Hematocrit and TRT. How to have balance.

[gerardo]

Hello everybody. When I changed my protocol from Nebido to cypionate, I read that for those with low SHBG 12, the most recommended would be 20mg EOD, but with this protocol my hematocrit went up, BP increased, I had to do phlebotomy and ended up giving myself time to recover ferritin. I know that some people can resist and carry on with their protocol, but with these side effects I couldn't.

I read several articles and topics about TRT and hematocrit control, but many people did not finish the topics saying how they managed to control or ended up giving up TRT and that Undecanoate would be the ester that least caused erythrocytosis. My own experience also says this because I spent 1 year in Nebido and the hematocrit was controlled, but it is a very long ester and any adjustment is time consuming.

If you are sensitive like me to the cypionate, could you share your protocol and your experience of how you did it to control the hematocrit and follow the TRT? If you do phlebotomy, how do you replace the iron so that your ferritin is around 70?

About the TRT protocol I read about the suppression of hepcidin and EPO and that what causes the increase in hematocrit would be more frequent doses such as DOE or ED since it would have little oscillation in the valley and thus our organism would spend more time producing RBCs and that the protocol, for example, 100 mg E7D with the cypionate the organism would stay longer ¨without producing¨ RBCs because there was a greater oscillation in the valley. How to reach the dose / frequency balance of the injections? What is your peak and your ideal valley? I'll leave one of the links where I read it if anyone wants to.

Does Injection Frequency Affect Hematocrit?

I switched from 76mg once a week to 38mg twice a week 2 months ago and my HCT did indeed rise a bit in last weeks blood. I only have 1 blood draw on the new protocol, but for whatever it’s worth RBC, Hemoglobin, Hematocrit, Platelets all rose higher than my previous 5 blood tests on various...

forums.t-nation.com

As this subject has many variables and that each person reacts differently to the frequencies and doses of testosterone I decided to post this topic.

This forum has helped a lot around the world and this topic should help a lot of people who are starting in TRT and who sometimes give up due to lack of information.

Thank you for participating. Good weekend to everyone.

 

[Vince]

Hello everybody. When I changed my protocol from Nebido to cypionate, I read that for those with low SHBG 12, the most recommended would be 20mg EOD, but with this protocol my hematocrit went up, BP increased, I had to do phlebotomy and ended up giving myself time to recover ferritin. I know that some people can resist and carry on with their protocol, but with these side effects I couldn't.

I read several articles and topics about TRT and hematocrit control, but many people did not finish the topics saying how they managed to control or ended up giving up TRT and that Undecanoate would be the ester that least caused erythrocytosis. My own experience also says this because I spent 1 year in Nebido and the hematocrit was controlled, but it is a very long ester and any adjustment is time consuming.

If you are sensitive like me to the cypionate, could you share your protocol and your experience of how you did it to control the hematocrit and follow the TRT? If you do phlebotomy, how do you replace the iron so that your ferritin is around 70?

About the TRT protocol I read about the suppression of hepcidin and EPO and that what causes the increase in hematocrit would be more frequent doses such as DOE or ED since it would have little oscillation in the valley and thus our organism would spend more time producing RBCs and that the protocol, for example, 100 mg E7D with the cypionate the organism would stay longer ¨without producing¨ RBCs because there was a greater oscillation in the valley. How to reach the dose / frequency balance of the injections? What is your peak and your ideal valley? I'll leave one of the links where I read it if anyone wants to.

Does Injection Frequency Affect Hematocrit?

I switched from 76mg once a week to 38mg twice a week 2 months ago and my HCT did indeed rise a bit in last weeks blood. I only have 1 blood draw on the new protocol, but for whatever it’s worth RBC, Hemoglobin, Hematocrit, Platelets all rose higher than my previous 5 blood tests on various...

forums.t-nation.com

As this subject has many variables and that each person reacts differently to the frequencies and doses of testosterone I decided to post this topic.

