Thanks for sharing.
"
However, concerns remain regarding the safety of TTh. Although most studies demonstrate benefit or no change in cardiovascular disease (CVD), a few have reported higher CVD in men prescribed TTh.14–17 An explanation for these discrepant findings is that the population of men with adult-onset TD is heterogeneous18; thus, subgroups with different lifestyles, genetic, and environmental factors may influence clinical outcomes. Hematocrit (HCT) is a possible candidate in determining outcome as an increase in this variable is the commonest effect of TTh.19–21 Different guidelines have set varying HCT percentage thresholds above which they recommend withholding/discontinuing TTh and/or phlebotomy. For example, the British Society of Sexual Medicine,4 Endocrine Society,22 American Urological Association,23 and European Association of Urology24 have all adopted a threshold of 54%. The International Society for the Study of the Aging Male has adopted an HCT threshold of 52%,25 whereas the International Consultation for Sexual Medicine26 has recommended an even more conservative HCT threshold of just 50%.
HCT levels have been associated with changes in morbidity and mortality, although findings vary.19 A meta-analysis of 16 studies has shown that the highest HCT tertile (>0.463) was associated with increased CVD compared with the lowest tertile (<0.417).27 Similarly, in the Framingham cohort (of >34 years follow-up), the highest HCT quintile was associated with increased CVD as well as all-cause mortality.28 However, the European Prospective Investigation into Cancer and Nutrition-Netherlands study found no difference in CVD between the tertile distributions (>0.47 vs. <0.45) in CVD-free individuals.29 In the Scottish Heart Health Extended Cohort Study, HCT (mean ± SD: 0.4381 ± 0.0394) was significantly associated with CVD events and mortality, although this association was lost when the analysis was adjusted for the following confounders: lipids, blood pressure (BP), diabetes, smoking status, family history of CVD, and fibrinogen.30
Boffetta et al. suggested that this lack of consensus may result from a nonlinear relationship between HCT, CVD, and mortality.31 Thus, a U-shaped relationship between categories of HCT and mortality was found in Iranian adults of both genders, with low and high HCT values associated with increased overall mortality.31 Locatelli et al. found, after erythropoietin therapy in patients with end-stage renal disease and low baseline HCT (0.301 ± 0.045), that mortality was inversely proportional to the increase in HCT, also suggesting that the association between morbidity/mortality and HCT is nonlinear.32
The clinical impact of increased HCT during TTh requires further understanding. In this study, we report baseline characteristics of the men prescribed/not prescribed TTh and compare changes in HCT (intra- and intergroup), though our focus is primarily on men prescribed TTh. This is because of the current uncertainty regarding clinical outcomes associated with change in HCT after TTh. We studied the relationship between HCT and all-cause mortality in men on TTh. HCT is associated with hemoglobin (Hb) level33,34 and BP,35–37 both of which are predictors of mortality.38–42 Hence, these and other established risk factors such as waist circumference (WC), HbA1c, total cholesterol (TC), and triglycerides (TG) at the final assessment were included (if found to be significantly associated with mortality) as confounding variables."
Results:
The median hematocrit was 49 on TRT (testosterone undecanoate. Not sure if oral or injectable).
These men also had good blood pressure values. I am not sure this is what I see in most men using T injections. They usually have hematocrit over 53 and higher blood pressure.
