Will breaking up the dose into 2-3 weekly injections help with Hematocrit?

[Greyfox]

I've been dealing with multiple issues with high H and H numbers and iron deficiency. In just the first 6 months on TRT I've needed 5 phlebotomies and probably need another. I am also iron deficient and needed 2 infusions to recover only to turn around and require more phlebotomies. At this point I can't supplement fast enough to replace the iron and infusions are expensive even with insurance. I am still seeking answers as to why I am deficient in the first place (pre existing). I have several options however I am interested in seeing others experience with divided dosing. Will it slow down the RBC production?

On a side note but related I am strongly considering HCG monotherapy at this moment since the low iron symptoms make TRT nearly useless. I am even wondering if my iron deficiency is the cause of my low T since both were discovered at the same time and low iron brings a specific set of symptoms in me including highly fragmented sleep with near panic attacks at night. All of this miraculously stopped after the second iron infusion and came back after phlebotomy. It may explain why both Clomid and Tamoxifen would sporadically work as well. I have appointments coming next week to see what my options are. I am somewhat optimistic that I have found my low T cause but am prepared to accept defeat depending on how things play out with results.

 

[Systemlord]

Multiple injection per weeks has been known to decrease hematocrit in a lot of men, once weekly is known for driving hematocrit high the majority of the time. My hematocrit was lowest on a daily protocol 45% versus EOD 50%. All other CBC labs were substantially lower.

 

[Greyfox]

Multiple injection per weeks has been known to decrease hematocrit in a lot of men, once weekly is known for driving hematocrit high the majority of the time. My hematocrit was lowest on a daily protocol 45% versus EOD 50%.

Would it be a good assumption to think 3 injections would be better than 2?

 

[Systemlord]

Would it be a good assumption to think 3 injections would be better than 2?

It's kind of a slippery slope, 50mg twice weekly had my HCT at 48% and higher testosterone, while 20mg EOD had it at 50% and lower testosterone but responded to treatment better, daily was the most dramatic difference at 45% with similar levels to my EOD protocol.

In the TRT world nothing is linear.

At what levels was your doctors forcing phlebotomy?

 

[Greyfox]

18.5 (55.5%) however it was rising insanely fast. A week after a phlebotomy my numbers were nearly identical to the week before. I am naturally high to begin with at around 17 give or take .1. So I am starting already at a disadvantage. I had to explain to the clinic that their cutoff of 16.9 wouldn't work for my "normal".

 

[Systemlord]

18.5 (55.5%) however it was rising insanely fast. A week after a phlebotomy my numbers were nearly identical to the week before. I am naturally high to begin with at around 17 give or take .1. So I am starting already at a disadvantage. I had to explain to the clinic that their cutoff of 16.9 wouldn't work for my "normal".

Your CBC labs would be identical to those living at high altitude, TRT is known to increase hematocrit and the problem is doctors are treating it as polycythemia, the fact is erythrocytosis is not polycythemia.

I would focus on keeping HCT under 54% and would rather keep it closer to 50%.

 

[HealthMan]

My theory about injection frequency and HCT is the following (it applies to me). There is a TT/FT number that will be an inflexion point in terms of RBC/HCT. So the further right and the longer you are to that point the more problems you will have with HCT. A lot of times once a week injections have a lower effect on HCT than more frequent injections. My theory is: this might happen simply because you will spend less time above that inflexion point (in certain cases). And depending on the dosage frequency and TT/FT levels you might end up spending more time over that threshold and cause HCT to increase more. Plus more frequent injection cause more peaks (and rapid acceleration of TT/FT levels that in my opinion might impact HCT).
This is only my theory. There are quite a few cases you see in forums that HCT gets worse by injecting more frequently. As a general rule i think more frequent injections will cause less impact to someone’s HCT. But i think this is far from a rule that applies to all or vast majority.

 

[Greyfox]

Yeah, its one of the reasons I am considering HCG at least until the iron issue is found. It could still happen with HCG as well however statistically the treatment is less associated with elevated H and H. From what I remember on the stats Cypionate is 56% above 50 vs 4% on HCG. I doubt I would get those kind of numbers by breaking up the injections though I have to keep that option open.

 

[Greyfox]

I feel Dr Crisler is right however, no Endo or Clinic I have here would be comfortable and have stated they pull therapy at 18.5 if I refuse phlebotomy. Also the rate of production is suggestive that if left unchecked I will only keep climbing so who knows what that would mean. Even my hematologist has doubts about the risks since the other risk factors like platelets, white blood cells and gene mutations aren't there like they are in Polycythemia Vera however he acknowledges there isn't enough info either way so he has to error on the side of the normal "consensus".

 

[Simon7]

High h/h will drive up your blood pressure and take a long term toll on your heart. You can consider switching to transdermals or nebido as they are not as prone to raising h/h as cypionate/enanthate are. Details in the link below.

Hematocrit elevation following testosterone therapy – does it increase risk of blood clots? - Nebido - Testosterone Undecanoate

 

[Cataceous]

High h/h will drive up your blood pressure and take a long term toll on your heart. You can consider switching to transdermals or nebido as they are not as prone to raising h/h as cypionate/enanthate are. Details in the link below.

Hematocrit elevation following testosterone therapy – does it increase risk of blood clots? - Nebido - Testosterone Undecanoate

It's not the type of testosterone, it's what your levels do. If you injected small amounts of propionate/enanthate/cypionate frequently and kept your serum testosterone midrange then you would have no higher risk than with any other method. As the paper says:

The risk of reaching hematocrit >54% is determined by the duration of supraphysiologic testosterone levels, which in turn is determined by testosterone formulation (and hence pharmacokinetics) and dose.18,26,55-57

 

[Greyfox]

And my SHBG isnt helping matters. Its around 16.5 lately so I imagine the supraphysiologic levels are bound to happen unless I break up the dose on top of lowering it.