This forum has helped a lot around the world and this topic should help a lot of people who are starting in TRT and who sometimes give up due to lack of information.

Thank you for participating. Good weekend to everyone.

How high does your HCT get, before you donate blood? And how high do you run your testosterone levels at?

 

[gerardo]

How high does your HCT get, before you donate blood? And how high do you run your testosterone levels at?

My blood count when it reaches 53 BP increases. This test was done when you were on 20 mg of EOD cypionate.

FREE TESTOSTERONE .................: 32.730 ng / dL
Sample: Serum Method: Chemiluminescence and Calculation
Reference Values:
Men:
41 to 60 years: 1,670 to 18,300 ng / dL

TOTAL TESTOSTERONE ..................: 959.04 ng / dL
Sample: Serum Method: Chemiluminescence
Reference Values:
142.3 to 923.1 ng / dL

SHBG 12.7

As the FT was high I decreased the dose to adjust it and over time I had to do another phlebotomy and stopped the TRT to adjust the ferritin, which dropped to 26 and was very weak. I went to a hematologist who asked for tests for polycythemia vera, but I don't think there is any of that. Now I'm thinking about restarting the TRT but it seems to me that even having a low shbg injections subq eod didn't work either it is the ester or I have to start over even more slowly, but I still don't know what my test dose leads to the peak and to the ideal valley.

 

[Vince]

My blood count when it reaches 53 BP increases. This test was done when you were on 20 mg of EOD cypionate.

FREE TESTOSTERONE .................: 32.730 ng / dL
Sample: Serum Method: Chemiluminescence and Calculation
Reference Values:
Men:
41 to 60 years: 1,670 to 18,300 ng / dL

TOTAL TESTOSTERONE ..................: 959.04 ng / dL
Sample: Serum Method: Chemiluminescence
Reference Values:
142.3 to 923.1 ng / dL

SHBG 12.7

As the FT was high I decreased the dose to adjust it and over time I had to do another phlebotomy and stopped the TRT to adjust the ferritin, which dropped to 26 and was very weak. I went to a hematologist who asked for tests for polycythemia vera, but I don't think there is any of that. Now I'm thinking about restarting the TRT but it seems to me that even having a low shbg injections subq eod didn't work either it is the ester or I have to start over even more slowly, but I still don't know what my test dose leads to the peak and to the ideal valley.

You could start with 10 mg of testosterone every other day and see what results you get. With that low shpg you're freeT will always be high.

 

[gerardo]

You could start with 10 mg of testosterone every other day and see what results you get. With that low shpg you're freeT will always be high.

Thank you, vince. What do you think about less frequent doses for hematocrit control based on suppression of hepcidin and EPO?

 

[Vince]

Thank you, vince. What do you think about less frequent doses for hematocrit control based on suppression of hepcidin and EPO?

Have you been tested for Sleep Apnea?

 

[Cataceous]

@gerardo: Be sure to read this thread on the subject of hematocrit, IM vs SC:

IM versus Sub-q T Injections: Effect on TT, hematocrit, E2, and PSA

Comparison of Outcomes for Hypogonadal Men Treated with Intramuscular Testosterone Cypionate Versus Subcutaneous Testosterone Enanthate (2020) Introduction Intramuscular testosterone cypionate (IM-TC) is the conventional treatment option for hypogonadal men with baseline serum total...

www.excelmale.com

The implication is that less variability in serum testosterone—at the same average—results in lower hematocrit. "readalot" does raise some valid questions about the study, however.

 

[gerardo]

@gerardo: Be sure to read this thread on the subject of hematocrit, IM vs SC:

IM versus Sub-q T Injections: Effect on TT, hematocrit, E2, and PSA

Comparison of Outcomes for Hypogonadal Men Treated with Intramuscular Testosterone Cypionate Versus Subcutaneous Testosterone Enanthate (2020) Introduction Intramuscular testosterone cypionate (IM-TC) is the conventional treatment option for hypogonadal men with baseline serum total...

www.excelmale.com

The implication is that less variability in serum testosterone—at the same average—results in lower hematocrit. "readalot" does raise some valid questions about the study, however.

