High Hematocrit: Effect on Blood Pressure & Effect of Altitude on Hematocrit

[maxadvance]

So Jay and Dr Nichols are doing a full court press on evidence based symptoms, saying most initial sides are basically psychosomatic and to quit being pussies and get through it, Dr Nichols wents so far a couple days ago and said pretty much the entire membership of Excel Male needs to apply Vagisil instead of Testosterone for their protocol. Classy doc!

So here's my reality based symptoms I'd like to share. My protocol for the past year has basically been 90-100 mg T pinned twice a week. Twice a week hcg as well at about 500 iu each. Bloods from last week and a month prior show my trough at about 900 and my day after at about 1600. My body has actually become more receptive to T doses as time has gone on, I'll likely drop my dose soon. But I'm also not using crap T cyp from Hallandale anymore, probably the worst pharmacy in the USA.

The reason to post though is an observation regarding my hct. Because of Drs Rouzier and crisler, I decided I won't phlebotomize for awhile and see what happens. And much of what they say is on point. Yes the blood gets thicker, but your platelets don't, and a likely coronary event shouldn't increase based on their research. Athletes love thick blood right? More RBC, more oxygen, better performance, yippee. So I didn't donate for a year. I was religious with my omega consumption, along with B complex and minerals.

A couple weeks back, my measured hct was 57. I had pushed through that mental feeling of something is different, and had settled in to my new reality of increasing hct. My body, my business. Here's what i noticed.

1. Complexion is always redder, I'd get comments frequently from hey nice tan, to hey why's your face so red all the time.
2. Libido went down, a lot
3. BP went up to 140-150/ over 90-100, and sometimes lower to that 130/85 range, not consistent
4. Strangely my eGfr for kidney function is as good as it's ever been, it's over 100, normal >59

So then I donated last week, and here's the difference in one week.

1. normal complexion
2. greater sense of calm
3. consistent BP reading of 112/70
4. Libido, we'll see

So that's just me. I think low 50's is fine, 52-53 is nothing to freak out over. But it's definitely something that needs to be managed.

#hct

 

[Outcome]

Agree with you there. I get out of breath more easily when my hct starts to approach 51. That's when I donate, which has been once a year and it always gets high during winter. And i always feel way way better afteward. My .02

 

[Dr Justin Saya MD]

So Jay and Dr Nichols are doing a full court press on evidence based symptoms, saying most initial sides are basically psychosomatic and to quit being pussies and get through it, Dr Nichols wents so far a couple days ago and said pretty much the entire membership of Excel Male needs to apply Vagisil instead of Testosterone for their protocol. Classy doc!

So here's my reality based symptoms I'd like to share. My protocol for the past year has basically been 90-100 mg T pinned twice a week. Twice a week hcg as well at about 500 iu each. Bloods from last week and a month prior show my trough at about 900 and my day after at about 1600. My body has actually become more receptive to T doses as time has gone on, I'll likely drop my dose soon. But I'm also not using crap T cyp from Hallandale anymore, probably the worst pharmacy in the USA.

The reason to post though is an observation regarding my hct. Because of Drs Rouzier and crisler, I decided I won't phlebotomize for awhile and see what happens. And much of what they say is on point. Yes the blood gets thicker, but your platelets don't, and a likely coronary event shouldn't increase based on their research. Athletes love thick blood right? More RBC, more oxygen, better performance, yippee. So I didn't donate for a year. I was religious with my omega consumption, along with B complex and minerals.

A couple weeks back, my measured hct was 57. I had pushed through that mental feeling of something is different, and had settled in to my new reality of increasing hct. My body, my business. Here's what i noticed.

1. Complexion is always redder, I'd get comments frequently from hey nice tan, to hey why's your face so red all the time.
2. Libido went down, a lot
3. BP went up to 140-150/ over 90-100, and sometimes lower to that 130/85 range, not consistent
4. Strangely my eGfr for kidney function is as good as it's ever been, it's over 100, normal >59

So then I donated last week, and here's the difference in one week.

