too often the price of a ticket to the TRT follies. Sometimes men stabilize spontaneously; we have members who acheved stability by lowering dose and increasing their injection frequency. Some men have to continue donating blood and some never have a problem.

Where does your SHBG sit? I ask because it will determine how well you respond to a once weekly injection schedule (regardless of Hct and Hgb issues).

Thanks for the very informative post! My doctor doesn’t always check SHBG but the last time it was checked (3/12/2018) it was at 19.5 nmol/L Ref range: 16.5-55.9 nmol/L

 

[Vince Carter]

HCT is such an individual thing as my friend @CoastWatcher says, who can say if you can stabilize, and how you'd do it. I've gone as low as 16mg/D and still have to donate.
Though there is some alternative thought on the whole phelbotomy/HCT front that is worth listening to.

trt phlebotomy - YouTube

 

[CoastWatcher]

Thanks for the very informative post! My doctor doesn’t always check SHBG but the last time it was checked (3/12/2018) it was at 19.5 nmol/L Ref range: 16.5-55.9 nmol/L

That level of SHBG doesn't typically permit a man to achieve success with once weekly injections. You'll likely be feeling somewhat hypogonadal as the end of the week approaches.

Put aside the question of Hct and Hgb: how did you feel when multiple, small, weekly injections were part of your protocol?

 

[liftingheavy220]

HCT is such an individual thing as my friend @CoastWatcher says, who can say if you can stabilize, and how you'd do it. I've gone as low as 16mg/D and still have to donate.
Though there is some alternative thought on the whole phelbotomy/HCT front that is worth listening to.

trt phlebotomy - YouTube

Thank you!

 

[liftingheavy220]

That level of SHBG doesn't typically permit a man to achieve success with once weekly injections. You'll likely be feeling somewhat hypogonadal as the end of the week approaches.

Put aside the question of Hct and Hgb: how did you feel when multiple, small, weekly injections were part of your protocol?

I really couldn’t tell much of a difference between twice a week vs every day injections. Although I did go from 150mg split into two injections to 28mg everyday (196mg a week) and the only benefit I noticed was a slight increase in strength in the gym.

 

[S1W]

I can't even quite figure it out for myself, let alone others. With consistent hydration, I've had my HCT higher at lower T levels than it has been at my highest T levels. Same goes for E2.

I'm also coming to realize that even though I'm a low normal SHBG guy, I feel better on 2x/week injections than smaller more frequent injections.

If you weren't already aware of this, know that simply going from a 1x or 2x per week injection schedule to more frequent injections while maintaining the same overall total weekly dosage will likely result in higher T levels on average throughout the week, and therefore may increase, not decrease unwanted side effects.

I think we all know significantly lowering dosage is the real key to lowering side effects. But many of us want to have our cake and eat it too...

 

[Gman86]

Where does your HCT sit when it’s “high”. The answer is most likely let your HCT go to where it wants, without donating blood, unless it’s 55+. Even at that level, or slightly above, it’s still debatable whether it’s an issue or not. Platelets being high seems to be the problem when it comes to blood thickening too much, and increasing cardiovascular risk, not high HGB, HCT, or red blood cells. My HCT was recently 53.8, but my platelets were on the low end of normal. I ended up donating, due to Defy wanting me to, but I wasn’t worried about the high HCT. My BP wasn’t elevated above baseline or anything.

With your low SHBG, my advice would be to inject ED, or EOD, and find a dose that keeps your total, and more importantly free testosterone where you want it, and not donate blood unless your HCT gets to around 54-55+.

 

[liftingheavy220]

Where does your HCT sit when it’s “high”. The answer is most likely let your HCT go to where it wants, without donating blood, unless it’s 55+. Even at that level, or slightly above, it’s still debatable whether it’s an issue or not. Platelets being high seems to be the problem when it comes to blood thickening too much, and increasing cardiovascular risk, not high HGB, HCT, or red blood cells. My HCT was recently 53.8, but my platelets were on the low end of normal. I ended up donating, due to Defy wanting me to, but I wasn’t worried about the high HCT. My BP wasn’t elevated above baseline or anything.

With your low SHBG, my advice would be to inject ED, or EOD, and find a dose that keeps your total, and more importantly free testosterone where you want it, and not donate blood unless your HCT gets to around 54-55+.

My HCT has gone as high as 53 Hemoglobin as high as 19 and RBC 6.3. That was on 250mg of testosterone per week. On 200mg HCT stays around 52.3, Hemoglobin 18.2, RBC 6.1.

Unfortunately my blood pressure is pretty elevated. I don’t think it’s due to E2 as my E2 stays in the 30-40 range (sensitive) without and AI. I’m only about 210lbs so I don’t know if weight contributes but before TRT I was about 200lbs and blood pressure was never an issue. Right now I’m running around at 150-160/90-100 bp.

