Hematocrit and TRT. How to have balance.

[GreenMachineX]

@Cataceous
I dropped my dose too low at 4mg daily. My HCT came down to 47 though, so I've increased to 5mg daily for now. It's been 4 weeks and my HCT is 47.9 now. How long should I stay at this dose to see where HCT will end up?

 

[M.J]

@Cataceous
I dropped my dose too low at 4mg daily. My HCT came down to 47 though, so I've increased to 5mg daily for now. It's been 4 weeks and my HCT is 47.9 now. How long should I stay at this dose to see where HCT will end up?

Becarful from frequent blood test, I have done one donation but was doing monthly blood test I took my ferritin down and had problems sleeping “I wake up after few hours and can’t sleep after” beside blood pressure problems.
As I know hct months before stabilizing depend on one person to person.

 

[TorontoTRT]

@Cataceous
I dropped my dose too low at 4mg daily. My HCT came down to 47 though, so I've increased to 5mg daily for now. It's been 4 weeks and my HCT is 47.9 now. How long should I stay at this dose to see where HCT will end up?

HCT will be the least of your worries with this ill advised protocol. You’ll be hypogonadal in a few weeks. Red blood cells have a life span of 4 months. You need to understand, once on trt your body sets new normals. Hct will be higher but your body compensates for this, because testosterone also increases nitricoxide which dilates your blood vessels.

 

[GreenMachineX]

HCT will be the least of your worries with this ill advised protocol. You’ll be hypogonadal in a few weeks. Red blood cells have a life span of 4 months. You need to understand, once on trt your body sets new normals. Hct will be higher but your body compensates for this, because testosterone also increases nitricoxide which dilates your blood vessels.

I've been on low dose for 4 or 5 months and not hypogonadal. My goal is healthy free T, not a mild cycle.

 

[Cataceous]

@Cataceous
I dropped my dose too low at 4mg daily. My HCT came down to 47 though, so I've increased to 5mg daily for now. It's been 4 weeks and my HCT is 47.9 now. How long should I stay at this dose to see where HCT will end up?

As noted, blood cells live three to four months, so ideally you'd allow this kind of time for things to stabilize.

HCT will be the least of your worries with this ill advised protocol. You’ll be hypogonadal in a few weeks. ...

So goes the more-is-better mentality. Four or five milligrams of testosterone cypionate per day provide 2.8 and 3.5 mg of testosterone respectively. Many men produce these amounts naturally without being hypogonadal. I've done just fine with 3.7 mg T per day, whereas I've had issues at a more average level of 6.5 mg. Don't discourage guys from experimenting with lower amounts, as these will often give the same benefits with fewer side effects.

 

[GreenMachineX]

As noted, blood cells live three to four months, so ideally you'd allow this kind of time for things to

I just wasn't sure if a dosage increase would need the same time frame or longer to see where hct would end up. Thanks.

 

[Deleted member 43589]

I just had the following test run at Quest at my doctors request:

JAK2 V617F CASCADING REFLEX TO CALR, JAK2 EXON 12, MPL, AND CSF3R

JAK2 V617F MUTATION ANALYSIS

All, NOT DETECTED

No mutations were detected in codon 617 or exon 12 of JAK2, or exon 9 of CALR, or exon 10 (codons 505 and 515) of MPL, or exons 14 and 17 of CSF3R. Insertions up to 30bp and deletions up to 52bp have been successfully detected by the assay. The absence of mutation does not exclude the presence of a myeloproliferative neoplasm. See below for additional recommendations on testing.

I also changed my injections to 40mgs every 5 days instead of 80mgs every 10 days. My doctor has not contacted me yet but will, he also sent in an order for another blood dump. My iron was in the middle low point last testing and I have double up on the supplement from 36mgs to 65mgs/d.

I am starting to think it may be the cypionate. So I may try something and go 50mg of test base in the morning and see if that changes anything. I will wait to hear from my doctor 1st.

