Hematocrit and TRT. How to have balance.

[tareload]

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

Weekly shallow IM (deep Sub-Q ).

 

[tareload]

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

Re-read the post:

What Benefits with Different Injection Frequencies?

I’ll posit this has to do with both dose and frequency. If I remember correctly trying to trace back the kinetics of testosterone on hepcidin suppression and to EPO, it’s first order. Once you reach saturation, you can’t make more RBCs. If your dosages are too high then daily frequency ain’t...

forums.t-nation.com

I'd argue at 70 mg/week with my clearance rate that it wouldn't make a difference whether you are doing ED or weekly frequency. My argument based on my response (TT vs TC dose) was that dosing less frequently may allow you to get away with higher effective weekly dose WRT Hct by dosing weekly instead of daily.

I haven't done the definitive trial to prove so it was just conjecture. As @Cataceous mentioned, primary driver would be weekly effective dose and trying to find balance between symptom resolution vs elevated Hct.

There are clearly many camps with some thinking physiologic TT/free T should be adequate and others who argue running supra-physiologic is needed for some. In the latter camp, elevated Hct is argued to be harmless many times. The later camp's system didn't work for me.

 

[Vince]

I was able to control my HCT, once I went to daily injection. I've not donated blood for, I'm guessing 4 plus years. After donating every 8 weeks for 2 years. I may have stabilize my HCT, because of longevity? Or daily injections? Or maybe a combination of both?

 

[gerardo]

Re-read the post:

What Benefits with Different Injection Frequencies?

I’ll posit this has to do with both dose and frequency. If I remember correctly trying to trace back the kinetics of testosterone on hepcidin suppression and to EPO, it’s first order. Once you reach saturation, you can’t make more RBCs. If your dosages are too high then daily frequency ain’t...

forums.t-nation.com

I'd argue at 70 mg/week with my clearance rate that it wouldn't make a difference whether you are doing ED or weekly frequency. My argument based on my response (TT vs TC dose) was that dosing less frequently may allow you to get away with higher effective weekly dose WRT Hct by dosing weekly instead of daily.

I haven't done the definitive trial to prove so it was just conjecture. As @Cataceous mentioned, primary driver would be weekly effective dose and trying to find balance between symptom resolution vs elevated Hct.

There are clearly many camps with some thinking physiologic TT/free T should be adequate and others who argue running supra-physiologic is needed for some. In the latter camp, elevated Hct is argued to be harmless many times. The later camp's system didn't work for me.

Weekly shallow IM (deep Sub-Q ).

OK thanks. Which needle do you use for Deep Subq?

 

[gerardo]

I was able to control my HCT, once I went to daily injection. I've not donated blood for, I'm guessing 4 plus years. After donating every 8 weeks for 2 years. I may have stabilize my HCT, because of longevity? Or daily injections? Or maybe a combination of both?

Thank you Vince. With the time and adjustment for more frequent injection you managed but to get to that how were your protocols that did not work well for the control of hematocrit?

 

[Vince]

Thank you Vince. With the time and adjustment for more frequent injection you managed but to get to that how were your protocols that did not work well for the control of hematocrit?

Twice a week injections.

 

[gerardo]

Twice a week injections.

Did you try injections once a week?

 

[Vince]

Did you try injections once a week?

No, I never did once a week injections.

 

[gerardo]

No, I never did once a week injections.

Ok Vince. Thank

 

[gerardo]

Hello. I am updating some data. On the 20th of March I was not doing TRT and I started trying 12.5 Mg of Clomid 2 x a week and 250 mcg of Hcg 2 x a week.


March 20, 2021:

HEMACIES IN MILLIONS / mm 5.31
HEMOGLOBIN IN g / dL 16.40
HEMATOCRIT IN% 50
RDW-13.0
LEUKOCYTES 8180, mm³
PLATELETS 187,000 / mm³
IRON 138
ESTRADIOL E2 .. <10.0 pg / mL
PROGESTERONE ........................: <0.10 ng / mL
FSH 0.55
LH 0.19 mIU / mL
FERRITINE 39.5 ng / mL
INSULIN 11.0 µU / mL
FREE TESTOSTERONE 9,410 ng / dL
TOTAL TESTOSTERONE 345.94 ng / dL

 

[gerardo]

On the 9th of April 2021

I kept trying Hcg and Clomid but the libido went down and the headache was very strong when I woke up. In the previous week I had a phlebotomy of 200 ML of blood.

