EPO vs high HCT

[Gman86]

Why do some guys report getting out of breath easier when their HCT is high, yet athletes use EPO to increase their RBC’s, which would obv increase their HCT as well. Why are these athletes getting improved cardio, while guys on TRT report decreased cardio when their HCT levels get too high?

 

[testiculus]

There is a point where increased HCT reduces oxygen transfer capacity due to high blood viscosity. Blood viscosity can become so high with EPO that death is the result. Several pro cyclists died in the early days of EPO use until they understood more is not better. As to why pro athletes get benefit when the average TRT patient gets reduced performance from the increased HCT:

The average guy on TRT isn't in their 20's
The average guy on TRT wasn't exercising 25 hours a week before starting TRT
The average guy on TRT doesn't have a resting HR of 28

In other words they are able to get benefit due the massive capacity of their cardiovascular system and tremendous flexibility of their arteries such that they can accommodate the increased blood viscosity (up to a point).

 

[tareload]

There is a point where increased HCT reduces oxygen transfer capacity due to high blood viscosity. Blood viscosity can become so high with EPO that death is the result. Several pro cyclists died in the early days of EPO use until they understood more is not better. As to why pro athletes get benefit when the average TRT patient gets reduced performance from the increased HCT:

The average guy on TRT isn't in their 20's
The average guy on TRT wasn't exercising 25 hours a week before starting TRT
The average guy on TRT doesn't have a resting HR of 28

In other words they are able to get benefit due the massive capacity of their cardiovascular system and tremendous flexibility of their arteries such that they can accommodate the increased blood viscosity (up to a point).

Awesome. I will throw in vasodilation and nitric oxide capabilities that your 35 BMI TOT patient ain't got.

Thank you @testiculus.

 

[Nelson Vergel]

Testosterone increases not only the proportion of red blood cells (hematocrit), but also blood volume. Older men with TRT-induced high hematocrit (and usually more blood volume due to water retention) may have more issues with lower VO2 max.

The paradox of hematocrit in exercise physiology: which is the "normal" range from an hemorheologist's viewpoint? - PubMed

The paradox of hematocrit in exercise physiology is that artificially increasing it by autotransfusion or erythropoietin doping improves VO2 max and performance, while in normal conditions there is a strong negative correlation between hematocrit and fitness, due to a training-induced...

pubmed.ncbi.nlm.nih.gov

Hematocrit: High or Low? All You Need to Know - SelfDecode Labs

Hematocrit measures red blood cells, which carry oxygen throughout the body. Learn what to do if your results are too high or low here.

labs.selfdecode.com

Interesting (and very long) article:

Limiting Factors – A Genesis of Blood Doping (Part Two) – FasterSkier.com

 

[tareload]

Also see here...

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

https://forums.t-nation.com/t/does-high-hematocrit-lead-to-complications-for-men-on-trt/268171/65 Update on my experiment with 325 mg/day of aspirin. Potent reduction in Hct while on TRT. One of the few supplements I've tried that really had a significant effect on Hct. Please consider the...

www.excelmale.com

 

[tareload]

Testosterone increases not only the proportion of red blood cells (hematocrit), but also blood volume. Older men with TRT-induced high hematocrit (and usually more blood volume due to water retention) may have more issues with lower VO2 max.

The paradox of hematocrit in exercise physiology: which is the "normal" range from an hemorheologist's viewpoint? - PubMed

The paradox of hematocrit in exercise physiology is that artificially increasing it by autotransfusion or erythropoietin doping improves VO2 max and performance, while in normal conditions there is a strong negative correlation between hematocrit and fitness, due to a training-induced...

pubmed.ncbi.nlm.nih.gov

Hematocrit: High or Low? All You Need to Know - SelfDecode Labs

Hematocrit measures red blood cells, which carry oxygen throughout the body. Learn what to do if your results are too high or low here.

labs.selfdecode.com

Interesting (and very long) article:

Limiting Factors – A Genesis of Blood Doping (Part Two) – FasterSkier.com

Very nice Nelson. Thanks!

 

[Willyt]

Great thread @Gman86 . I have often wondered the same usually at this time of year with the Tour de France. When above range, my cardio dropped off significantly with that heavy breath feeling. The 10+ lbs of water retention at higher levels did not help either.

I have also wondered how a cardio athlete doping with T would deal with the poor sleep side effect that many experience with supra-physiological levels of T. Sleep would seem essential to a highly tuned cardio machine. Maybe being younger enables them to power through it.

 

[Gman86]

Great thread @Gman86 . I have often wondered the same usually at this time of year with the Tour de France. When above range, my cardio dropped off significantly with that heavy breath feeling. The 10+ lbs of water retention at higher levels did not help either.

I have also wondered how a cardio athlete doping with T would deal with the poor sleep side effect that many experience with supra-physiological levels of T. Sleep would seem essential to a highly tuned cardio machine. Maybe being younger enables them to power through it.

