Hi, new guy (40) on TRT from the Netherlands

[NoMuscle]

Hey everyone,

I just got my blood report back after 3 months on 80mg EOD subq injections. Overall, I wasn’t feeling as great as before—lower libido, less energy—but no major symptoms either. After my blood work, I decided to increase my dose to 100mg EOD subq, and wow... I felt a huge improvement almost immediately.

BUT, the lab messed up and forgot to include the basic blood panel and Gamma-GT. Super frustrating, especially since I was most concerned about my hematocrit. After several back-and-forth emails with the lab, they sent me a kit for the missing blood markers. However, by the time I got the kit, I’d already been on the 100mg dose for a couple of weeks. I probably should have waited to adjust the dose, but didn’t expect the lab to mess up.

Here’s the new data (right side: green for 3 months on 80mg, light green for 2 weeks on 100mg):

View attachment 48126

(they forgot to include the RDW-CV somehow)​

• Hematocrit has improved a bit but could still be lower.
• My total and free testosterone levels look much better now, so that’s reassuring.
• I’ve been working out consistently for the last 3 months and really trying to push my progress. Also, I’ve been taking a naringin supplement for about 2 months.

Would love your input—do you see anything that stands out or have any advice based on the results? Curious to hear your thoughts!

(i) Your MCV is high (ideally in the low 90s), which is often caused by one of two things: lack of B12 or lack of copper. Regarding copper, do you take a lot of zinc? Men trying to improve their testosterone and lower estrogens often take zinc. Zinc depletes copper. If you take zinc, I would add copper in the ratio of 1:7. For 20mg zinc, you may want to have about 3mg copper.

(ii) Hematocrit: Ideal levels 46 - 49. Although people selling TRT try to downplay high hematocrit levels, hematocrit is a longevity marker, and levels in the high-50s or even your 60 level won't allow you to become old.

 

[mrblonde01]

(i) Your MCV is high (ideally in the low 90s), which is often caused by one of two things: lack of B12 or lack of copper. Regarding copper, do you take a lot of zinc? Men trying to improve their testosterone and lower estrogens often take zinc. Zinc depletes copper. If you take zinc, I would add copper in the ratio of 1:7. For 20mg zinc, you may want to have about 3mg copper.

(ii) Hematocrit: Ideal levels 46 - 49. Although people selling TRT try to downplay high hematocrit levels, hematocrit is a longevity marker, and levels in the high-50s or even your 60 level won't allow you to become old.

Thanks for the reply and looking at my numbers man, I really appreciate it!

I have no idea if I have a lack of B12/copper actually. Is this something that is often lacking in people on TRT? I'm not taking any zinc at the moment, I have done so sporadically in the past, but never strictly. I've had one box of 60 zinc pills for years, and it's still not empty. That should say enough.

Most recent MCV is 95 though...so that's almost lower 90's, right?

And yeah the hematocrit. I agree it should be lower ideally. I'll keep on trying to bring it down but getting it back to this amount is a win for me. Plus, I suspect I already had a relatively higher hematocrit before, though I don't have the blood work to back that suspicion up unfortunately. I'm in the gym a lot recently, I hope this will also help bring it down further.

 

[Systemlord]

Although people selling TRT try to downplay high hematocrit levels, hematocrit is a longevity marker, and levels in the high-50s or even your 60 level won't allow you to become old.

You’re oversimplifying it, try to be more specific, because there are many causes of elevated hematocrit levels, like COPD, and TRT induced erythrocytosis or even spending time at high elevation. One of these is a disease process, and the other two scenarios are benign.

I propose that it is the disease process that is causing the harm, not the high hematocrit numbers. The high hematocrit is a response to the disease starving the body of oxygen like in cases of COPD whereas if you phlebotomize them, you’ll kill them.

In secondary erythrocytosis caused by TRT, there is no underlying disease process causing harm. Now, if your cardiovascular system is already compromised, TRT can contribute to the problem.

Glenn Cunningham. Dr. Abraham Morgantaler, asked him both on stage and in person where did you come up with 54% cut off? His answer was we actually don't have much data to say anything but we had to pick a number and it seemed like a reasonable number.

With a secondary erythrocytosis there is an increase in blood volume which enlarges the vascular bed, decreases peripheral resistance and increases cardiac output. Therefore, in a secondary erythrocytosis optimal oxygen transport with increased blood volume occurs at a higher hematocrit value than with a normal blood volume. A moderate increase in hematocrit may be beneficial despite the increased viscosity.

There are over 80 million people that live higher than 2,500 meters and they develop a secondary erythrocytosis. Men in parts of Bolivia for instance have a normal range of HCT from 45-61%. These men are not at an increased risk of thrombotic events nor do they have to undergo phlebotomies to manage their hematocrit.

As for high hematocrit being a longevity marker, have a look at the links below.

