Are there any specific tests/activites that you would recommend/advise that I do? Any particular questions that I should raise with my provider?
I donated blood shortly after I posted my original message and am going to restest in the next 2 weeks to see how things look. I am willing to pay out of pocket for the appropriate tests, but I'm not sure what else to do on my end/what tweaks to make.
I'm not trying to be disrespectful, but so far you've pointed out a lot of issues without pointing out potential solutions, so I'm just trying to sort out what avenues you would recommend so I can explore those.
Thank you!
As I stated in one of my previous replies factors such as sleep apnea, smoking, asthma, and COPD can have a negative impact on hematocrit.
If you are dehydrated labs will be skewed.
When using exogenous T studies show an average increase of 3-5% in the first year and even then some men can see bigger increases.
T-formulation let alone age, genetics, and baseline levels play a role.
You need to stick with a consistent protocol (dose of T/injection frequency, IM or sub-q) let alone make sure your are always getting your follow-up blood work done using the same lab/testing methods (most accurate) for TT (LC/MS-MS) and more importantly FT (Equilibrium Dialysis) and always make sure you have your blood work done at true trough (lowest point) before your next injection.
This is the only way we will know where your trough FT truly sits on said protocol (dose of T/injection frequency).
Again for the majority of men it is a given that RBCs, hemoglobin and hematocrit will be driven up due to running too high a steady-state/trough FT level!
Those with a high-end/high baseline will have issues with
high hematocrit.
If you have any underlying issues such as sleep apnea. asthma, COPD or smoke then you are at a much higher risk for elevated hematocrit especially when using exogenous T.
Have you ever been tested for sleep apnea?
Where does your ferritin sit?
Polycythemia:
Defined as:
- An erythrocyte mass exceeding 125% predicted based on sex and body mass
- Hematocrit of 48% – 55% (threshold differs according to guideline organization)
May be divided into:
Primary
- Also known as polycythemia vera
- Caused by an over-production of erythrocytes secondary to intrinsic cellular defects within the bone marrow (almost always associated with mutation in JAK2)
Secondary
- Physiological response to decreased tissue oxygenation
- Inappropriate stimulation of erythropoiesis, such as with testosterone therapy
Erythrocytosis often used interchangeably with polycythemia, but actually refers to increased red blood cell count.
Risk factors for developing erythrocytosis after testosterone therapy include:
- Obstructive sleep apnea
- Advanced age
- Obesity
- Type II diabetes mellitus
- Elevated baseline hematocrit (>50%)
- Those who live in high altitudes
Testosterone formulation, dose and pharmacokinetics
- Short-acting intramuscular (IM) formulations result in supraphysiological testosterone levels achieved days after administration.
- Extended-release injectable testosterone and transdermal options maintain physiological testosterone levels more effectively and reduce the risk of secondary erythrocytosis.
Risk/rate of erythrocytosis according to formulation:
- Intramuscular injections – 40%
- Subcutaneous pellets – 35%
- Transdermal – 15%
- Androgel – 3%
- Intranasal testosterone – 0–2%
- Oral testosterone – 0.03%
Clinical presentation of testosterone therapy-associated erythrocytosis
- Objective increases in hematocrit noted after one month of therapy.
- Erythropoiesis tends to occur primarily in the first 6 months of treatment and then reaches a plateau.
- The largest increase typically seen in the first year after initiation of testosterone therapy.
- The hematocrit and hemoglobin tend to return to baseline after 3–12 months once testosterone therapy is discontinued.
Introduction Androgens play a crucial role in the development and maintenance of: Male reproductive and sexual functions Body composition Erythropoiesis
www.thebloodproject.com
Introduction
- Androgens play a crucial role in the development and maintenance of:
- Male reproductive and sexual functions
- Body composition
- Erythropoiesis
- Muscle and bone health
- Cognitive function
- Testosterone falls progressively with age and a significant percentage of men over the age of 60 years have serum testosterone levels that are below the lower limits of young...
Diagnosis and Management of Obstructive Sleep Apnea A Review (2020)
Daniel J. Gottlieb, MD, MPH; Naresh M. Punjabi, MD, PhD
IMPORTANCE Obstructive sleep apnea (OSA) affects 17% of women and 34% of men in the US and has a similar prevalence in other countries. This review provides an update on the diagnosis and treatment of OSA.
OBSERVATIONS The most common presenting symptom of OSA is excessive sleepiness, although this symptom is reported by as few as 15% to 50% of people with OSA in the general population. OSA is associated with a 2- to 3-fold...