1. normal complexion
2. greater sense of calm
3. consistent BP reading of 112/70
4. Libido, we'll see

So that's just me. I think low 50's is fine, 52-53 is nothing to freak out over. But it's definitely something that needs to be managed.

#hct

Your future self (heart and vessels) will thank you. See bolded above. This is the concern I’ve repeated in the past with higher HCT. Thicker fluid in the pipes = higher pressure. Now vasodilation can counteract, to some extent, but vasodilation is much more transient/variable...whereas the increase in HCT/viscosity is more static.

 

[Vince Carter]

I think I can feel a little winded but my cardio conditioning is pretty poor, too. I just don't like having my Ferritin destroyed in to the teens. I've been extremely aggressive at trying to raise that between ~60 day donations and I don't get but to 20 or 30's before I get forced in to donating again, destroys that little Ferritin I recouped. I'm stuck in this vicious cycle.

 

[HealthMan]

I think I can feel a little winded but my cardio conditioning is pretty poor, too. I just don't like having my Ferritin destroyed in to the teens. I've been extremely aggressive at trying to raise that between ~60 day donations and I don't get but to 20 or 30's before I get forced in to donating again, destroys that little Ferritin I recouped. I'm stuck in this vicious cycle.

Have you tried to stop iron supplementation and donations to see if your HCT plateau?

 

[Nelson Vergel]

Maxadvance

Thanks for sharing!

You guys are obsessed with those two. Who cares ??

Good article:

High Hematocrit: How Testosterone Replacement Therapy Can Affect Your Health

Learn how testosterone replacement therapy can increase your hematocrit levels and what you can do to lower high hematocrit safely and effectively.

www.discountedlabs.com

 

[Nelson Vergel]

Those two have not read all these articles

High hematocrit as a risk factor for venous thrombosis. Cause or innocent bystander?

The effects of high hematocrit on arterial flow—A phenomenological study of the health risk implication

Importance of the Hematocrit as a Risk Factor in Cerebral Infarction

Mechanism of Increased Mortality Risk with Erythropoietin Treatment to Higher Hemoglobin Targets

A U-shaped relationship between haematocrit and mortality in a large prospective cohort study

High and Low Hematocrit Increase Cardiovascular Risks


Dr Ramasamy published these data a year ago.

 

[Vince Carter]

Have you tried to stop iron supplementation and donations to see if your HCT plateau?

Ive well considered does the iron drive up RBC/HCT but as I tend to think I'm just stuck in this cycle and that's a part of it.

 

[Gman86]

Ive well considered does the iron drive up RBC/HCT but as I tend to think I'm just stuck in this cycle and that's a part of it.

So I’m still learning myself about iron, and how it interacts in our body, but check out this guy Morley Robbins. In the future, I think we will all be viewing iron status extremely differently. Iron overload can be one of the most toxic things, when we have too much of it, and way more of us have too much iron than I think we realize. Ferritin is a horrible marker of iron status. So as long as we are at least at 20, don’t worry so much. If you are still testing Ferris to check iron status, you are doing it wrong. And 99.9% of the time of you’re taking an iron supplement while on TRT you are literally just poisoning yourself. I know it sounds extreme, but once you learn about iron, and how to test real iron status, and how toxic excess iron is for the body, it won’t sound as extreme. I’m still learning about how to test real iron status myself, but check out this doctor, and his views on everything. It will change everyone’s view on iron, and for the better, that I promise. Carl Lanore, from the superhumanradio podcast has also been talking about iron, and all the misconceptions we believe about it, and all the harm it can do when we have too much of it. And again, most men have way too much iron in their system, especially guys on TRT, due to testosterone increasing iron uptake.

 

[Sean Mosher]

Good post MaxAdvance.
And thank you for sharing.

And yes, those 2 in particular don't really have the whole business development thing down yet I guess lol..............I mean how many guys frequent this board and listen to the roundtable only to have themselves bashed by 2 highly insecure individuals.
Should have been easy free advertising for them but.........
Kind of amusing ;-)

 

[GreenMachineX]

Those two have not read all these articles

High hematocrit as a risk factor for venous thrombosis. Cause or innocent bystander?

