T Nation

Daily Injections to Manage Hematocrit - Not Working

Ok I’ll try to keep it short but provide enough details.

This is my 2nd try with TRT. Stopped first time because of high HCT side effects. I kept making blood donations to manage, but it caused really low Ferritin and was feeling with really low energy. During the first go around I injected once a week and then went to 2X and then 3X a week. No success managing the red blood cells reaction plus I was trying to balance HCG and AI.

I decided to do a reset and see if between Clomid and HCG I could get my natural T to near 500 ng/dL. That did not work. My natural T has been as low as 150 ng/dL.

So after research decided to give another try without HCG and AI’s and do daily injections. Currently doing about 5-6 units or 10 to 12MG daily. My current total T is 692 ng/dL and Free T is 135 pg/mL. Well my Hematocrit is at 53.7%, Hemo at 18.1g/dl and RBC at 5.98M/CMM. Dr told me to do another blood donation, but I checked my Ferritin (since I’ve already done two blood donations in the last 8 months) and it is low at 26ng/mL with a reference range of 38ng/mL - 380 ng/mL. My current side effects due high hematocrit is higher than normal blood pressure, headaches, and redness chest/face, etc. At the last donation the phlebotomist told me my blood was “thick”. I’m also feeling a bit rundown which I think is the low ferritin, so I don’t want to do another blood donation but I feel I have too if I don’t want to have a heart attack.

So daily injections did not work;… I can’t be a unicorn. What am I doing wrong? I can’t go lower on T because as it is (I do feel better in regards to workout recovery and mood) but at the same time is not like I’m reaping the full benefits of optimal T. I’am about 50 lbs overweight fyi…

So are my options get out of TRT and suffer through all the effects on low T or continue TRT and risk a heart attack with thick blood? Those cannot be my only options because neither is acceptable…so thoughts on what I can do?

Try a baby aspirin.

Are you taking high dose of iron for increasing your ferritin?

Polycythemia. probaby secondary. You should see a hematologist. It can be caused by being overweight, dehydrated, kidney problems, too much alcohol, smoking, or over production of erythropoietin from the kidneys. Its true that T can cause the kidneys to release more erythro but usually not to this extent. To manage the increased risk of stroke and acute coronary syndrome 325 of aspirin daily would be wise. I’d like to add Plavix here but that might be overkill. Donating is only a short term solution because it doesn’t correct the underlying cause. Seeing a hematologist might help you A. correct the underlying cause, B. find a way to raise your T without a correlating increase in H&H.

Just curious are you a DR? I have read many forums and no one had suggested a hematologist to approach it the way you described here. I think I will be making an appointment with one.

I’m overweight but I don’t think I’m obese yet … well maybe light obese lol… so maybe all of these have merit.

Isn’t 325 daily aspirin too much?

Nope I’m a nurse. And no 325 not too much unless you have a bleeding disorder. But like I said you should see a professional cus you’re at somewhat high risk

I said baby aspirin, 81mg.

You have erythrocytosis because you are on TRT. This is a typical and expected result and usually of no consequence. However, you are having symptoms.

You can see a hematologist, but expect little, if any, help. He/she will look at your labs, review your history, including meds, and give you a brief examination. The cause is obvious. Testosterone is increasing erythropoietin, which is increasing RBCs. The fix? Stop taking testosterone. Done.

It appears you’ve tried multiple options to bring your counts down, without success. That is why I suggested trying a baby aspirin. I’m curious, what is your platelet level?

This may be of interest to you:

Interesting video.

Are there actually any studies that shows erythrocytosis induced by testosterone (and not other causes) is actually dangerous?

I sat in a room with 100 other doctors while Dr. Neal Rouzier challenged us to produce any evidence from the literature showing TRT causes blood clots, heart disease or stokes. Silence.

I have not been able to find anything.


I do not understand why people focus on hematocrit when it is meaningless. Hematocrit can be high from just dehydratation. How much water do you drink a day?

What matters is hemoglobin and platelets. How are they?

Also have you tested yourself for sleep apnea or are you a smoker?

What’s a good platelet level?

I have high hemoglobin and low normal platelets.

Platelets are good to be normal and not on the high end. For hemoglobin I would like to see the whole cbp

I did do a sleep apnea test and they said “mild”. They tried to sell me the machine, but at the same time not enough to be fully concerned.
Hemoglobin is high at 18.1g/dL
Platelets normal at 251K/CMM

Hct is definitely not meaningless. Take a read if you’d like to educate yourself.

Doesn’t look like there’s a way to auto-post this link every time someone posts that video. Overconfidence and simplification seems like a dangerous approach when you are dealing with the circulatory system.

I have struggled with High HGB/HCT since starting trt 4 years ago. I have some mild plaque build up, so keeping this in an acceptable range is important to my hematologist, who also prescribes my T. I have tried all shot regimens and none lowered my HGB/HCT to an acceptable range. For some of us on TRT, a phlebotomy every 4 months, or so is cost of admission. At 4 month intervals I do not tank my ferritin and keeps my HGB around 17 and HCT sub 52. Levels my doc is comfortable with. I also am on an aspirin regimen as well and have severe apnea that is treated with CPAP.

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Do you know what HCT is? This is the percentage of hemoglobin in plasma. Thats why I said hemoglobin matters and HCT doesnt.

Thank you.

So, your proposing that hemoglobin doesn’t matter because hemoglobin matters? Or is it HCT doesn’t matter because HCT matters?

If your hemoglobin is ok and your hct is high your are dehydrated. If your are not dehydrated and hct is high hemoglobin will be high as well. So high HCT should cause any concern only if hemoglobin is high as well. So from that perspective it looks it doesnt matter if hct is high when we can pay attention to hemoglobin and other CBP readings