High Hematocrit - Off TRT

[notsure]

Ok I was diagnosed with Low T about five years ago. Short story is I had most symptoms, but mostly very low energy. My numbers were around 200 ng/dL. I started treatment with injections and adjusted everything but with time my HCT and blood pressure started to go up. I started to make blood donations every three months, but after a year my Ferritin crashed, so I was told not to donate for a while. I reduced my dosage and started injecting 3X a week instead of twice. This did not help with my HCT and blood pressure, so I reduced the dosage more. My T then around 400-500. Still had high HCT. Dr. recommended I do a sleep study to see if I had sleep apnea since this might be the cause. I went ahead, was diagnosed with mild sleep apnea. By then my HCT was again around 55% with Ferritin below normal level and with higher blood pressure (even when I donated blood they told me my blood was thick).

SO I decided to stop TRT and get my HCT and BP under control. I was put on a reset program and I am now taking Clomid daily (1/4 pill). My new blood work shows my HCT back down to 45, T at 227 (free at 4.5) and Estradiol sensitive at 10 (not sure why so low?) Needless to say I'm back to no energy, motivation, and when I find the energy to workout it takes me a week to recover....on top of low libido and no morning wood. Obviously I'm very sensitive to the injectable T.

So I say all this to ask..... are my options (a) Live like this; (B) Get back into TRT and well BP will go up so will HCT and I guess I will eventually pay the price? I can't be the only one who is this sensitive. I have kids so I don't want to do creams/gels? I don't like either of these options....

What are my other options to increase T and feel better? Starting to get a bit desperate. The problem is not sleep apnea. So I'm all ears. BTW any good Drs. in Houston that I can work with? Was using one of the credible clinics mentioned on this forum, bu I think is time I meet face to face with A Dr.

Thanks!

 

[SilverSurfer]

What is your height / weight / diet / and exercise regimen look like?

 

[notsure]

5'11" / 240/ diet well... clean 3 out of 7 days/ would like to exercise 3X a week, but most weeks only get to two.

I have been told that with low T I'm fighting a loosing battle even if I clean my diet

 

[Starplex]

Do you really think your higher BP was a result of hemocrit values? I only ask because I think many people chase the hemocrit number just because of the number. All people are different but some have had a higher value (but <60) and just let it ride. Maybe a blood donation once per year. Then after about 3 years the body adjusts to bring the value to a more natural value. My case and Vince's too I think. All that said to say do you think you acted to quickly based off of the lab value?

 

[SilverSurfer]

5'11" / 240/ diet well... clean 3 out of 7 days/ would like to exercise 3X a week, but most weeks only get to two.

I have been told that with low T I'm fighting a loosing battle even if I clean my diet

Therein lies your answer. I easily lost 60 lbs even with low T. My PCP doc told me to lose 50 lbs before he would start me on TRT, so I lost 60 lbs in 6 months. From 285 to 225. My cholesterol and triglycerides sucked before I got serious about losing weight and getting active. I started working out and walking 6 days per week, and eating healthy, no excuses.

Once I started TRT I lost another 40 lbs of fat, and gained 22 lbs of lean muscle mass.

You aren’t fighting a losing battle. Weight loss is a simple calculation of calories in vs calories out. Get your weight under control and up your exercise to a MINIMUM of 5 times per week (8 hrs weekly minimum) and then reassess if you need TRT.

After I lost 60 lbs I no longer needed high blood pressure meds at all. I also quit drinking any alcohol.

When my HCT started creeping up, I began drinking 4 to 6 oz of fresh squeezed grapefruit juice per day. Within 6 weeks my HCT went down 3 points. I’ve never needed to give blood.

 

[Miironleg]

Your situation is very similar to mine. Hematocrit climbed to 56 a few months after starting trt. Urologist sent me to hematologist, he said don't worry about it until it hits 60. Recommended I go daily subq. Injecting daily subq, grapefruit everyday, and lots of cardio got it down to 50.4. New doctor insisted I do blood donations, mistake for me as it climbed back up to 5 4 and almost crashed iron. I'm now with a Dr Rouzier trained physician who understands the difference between erythrocytosis and polycythemia Vera.

 

[notsure]

Yes at this point lab work and Dr visits seem to point at T for higher BP and HCT. Since I stopped injecting BP is back down to almost normal (125/82) and HCT mid 40’s. Just like it was before I started TRT.

But let me ask, when you lost the first 60lbs, did your total and free T go up substantially?

Based on my symptoms and lab work of three years of trying to balance hormones with HCT and BP I obviously understand I need to increase my T to feel better. Never reached optimum levels because of the issues stated here. So how much did it go up with 60 lbs less?

 

[notsure]

Your situation is very similar to mine. Hematocrit climbed to 56 a few months after starting trt. Urologist sent me to hematologist, he said don't worry about it until it hits 60. Recommended I go daily subq. Injecting daily subq, grapefruit everyday, and lots of cardio got it down to 50.4. New doctor insisted I do blood donations, mistake for me as it climbed back up to 5 4 and almost crashed iron. I'm now with a Dr Rouzier trained physician who understands the difference between erythrocytosis and polycythemia Vera.

Daily injections..... that’s a hell of commitment. I did not try that. I guess if I prepare them on a weekly basis I could just quickly inject when I get up. Still one massive commitment. I’m in my late 40s so that’s a lot of pinning....