The effects of high hematocrit on arterial flow—A phenomenological study of the health risk implication

Importance of the Hematocrit as a Risk Factor in Cerebral Infarction

Mechanism of Increased Mortality Risk with Erythropoietin Treatment to Higher Hemoglobin Targets

A U-shaped relationship between haematocrit and mortality in a large prospective cohort study

High and Low Hematocrit Increase Cardiovascular Risks

@Nelson Vergel
Given all that info, what do you suggest our hematocrit to top out at? My total test is about 550 and free T is 19 (range 10-25), e2 sensitive is 17, hematocrit at 50 and hemoglobin 17.5. Any higher test and it goes up, but if I lower my test dose any lower my e2 sensitive drops low enough to cause bad symptoms. Donating doesn’t even drop it that much and it climbs back to these levels super quickly. I can’t tolerate DHEA, my only long term solution is to come off and live with low T or risk cardiovascular issues???

 

[Gman86]

@Nelson Vergel
Given all that info, what do you suggest our hematocrit to top out at? My total test is about 550 and free T is 19 (range 10-25), e2 sensitive is 17, hematocrit at 50 and hemoglobin 17.5. Any higher test and it goes up, but if I lower my test dose any lower my e2 sensitive drops low enough to cause bad symptoms. Donating doesn’t even drop it that much and it climbs back to these levels super quickly. I can’t tolerate DHEA, my only long term solution is to come off and live with low T or risk cardiovascular issues???

Imo, you don’t have to worry about HCT until it’s 54 or above. Dr. Rouzier, who is a well known, and respected doctor in regards to hormone optimization, will most likely say you can have even higher HCT, without any risk to your cardiovascular system. He has openly stated that high HCT levels while on TRT are not something to be concerned about.

In your case, you are 100% fine to maintain your testosterone levels without worrying about your HCT. You even have room to increase your dose if you want. HCT of 50 is nothing to be concerned about.

I’m a nurse, and from my understanding, higher HCT doesn’t put you at a greater risk for a cardiovascular event, it’s platelets being too high that is what puts you at risk.

 

[GreenMachineX]

Imo, you don’t have to worry about HCT until it’s 54 or above. Dr. Rouzier, who is a well known, and respected doctor in regards to hormone optimization, will most likely say you can have even higher HCT, without any risk to your cardiovascular system. He has openly stated that high HCT levels while on TRT are not something to be concerned about.

In your case, you are 100% fine to maintain your testosterone levels without worrying about your HCT. You even have room to increase your dose if you want. HCT of 50 is nothing to be concerned about.

I’m a nurse, and from my understanding, higher HCT doesn’t put you at a greater risk for a cardiovascular event, it’s platelets being too high that is what puts you at risk.

Forgot about this thread! Thanks man.

 

[Nelson Vergel]

"In order to compensate for the low partial pressure of oxygen at altitude, the human body undergoes a number of physiological changes. A vital component in this process is the increase in the concentration of circulating hemoglobin. The role of HIF-1alpha, erythropoietin and red blood cells in this acclimatization process is described, together with the fall in plasma volume that increases the concentration of hemoglobin in the early stages of hypoxic exposure."

Difference between these people and men on TRT: We have increased blood volume and hemoglobin/hematocrit.

Full paper: Heights and haematology: the story of haemoglobin at altitude

Prevalence, Clinical Profile, Iron Status, and Subject-Specific Traits for Excessive Erythrocytosis in Andean Adults Living Permanently at 3,825 Meters Above Sea Level

"We found a lower prevalence of high red blood cells than in previous reports in the Peruvian Andes. Although the presence of hypoxemia and decreased vital capacity were strongly associated with excessive erythrocytosis, being overweight or having metabolic syndrome were associated with an important fraction of cases in our study population."