HEMACIES IN MILLIONS / mm3 ......: 5.07 (4.5 to 5.9)
HEMOGLOBIN IN g / dL ..........: 15.40 (13.5 to 18.0)
HEMATOCRIT IN% .............: 45 (40.0 to 55)
RDW- 10.2 (11.5 to 16.0)
LEUKOCYTES 5550, mm³ (4,000 to 10,600)
PLATE COUNTING ..............: 188,000 / mm (150,000 to 450,000)
GLYCOSYLED HEMOGLOBIN .............: 5.6%
TSH .....: 1,864 µUI / mL (0.35 µUI / mL to 4.94 µUI / mL)
PROLACTIN .........................: 8.74 ng / mL (3.46 to 19.40)
FREE TESTOSTERONE .................: 10,290 ng
TOTAL TESTOSTERONE ..................: 381.87 ng /
SHBG 18.7 nmol / L (Men 20 to 50 years old ..................: 13.2 to 89)
T3 REVERSE ..........................: 22.30 ng / dL (6 to 76 ng / Dl)
TOTAL CHOLESTEROL ....................: 254 mg / dL (Desirable Value: Less than 190 mg / dL
CHOLESTEROL HDL ......................: 34 mg / dL (Desirable Value: Greater than 40 mg / dL) CHOLESTEROL LDL ........ ..............: 163 mg / dL
TRIGLYCERIDES .......................: 285.0 mg / dL (Desirable Value: Less than 150 mg / dL CREATININ ........ ..................: 0.8 mg / dL (0.8 to 1.5 mg / dL)
TGP ......: 27.0 U / L
FSH ..: 1.74 mIU / mL (0.95 to 11.95 mIU / mL)
LH ..........: 0.48 mIU / mL (0.57 to 12.7 mIU / mL)
FREE THYROXIN - FREE T4 ...........: 0.80 ng / (0.70 to 1.48 ng / dL)
CORTISOL BASAL ......................: 6.80 µg / dL (Collection before 10: 00hrs: 3.7 - 19.4 µg / dL)

 

[gerardo]

No, I never did once a week injections.

May 1, 2021 after taking the blood test I took 12.5mg of clomid and started the protocol with 25MG of subq enanthate in the EOD deltoid with a 27G1 / 2 needle. The libido got low and I stopped the clomid. Day 03 I applied 50Mg of enanthate and day 05 today I applied another 50 Mg IM in the gluteus in the needle 30x0.7. I did a quick scan of the hematocrit and it is now 45. What a strange thing. With the cypionate I was very sensitive and now with the enanthate I feel nothing. Could it be that this enanthate is underdosed? 125Mg should I raise my TT for how much?

These exams below were done on May 1st before starting the protocol with Enantato. I am also taking 12.5 mcg of T4 + 5 mcg of T3 a day, 50 Mg of Chelated Iron.

HEMACIES IN MILLIONS / mm3 ......: 5.15 (4.5 to 5.9)
HEMOGLOBIN IN g / dL ..........: 15.80 (13.5 to 18.0)
HEMATOCRIT IN% .............: 45 (40.0 to 55.0)
LEUKOCYTES 8080, mm³ (4,000 to 10,600)
PLATE COUNTING ..............: 178,000 / mm³ (150,000 to 450,000 / mm³) IRON ..................... ..........: 130 ug / dL (49 to 181 ug / dL)
GLYCOSYLED HEMOGLOBIN .............: 5.6%
ANTIBODY ANTI PEROXIDASE ANTI-TPO ..: Less than 1.0 IU / mL (Less than 5.61 IU / mL)
ESTRADIOL E2 ........................: <10.0 pg / mL (Men: 11.0 to 44.0)
FSH ..: 2.93 mIU / mL (Men: 0.95 to 11.95 mIU / mL)
LUTEINIZING HORMONE - LH ..........: 1.30 mIU / mL (Men: 0.57 to 12.7 mIU / mL)
PROGESTERONE ........................: 0.10 ng / mL (Men: Up to 0.2 ng / mL)
PROLACTIN .........................: 10.64 ng / mL (Men: 3.46 to 19.40 ng / mL)
T3- FREE TRIIODOTHYRONIN ...........: 3.39 pg / mL (1.71 to 3.71 pg / mL)
FREE THYROXIN - FREE T4 ...........: 0.81 ng / dL (0.70 to 1.48 ng / dL)
FERRITINE ...........................: 91.3 ng / mL (17.9 to 464 ng / mL)
ANTI-THYREOGLOBULIN - AAT ...........: 0.85 IU / mL (Less than 4.11 IU / mL)
INSULIN ............................: 12.2 µU / mL (2.0 to 25.0 µU / mL)
FREE TESTOSTERONE .................: 10,950 ng / dL
TOTAL TESTOSTERONE ..................: 396.96 ng / dL
SHBG: 17.8 nmol / L

What do you think? Estradiol is always low and SHBG has increased well.

