Does a high hematocrit change your blood's clotting profile? High altitude vs TRT.

[Ribeye]

Definitely both increase thrombotic risks

Is it safe for men with history of PE and on blood thinners to start testosterone ?

There are no published studies conducted on men with a history of pulmonary embolism (PE) who are taking blood thinners and want to use testosterone replacement therapy (TRT). However, they do provide a broad overview of the relationship between TRT and the risk of venous thromboembolism (VTE)...

www.excelmale.com

This makes sense, but perhaps because they have underlying risk factors a clotting risk in the first place not because of hematocrit per se, but platelet dysfunction...why else would they be on blood thinners?

 

[aloetard]

not to worry about it until it gets to at least 54%

Blanket advice like this seems dangerous to me until one understands the individual's particular history. Hct by itself just a part of what determines whole blood viscosity (WBV)...see plasma viscosity discussion above. 54% may result in widely different WBVs (and blood pressure, endothelial shear stress) for two different patients.

 

[Ribeye]

Blanket advice like this seems dangerous to me until one understands the individual's particular history. Hct by itself just a part of what determines whole blood viscosity (WBV)...see plasma viscosity discussion above. 54% may result in widely different WBVs (and blood pressure, endothelial shear stress) for two different patients.

Your evidence makes for good reading but in and of itself, isn't conclusive clinical study. Consequently, it adds cost, worry for perhaps very few people, and based on the more recently clinical studies on testosterone replacement, contradictory in that those show no increased risk of cardiovascular events. Men are not stroking out from T therapy right and left or suffering other cardiovascular events. Medical history is replete with theoretical risks that never seem to bear out clinical reality. There are now likely millions getting replacement therapy. IF your theory were a significant, common or even somewhat likely risk, leading clinical physicians would be seeing more of it expressed clinically. It would be getting published. It is likely, there are some, but relatively few who are at real risk, and they likely are at risk whether they are getting T replacement or not.

 

[Systemlord]

As one who nearly depleted my iron, it was a stupid decision I made because a primary care doc, not my HRT provider, convinced me I was going to have a stroke if my HCT didn't come down.

All doctors know is the polycythemia vera data which is an inherited blood clotting disorder. These people can clot and have a stroke if their HCT is low but more likely when HCT is high. It's the disease process that causes the clotting, not the HCT values.

Many doctors can't even differentiate between high altitude induced secondary erythrocytosis and erythrocytosis caused by TRT.

 

[Systemlord]

Blanket advice like this seems dangerous to me until one understands the individual's particular history. Hct by itself just a part of what determines whole blood viscosity (WBV)...see plasma viscosity discussion above. 54% may result in widely different WBVs (and blood pressure, endothelial shear stress) for two different patients.

My HCT is 55% and hemoglobin 19.4 and blood pressure 118/71 69 bpm. My blood pressure is continuing to decline since stopping my beta blocker. It's funny really, my blood pressure numbers are better off the beta blocker.

As one who nearly depleted my iron, it was a stupid decision I made because a primary care doc, not my HRT provider, convinced me I was going to have a stroke if my HCT didn't come down. He then sent me to hematologist, who was more knowledgeable, and didn't think I even needed to donate with an HCT at 51%. Bottom line, my HRT provider that I should have trusted, was telling me the truth all along and not to worry about it until it gets to at least 54%.

I went through the same experience, monthly phlebotomies and out of the blue my endo contacted me to tell me I no longer need to blood let if I have no symptoms. It's difficult to know who to trust when it's your life on the line.

That doesn't mean a guy won't have issues with HCT at 52%, it's very individual. Doctors need to stop treating everyone same.

 

[aloetard]

Your evidence makes for good reading but in and of itself, isn't conclusive clinical study. Consequently, it adds cost, worry for perhaps very few people, and based on the more recently clinical studies on testosterone replacement, contradictory in that those show no increased risk of cardiovascular events. Men are not stroking out from T therapy right and left or suffering other cardiovascular events. Medical history is replete with theoretical risks that never seem to bear out clinical reality. There are now likely millions getting replacement therapy. IF your theory were a significant, common or even somewhat likely risk, leading clinical physicians would be seeing more of it expressed clinically. It would be getting published. It is likely, there are some, but relatively few who are at real risk, and they likely are at risk whether they are getting T replacement or not.

I respect your perspective.

It is getting published...

Testosterone use causing erythrocytosis

www.ncbi.nlm.nih.gov

I hope you are right that for most it is not a concern. In the end it is what happens for each individual that is important to them. I am happy to flag the concern.

 

[Ribeye]

My HCT is 55% and hemoglobin 19.4 and blood pressure 118/71 69 bpm. My blood pressure is continuing to decline since stopping my beta blocker. It's funny really, my blood pressure numbers are better off the beta blocker.


I went through the same experience, monthly phlebotomies and out of the blue my endo contacted me to tell me I no longer need to blood let if I have no symptoms. It's difficult to know who to trust when it's your life on the line.

That doesn't mean a guy won't have issues with HCT at 52%, it's very individual. Doctors need to stop treating everyone same.

Absolutely true. some may be symptomatic at HCT 52% others might be just fine. its what is contemptuously referred to by those in the medicine as "cookbook" medicine. Problem is X everyone gets drugY, and the response is in the therapeutic window so the patient must be good.....not really. My Hypothyroid Hashimoto's proved to me cookbook medicine doesn't work. We are all individuals.