Lack of Prominent Compensatory Polycythemia in Traditional Native Andeans Living at 4,200 Meters

Abstract
Red blood cell count (RBC), hemoglobin concentration ([Hb]) and hematocrit (Hct) were measured in 303 male Quechua children and adults, aged 6 to 57 years, living a lifestyle as traditional pastoralists and horticulturalists at a mean altitude of 4,200 m in the Southern Peruvian Andes. Values for RBC, [Hb], and Hct increased with age from middle childhood to young adulthood. However, among adults there was no significant association between age and any of these three parameters. Overall, there was approximately a 10-12% increase in the RBC, [Hb], and Hct above sea-level norms for all age groups. Mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) showed a slight but significant increase with age in children and adolescents, but the mean corpuscular hemoglobin concentration (MCHC) did not. We conclude that the study of highland Quechua Indians, living a traditional lifestyle as pastoralists and horticulturalists, does not support the long-held belief that altitude hypoxia provokes a dramatic compensatory polycythemia in healthy Andeans.

 

[Nelson Vergel]

Hematocrit drives Blood Viscosity- Does that Matter in Men on TRT? Effect of Altitude?

Hi ExcelMale folks, I wanted to start off by expressing my gratitude for this site, all of the amazing work that has been put in to make this place such a great source of information. I would expect no less from a chemical engineer :). I've been following this "debate" about how to properly...

www.excelmale.com

 

[Nighthawk]

"In order to compensate for the low partial pressure of oxygen at altitude, the human body undergoes a number of physiological changes. A vital component in this process is the increase in the concentration of circulating hemoglobin. The role of HIF-1alpha, erythropoietin and red blood cells in this acclimatization process is described, together with the fall in plasma volume that increases the concentration of hemoglobin in the early stages of hypoxic exposure."

Difference between these people and men on TRT: We have increased blood volume and hemoglobin/hematocrit.

Full paper: Heights and haematology: the story of haemoglobin at altitude

Prevalence, Clinical Profile, Iron Status, and Subject-Specific Traits for Excessive Erythrocytosis in Andean Adults Living Permanently at 3,825 Meters Above Sea Level

"We found a lower prevalence of high red blood cells than in previous reports in the Peruvian Andes. Although the presence of hypoxemia and decreased vital capacity were strongly associated with excessive erythrocytosis, being overweight or having metabolic syndrome were associated with an important fraction of cases in our study population."

Lack of Prominent Compensatory Polycythemia in Traditional Native Andeans Living at 4,200 Meters

Abstract
Red blood cell count (RBC), hemoglobin concentration ([Hb]) and hematocrit (Hct) were measured in 303 male Quechua children and adults, aged 6 to 57 years, living a lifestyle as traditional pastoralists and horticulturalists at a mean altitude of 4,200 m in the Southern Peruvian Andes. Values for RBC, [Hb], and Hct increased with age from middle childhood to young adulthood. However, among adults there was no significant association between age and any of these three parameters. Overall, there was approximately a 10-12% increase in the RBC, [Hb], and Hct above sea-level norms for all age groups. Mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) showed a slight but significant increase with age in children and adolescents, but the mean corpuscular hemoglobin concentration (MCHC) did not. We conclude that the study of highland Quechua Indians, living a traditional lifestyle as pastoralists and horticulturalists, does not support the long-held belief that altitude hypoxia provokes a dramatic compensatory polycythemia in healthy Andeans.

"In order to compensate for the low partial pressure of oxygen at altitude, the human body undergoes a number of physiological changes. A vital component in this process is the increase in the concentration of circulating hemoglobin. The role of HIF-1alpha, erythropoietin and red blood cells in this acclimatization process is described, together with the fall in plasma volume that increases the concentration of hemoglobin in the early stages of hypoxic exposure."

Difference between these people and men on TRT: We have increased blood volume and hemoglobin/hematocrit.

Full paper: Heights and haematology: the story of haemoglobin at altitude

Prevalence, Clinical Profile, Iron Status, and Subject-Specific Traits for Excessive Erythrocytosis in Andean Adults Living Permanently at 3,825 Meters Above Sea Level

"We found a lower prevalence of high red blood cells than in previous reports in the Peruvian Andes. Although the presence of hypoxemia and decreased vital capacity were strongly associated with excessive erythrocytosis, being overweight or having metabolic syndrome were associated with an important fraction of cases in our study population."