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.

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]

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.

Hello Cataceous. 150 mg of enanthate (25 Monday + 25 Tuesday + 50 Thursday + 50 Friday) and taking the blood test on Saturday after 24 hours of the last injection is expected to increase TT by how many ng? Thank

 

[S1W]

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.

I’ve done just about every injection frequency possible.

For me, high TT/FT = high HCT. Regardless of whether I’m injecting daily, EOD, MWF, E3.5D, weekly.

In my case, it really is that simple. Run high levels, expect side effects.

 

[gerardo]

I’ve done just about every injection frequency possible.

For me, high TT/FT = high HCT. Regardless of whether I’m injecting daily, EOD, MWF, E3.5D, weekly.

In my case, it really is that simple. Run high levels, expect side effects.

Thanks. Which protocol did you feel better? Is your shbg low?

 

[S1W]

Thanks. Which protocol did you feel better? Is your shbg low?

Re SHBG: My personal experience has been that SHBG levels, like side effects, are somewhat dose dependent. For me, higher overall dose combined with more frequent injections lowers my SHBG. Point being, for me, SHBG is somewhat fluid so I cannot accurately answer your question in any way that might be applicable to you/your situation.

Weekly wasn’t for me, but the other injection frequencies all had pros/cons.

I think the more important thing to focus on is overall dose, not injection frequency (within reason of course).

To be clear, I don’t think having relatively high levels is automatically a bad thing, and some guys (myself included) need to in order to get any benefits from TRT.

That said, I accept that when my levels are high, I should expect some acne, high E2, high HCT, etc. Seems like people do a lot of tail chasing trying to mitigate side effects...but T is like any other medication - at a certain dosage, most people will experience side effects.

 

[gerardo]

Re SHBG: My personal experience has been that SHBG levels, like side effects, are somewhat dose dependent. For me, higher overall dose combined with more frequent injections lowers my SHBG. Point being, for me, SHBG is somewhat fluid so I cannot accurately answer your question in any way that might be applicable to you/your situation.

Weekly wasn’t for me, but the other injection frequencies all had pros/cons.

I think the more important thing to focus on is overall dose, not injection frequency (within reason of course).

To be clear, I don’t think having relatively high levels is automatically a bad thing, and some guys (myself included) need to in order to get any benefits from TRT.

That said, I accept that when my levels are high, I should expect some acne, high E2, high HCT, etc. Seems like people do a lot of tail chasing trying to mitigate side effects...but T is like any other medication - at a certain dosage, most people will experience side effects.

I agree with you. I also believe that depending on the shbg, the levels of Free Testerone can increase a lot with an even lower level of Testosterone.

 

[Nelson Vergel]

Here is a good read:

Search results for: 'blog high hematocrit caused by trt how to lower it'

www.discountedlabs.com

 

[gerardo]

Here is a good read:

Search results for: 'blog high hematocrit caused by trt how to lower it'

www.discountedlabs.com

Thanks Nelson

 

[gerardo]

Updating this topic. On May 1st, I started the new TRT protocol. In the first week I applied 150 mg of Enanthate and in the following weeks I followed 50mg E3.5D. So far the hematocrit is controlled and it was between 45 - 47. It started to increase a little and I lowered the dose to 40Mg E3.5D. The TT is at 900 at the peak and the FT is 30 because my SHBG has dropped to 11.4. Ferritin has dropped to 36 and serum iron is at 82. I am back to supplementing 50 mg of chelated iron + 200Mg of vit C every day and I am also keeping a 5Mg progesterone capsule. Finally my E2 increased to 42, prolactin 9 and progesterone 0.2. Free T3 is at 3.18. So my protocol is like this: 40 Mg enanthate E3.5D + 12.5 mcg T4 + 10 mcg T3 + 5 Mg progesterone. As my FT is very high due to the low Shbg will I have to lower the dose of enanthate? I thought of 35mg E3.5D. I will increase the T4 to 25mcg per day. What do you think? I know you have only 20 days of my protocol, but I can't let my hematocrit go out of control.