 

[gerardo]

I stopped the TRT to see how my hematocrit would look. It simply collapsed and I felt a general weakness. What do you think?

Hematocrit: 39.30 Reference 42 - 50
Red blood cells: 4.36 Reference 4.3 - 5.7
Hemoglobin: 13.10 Reference 13.5 - 17.5

 

[TRicker]

I have a related question for anyone that may have experience with donating blood due to high HCT/Hemoglobin. I don't want to derail the thread, but thought this info would be useful for those interested in HCT issues.

How long after a donation would high HCT symptoms reappear? I know that if simply reducing trt dosages, it can take 2-3 months, and it of course also depends on how high your numbers are before donating. But has anyone ever experienced symptoms of high HCT, donated blood and found immediate relief, and then have those symptoms reappear within days?
I've had HCT levels up to 55 and hemoglobin levels up to 19 in the past with no symptoms, on anywhere from 100mg-200mg of test per week. Since restarting TRT after a 5 month fertility reboot on enclomiphene, nothing seems to be working properly. I should note that even completely off TRT for 5 months, my hemoglobin was at 17.
My latest weird symptoms I believed to be related to high HCT were numbness, tingling, and a pressure-like feeling in my fingers and fingertips. So 2 months ago I went to donate blood and my hemoglobin at Red Cross was 18.9 before whole blood donation, and after the tingling/numbness went away for 2-3 days, and then it came back. I just went to donate again today, and my hemoglobin was 18, and now several hours later the tingling/numbness seems to have faded slightly, but I'm thinking this may totally be a placebo effect. My blood pressure has always been great, and still is (110/70 and 108/80). I'm trying to think what else could cause this, and if it could be thyroid related, as I've also had some hypothyroid symptoms.
@readalot @Cataceous or anyone else have any experience with this? I also read @BigTex has had to donate more frequently lately?

 

[sexualathlete]

ARBs like telmisartan will prevent it from getting high among a ton of other benefits.

 

[NeverSayNeverAgain]

I have a related question for anyone that may have experience with donating blood due to high HCT/Hemoglobin. I don't want to derail the thread, but thought this info would be useful for those interested in HCT issues.

How long after a donation would high HCT symptoms reappear? I know that if simply reducing trt dosages, it can take 2-3 months, and it of course also depends on how high your numbers are before donating. But has anyone ever experienced symptoms of high HCT, donated blood and found immediate relief, and then have those symptoms reappear within days?
I've had HCT levels up to 55 and hemoglobin levels up to 19 in the past with no symptoms, on anywhere from 100mg-200mg of test per week. Since restarting TRT after a 5 month fertility reboot on enclomiphene, nothing seems to be working properly. I should note that even completely off TRT for 5 months, my hemoglobin was at 17.
My latest weird symptoms I believed to be related to high HCT were numbness, tingling, and a pressure-like feeling in my fingers and fingertips. So 2 months ago I went to donate blood and my hemoglobin at Red Cross was 18.9 before whole blood donation, and after the tingling/numbness went away for 2-3 days, and then it came back. I just went to donate again today, and my hemoglobin was 18, and now several hours later the tingling/numbness seems to have faded slightly, but I'm thinking this may totally be a placebo effect. My blood pressure has always been great, and still is (110/70 and 108/80). I'm trying to think what else could cause this, and if it could be thyroid related, as I've also had some hypothyroid symptoms.
@readalot @Cataceous or anyone else have any experience with this? I also read @BigTex has had to donate more frequently lately?

No sleep apnea or smoking right? Typically you will need a complete protocol overhaul to fix it like switching to creams then Androgel, then Natesto or Jatenzo no injections. I will add although not mention here a lot is guys go through great lengths to avoid almost all iron intake (and chelating agents like tea, tumeric, basically trying to stay anemic) and that does work as long as your not symptomatic to no iron lol.

 

[TRicker]

ARBs like telmisartan will prevent it from getting high among a ton of other benefits.

