High HCT - trying to decide whether to get phlebotomy

[Biggee]

I have been on TRT for over ten years and my lab values always hover around 56 Hct and 19 Hgb. I never paid much attention to it but now that I am mid 40s I am starting to worry more about those things. As far as I can tell, I have never had any ill effects from those levels. There seems to be a broad consensus to stay closer to the normal range but when I looked at a study of people living at high altitude, their normal range was 45 to 61%. (Normal hematological values for healthy persons living at 4000 meters in Bolivia. - PubMed - NCBI) I also heard that for people living at higher altitude in the US, some doctors consider 55% Hct normal, no treatment required.

But just because the body is able to adapt, does not mean that it's a good idea. So then I looked whether there are long term negative consequences associated with adaptation to high altitudes but, if anything, the opposite seems to be the case: no negative effects and some protective effects on coronary heart disease and stroke mortality. (Lower mortality from coronary heart disease and stroke at higher altitudes in Switzerland. - PubMed - NCBI)

I also read that starting around 60% Hct, blood viscosity increases exponentially which interestingly is the same as the upper limit of normal in high altitude adjusted individuals. But what about the 51% - 60% range. It's definitely not "normal" but does it require intervention?

 

[Vince Carter]

Opinions vary on this but this forum is overwhelmingly in the camp that >50 HCT is bad, you need a phlebotomy and that's pretty much the end of it. So do whatever you think is best for you or whatever your Dr insists on but you won't find people here that agree with leaving HCT untreated.

 

[xqfq]

The most important thing is to monitor your blood pressure. Do you? In some men, at some point the increase in hematocrit will cause an increase in blood pressure. See this thread:

Hematocrit, TRT --> systemic vascular resistance response

Dr. Thomas O'Connor, per this video, says his comfort zone is < 52% (good video):

 

[bloathog21]

I definitely can attest to the side effects. Confusion, occasional dizziness, high bp. Your lucky that you don't have the sides yet. But you should go donate double reds.

 

[Systemlord]

There is no good reason not to donate, if you can keep it under 50%, great, if not <52% is a good compromise, but letting HCT go where it wants is not advisable.

 

[n2turbo2]

Mine is 55 can i still donate, or do i need a prescription.

 

[TorontoTRT]

What my experience shows me is that phlebotomy is only a short term band aid that kills your ferritin. My last donation I went from 52 to 47 then back to 52 4 weeks later. Your body creates a new set point. A new normal where it wants blood markers at. You can donate all you want. The body immediately starts bringing you back up to the new set point using up all your ferritin in doing so.

 

[jkozlow3]

There is no good reason not to donate, if you can keep it under 50%, great, if not <52% is a good compromise, but letting HCT go where it wants is not advisable.

How about ferritin tanking??

What my experience shows me is that phlebotomy is only a short term band aid that kills your ferritin. My last donation I went from 52 to 47 then back to 52 4 weeks later. Your body creates a new set point. A new normal where it wants blood markers at. You can donate all you want. The body immediately starts bringing you back up to the new set point using up all your ferritin in doing so.

Agree. I don't think most guys test ferritin and it pisses me off that blood banks don't test it when donating. I donated a couple of times in 2019 and my ferritin TANKED. My ferritin was 14 with a range of 38-380! Not good! My previous ferritin results from awhile back were in the 200s I believe - before I did any blood donations.

I'm guessing there are a lot of guys on TRT with VERY LOW ferritin values after some blood donations and they aren't even aware!

 

[Systemlord]

How about ferritin tanking??

If you have low ferritin, than you need to take care of it, but not everyone will have this problem..

 

[jkozlow3]

If you have low ferritin, than you need to take care of it, but not everyone will have this problem..

I didn't have low ferritin before donating - far from it. I was in the middle of the range or better. It didn't tank until after after a couple of donations in 2019 - 6 months apart (whole blood only - not double red cells). I only found out my ferritin tanked because I decided to test it myself. Blood banks should be testing ferritin before a donation IMO!

 

[lenny]

Yeah, don't mess around with that. Get the phlebotomies. When I used to do them I only needed to have it done once every two to three months.

Side note: now that I'm on a daily injection schedule, hematocrit is no longer a concern for me, but I understand that's not true for everyone who's tried daily.

 

[evansjamesk]

And where, exactly, does one get a phlebotomy? When I tried to donate with the Red Cross, they said my hemoglobin levels (or maybe hematocrit, I don't know) was too high and they would not let me donate. As if last weekend, my hemoglobin was 19.1 and hematocrit was 55.2.
For that matter, why can't my wife (a nurse practitioner) draw the blood at home? Where would she dispose of it? And BTW, I alternate days of HCG with days of Test, rather than the twice-a-week protocol my doctor prescribed, and it has NOT had a positive affect on my hemoglobin and hematocrit levels.