Lack of Prominent Compensatory Polycythemia in Traditional Native Andeans Living at 4,200 Meters

Abstract
Red blood cell count (RBC), hemoglobin concentration ([Hb]) and hematocrit (Hct) were measured in 303 male Quechua children and adults, aged 6 to 57 years, living a lifestyle as traditional pastoralists and horticulturalists at a mean altitude of 4,200 m in the Southern Peruvian Andes. Values for RBC, [Hb], and Hct increased with age from middle childhood to young adulthood. However, among adults there was no significant association between age and any of these three parameters. Overall, there was approximately a 10-12% increase in the RBC, [Hb], and Hct above sea-level norms for all age groups. Mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) showed a slight but significant increase with age in children and adolescents, but the mean corpuscular hemoglobin concentration (MCHC) did not. We conclude that the study of highland Quechua Indians, living a traditional lifestyle as pastoralists and horticulturalists, does not support the long-held belief that altitude hypoxia provokes a dramatic compensatory polycythemia in healthy Andeans.

Nelson, from your experience and what you know from others....do men on TRT who currently live at sea level and have a stable Hematocrit/Hemoglobin that sits usually in the low 50's....If I were to relocate to a higher elevation location like 2,500-3,000 ft would my Hematocrit and Hemoglobin further increase because of the thinner oxygen or would they remain stable as I already have an increased RBC to counteract this increase in altitude due to the fact that I'm on testosterone?

I have been on TRT 3 years and have had to employ all the tricks to maintain my H/H in decent levels, lowered my overall T dose, inject daily, drink a gallon of water per day and eat 2 whole grapefruit per day.

Additionally is there any correlation to the difference in injecting Subq vs Intramuscular as it pertains to H/H? Basically wanting to relocate from Florida to Arizona, but don't want the headache of my H/H further increasing because I am now living at a much higher altitude.

I would greatly appreciate any of the experts to chime in...Thanks!

 

[Nelson Vergel]

@Nighthawk

Search results for: 'blog intramuscular vs subcutaneous testosterone injections are they both effective'

www.discountedlabs.com

 

[GreenMachineX]

@Nighthawk

Search results for: 'blog intramuscular vs subcutaneous testosterone injections are they both effective'

www.discountedlabs.com

What could the mechanism be that subq allows for more test but lower hct?

 

[Nelson Vergel]

I don't think comparing the same dose per week of 1 IM shot versus 2 subq shots leads to more testosterone. What it does is smoothing peaks and valleys, so testosterone tests may catch what seems more testosterone blood levels. Having lower peaks may lower the chances to stimulate more red blood cell production.

I also think lower dose subcutaneous (or shallow IM) doses can decrease chances of water retention and blood pressure. At least that is my experience.

 

[Deleted member 16042]

Nelson, from your experience and what you know from others....do men on TRT who currently live at sea level and have a stable Hematocrit/Hemoglobin that sits usually in the low 50's....If I were to relocate to a higher elevation location like 2,500-3,000 ft would my Hematocrit and Hemoglobin further increase because of the thinner oxygen or would they remain stable as I already have an increased RBC to counteract this increase in altitude due to the fact that I'm on testosterone?

I have been on TRT 3 years and have had to employ all the tricks to maintain my H/H in decent levels, lowered my overall T dose, inject daily, drink a gallon of water per day and eat 2 whole grapefruit per day.

Additionally is there any correlation to the difference in injecting Subq vs Intramuscular as it pertains to H/H? Basically wanting to relocate from Florida to Arizona, but don't want the headache of my H/H further increasing because I am now living at a much higher altitude.

I would greatly appreciate any of the experts to chime in...Thanks!

I live at over 9000' and was able to mitigate high HCT easily through dose reduction. (N=1), leaving my labs at the edge of high normal range for TT and FT. I also had elevated BP that resolved.