Hematocrit and TRT. How to have balance.

[Gianluca]

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.

Just looking back at labs, i saw an increased in RBC with more frequent injections, especially everyday protocol. Always IM with the same dose.

 

[M.J]

I do 20 mg EOD until now I am around 49 hematocrit been like this for about 8 month now.

Although my hemoglobin went to 17.3 did one donation which I bit took my hematocrit even lower maybe 47 ?
Not sure why hemoglobin is high maybe because of something I took during this time. We will see

 

[Deleted member 43589]

Interestingly enough, I just did my blood work for my PCP. I do it every 3 months. I got the results from Quest early today and here is what I got:

red blood cell - 6.23 down from 6.42 (4.20 - 5.80)
hemoglobin - 18.9 down from 20.2 (13.2 - 17.1)
Hematocrit - 57 down from 58.5 (38.5 - 50.0)

I gave blood about 2 months ago so it didn't do much. Taking aspirin and Eliquis

Testosterone - 883 up from 839 (250 - 827)

ESTRADIOL - 79 up from 38 </= 39 Never had high estradiol in my life and have made no changes in what I do but adding metoprolol and eliquis. The testosterone is not so out of range as to cause all of this mess.

I am doing 100mg of Test C every 10 days sub-q, 250iu HCG on day 8 & 9. Maybe I will go 80 and do 8mg every day for the 10 days and see where I am?

 

[tareload]

Interestingly enough, I just did my blood work for my PCP. I do it every 3 months. I got the results from Quest early today and here is what I got:

red blood cell - 6.23 down from 6.42 (4.20 - 5.80)
hemoglobin - 18.9 down from 20.2 (13.2 - 17.1)
Hematocrit - 57 down from 58.5 (38.5 - 50.0)

I gave blood about 2 months ago so it didn't do much. Taking aspirin and Eliquis

Testosterone - 883 up from 839 (250 - 827)

ESTRADIOL - 79 up from 38 </= 39 Never had high estradiol in my life and have made no changes in what I do but adding metoprolol and eliquis. The testosterone is not so out of range as to cause all of this mess.

I am doing 100mg of Test C every 10 days sub-q, 250iu HCG on day 8 & 9. Maybe I will go 80 and do 8mg every day for the 10 days and see where I am?

Have you been tested for hemochromatosis? Consulted with hematologist? What was your Hct on higher chronic T dosing?

Prior E2 from a few months back? I've had a few of these outlier type RIA E2 results. Have the lab rerun or run an RIA with LCMS side by side?

You are testing TT day 7 IIRC?

 

[Deleted member 43589]

In 2017
RBC - 5.6
Hemoglobin - 16.8
Hematocrit - 50

Testosterone - 1203

I tested yesterday which was my 9th day out of 10. Today I do my 100mg of TC.

Have you been tested for hemochromatosis? No
Consulted with hematologist? NO

 

[Gianluca]

In 2017
RBC - 5.6
Hemoglobin - 16.8
Hematocrit - 50

Testosterone - 1203

I tested yesterday which was my 9th day out of 10. Today I do my 100mg of TC.

Have you been tested for hemochromatosis? No
Consulted with hematologist? NO

Sleep apnea? Testosterone cream may increase less RBC

 

[tareload]

In 2017
RBC - 5.6
Hemoglobin - 16.8
Hematocrit - 50

Testosterone - 1203

I tested yesterday which was my 9th day out of 10. Today I do my 100mg of TC.

Have you been tested for hemochromatosis? No
Consulted with hematologist? NO

If sleep apnea ruled out would be interesting if age played a part. Check this out:

Testosterone Suppresses Hepcidin in Men: A Potential Mechanism for Testosterone-Induced Erythrocytosis

Testosterone suppresses the iron regulatory peptide hepcidin in men, and this effect is more pronounced in older men who also experience greater erythrocyt

academic.oup.com

More context:

New Study - SubQ Alledgedly Leads To Lower HCT/E2/PSA Than IM Just Published

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

Slower apparent elimination of fT and more sensitivity of Hct may be good reasons to be cautious with dosing as you age.