Thanks Cataceous. Regarding hematocrit and variations, what do you think of an injection, for example, 80mg of cypionate once a week or 40mg E3,5D or 20mg EOD?

 

[Cataceous]

Thanks Cataceous. Regarding hematocrit and variations, what do you think of an injection, for example, 80mg of cypionate once a week or 40mg E3,5D or 20mg EOD?

That research suggests that more frequent injections are better. However, even 20 mg EOD can be too much for some guys. That's 7 mg per day of testosterone, above the average production for healthy young men. I've experimented with taking half as much and still did not see a return of hypogonadal symptoms. If testosterone is causing high hematocrit then there must be a dose low enough where this doesn't occur. If this dose is so low that benefits are lost then I hypothesize that creating diurnal variation in serum testosterone levels may help.

 

[gerardo]

Have you been tested for Sleep Apnea?

Have you been tested for Sleep Apnea?

Yes. I have a mild apnea.

 

[gerardo]

That research suggests that more frequent injections are better. However, even 20 mg EOD can be too much for some guys. That's 7 mg per day of testosterone, above the average production for healthy young men. I've experimented with taking half as much and still did not see a return of hypogonadal symptoms. If testosterone is causing high hematocrit then there must be a dose low enough where this doesn't occur. If this dose is so low that benefits are lost then I hypothesize that creating diurnal variation in serum testosterone levels may help.

In the study he used the auto injector but I believe that the cypionate or enanthate that we use must have something different that the half life is not the same as xyosted.

Maybe start with 10Mg EOD as vince suggested.

 

[tareload]

If you are sensitive like me to the cypionate, could you share your protocol and your experience of how you did it to control the hematocrit and follow the TRT? If you do phlebotomy, how do you replace the iron so that your ferritin is around 70?

Daily Injections to Manage Hematocrit - Not Working

Thanks for the question and background. Currently injecting 70 mg TC once per week and just recently added back u-hCG at 400 IU twice per week (which has also helped with mood and well-being). I’ve tried to be meticulous over last year as I recovered from A-FIB episode. 70 mg TC every week...

forums.t-nation.com

 

[tareload]

@gerardo: Be sure to read this thread on the subject of hematocrit, IM vs SC:

IM versus Sub-q T Injections: Effect on TT, hematocrit, E2, and PSA

Comparison of Outcomes for Hypogonadal Men Treated with Intramuscular Testosterone Cypionate Versus Subcutaneous Testosterone Enanthate (2020) Introduction Intramuscular testosterone cypionate (IM-TC) is the conventional treatment option for hypogonadal men with baseline serum total...

www.excelmale.com

The implication is that less variability in serum testosterone—at the same average—results in lower hematocrit. "readalot" does raise some valid questions about the study, however.

I should add some additional comments over at that thread. I don't think we have enough information about that study to make meaningful conclusions. If I remember correctly, I thought my takeaway was the weekly dose for the control arm of the study was different that the Xyosted-equivalent arm:

He did confirm that the sub-Q group received Xyosted. And the other group was dosed weekly. Also: "the IM group was all 100mg cypionate, the Xyosted was a combination of 75 and 100mg. 75mg Xyosted tends to mirror levels obtained with 100mg IM in general."

Compare 75 mg/week or 100 mg/week (pick a number) of TC dose-equivalent - dosed every day vs once weekly for the win! Test hypothesis that dosing frequency makes a difference (peak vs trough, etc).

Or compare sub-Q vs IM once per week at XX mg/week.

But please don't compare Xyosted dosed at 75-100 mg/week vs TC at 100 mg/week, then have two different groups wrt mean age and conclude that Xyosted is the winner. My Hct at 70 mg/week TC very different than at 100 mg/week (same dosing frequency). Some of us very sensitive evidently.