 

[jkozlow3]

And where, exactly, does one get a phlebotomy? When I tried to donate with the Red Cross, they said my hemoglobin levels (or maybe hematocrit, I don't know) was too high and they would not let me donate. As if last weekend, my hemoglobin was 19.1 and hematocrit was 55.2.
For that matter, why can't my wife (a nurse practitioner) draw the blood at home? Where would she dispose of it? And BTW, I alternate days of HCG with days of Test, rather than the twice-a-week protocol my doctor prescribed, and it has NOT had a positive affect on my hemoglobin and hematocrit levels.

Lots of areas have blood banks throughout the city/county - we've got 6 blood bank locations in my county and 100+ mobile blood drive locations in any given month. If your HGB/HCT levels get TOO high it's my understanding that you may need a doctor prescribed phlebotomy. I think they basically draw the blood and dispose of it in that instance. Not positive however.

 

[JohnTaylorHK]

I'm not sure that you need to do anything if you are asymptomatic, but donating blood (if you are allowed) has many other benefits other than reducing iron levels. I have donated regularly for the last 45 years with no ill effects. I have also considered what I will do after next year, as the Philippines Red Cross does not allow donating after you reach 65. If you cannot donate and are capable of getting it done professionally, then blood is very good for the roses. Namaste.

 

[Vince Carter]

Most blood banks are I think have a HGB ~19 as their cutoff as some some of medical condition is at play and they question your health and ability to donate in that regard.
That's where the Dr prescribed Phelbotomy comes in and unlike a blood donation, you do it at a blood bank like American Red Cross, but in this instance you have to pay for it to be done, last I looked was $60. You have to pay for it because the blood is dumped and disposed of because of the "medical condition" so they bill you to recover the costs of their time and supplies.

Ive seen I think it was California that some one was running a mobile phlebotomy service (HA). I see no reason like the guy above with the wife NP couldn't do it or get it done thru their professional connection(s)

 

[Sly]

Most blood banks are I think have a HGB ~19 as their cutoff as some some of medical condition is at play and they question your health and ability to donate in that regard.
That's where the Dr prescribed Phelbotomy comes in and unlike a blood donation, you do it at a blood bank like American Red Cross, but in this instance you have to pay for it to be done, last I looked was $60. You have to pay for it because the blood is dumped and disposed of because of the "medical condition" so they bill you to recover the costs of their time and supplies.

Ive seen I think it was California that some one was running a mobile phlebotomy service (HA). I see no reason like the guy above with the wife NP couldn't do it or get it done thru their professional connection(s)

I donate blood every 2 months to keep my HGB in check. I usually come in around 18 or 19 and have been turned away once. I’ve found Red Cross has the highest threshold at 20, so that’s where I go now. Since I was turned away once, I’m nervous what my number will be each time I go. I was shocked at my last donation when it was 16.5!

 

[SkyWarn]

How about ferritin tanking??



Agree. I don't think most guys test ferritin and it pisses me off that blood banks don't test it when donating. I donated a couple of times in 2019 and my ferritin TANKED. My ferritin was 14 with a range of 38-380! Not good! My previous ferritin results from awhile back were in the 200s I believe - before I did any blood donations.

I'm guessing there are a lot of guys on TRT with VERY LOW ferritin values after some blood donations and they aren't even aware!

A few years ago after too many donations my ferritin came back at 0 as in ZERO. Undetectable levels. I was having dizzy spells.

 

[TorontoTRT]

In Canada there’s no upper limit.

 

[bloathog21]

I’m at 10 was at 11 a month ago no donations between those labs.

 

[BobF]

I have been in TRT over 20 years, will give you my findings on H&H. Yours are too high, you can go to the blood bank but you will require an override by Administration as you are on TRT and that blood will be tossed. Estimate your numbers being reduced 2 points per visit, every 8 weeks. Unfortunately for me, mine rose faster than I could get it off me. End result, removed from TRT now almost a year. Oddly, H&H stayed at very high levels the entire time over the past year, no blood had been taken off. Reduction in red meat, I saw a significant drop only then and that was last month. So, if you are under a doctor's care, you need to get an order for a hematologist to remove more and more often. This can also be accomplished through the blood bank with a doctor's authorization and on file at the blood bank.

You need to keep track of your H&H, all those mortalities they say comes from being on TRT, it's due to lack of oversight of the person taking it. Bloods should be treated IMO every 90 days MINIMUM.