 

[M.J]

Interestingly enough, I just did my blood work for my PCP. I do it every 3 months. I got the results from Quest early today and here is what I got:

red blood cell - 6.23 down from 6.42 (4.20 - 5.80)
hemoglobin - 18.9 down from 20.2 (13.2 - 17.1)
Hematocrit - 57 down from 58.5 (38.5 - 50.0)

I gave blood about 2 months ago so it didn't do much. Taking aspirin and Eliquis

Testosterone - 883 up from 839 (250 - 827)

ESTRADIOL - 79 up from 38 </= 39 Never had high estradiol in my life and have made no changes in what I do but adding metoprolol and eliquis. The testosterone is not so out of range as to cause all of this mess.

I am doing 100mg of Test C every 10 days sub-q, 250iu HCG on day 8 & 9. Maybe I will go 80 and do 8mg every day for the 10 days and see where I am?

Becarful of low ferritin due to blood donations. When I had low ferritin I go to sleep and wake up one hour or two max after and can’t sleep again plus I had blood pressure problems.

I have stopped donations and do 20 mg eod. It’s been around 8 month now everything good. Except of course some libido issues.

 

[Deleted member 43589]

If sleep apnea ruled out would be interesting if age played a part. Check this out:

Testosterone Suppresses Hepcidin in Men: A Potential Mechanism for Testosterone-Induced Erythrocytosis

Testosterone suppresses the iron regulatory peptide hepcidin in men, and this effect is more pronounced in older men who also experience greater erythrocyt

academic.oup.com

More context:

New Study - SubQ Alledgedly Leads To Lower HCT/E2/PSA Than IM Just Published

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

Slower apparent elimination of fT and more sensitivity of Hct may be good reasons to be cautious with dosing as you age.

I think around 2005 my wife finally talked me into doing a sleep study. I had a BAD case of sleep apnea where I stopped breathing several time a minute. So I have been using a CPAP since then and sleep well now.

Being that a react so well to testosterone I am considering lowering the dose to 80mg ever 10 days.

Thanks MJ, I have only donated once in my life. My iron status is way up there, lot of red meat. I also take in 57.7mg of iron through my diet daily.

 

[M.J]

I think around 2005 my wife finally talked me into doing a sleep study. I had a BAD case of sleep apnea where I stopped breathing several time a minute. So I have been using a CPAP since then and sleep well now.

Being that a react so well to testosterone I am considering lowering the dose to 80mg ever 10 days.

Thanks MJ, I have only donated once in my life. My iron status is way up there, lot of red meat. I also take in 57.7mg of iron through my diet daily.

As I know the secret for stable hematocrit is lower dose and frequent. Doing EOD can do the trick. Some do EOD.
Why do you take iron ? Usually men don’t need iron.

 

[Deleted member 43589]

you possibly misunderstood what I wrote. I don't take iron supplements, I eat a high protein diet. I actually consume about 370g of protein a day eating pork, chicken, red meat and fish. All of the iron in my diet is through food sources which totals on average to 57.7mg per day. This is 722% of the RDA.

 

[tareload]

you possibly misunderstood what I wrote. I don't take iron supplements, I eat a high protein diet. I actually consume about 370g of protein a day eating pork, chicken, red meat and fish. All of the iron in my diet is through food sources which totals on average to 57.7mg per day. This is 722% of the RDA.

Love your attention to detail @BigTex . If you can stand that dose reduction that sounds prudent to me. I don't know your inflammation status to put your Hct in quantitative context with blood viscosity. But you know pushing FFMI and Hct is making your heart do more work 24 hr a day. Probably not the best idea as we get older but everyone has to do what they need to do. Maybe doing "cycles" of higher and lower dose TRT throughout the year could be a compromise that removes phlebotomy from picture.

I have found staying at 70 mg/week TC or below keeps Hct in check. 100 or 120 mg/week TC and I am back above 50% (Hct) in a few months.

Perhaps doing your own dose response study could locate your critical weekly dosage of test ester?

With all that being said I just took my dose back to 100 mg/week TC from 80 mg/week as my Hct is 43 after going off TRT for 4 months (not fun).

Take care.

 

[FunkOdyssey]

With all that being said I just took my dose back to 100 mg/week TC from 80 mg/week as my Hct is 43 after going off TRT for 4 months (not fun).

You wild man (lol). If after researching and posting about every possible risk of higher doses for a few years now, you cannot resist the urge to push the envelope, what hope is there for the rest of us?

 

[tareload]

Love the picture!

Here's my log since going back on...