 

[aloetard]

Hypothyroid Hashimoto's

Agreed. I take 336 mcg/day of T4 plus a smidge (12.5 mcg/day) of T3 to keep my TSH around 3. Tricky business.

 

[Ribeye]

Agreed. I take 336 mcg/day of T4 plus a smidge (12.5 mcg/day) of T3 to keep my TSH around 3. Tricky business.

Know what you mean. After three endocrinoligists telling me that my Synthroid (T4) "level" was in the middle of the therapeutic window, it's not my thyroid, basically go away. When I started on NP Thyroid, I take 120mg, it was like turning on a light bulb. And amazingly, my symptoms dissipated, no more constipation, thinning hair, being cold all the time, and joint aches.

 

[Gman86]

Know what you mean. After three endocrinoligists telling me that my Synthroid (T4) "level" was in the middle of the therapeutic window, it's not my thyroid, basically go away. When I started on NP Thyroid, I take 120mg, it was like turning on a light bulb. And amazingly, my symptoms dissipated, no more constipation, thinning hair, being cold all the time, and joint aches.

Where does ur TSH sit on 120mg of NP thyroid per day? I know it’s irrelevant, since all that matters is how u feel, but still jc where it sits

 

[Ribeye]

Where does ur TSH sit on 120mg of NP thyroid per day? I know it’s irrelevant, since all that matters is how u feel, but still jc where it sits

I have not had it tested for a while but I have been steady on the dose of NP Thyroid for some time now. Symptoms have improved greatly and just not changed. Having said that, my TSH was very low normal range in the therapeutic level. I have no adverse effects. No shaking, no fast heartbeat (if anything my heart rate is already low) no BP changes, nothing. But the best thing for me, since I have Hashimoto's I have NONE of the joint aches anymore. The antibodies tend to accumulate in the joints, especially in the elbows and it becomes or can, painfully similar to arthritis. that's all stopped. I have no real evidence, but I think its because I have taken so much of the load off my thyroid, I am supplementing a good bit to have my TSH at the low end of the window. I don't think my immune system sees my thyroid as foreign any longer and antibody levels have fallen at last tests.

 

[aloetard]

I have not had it tested for a while but I have been steady on the dose of NP Thyroid for some time now. Symptoms have improved greatly and just not changed. Having said that, my TSH was very low normal range in the therapeutic level. I have no adverse effects. No shaking, no fast heartbeat (if anything my heart rate is already low) no BP changes, nothing. But the best thing for me, since I have Hashimoto's I have NONE of the joint aches anymore. The antibodies tend to accumulate in the joints, especially in the elbows and it becomes or can, painfully similar to arthritis. that's all stopped. I have no real evidence, but I think its because I have taken so much of the load off my thyroid, I am supplementing a good bit to have my TSH at the low end of the window. I don't think my immune system sees my thyroid as foreign any longer and antibody levels have fallen at last tests.

Wow, you were able to lick your joint pain and reduce your autoantibody levels with dessicated thyroid treatment? Congrats!

Any before/after data for TPO / TgAB testing?

 

[Gman86]

I have not had it tested for a while but I have been steady on the dose of NP Thyroid for some time now. Symptoms have improved greatly and just not changed. Having said that, my TSH was very low normal range in the therapeutic level. I have no adverse effects. No shaking, no fast heartbeat (if anything my heart rate is already low) no BP changes, nothing. But the best thing for me, since I have Hashimoto's I have NONE of the joint aches anymore. The antibodies tend to accumulate in the joints, especially in the elbows and it becomes or can, painfully similar to arthritis. that's all stopped. I have no real evidence, but I think its because I have taken so much of the load off my thyroid, I am supplementing a good bit to have my TSH at the low end of the window. I don't think my immune system sees my thyroid as foreign any longer and antibody levels have fallen at last tests.

That’s all awesome to hear man! LOVE hearing success stories/ when people figure out what works for them, or at least figure out how to improve upon things. And I was jc where it sits, but pretty sure it’s irrelevant where it sits, while taking exogenous thyroid hormones.

From ur research, do u think where TSH sits is irrelevant while supplementing with exogenous thyroid hormones, or it still matters, to a degree?

I actually stopped taking lugols iodine because I was a little worried that it basically zeroed out my TSH, even tho it did improve my free T3 level. But I’m not sure now if I should have even been concerned with my TSH level, looking back. Do u think I should have been concerned at all? Obv ur not a doctor lol, jc what u personally think. Here’s my labs on lugols below

5/30/23
(1 drop of 2% lugol’s everyday)

TSH - 0.02 (0.4-4.5)

T3 total - 126 (76-181)

T4 total - 4.8 (4.5-10.5)

Free T3 - 5.3 (2.3-4.2)

Free t4 - 1.2 (0.8-1.8)

RT3 - 15 (8-25)

 

[Big_Alan]

Blanket advice like this seems dangerous to me until one understands the individual's particular history. Hct by itself just a part of what determines whole blood viscosity (WBV)...see plasma viscosity discussion above. 54% may result in widely different WBVs (and blood pressure, endothelial shear stress) for two different patients.

Maybe I missed it, but is there a standard blood test that measures WBV? I found this at Quest, is this what the studies use?

Quest Diagnostics: Test Directory