Thanks for sharing his response. Very smooth, I give you guys credit for trying to steer the debate towards terms that may be favorable to your position, regardless of what the other person has said. I can give uneducated folks a pass since they don’t know any better but for an educated person who claims to understand the literature, this is inexcusable. This is what you call an academic con job of “look up here, not down there”. Nowhere in my above posts did I say my main concern was hypercoagulation. Scott hasn’t shared one item that refutes anything I’ve shared regarding Hct and blood viscosity. I take it then you agree with the facts as I’ve presented them?
The primary concern with elevated blood viscosity is hypertension, increased shear stress to the lumen (I’m sure you are familiar with what that does), and risk of ischemia and reduced perfusion for compromised patients / older patients. Also, what’s the concern with young person running high blood viscosity for years? Ask AAS abusers what the long term implications of elevated Hct are? Integrate out over 20 years the cost of making your heart do extra, measurably more work. Combine that with a patient who has limited vasodilation ability. Do you guys hand out 50 mg of losartan/day with your TRT program?
No discussion of concern re: LVH with medium/long term elevation of blood viscosity. So according to this logic, no worries with elevating serum viscosity, just let it ride? For a patient with plenty of mileage on the heart, pre-CHF or CHF, no worries with cranking up the blood viscosity? Harmless?
This response is lazy and avoids having to discuss the fact the heart is a pump and a pump is designed to operate on a pump curve (just to keep it simple). Depending on the viscosity of the fluid the pump is pumping, you will land on a point on that curve. Surely you understand the long term implications of running a pump too high on the gpm vs hp curve? Any concerns for long term issues if you want that pump in service for a while? We aint talking about a pump in a manufacturing facility that can be replaced rather easily. We are talking about a heart.
For folks who talk about optimization, you seem to not understand or ignore the penalty function associated with performance vs longevity. For readers, I’ve shared what I think is important for you to consider. Take care of your cardiovascular system. That means use reasonable caution. Running your Hct above 50, or even 55 is not that. But given the TT levels you guys are recommending, I can see how this little inconvenience causes an issue. Elevated Hct has to be harmless in your practice otherwise you have to have your patients doing an oil drain on a regular, painful basis.