Week 1 60 mg TC
Week 2 70 mg TC
Week 3 80 mg TC
Week 4 " "
Week 5 ""
Week 6 100 mg TC

It's a slippery slope. I have some interesting Echocardiogram data taken before going off TRT and then 4 months off TRT. But it didn't correlate at all with my symptoms. In fact they got worse given thyroid interaction with T.

Abandoning hope ~ Pema Chödron - Just Dharma

Hope and fear is a feeling with two sides. As long as there’s one, there’s always the other. This is the root of our pain. In the world of hope and fear, we always have to change the channel, change the temperature, change the music, because something is getting uneasy, something is getting...

justdharma.org

 

[Deleted member 43589]

Thanks Readalot.....my wife says I am anal.....I consider it part of my excessive compulsive side. Anyway, I am going to see what the every day dose does to my blood work. I will give it 3 weeks and then test. If that doesn't work I am going to drop the dose from 100mg to 80mg every 10 days and then test again. Next week I will also add 30 minutes of low intensity cardio to my workout 4 days a week. I believe that low intensity aerobic exercise may help lower the HTC.

I went to o see my new cardiologist yesterday and he expressed concern about the HTC. I ask him if I should see a hematologist and he advised against it because all they will do is take me off testosterone. He did schedule an Echocardiogram in two weeks.

 

[tareload]

Thanks Readalot.....my wife says I am anal.....I consider it part of my excessive compulsive side. Anyway, I am going to see what the every day dose does to my blood work. I will give it 3 weeks and then test. If that doesn't work I am going to drop the dose from 100mg to 80mg every 10 days and then test again. Next week I will also add 30 minutes of low intensity cardio to my workout 4 days a week. I believe that low intensity aerobic exercise may help lower the HTC.

I went to o see my new cardiologist yesterday and he expressed concern about the HTC. I ask him if I should see a hematologist and he advised against it because all they will do is take me off testosterone. He did schedule an Echocardiogram in two weeks.

Without phlebotomy you will need a solid 2 months (RBC lifetime about 3 months) to see any noticeable reduction in Hct from dose manipulation. I am assuming given your attention to detail you stay quite hydrated. If you don't want to see hematologist you could ask your primary doc to screen for JAK2 mutation and hemochromatosis status. May be instructive to inform on any potential dietary manipulation of iron intake. What's your iron panel look like?

1. IRON PROFILE (IRON,TIBC,%SAT.(CALC))
2. FERRITIN
3. RETIC, AUTOMATED (sneak peek on RBC production)

FYI

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

 

[Deleted member 43589]

Without phlebotomy you will need a solid 2 months (RBC lifetime about 3 months) to see any noticeable reduction in Hct from dose manipulation. I am assuming given your attention to detail you stay quite hydrated. If you don't want to see hematologist you could ask your primary doc to screen for JAK2 mutation and hemochromatosis status. May be instructive to inform on any potential dietary manipulation of iron intake. What's your iron panel look like?

1. IRON PROFILE (IRON,TIBC,%SAT.(CALC))
2. FERRITIN
3. RETIC, AUTOMATED

I gave blood about 2 months ago. I only saw a drop of 1 point on the HTC. I have never checked my iron status because I have really high dietary intakes. So I have never been concerned about it but I plan on checking the status in 3 weeks. My average iron intake is 54.8mg/d which is 685% over RDA. What blood test should I ask for. I am not familiar with either of these.

 

[tareload]

I gave blood about 2 months ago. I only saw a drop of 1 point on the HTC. I have never checked my iron status because I have really high dietary intakes. So I have never been concerned about it but I plan on checking the status in 3 weeks. My average iron intake is 54.8mg/d which is 685% over RDA. What blood test should I ask for. I am not familiar with either of these.

The descriptions and detailed information in the hyperlinks (what Labcorp offers for example). You could also get these at other reference laboratories like ARUP.

 

[Deleted member 43589]

The descriptions and detailed information in the hyperlinks (what Labcorp offers for example). You could also get these at other reference laboratories like ARUP.

OK, I found it at Quest

Quest Diagnostics: Test Directory

testdirectory.questdiagnostics.com

Quest Diagnostics: Test Directory

testdirectory.questdiagnostics.com

 

[tareload]

OK, I found it at Quest

Quest Diagnostics: Test Directory

testdirectory.questdiagnostics.com

Quest Diagnostics: Test Directory

testdirectory.questdiagnostics.com

Yep you got 'em.