Success stories for managing TRT induced increase in hematocrit?

[Michael D]

I have been using testosterone cyp injections for the last 6 years to treat low T levels. I inject 0.66 ml once per week. I recently had to get a new Dr. because my regular GP retired. I live on the Big Island, where it is very hard to find good doctors. Long story short, my new Doc ordered lots of tests when he took me on and he found raised levels of hemoglobin (18.3) and hematocrit (54.6). Once diagnosed I started lots of reading, and this site has been very helpful. But there is so much material to wade through, and the topic is controversial even among the medical community. But I can say I have had a lot of headaches and ringing in my ears, and I already have marginally high blood pressure and elevated cholesterol (take Lipitor). I'm wondering if the erthrocytosis/polycythemia is the cause? If these raised levels are the cause, will I feel better after my first phlebotomy (I'm scheduled for 3, 3 weeks apart).

I go for my first phlebotomy in a few days, and the doc is wanting to stop my TRT. I do NOT want to stop TRT, since it has really improved my quality of life. I haven't read many success stories in managing this problem and staying on T. Can anyone tell me if/how they manage this problem? I'm not new to TRT, so I don't think I will "stabilize." Has anyone switched to a gel and had success, or AVEED (yikes, that's expensive)?

 

[fifty]

I’d do 1 donation then make it your job to drink 100oz+ water per day w/ celtic sea salt or pink himalayan salt to try to address bp and hematocrit.

Also address any possible sleep apnea issues and include some sprints or cardio or hiit training in your exercise regimen.

3 donations in 2 months will tank your iron levels. Highly questionable.

 

[Michael D]

I'm actually quite fit (5'10" 180 lb)...play a lot of tennis. I'm wondering about your salt water recommendation. That would dehydrate, which would lower BP, but dehydration increases hematocrit/RBC.

I'm less concerned with the immediate task of getting my hematocrit down than I am with long term control while staying to TRT. Have others done accomplished this?

 

[fifty]

Salt water...I am talking a smidgen of salt (aka ~1/32 tsp) in a 28oz glass of water.

 

[Deleted member 16042]

There is some evidence, at least anecdotal, that lower peaks in your Blood levels of T can lower production of hematocrit. i.e. your once a week injection schedule means higher peaks and troughs in your blood levels compared to more frequent dosing.

You may benefit from smaller doses every three days or every other day to bring down the peaks.

Also, lowering total dose can work, though withdrawal can be Hell.

I had to do both, and it worked, though again, lowering dosage was misery. Now on EOD dosing at lower total weekly dose, and withdrawal symptoms are long gone (did this years ago).

 

[Vince]

Try daily injections, it works for some members.

 

[DragonBits]

There is some evidence, at least anecdotal, that lower peaks in your Blood levels of T can lower production of hematocrit. i.e. your once a week injection schedule means higher peaks and troughs in your blood levels compared to more frequent dosing.

You may benefit from smaller doses every three days or every other day to bring down the peaks.

Also, lowering total dose can work, though withdrawal can be Hell.

I had to do both, and it worked, though again, lowering dosage was misery. Now on EOD dosing at lower total weekly dose, and withdrawal symptoms are long gone (did this years ago).

I agree, the basis I use is the nebido and creams have lower incidence of high hematocrit. Nebido has one period of high peak that lasts maybe a week once every 3 months, and creams are daily.

I do wonder if steady state high levels of testosterone result in similar lower levels of high hematocrit, I suppose pellets would give a steady state?

 

[UCFguy01]

I was on pellets a few years back and they definitely give you that slow drip of T making you have a more stable and steady state. They raised my HCT to around 48-49. When I first started injections my HCT went up to 51 but for some reason it dropped after about a year. Now my HCT is is 45-47. It stabilized over time for some reason. Not really sure why.

 

[Michael D]

There is some evidence, at least anecdotal, that lower peaks in your Blood levels of T can lower production of hematocrit. i.e. your once a week injection schedule means higher peaks and troughs in your blood levels compared to more frequent dosing.

You may benefit from smaller doses every three days or every other day to bring down the peaks.

Also, lowering total dose can work, though withdrawal can be Hell.

I had to do both, and it worked, though again, lowering dosage was misery. Now on EOD dosing at lower total weekly dose, and withdrawal symptoms are long gone (did this years ago).

Did you ever have to go through a phlebotomy? My HCT is almost 55...so the doc wants that down pronto before we settle on how to go forward with TRT. But I have no problem with more frequent injections. I used to do that, but just got tired of it, once a week is more convenient. Unfortunately, my previous doc never checked RBC and HCT, so I have no idea how long I've been hovering near the red line.

 

[Michael D]

I was on pellets a few years back and they definitely give you that slow drip of T making you have a more stable and steady state. They raised my HCT to around 48-49. When I first started injections my HCT went up to 51 but for some reason it dropped after about a year. Now my HCT is is 45-47. It stabilized over time for some reason. Not really sure why.

Why did you switch from pellets to injections? I switched from gel to injections mainly because it is much more cost effective when you buy 10ml vials.