 

[madman]

Hello everyone,

I’ve been on TRT for over a year now and I’ve had some trouble with my hematocrit and RBCs getting too high. I’ve had to donate blood about 3 times and every time I do my ferritin drops pretty dramatically. I’d like to avoid donating blood so frequently or at least because I have to.

I have been on testosterone dosages as high as 250mg and as low as 150mg a week. 250mg was too much and I would have trouble sleeping and my hematocrit would get high fast. At 150mg my hematocrit would be at a healthy range but my testosterone would be in the 700s and I wouldn’t feel as great.

I’ve tried daily dosing but found that it raised my hematocrit even higher than twice weekly. Is there any way that I can keep my testosterone in the 900-1100 range without raising my hematocrit? Since I’ve started testosterone I’ve been doing a minimum of two shots a week. Would going to once a week lower my hematocrit?

If anyone has had success with being able to lower their hematocrit while keeping their total T in a high normal range please share how you did it.

Your missing the point here as FT is what truly matters since it is the unbound active fraction of testosterone responsible for the positive effects and we have no idea where your FT sits on said protocols (dose/injection frequency) as you posted no lab work.

More importantly your SHBG is low 19 nmol/L so where did your FT sit when your TT was in the 700s let alone what TT/FT level were you hitting when you were injecting 250 mg/week?

When one has low SHBG do understand that running high FT levels can result in high e2/free e2 levels.

Where do your e2 levels sit on said protocols (dose/injection frequency) as although you stated "but my testosterone would be in the 700s and I wouldn’t feel as great"
.....seeing as your SHBG is low you may very well have still had a descent FT level at a TT in the 700s but your e2 could be elevated.

You need to know where your FT and e2 levels sit on such protocols as not only can high FT levels cause issues but the elevated e2.

 

[Gman86]

My HCT has gone as high as 53 Hemoglobin as high as 19 and RBC 6.3. That was on 250mg of testosterone per week. On 200mg HCT stays around 52.3, Hemoglobin 18.2, RBC 6.1.

Unfortunately my blood pressure is pretty elevated. I don’t think it’s due to E2 as my E2 stays in the 30-40 range (sensitive) without and AI. I’m only about 210lbs so I don’t know if weight contributes but before TRT I was about 200lbs and blood pressure was never an issue. Right now I’m running around at 150-160/90-100 bp.

That’s a pretty significant elevation of your BP. I personally doubt that gaining 10lbs would jump it up that high. Do you know how many platelets you have? Cuz I’ve had HCT at 53.8, and high HGB and RBC’s, and still had a pretty good BP. It might of bumped it up slightly, but I was still averaging around 120/70. Usually I run around 108/60. Do you take magnesium? Magnesium should significantly lower BP. It’s one of the best natural remedies for high BP that I know of. I’m a nurse, and I recommend it to all my patients that have trouble with BP. Not many stick to taking it, but the ones that have usually see a nice drop. They also sleep a lot better, which probably plays a big part as well. I had a patient that was able to get off of her trazadone at night, just by using magnesium before bed.

 

[SkyWarn]

Interesting thread. When I was donating 3 to 4 times a year my Ferritin came back at 0, believe it or not. Levels were undetectable. I only inject 45mg every 4 days which equals about 80 mg weekly and I struggle with HCT. My total T averages around 700 on that dosage.
In December my HCT was 50. 4 weeks latter in January it was 52. Now its February and time for me to donate again as Im probably in the 53 area. I wish I could figure put a way to avoid these blood donations as I'm incredible light headed all day after a donation.
I had no idea platelets were significant. Mine were good at 235 .

 

[HealthMan]

Interesting thread. When I was donating 3 to 4 times a year my Ferritin came back at 0, believe it or not. Levels were undetectable. I only inject 45mg every 4 days which equals about 80 mg weekly and I struggle with HCT. My total T averages around 700 on that dosage.
In December my HCT was 50. 4 weeks latter in January it was 52. Now its February and time for me to donate again as Im probably in the 53 area. I wish I could figure put a way to avoid these blood donations as I'm incredible light headed all day after a donation.
I had no idea platelets were significant. Mine were good at 235 .

What is your FT? TT doesn’t really matter for HCT

 

[liftingheavy220]

Your missing the point here as FT is what truly matters since it is the unbound active fraction of testosterone responsible for the positive effects and we have no idea where your FT sits on said protocols (dose/injection frequency) as you posted no lab work.

More importantly your SHBG is low 19 nmol/L so where did your FT sit when your TT was in the 700s let alone what TT/FT level were you hitting when you were injecting 250 mg/week?

When one has low SHBG do understand that running high FT levels can result in high e2/free e2 levels.

Where do your e2 levels sit on said protocols (dose/injection frequency) as although you stated "but my testosterone would be in the 700s and I wouldn’t feel as great"
.....seeing as your SHBG is low you may very well have still had a descent FT level at a TT in the 700s but your e2 could be elevated.