Stroke-Related Mortality at Different Altitudes: A 17-Year Nationwide Population-Based Analysis From Ecuador.

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

Does having a high hematocrit mean your blood is more likely to clot? This study looks at a city where people with the highest hematocrit in the world live and work.

www.excelmale.com

 

[mrblonde01]

As you might see in the report, my ferritin is almost cut in half by a blood donation, so I'm doubting if a blood donation is wise at this point.

 

[Seagal]

Hey everyone,

I just got my blood report back after 3 months on 80mg EOD subq injections. Overall, I wasn’t feeling as great as before—lower libido, less energy—but no major symptoms either. After my blood work, I decided to increase my dose to 100mg EOD subq, and wow... I felt a huge improvement almost immediately.

BUT, the lab messed up and forgot to include the basic blood panel and Gamma-GT. Super frustrating, especially since I was most concerned about my hematocrit. After several back-and-forth emails with the lab, they sent me a kit for the missing blood markers. However, by the time I got the kit, I’d already been on the 100mg dose for a couple of weeks. I probably should have waited to adjust the dose, but didn’t expect the lab to mess up.

Here’s the new data (right side: green for 3 months on 80mg, light green for 2 weeks on 100mg):

View attachment 48126

(they forgot to include the RDW-CV somehow)​

• Hematocrit has improved a bit but could still be lower.
• My total and free testosterone levels look much better now, so that’s reassuring.
• I’ve been working out consistently for the last 3 months and really trying to push my progress. Also, I’ve been taking a naringin supplement for about 2 months.

Would love your input—do you see anything that stands out or have any advice based on the results? Curious to hear your thoughts!

Why did you increase the HCG, from initially 2x500 to now 3.5x800?

 

[mrblonde01]

Why did you increase the HCG, from initially 2x500 to now 3.5x800?

I increased from 500iu total per week to 800iu total per week, as I've heard this is a minimum to preserve fertility.

I went from injecting twice a week to 3 times a week and now arrived at every other day injections

 

[Seagal]

I increased from 500iu total per week to 800iu total per week, as I've heard this is a minimum to preserve fertility.

I went from injecting twice a week to 3 times a week and now arrived at every other day injections

My fault, it's the total per week.
I noted that your E2 increased while your T decreased, thought it's related to HCG.
Think you just have to see if your current dose increase keeps you happy. Or you could lower the HCG dose... Question could be whether T is too low or E2 too high for you personally.
When did you donate blood?

 

[NoMuscle]

Thanks for the reply and looking at my numbers man, I really appreciate it!

I have no idea if I have a lack of B12/copper actually. Is this something that is often lacking in people on TRT? I'm not taking any zinc at the moment, I have done so sporadically in the past, but never strictly. I've had one box of 60 zinc pills for years, and it's still not empty. That should say enough.

Most recent MCV is 95 though...so that's almost lower 90's, right?

And yeah the hematocrit. I agree it should be lower ideally. I'll keep on trying to bring it down but getting it back to this amount is a win for me. Plus, I suspect I already had a relatively higher hematocrit before, though I don't have the blood work to back that suspicion up unfortunately. I'm in the gym a lot recently, I hope this will also help bring it down further.

95 MCV is fine. - Neither a B12 nor a copper deficiency would be directly caused by TRT. Possibly a copper deficiency indirectly by too much zinc, which isn't the case with you.

Although 95 does not require any action, you could at some point take a methylmalonic acid (MMA) test to check B12 (normal B12 serum tests are useless). If you are genetically an under-methylator ("MTHFR gene", about 20% of people of European heritage), you would benefit from B12+ folate (1 - 2mg per day). Even meat eaters can be B12 deficient as the absorbed amount is tiny.

Re hematocrit, some aerobic endurance exercise can help (low-intensity "zone 2" jogging or biking).

 

[mrblonde01]

My fault, it's the total per week.
I noted that your E2 increased while your T decreased, thought it's related to HCG.
Think you just have to see if your current dose increase keeps you happy. Or you could lower the HCG dose... Question could be whether T is too low or E2 too high for you personally.
When did you donate blood?

I think I donated about 3 months ago now

I read a lot about people switching to subq shots and their E2 increased. Since I did the same (switched from IM to Subq), maybe that's also what's happening to me?

 

[mrblonde01]

95 MCV is fine. - Neither a B12 nor a copper deficiency would be directly caused by TRT. Possibly a copper deficiency indirectly by too much zinc, which isn't the case with you.

Although 95 does not require any action, you could at some point take a methylmalonic acid (MMA) test to check B12 (normal B12 serum tests are useless). If you are genetically an under-methylator ("MTHFR gene", about 20% of people of European heritage), you would benefit from B12+ folate (1 - 2mg per day). Even meat eaters can be B12 deficient as the absorbed amount is tiny.