The other issue is it seems that my health issue that lead to low testosterone was sleep fragmentation from having iron deficiency for years. It slipped through every doctors observation. It interrupts every Rem cycle, I sleep, dream, wake in a panic, repeat. Its giving me hope that I may recover in time but the cypionate needs to be out of the equation for my hematologist to take things more serious. HCG would be less likely to have this effect and my SHBG could rise as well again reducing the effect more.

 

[Cataceous]

And my SHBG isnt helping matters. Its around 16.5 lately so I imagine the supraphysiologic levels are bound to happen unless I break up the dose on top of lowering it.
...

I'd tend to think that hCG will just be harder to manage, though I could be wrong. In your shoes I would inject as frequently as I could stand and aim for calculated free testosterone to peak at not much over 15 ng/dL. This sounds low compared to what guys on TRT usually achieve, but we tend to forget that it is where young guys peak on average (with total T at 600-700 ng/dL and SHBG at ~30 nmol/L).

 

[madman]

And my SHBG isnt helping matters. Its around 16.5 lately so I imagine the supraphysiologic levels are bound to happen unless I break up the dose on top of lowering it.

The other issue is it seems that my health issue that lead to low testosterone was sleep fragmentation from having iron deficiency for years. It slipped through every doctors observation. It interrupts every Rem cycle, I sleep, dream, wake in a panic, repeat. Its giving me hope that I may recover in time but the cypionate needs to be out of the equation for my hematologist to take things more serious. HCG would be less likely to have this effect and my SHBG could rise as well again reducing the effect more.

You have been posting on here since Oct 2018 and you were dead set on the 200 mg/week protocol when in fact you finally mentioned you have low SHBG and many of the members had given you sound advice to lower your dose and move to more frequent injections.

You stated it was hard convincing your doctor to start twice weekly (every 3.5 days) when in fact injecting more frequently as in daily or EOD would be the most effective in your situation seeing as your SHBG is low 16-19 nmol/L.

What is your exact protocol as of now.....still once weekly injections?

Most importantly where does your TT/FT and e2 levels sit on such protocol as you posted no lab work.....let alone protocol you are on when you started this thread.

When starting trt or anytime T dose is increased due to tweaking ones protocol hemoglobin/hematocrit levels will increase within the first month and can take 9-12 months to reach peak levels.....unfortunately most jump on the too frequent blood donation band wagon only to end up with the....opps I crashed my iron/ferritin!

You donated 5 times in 6 months.....what did you expect as regardless of iron supplementation your levels could never recover that fast.

If anything when donating no more than 3 times/year as in every 4 months otherwise your ferritin/iron will be constantly low.

Although elevated supra-physiological peaks can increase ones H/H.....overall T levels will also have an impact.

Aside from supra-physiological peaks from higher doses of T injected less frequently as in once weekly or twice weekly.....running too high TT/FT levels regardless of injection frequency can cause elevated H/H.

Before worrying about your H/H being elevated you need to post your protocol/lab work so we can see where your TT/FT levels sit on such protocol and if anything you need to look into injecting daily or EOD due to your low SHBG before you state "On a side note but related I am strongly considering HCG monotherapy at this moment since the low iron symptoms make TRT nearly useless"

Is it truly the low iron symptoms or your piss poor protocol (for one with low SHBG) that make TRT nearly useless.....I would say the latter!

 

[Greyfox]

My ferritin issue predates TRT and wasn't properly managed by at least 4 physicians. Reference range medicine is certainly something many here have had problems with and that certainly allowed for this condition do go unchecked. The cause hasn't been found regardless of the phlebotomies. I've had upper and lower GI scopes to find causes. Pill cam is next and if thats a dead end then looking for other causes would be next. As for my H and H numbers, they elevated too quickly to be managed. Had I refused my treatment would have halted anyway. I am essentially trapped in my treatment options and unless a physician signs off on the prescription I can't self inject which is the only way I can make TRT work. Thats going to be part of my discussion tomorrow with my Endo. We were never able to determine the cause of the Low T to begin with however my symptoms all started with the sleep fragmentation caused by low ferritin. I have been to so many specialists during my 2.5 year struggle and the biggest breakthru was after the second iron infusion. I am confident this has been the issue the whole time and will see this through until either I am off TRT or back on something like Clomid assuming my levels recover. I am also aware the protocol wasn't right but again, I had no options. So all thats left is for a change in therapy options to afford me time to find the cause and attempt a restart after the cause is treated.

 

[Greyfox]

UPDATE.

Doc decided it was best to switch to HCG based on the unusual RBC production and the issues with Iron deficiency. He wants to rule out other conditions and to do so we needed to remove that variable. MWF 500 iu HCG. Will know more next month after testing.

 

[TorontoTRT]

I switched from once a week 100 mg to twice a week 40 mg x2. My hematocrit went up! From 53 to 55. Blood pressure stayed the same. Low normal. Average 100/70.

 

[Greyfox]

Yeah, the Doc realized that breaking the dose still wasnt a guarantee it would bring my hematocrit down. My response was so strong he wants to rule out some other conditions. I would donate at 55 hematocrit and within a week it would be back to 55. I would donate again and a week and a half later I would be back to 55 hematocrit.

 

[TorontoTRT]

It might be sleep apnea. I’m gonna try a CPAP machine and see how that affects numbers. Hematocrit is not even a real measurement per se. it’s an estimated percentage. They multiply RBC count by MCV count. So most important numbers are RBC and hemoglobin.

 

[Greyfox]

I have a CPAP and my Apnea is near zero with it. As for RBC its always run high.