You need to know where your FT and e2 levels sit on such protocols as not only can high FT levels cause issues but the elevated e2.

Interesting, I had no idea free T was so important. I’ve looked over my two labs. Most recent was at 200mg a week divided into 28mg ED dosing 1/31/2019

Total T: 1003 ng/dL
Free test: 32.8pg/mL ref range 9.6-26.5
Platelets 185 ref range 150-379x10E3/uL

HCT: 52.3 range 37-51
RBC: 6.11 range 4.14-5.8
Hemoglobin: 18.4 range 13-17.7


Blood work before that when I was on 150mg a week 1/08/2019 :

Total T: 784 range 264-916
Free T: 23.2 range 9.3-26.5
Platelets: 179 range 150-379

HCT: 48.9 range 37-51
RBC: 5.8 range 4.14-5.8
Hemoglobin: 17.4 range 13-17.7.

 

[Gman86]

Interesting thread. When I was donating 3 to 4 times a year my Ferritin came back at 0, believe it or not. Levels were undetectable. I only inject 45mg every 4 days which equals about 80 mg weekly and I struggle with HCT. My total T averages around 700 on that dosage.
In December my HCT was 50. 4 weeks latter in January it was 52. Now its February and time for me to donate again as Im probably in the 53 area. I wish I could figure put a way to avoid these blood donations as I'm incredible light headed all day after a donation.
I had no idea platelets were significant. Mine were good at 235 .

Honestly the answer is simple, just stop donating for a while. Your HCT is absolutely fine at 50, 52, 53, or even slightly higher. I promise you, the answer is just don’t donate for a while. A slightly higher HCT level will not effect your health negatively in anyway, especially considering your platelets are perfectly in range.

 

[liftingheavy220]

That’s a pretty significant elevation of your BP. I personally doubt that gaining 10lbs would jump it up that high. Do you know how many platelets you have? Cuz I’ve had HCT at 53.8, and high HGB and RBC’s, and still had a pretty good BP. It might of bumped it up slightly, but I was still averaging around 120/70. Usually I run around 108/60. Do you take magnesium? Magnesium should significantly lower BP. It’s one of the best natural remedies for high BP that I know of. I’m a nurse, and I recommend it to all my patients that have trouble with BP. Not many stick to taking it, but the ones that have usually see a nice drop. They also sleep a lot better, which probably plays a big part as well. I had a patient that was able to get off of her trazadone at night, just by using magnesium before bed.

Thanks for the insight. I just posted my platelet values. I actually don’t take any magnesium but I will start as my doc recommended it as well. What type of dosing and which form do you recommend?

 

[liftingheavy220]

Honestly the answer is simple, just stop donating for a while. Your HCT is absolutely fine at 50, 52, 53, or even slightly higher. I promise you, the answer is just don’t donate for a while. A slightly higher HCT level will not effect your health negatively in anyway, especially considering your platelets are perfectly in range.

Ok I was really concerned as my endocrinologist was worried. What’s crazy is that my ferritin went from 68-100 between the two labs I posted, despite being less than 4 weeks apart. What do you think could be causing my high BP?

 

[Gman86]

Interesting, I had no idea free T was so important. I’ve looked over my two labs. Most recent was at 200mg a week divided into 28mg ED dosing 1/31/2019

Total T: 1003 ng/dL
Free test: 32.8pg/mL ref range 9.6-26.5
Platelets 185 ref range 150-379x10E3/uL

HCT: 52.3 range 37-51
RBC: 6.11 range 4.14-5.8
Hemoglobin: 18.4 range 13-17.7


Blood work before that when I was on 150mg a week 1/08/2019 :

Total T: 784 range 264-916
Free T: 23.2 range 9.3-26.5
Platelets: 179 range 150-379

HCT: 48.9 range 37-51
RBC: 5.8 range 4.14-5.8
Hemoglobin: 17.4 range 13-17.7.

Even on 200mg/ week, your HCT, HGB and RBC levels look perfect. Not only are they not effecting your cardiovascular system in a negative way, you should be getting a nice boost in energy from these levels due to a higher concentration of oxygen flowing through your blood. And your platelets are actually on the low side, so you are at a very low risk for any clotting or blood viscosity issues, such as a DVT or stroke.

 

[liftingheavy220]

Even on 200mg/ week, your HCT, HGB and RBC levels look perfect. Not only are they not effecting your cardiovascular system in a negative way, you should be getting a nice boost in energy from these levels due to a higher concentration of oxygen flowing through your blood. And your platelets are actually on the low side, so you are at a very low risk for any clotting or blood viscosity issues, such as a DVT or stroke.

Thanks Gman, that really puts me at ease. In your post above you mentioned taking some magnesium for the BP. What dosage do you recommend and what form?