 

[Vince]

Daily injections..... that’s a hell of commitment. I did not try that. I guess if I prepare them on a weekly basis I could just quickly inject when I get up. Still one massive commitment. I’m in my late 40s so that’s a lot of pinning....

I do daily injections and my fear was could I be committed to it. For me now it's pretty simple, I just get up and inject. The nice part is, I no longer have to donate blood. My HCT has held steady at 48. I believe it was a combination of daily injection and longevity of trt.

 

[Miironleg]

Daily injections..... that’s a hell of commitment. I did not try that. I guess if I prepare them on a weekly basis I could just quickly inject when I get up. Still one massive commitment. I’m in my late 40s so that’s a lot of pinning....

It quickly becomes part of your daily routine. I get up, do my business, inject, gather my stuff for the day, and off to the gym. No biggie

 

[mooseman109]

my HCT stays 51 -54. I do donate 3 times a year. I have been as high as 62. Lived at 55-57 for a couple years. Never noticed any BP issues with it.
I inject every day, and that helped keep my HCT lower. Longer between donations. For some of us donations is the price of entrance to be in the game

 

[notsure]

Can you guys recommend a couple of good Drs in Houston TX that are knowledgeable about TRT and how to manage these side effects?

 

[Pringle]

my HCT stays 51 -54. I do donate 3 times a year. I have been as high as 62. Lived at 55-57 for a couple years. Never noticed any BP issues with it.
I inject every day, and that helped keep my HCT lower. Longer between donations. For some of us donations is the price of entrance to be in the game

Higher HCT has also been the price of admission for me. Regardless of injection frequency, changing doses, days, etc. I have a phlebotomy every 3-4 months and HCT always climbs up into the 54-55 range by that time. after phlebotomy it will be around 50-51, then cycle starts over!
This always keeps my ferritin in low normal range.....would like to raise it, but just not going to happen and stay at a T levels that gets rid of my symptoms of low T. Cost of admission for me as well.

 

[SilverSurfer]

Higher HCT has also been the price of admission for me. Regardless of injection frequency, changing doses, days, etc. I have a phlebotomy every 3-4 months and HCT always climbs up into the 54-55 range by that time. after phlebotomy it will be around 50-51, then cycle starts over!
This always keeps my ferritin in low normal range.....would like to raise it, but just not going to happen and stay at a T levels that gets rid of my symptoms of low T. Cost of admission for me as well.

Do you have any noticeable side effects when your HCT gets up to 54 or 55?

 

[Miironleg]

Can you guys recommend a couple of good Drs in Houston TX that are knowledgeable about TRT and how to manage these side effects?

Jordan Grant

 

[Pringle]

My BP will creep up slightly as HCT rises, but my HGB/red blood cell markers rise over high lab values as well. I am with Defy and the Doc’s position is phlebotomy when I reach a certain level regardless of symptoms. With coronary disease rampant in my family, I won’t risk letting these values climb high and stay there. Some are lucky and HCT normalizes over time on TRT. I am almost at 4 years and mine has not yet.

 

[notsure]

Do you have any noticeable side effects when your HCT gets up to 54 or 55?

Oh yes.... my ears and chest get red and I get like hot spells. I’m running hot if you will. I also feel like a very mild headache; not pounding but mild constant headache. My BP goes up( I take weekly allergy injections and they take my BP weekly). And when I go and donate it all improves for about two to three months. My phlebotomist even tells me that my blood is thick and not flowing easily. It takes longer to take the pint of blood.

So needless to say it scares the heck out of me.

But then with low T I also have all these other side effects. As I said it can’t be that my choices are stay on TRT and be afraid my heart will explode or stay with low T and feel like $hit.

 

[mooseman109]

Do you have any noticeable side effects when your HCT gets up to 54 or 55?

I do not. At 62 i did, short of breath on excertion

 

[DragonBits]

I take Nebido, my recent blood test was total T of 1492 with a shbg of 57.2 and HCT/Hemo of 45.4 / 15.6. The highest HCT has ever been was 47.5. This was 20 days after an injection of nebido, that short a time typically my T would be high. But it's a long drawn out move up than gradually down, that doesn't seem to trigger higher hct.

You could try Nebido, aveed in the usa, it's unlikely to tripper a higher hct. But it's trickly to get Nebido in the usa and aveed is super expensive without insurance paying.

Nebido causes too high a hct 7% of the, gels 13% of the time, Testosterone cypionate 67% of the time.

So go to a gels or cream, it's likely you won't get over range hct.

If you must use Testosterone cypionate, do daily injections, it's less likely to cause a big increase in hct.

Once your HCT is elevated, not sure how long it takes to lower after changing your protocol or stopping TRT.

My blood pressure goes up from E2 over 45 or so, I can see it the first month after a nebido injection, then it declines. Along with water weight gain. I recently tried taking a small amount of anastrozole, like 1/2 a 0.125 dose 3 times a week, my E2 now is 32.6 despite my total T of 1492, my bp only went up a little, like 129/80 vs 119/75.

But I haven't taken an AI now for 2 weeks, as a reminder, nebido is only high T for ~25 days, so it should have naturally declined to 900s or so.

Progesterone cream also seems to help with BP, not that was why I tried it, but it did seem to lower BP even more.107/73 was a frequent reading.

 

[TorontoTRT]

With HCT running at 56 and E2 at 72 test around 1000 my blood pressure stays stable at a lowish 100/70