 

[TorontoTRT]

If you’re prone to rapid red cell production and high hematocrit, dosage or frequency change will have zero effect in lowering hematocrit. I’ve been on as low as 80 mg to as high as 200 mg a week. Injecting from every day, to once a week. Hematocrit always stays in the 55-56 range. But unlike you I’ve never had a side effect, and my blood pressure stays low normal.

 

[tareload]

If you’re prone to rapid red cell production and high hematocrit, dosage or frequency change will have zero effect in lowering hematocrit. I’ve been on as low as 80 mg to as high as 200 mg a week. Injecting from every day, to once a week. Hematocrit always stays in the 55-56 range. But unlike you I’ve never had a side effect, and my blood pressure stays low normal.

My experience indicates this blanket statement is not accurate. I'll share the link again and graph.

Daily Injections to Manage Hematocrit - Not Working

Thanks for the question and background. Currently injecting 70 mg TC once per week and just recently added back u-hCG at 400 IU twice per week (which has also helped with mood and well-being). I’ve tried to be meticulous over last year as I recovered from A-FIB episode. 70 mg TC every week...

forums.t-nation.com

Spike in Hct with TC at >120 mg/week. Drop on the right side with 70 mg/week and stable.

 

[TorontoTRT]

I have quarterly tests for over 3 years. Zero effect of lowering hematocrit. Graphs and studies don’t always translate to real life.

 

[tareload]

I have quarterly tests for over 3 years. Zero effect of lowering hematocrit. Graphs and studies don’t always translate to real life.

The graph is my data. Yes, I am a real human, not an AI (artificial intelligence). We have two very different experiences with dose response of TRT on Hct.

 

[gerardo]

I should add some additional comments over at that thread. I don't think we have enough information about that study to make meaningful conclusions. If I remember correctly, I thought my takeaway was the weekly dose for the control arm of the study was different that the Xyosted-equivalent arm:



Compare 75 mg/week or 100 mg/week (pick a number) of TC dose-equivalent - dosed every day vs once weekly for the win! Test hypothesis that dosing frequency makes a difference (peak vs trough, etc).

Or compare sub-Q vs IM once per week at XX mg/week.

But please don't compare Xyosted dosed at 75-100 mg/week vs TC at 100 mg/week, then have two different groups wrt mean age and conclude that Xyosted is the winner. My Hct at 70 mg/week TC very different than at 100 mg/week (same dosing frequency). Some of us very sensitive evidently.

Yes. I agree that this study still needs to be improved.

When you control your hematocrit with 70 mg a week, do you inject once a week or E3D .. with a little more frequency? Thank

 

[gerardo]

If you’re prone to rapid red cell production and high hematocrit, dosage or frequency change will have zero effect in lowering hematocrit. I’ve been on as low as 80 mg to as high as 200 mg a week. Injecting from every day, to once a week. Hematocrit always stays in the 55-56 range. But unlike you I’ve never had a side effect, and my blood pressure stays low normal.

Did you stop a protocol and give the hematocrit time to get low to start another protocol? If you have done this in all attempts with low doses or high doses with more and less often there is really a lot of sensitivity to the testosterone ester. When I used Nebido to control the hematocrit, then I believe that some mechanism in the absorption and in its speed can determine the levels of the hematocrit. However, in some people, the sensitivity is too much.

 

[gerardo]

My experience indicates this blanket statement is not accurate. I'll share the link again and graph.

Daily Injections to Manage Hematocrit - Not Working

Thanks for the question and background. Currently injecting 70 mg TC once per week and just recently added back u-hCG at 400 IU twice per week (which has also helped with mood and well-being). I’ve tried to be meticulous over last year as I recovered from A-FIB episode. 70 mg TC every week...

forums.t-nation.com

View attachment 13856


Spike in Hct with TC at >120 mg/week. Drop on the right side with 70 mg/week and stable.

Your injections of 70 mg once a week Were subq or IM? Have you tested any E4D or E5D or E6D protocols? Thank