 

[UCFguy01]

Why did you switch from pellets to injections? I switched from gel to injections mainly because it is much more cost effective when you buy 10ml vials.

I actually loved the pellets. Best I've ever felt. I didn't worry about E2 or anything really. Every 3 months I'd get them and I'd be set feeling amazing everyday.

The problem was I had issues a few times with them falling out. I don't have enough fat on my backside and I do crossfit so every so often a pellet or two would work it's way out. I didn't like that I was paying a lot of money and losing them so I switched to injections which are so much more complicated. I'm feeling good on injections now but I don't know if they'll ever match up with the smooth daily drip that the pellets give you. My Total T on pellets would be around 1400 - 1500 and my E2 around 40 with no AI.

 

[Deleted member 16042]

Did you ever have to go through a phlebotomy? My HCT is almost 55...so the doc wants that down pronto before we settle on how to go forward with TRT. But I have no problem with more frequent injections. I used to do that, but just got tired of it, once a week is more convenient. Unfortunately, my previous doc never checked RBC and HCT, so I have no idea how long I've been hovering near the red line.

Yes, though i was only able once due to low ferritin.I'm not the only one, some other members have run into this problem too.

 

[DFL]

My Hematocrit was almost 55 at one point, at 120 or 130mg/week Cyp, and I began donating every 3 months.

I tried more frequent and daily injections and a few natural “remedies.” The only thing that worked in the end was reducing my dosage. I changed to 100mg/week for 3 months and it dropped to 52.1 (without donating).

I’m now at 80mg (40x2 week) and due for labs so I don’t know where it is right now. I actually feel great right now at 80mg, and my sex drive is rockin like college...

 

[Michael D]

My Hematocrit was almost 55 at one point, at 120 or 130mg/week Cyp, and I began donating every 3 months.

I tried more frequent and daily injections and a few natural “remedies.” The only thing that worked in the end was reducing my dosage. I changed to 100mg/week for 3 months and it dropped to 52.1 (without donating).

I’m now at 80mg (40x2 week) and due for labs so I don’t know where it is right now. I actually feel great right now at 80mg, and my sex drive is rockin like college...

Thanks for the success story. I'm hoping I can find a balance. This week I started logging my water intake and targeting 100 oz per day (3 L)...which is probably triple my typical intake. I tend to drink very little. That has made me feel better in many ways. After a few days the ringing in my ears stopped. I also had my first phlebotomy yesterday. I have one per week for 3-weeks. I asked if they will be testing iron and ferritin..."no." Oh well, part of the price of living in paradise! (poor health care). I'm reducing my T to 60mg/week and I'll see where I end up, and increase if I can. I won't have another set of labs to see my hematocrit level until after the 3rd phlebotomy.

 

[fifty]

Good to hear.

I would really consider whether phlebotomy #2 & especially #3 are necessary. Do they check hematocrit or hemoglobin beforehand during the phlebotomy intake?

 

[Michael D]

The doc did not order any labs between phlebotomies. But I was nearly 56 HCT...and from what I've read it will only come down about 3 points after the blood draw. So I have a ways to go. I might ask him to order labs after my 2nd one.

 

[madman]

My Hematocrit was almost 55 at one point, at 120 or 130mg/week Cyp, and I began donating every 3 months.

I tried more frequent and daily injections and a few natural “remedies.” The only thing that worked in the end was reducing my dosage. I changed to 100mg/week for 3 months and it dropped to 52.1 (without donating).

I’m now at 80mg (40x2 week) and due for labs so I don’t know where it is right now. I actually feel great right now at 80mg, and my sex drive is rockin like college...

This is key as lowering one's overall TT/FT levels will have the biggest impact but the main issue is finding the lowest TT/FT level you can run without losing all of the beneficial effects of testosterone.

Although switching to daily using lower dose of T may work for some it is not a given and the downfall in many cases is these same individuals that tend to struggle with elevated RBCs/hemoglobin/hematocrit are still running absurdly high TT/FT levels!

 

[fifty]

The doc did not order any labs between phlebotomies. But I was nearly 56 HCT...and from what I've read it will only come down about 3 points after the blood draw. So I have a ways to go. I might ask him to order labs after my 2nd one.

I'm just saying that in the US, usually before a blood donation they go through an intake process where they check your blood pressure, pulse, and do a finger prick to check hematocrit (or hemoglobin).

 

[tareload]

This is key as lowering one's overall TT/FT levels will have the biggest impact but the main issue is finding the lowest TT/FT level you can run without losing all of the beneficial effects of testosterone.

Although switching to daily using lower dose of T may work for some it is not a given and the downfall in many cases is these same individuals that tend to struggle with elevated RBCs/hemoglobin/hematocrit are still running absurdly high TT/FT levels!

How do you double like a comment? Bravo, my good man!

 

[Michael D]

I'm just saying that in the US, usually before a blood donation they go through an intake process where they check your blood pressure, pulse, and do a finger prick to check hematocrit (or hemoglobin).

Well, Hawaii is not really US when it comes to medical care! They did none of that when I showed up for my phlebotomy. I asked if they would do it, and they said no.