I feel like not sleeping well on HRT is most likely due to HRT using up more micronutrients, and leaving the person with micronutrient deficiencies. Guys have no idea how important it is to give the body all
the micronutrients it needs everyday. I’d put money on ur sleep improving if u got most of ur protein for the day from red meat, and ate 0.75-1g of protein per 1lb of bodyweight, increased ur pastured egg yolk intake, regularly consumed beef liver, and supplemented with magnesium and vitamin D.

I’ve tried every protocol there is, as far as HRT goes, and I push the limits a decent amount, and I’ve always slept well on HRT these past 10 years. I personally chalk that up to being a health freak and eating such a healthy/ micronutrient packed diet everyday. Don’t mean to derail my own thread lol, but hopefully those tips help u out sleep wise, if ur willing to implement them. Sleep is literally everything, so I hope u can get that issue figured out

 

[Gman86]

Thanks for all the replies. They definitely make sense

 

[mikeb29]

Im confused (easily done). I do full distance triathlons and have HCT around 50%. My running ability has decreased whilst on TRT over the last 5 years (although I am older now at 40). Would I actually be better off trying to reduce my HCT?

 

[Willyt]

Im confused (easily done). I do full distance triathlons and have HCT around 50%. My running ability has decreased whilst on TRT over the last 5 years (although I am older now at 40). Would I actually be better off trying to reduce my HCT?

Interesting. Do you sense that the slow down is due mostly to age? Or do you feel that your endurance has suffered post TRT? If the latter, what do you think is the main TRT-related driver? Water weight, labored breathing, increased heart rate, etc?

 

[aneuman]

Im confused (easily done). I do full distance triathlons and have HCT around 50%. My running ability has decreased whilst on TRT over the last 5 years (although I am older now at 40). Would I actually be better off trying to reduce my HCT?

Interesting. A year ago I starting working out and walking close to 5 miles a day every day. Every morning I walk 1.25 miles around the office which I did fairly comfortable. Up until May 31, based on my Apple Watch activity monitor, my "Cardio Fitness" (VO2Max) was 35.4, and my "cardio recovery" (drop in heart rate after exercise) was 37 bpm.

I started TRT at 90 mg T.Cyp. a week (3 x 30, M-W-F) on June 1st, and now my 1.25 miles morning walk feel like I'm slightly gasping for air, nothing major, but get the psychological need to breath stronger, as if my chest wouldn't dilate enough, or my throat was constricted, my cardio recovery is now 34 bpm, and my VO2max is 33.1

The only change has been starting TRT 6 weeks ago. When I started out, my blood work indicated my hemoglobin was 15.5 g/dL and my HCT was 47. I had been on Enclomiphene + hCG in one form or another for the past year and a half and my average total T during that time was 767 ng/dL, so that may explain why my HCT was 47

These are my stats now:

I do not have the results of the first lab work after starting TRT, but it correlates with your experience.

Anyone has any thoughts?

Edit: In general I feel like I have to make an effort to breathe. Notice, it's not like I'm gasping for air, my blood oxygen is about 95% (never been very high though) but it's more like a "feeling" or "awareness" that I need to breath harder, difficult to explain, so I understand if you are confused. No need to go to the ER or get an oxygen tank yet, at least for now.

 

[tareload]

Im confused (easily done). I do full distance triathlons and have HCT around 50%. My running ability has decreased whilst on TRT over the last 5 years (although I am older now at 40). Would I actually be better off trying to reduce my HCT?

Any idea what your VO2max was then vs now? What do you mean running ability? Your times, pain, what?

Yes your times will drop as you age. We are all slowly dying. Some faster than others.

 

[aneuman]

Any idea what your VO2max was then vs now? What do you mean running ability? Your times, pain, what?

Yes your times will drop as you age. We are all slowly dying. Some faster than others.

Interesting. I just replied to this thread just a minute ago with a similar anecdote listing my VO2. I'd be glad if you looked at it.

 

[tareload]

I feel like not sleeping well on HRT is most likely due to HRT using up more micronutrients, and leaving the person with micronutrient deficiencies. Guys have no idea how important it is to give the body all
the micronutrients it needs everyday. I’d put money on ur sleep improving if u got most of ur protein for the day from red meat, and ate 0.75-1g of protein per 1lb of bodyweight, increased ur pastured egg yolk intake, regularly consumed beef liver, and supplemented with magnesium and vitamin D.

I’ve tried every protocol there is, as far as HRT goes, and I push the limits a decent amount, and I’ve always slept well on HRT these past 10 years. I personally chalk that up to being a health freak and eating such a healthy/ micronutrient packed diet everyday. Don’t mean to derail my own thread lol, but hopefully those tips help u out sleep wise, if ur willing to implement them. Sleep is literally everything, so I hope u can get that issue figured out

I do all of that and it helps zero once I was too high on the androgens. Pushing on the androgen disrupts sleep cycle and keeps you sympathetically activated 24 hours a day with typical injectable regimens which also are best bang for your buck muscle wise.

I know this will be controversial but you know what works great for sleep on lots of Test?.....clonazepam intermittently on top of escitalopram.. key word is intermittent hence it is not a sustainable solution but a nice treat on cycle or TOT

Ahh, polypharmacy. Can get ugly in a hurry.