Re hematocrit, some aerobic endurance exercise can help (low-intensity "zone 2" jogging or biking).

Interesting! Can you just order a test like that for home use, or is it a blood test? I'll definitely look it up. I also did a DNA test once, maybe I can check if I have that gene there? (23andme)

 

[NoMuscle]

Interesting! Can you just order a test like that for home use, or is it a blood test? I'll definitely look it up. I also did a DNA test once, maybe I can check if I have that gene there? (23andme)

OmegaQuant has a very good MMA test. They are US-based, not sure whether they would cover a customer abroad. Check with them. These tests definitely exist in Europe, too.

23andMe would give you an answer. Although there are several genes governing methylation, MTHFR is the most prominent one.

 

[NoMuscle]

You’re oversimplifying it, try to be more specific, because there are many causes of elevated hematocrit levels, like COPD, and TRT induced erythrocytosis or even spending time at high elevation. One of these is a disease process, and the other two scenarios are benign.

I propose that it is the disease process that is causing the harm, not the high hematocrit numbers. The high hematocrit isn’t response to the disease starve the body of oxygen like in cases of COPD whereas if you phlebotomize them, you’ll kill them.

In secondary erythrocytosis caused by TRT, there is no disease process causing harm. Now, if your cardiovascular system is already compromised, TRT can contribute to the problem.

Glenn Cunningham. Dr. Abraham Morgantaler, asked him both on stage and in person where did you come up with 54% cut off? His answer was we actually don't have much data to say anything but we had to pick a number and it seemed like a reasonable number.

With a secondary erythrocytosis there is an increase in blood volume which enlarges the vascular bed, decreases peripheral resistance and increases cardiac output. Therefore, in a secondary erythrocytosis optimal oxygen transport with increased blood volume occurs at a higher hematocrit value than with a normal blood volume. A moderate increase in hematocrit may be beneficial despite the increased viscosity.

There are over 80 million people that live higher than 2,500 meters and they develop a secondary erythrocytosis. Men in parts of Bolivia for instance have a normal range of HCT from 45-61%. These men are not at an increased risk of thrombotic events nor do they have to undergo phlebotomies to manage their hematocrit.

As for high hematocrit being a longevity marker, have a look at the links below.

Stroke-Related Mortality at Different Altitudes: A 17-Year Nationwide Population-Based Analysis From Ecuador.

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

Does having a high hematocrit mean your blood is more likely to clot? This study looks at a city where people with the highest hematocrit in the world live and work.

www.excelmale.com

Thank you for referencing the Ecuador study, which I just read! The optimal window 2,000 - 3,500 meters and that they looked across the population living at different altitudes is very interesting. Although they reference one article mentioning "hematocrit", they did not elaborate on hematocrit levels directly. We need to keep guessing whether it is higher hematocrit that is health protective, or whether it is cleaner air, simpler lifestyle, intact social structure etc.

I also think it makes a difference whether locals whose genetic background has developed over thousand of years can deal well with higher altitude or whether you transplant a Dutch with a sea level (or below!) gene pool into high altitude. If you look at athletes going to Colorado Springs or Boulder for high altitude training, the performance effects arises after returning to low altitude, essentially as a stress relief effect post hormesis.

Despite the qualifiers, I acknowledge that slightly higher hematocrit levels may be acceptable. But high-50s or the 60s that he once had, without the need to transport more oxygen because of the lack of high altitude conditions, gives me a very bad feeling.

 

[mrblonde01]

It would be interesting to know if high hematocrit is mainly considered bad because it generally points to other health problems, like sleep apnea, copd or other non-TRT related issues.

Of course very high, like I had at one point, is bad. But what if it's slightly elevated, your blood looks fine otherwise, you have a good blood pressure, work out and stay hydrated properly, how bad is a slightly elevated TRT-induced hematocrit? Are we able to answer such a question? Is all science on the risks of high hematocrit based on people with other health issues or bad lifestyles?

 

[mrblonde01]

I had another idea; would switching to propionate make sense for me?

Because it has a shorter ester - maybe less time to raise my HTC?

 

[NoMuscle]

I had another idea; would switching to propionate make sense for me?

Because it has a shorter ester - maybe less time to raise my HTC?

Probably. I only consider short-lived testosterone for myself. I use cream, but if I were to use an injectible, it would be prop. Beyond hematocrit, I strongly feel that the body benefits from peaks and troughs, ideally daily, as this mirrors the natural T production cycle. You must be willing to inject small amounts daily, possibly every other day. I would expect hematocrit and estrogens to be lower.

Low-intensity endurance training will help with hematocrit, too.

 

[mrblonde01]

Alright, I am going to switch from testosterone enanthate to propionate. I heard the dosing should be different for the 2 esters.

If I took 100mg total of enanthate per week (E.O.D. injections), how would that equate to a propionate dosis?

 

[mrblonde01]