Is telmisartan safe to take even if I don't have high blood pressure?

 

[Systemlord]

What do you think?

Hematocrit: 39.30 Reference 42 - 50
Red blood cells: 4.36 Reference 4.3 - 5.7
Hemoglobin: 13.10 Reference 13.5 - 17.5

Why in the world you even have to ask the question?

It should be a no-brainer.

 

[Deleted member 16042]

How long after a donation would high HCT symptoms reappear? I know that if simply reducing trt dosages, it can take 2-3 months, and it of course also depends on how high your numbers are before donating. But has anyone ever experienced symptoms of high HCT, donated blood and found immediate relief, and then have those symptoms reappear within days?

Don't confuse the time it takes for HCT to DECREASE from dose reduction with the time it takes to INCREASE after a phlebotomy, they are entirely different.

The decrease is from attrition of red blood cells, i.e. natural cell death at the end of their life span.

The increase is from erythopoesis which is called for by the Kidneys releasing EPO, and held in check by hepcidin. EPO increases due to hypoxemia, so any time the set point (HCT/HGB levels) is not met, they crank into high gear and production can increase quite dynamically. This does not take months. It happens rapidly. A well documented example, RBC, HG and HCT increase significantly in about 6 days as adaptation to lower blood oxygenation when a human goes to significantly higher altitude.

Testosterone inhibits hepcidin, and when that brake is released more RBCs are produced. The erythropoetic stem cells normally crank out roughly 292 million red cells per second (by one simple mathematical model), and much more is possible when EPO increased and hepcidin is inhibited.

If you have a problem from taking steroids, your body's set point has changed. Hepcidin is inhibited, and EPO can rise. Those factors have nothing to do with how long it takes red cells to die after they are intially created, only what the regulation system senses. If it expects a HCT of 55, and a unit of blood is removed, and plasma volume recovers. it in effect will try to make up for the loss quickly. That adaptive process is non linear. Every person's body will react to this according to it's own dynamics.

 

[Deleted member 43589]

I have a related question for anyone that may have experience with donating blood due to high HCT/Hemoglobin. I don't want to derail the thread, but thought this info would be useful for those interested in HCT issues.

How long after a donation would high HCT symptoms reappear? I know that if simply reducing trt dosages, it can take 2-3 months, and it of course also depends on how high your numbers are before donating. But has anyone ever experienced symptoms of high HCT, donated blood and found immediate relief, and then have those symptoms reappear within days?
I've had HCT levels up to 55 and hemoglobin levels up to 19 in the past with no symptoms, on anywhere from 100mg-200mg of test per week. Since restarting TRT after a 5 month fertility reboot on enclomiphene, nothing seems to be working properly. I should note that even completely off TRT for 5 months, my hemoglobin was at 17.
My latest weird symptoms I believed to be related to high HCT were numbness, tingling, and a pressure-like feeling in my fingers and fingertips. So 2 months ago I went to donate blood and my hemoglobin at Red Cross was 18.9 before whole blood donation, and after the tingling/numbness went away for 2-3 days, and then it came back. I just went to donate again today, and my hemoglobin was 18, and now several hours later the tingling/numbness seems to have faded slightly, but I'm thinking this may totally be a placebo effect. My blood pressure has always been great, and still is (110/70 and 108/80). I'm trying to think what else could cause this, and if it could be thyroid related, as I've also had some hypothyroid symptoms.
@readalot @Cataceous or anyone else have any experience with this? I also read @BigTex has had to donate more frequently lately?

Yes, I have got to make an appointment to do a blood dump next week. I am hoping that changine my dose from 80mg every 10 days to 40mg, every 5 days will help solve some of the issue. Obviously from my recent testing I have no blood disorders that are causing this. In the 42+ years I have done anabolic steroids I have never had any HTC issues even at higher doses.

As a note, I have been taking ARBs since the year 2000. I am on 80mg of telmisartin now and it has done noting to help the HTC issue.