 

[tareload]

Interesting. A year ago I starting working out and walking close to 5 miles a day every day. Every morning I walk 1.25 miles around the office which I did fairly comfortable. Up until May 31, based on my Apple Watch activity monitor, my "Cardio Fitness" (VO2Max) was 35.4, and my "cardio recovery" (drop in heart rate after exercise) was 37 bpm.

I started TRT at 90 mg T.Cyp. a week (3 x 30, M-W-F) on June 1st, and now my 1.25 miles morning walk feel like I'm slightly gasping for air, nothing major, but get the psychological need to breath stronger, as if my chest wouldn't dilate enough, or my throat was constricted, my cardio recovery is now 34 bpm, and my VO2max is 33.1

The only change has been starting TRT 6 weeks ago. When I started out, my blood work indicated my hemoglobin was 15.5 g/dL and my HCT was 47. I had been on Enclomiphene + hCG in one form or another for the past year and a half and my average total T during that time was 767 ng/dL, so that may explain why my HCT was 47

I do not have the results of the first lab work after starting TRT, but it correlates with your experience.

Anyone has any thoughts?

Edit: In general I feel like I have to make an effort to breathe. Notice, it's not like I'm gasping for air, my blood oxygen is about 95% (never been very high though) but it's more like a "feeling" or "awareness" that I need to breath harder, difficult to explain, so I understand if you are confused. No need to go to the ER or get an oxygen tank yet, at least for now.

Be interesting to see your latest Hct after a few months post T intervention. I am not familiar with the variance or accuracy of the Apple products for VO2max. The HRR should be reliable if you are getting your HR up there during exercise.

Your protocol seems quite reasonable so if you see a large bump in Hct then more blood work may be in order. I also have experienced this air hunger symptom in the past.

 

[aneuman]

Be interesting to see your latest Hct after a few months post T intervention. I am not familiar with the variance or accuracy of the Apple products for VO2max. The HRR should be reliable if you are getting your HR up there during exercise.

Your protocol seems quite reasonable so if you see a large bump in Hct then more blood work may be in order. I also have experienced this air hunger symptom in the past.

Do you think an increase in HCT could explain the "perceived" shortness of breath? Is that common on those starting TRT?

 

[tareload]

Do you think an increase in HCT could explain the "perceived" shortness of breath? Is that common on those starting TRT?

Common? Probably not. But definitely possible depending on baseline cardiovascular status.

Extreme example:

Nandrolone for Mood | Feeling much Better..

I think they all contribute some really good things to the field overall, but u unfortunately have to take certain things they all say with a grain of salt, @readalot, lets go with @Gman86 here. Let's critically listen to everything these guys say, and use what's good (if any), discard what's...

www.excelmale.com

My experience was similar to going up to 10,000 feet and hiking but obviously not as bad. Your cardiopulmonary system may be adapting to your changing Hct/blood viscosity. Hard to say without bloodwork.

You look like your cardio fitness is good.

Me: I get extremely red in the chest when the Hct climbs. BP ok but vascularity really pops. Probably not smart long term. I have switched from regular dose aspirin (325 mg) daily to baby aspirin (80 mg) daily.

Escitalopram has worked well for me the last 10 months to control anxiety / panic as I have ramped T dose starting back at 60 mg/week last June 2022. Been ramping in 20 mg/week increments every few months. Sleep has finally started to really fail on my last bump up to 160 mg/week hence adding back in the clonazepam on top of melatonin.

Reminder to update all this in @FunkOdyssey 's nice thread on SSRI/ADs. At least for me there is no free lunch on even modest TOT. Pay to play.

 

[aneuman]

Escitalopram has worked well for me the last 10 months to control anxiety / panic as I have ramped T dose starting back at 60 mg/week last June 2022. Been ramping in 20 mg/week increments every few months. Sleep has finally started to really fail on my last bump up to 160 mg/week hence adding back in the clonazepam on top of melatonin.

That's my hypothesis actually. I feel a little bit more anxious/on edge (something I'm very familiar with) after starting TRT (after the 3rd week actually) and I think that this "breathing" issue could be somehow anxiety, as it's very similar to how it feels when you have a panic attack. Like having an "elephant sitting on your chest", this time a baby elephant, not a grown one, so I hope that the body adapts to it. I had a slightly better experience with HCG, not nearly as pronounced, and it went away eventually.

I'm using 0.5mg clonazepam to sleep. I'm actually very apprehensive of taking any SSRI as it ruined my ability to orgasm about 15 years ago, and I'm not sure I've ever recovered. I took Lexapro I believe. Not something I'm willing to do again.

 

[aneuman]

Me: I get extremely red in the chest when the Hct climbs. BP ok but vascularity really pops.

I know I should be careful what I wish for, but I need some of this. Every time I go to quest they stab me in the arm 20 times trying to locate a vein and they can't find one. Is there any way to attach a faucet to a vein? Doing this every 6 months amounts to torture.