 

[sexualathlete]

Is telmisartan safe to take even if I don't have high blood pressure?

It's becoming more and more popular among people who are concerned with safer use when it comes to PEDs and TRT. I don't have BP issues yet I take it for the benefits below. It's even beneficial for lipids (missing from the list).

ARBs are Renal Protective

ARBs are Cognitive Protective

ARB will prevent LVH and Cardiac Tissue Remodeling

ARBs lower Hematocrit

ARBs will do for you what you think you are taking an Ai for now

Its not estrogen that underlies water retention.

hell ARBs are Myostatin Inhibitors

and sure they Control your BP

The goals is to get you onto an ARB not ” off ”

credit to Victor Black

 

[TRicker]

In the 42+ years I have done anabolic steroids I have never had any HTC issues even at higher doses

Why do you think you are now having issues at much lower dosages?
When I started TRT 8 years ago on 200mg/week (Dr supervised), my hct rose to 53-55, but then would settle back down to 50 from time to time, and even then I felt zero symptoms.

 

[TRicker]

If you have a problem from taking steroids, your body's set point has changed. Hepcidin is inhibited, and EPO can rise. Those factors have nothing to do with how long it takes red cells to die after they are intially created, only what the regulation system senses. If it expects a HCT of 55, and a unit of blood is removed, and plasma volume recovers. it in effect will try to make up for the loss quickly

So according to this information, do you think therapeutic phlebotomies are a waste of time if hct and hemoglobin rise very quickly after a donation? In other words, if my body has created a new set point due to trt, the best way to lower hct is to lower the set point by reducing the dosage?

 

[tareload]

Assuming (big assumption) altitude adaptation has similar time constant to TRT induced erythrocytosis, this reference may be of interest:

Altitude adaptation through hematocrit changes - PubMed

Adaptation takes place not only when going to high altitude, as generally accepted, but also when going down to sea level. Immediately upon ascent to high altitude, the carotid body senses the lowering of the arterial oxygen partial pressure due to a diminished barometric pressure. High altitude...

pubmed.ncbi.nlm.nih.gov

High altitude adaptation is altitude and time dependent, following the simplified equation: Adaptation=Time/Altitude where High altitude adaptation factor=Time at altitude (days)/Altitude in kilometers (km). A complete and optimal hematocrit adaptation is only achieved at around 40 days for a subject going from sea level to 3510 m in La Paz. The time in days required to achieve full adaptation to any altitude, ascending from sea level, can be calculated by multiplying the adaptation factor of 11.4 times the altitude in km. Descending from high altitude in La Paz to sea level in Copenhagen, the hematocrit response is a linear fall over 18 to 23 days.


Notice the rapid Hct descent noted upon returning to sea level. I am not aware of similar study for TRT patients.

 

[Deleted member 16042]

So according to this information, do you think therapeutic phlebotomies are a waste of time if hct and hemoglobin rise very quickly after a donation? In other words, if my body has created a new set point due to trt, the best way to lower hct is to lower the set point by reducing the dosage?

No, I don't think phlebotomies are a waste of time, they are useful for the short term, or until a body adapts to injected testosterone and readjusts itself. Some men can remain on robust dose of T and after months or a year, the HCT problem resolves to an acceptable level and they can stop phlebotomies. Others lower dose to solve the problem. I lowered dose to when i was first put on too much T cyp because of HCT. Some men like @Vince have success with more frequent dosing

I personally have just come though a pretty wild set of circumstances with Hematocrit, but not primarily from Testosterone, rather from high EPO after recovering from transfusion dependent anemia for 2 1/2 years. It's like my body rebounded too far. There may also be kidney trouble leading to this related to the cancer and chelating drugs I am/was on. My HCT reached 57.7, and remained around 54 for months even with weekly phlebotomies. I've had more than 20 phlebotomies since last spring, and for a while they were weekly.