Daily Injections to Manage Hematocrit - Not Working

You should try reading @readalot 's posts in that thread,he’s pretty sharp and you will probably learn something.

So what according to you is wrong in the above statement?

One thing nobody mentions and it’s very important. The rise in blood thickness onTRT caused by increased red blood cells and hemoglobin is OFFSET by testosterone which is also increasing nitric oxide production and hence increasing vein and vessel dilation resulting in a nil differential resistance in blood flow. Thicker blood, wider blood vessels. I’ve had HCT as high as 58 and hemoglobin as high as 19 with a resting heart rate of 53 and blood pressure averaging 100/67.

Yes, I think I know what Hct is. And no, it isn’t the % of hemoglobin in plasma. It is the volume percentage of red blood cells in whole blood. Contrary to your statement above, dehydration will affect both Hct and Hgb.

Here’s a good reference for you to read:

Hemoglobin (Hb) is the protein contained in red blood cells that is responsible for delivery of oxygen to the tissues. To ensure adequate tissue oxygenation, a sufficient hemoglobin level must be maintained. The amount of hemoglobin in whole blood is expressed in grams per deciliter (g/dl). The normal Hb level for males is 14 to 18 g/dl; that for females is 12 to 16 g/dl. When the hemoglobin level is low, the patient has anemia . An erythrocytosis is the consequence of too many red cells; this results in hemoglobin levels above normal.

The hematocrit measures the volume of red blood cells compared to the total blood volume (red blood cells and plasma). The normal hematocrit for men is 40 to 54%; for women it is 36 to 48%. This value can be determined directly by microhematocrit centrifugation or calculated indirectly. Automated cell counters calculate the hematocrit by multiplying the red cell number (in millions/mm3) by the mean cell volume (MCV, in femtoliters). When so assayed, it is subject to the vagaries inherent in obtaining an accurate measurement of the MCV (see Chapter 152).

Both the hemoglobin and the hematocrit are based on whole blood and are therefore dependent on plasma volume. If a patient is severely dehydrated, the hemoglobin and hematocrit will appear higher than if the patient were normovolemic; if the patient is fluid overloaded, they will be lower than their actual level. To assess true red cell mass, independent radionuclide evaluation of the red cells and plasma (by 51Cr and 131I respectively) must be performed.

Some information of whole blood, plasma and serum:

differentiating between whole-blood serum and plasma

I understand it can be confusing. That’s why it’s important to not post incorrect information on these forums.

Finally, what does a plot of Hct vs Hgb look like for a reasonable group size of trauma patients? I don’t like the title of the page below (they are not the same), but Hct and Hgb are highly correlated as they should be once you understand what they are.

What is Fact?

There simply is NO difference between Hemoglobin and Hematocrit by means of clinical information!

  • In fact, virtually all haemoglobin in our blood is contained within erythrocytes

  • Therefore, whether the amount of Hb per litre of blood is determined or the blood’s volume occupied by the Hb filled erythrocytes is determined, similar information is gained.

  • Nijboer at al. have brilliantly proven that Hb and Hct correlate in all ranges and all patients and also nicely show this in their figure 1 (see below)

  • The only rare exceptions are macrocytic and polycytemic anaemia in which the Hct is defined by erythrocytes containing a normal mean corpuscular Hb concentration

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Here’s an entire paper devoted to explaining why your statement is wrong.

image

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Thank you for bringing this up. As one would expect, there is a distribution of responses to TRT [Hct and inflammation status (–> plasma viscosity) and hence whole blood viscosity response, NO production,…]. So you better know where you are on each of the distributions. Some guys (congratulations BTW) can handle a Hct of 58 (for XX amount of time?), whereas other mortals like me and the OP (it appears) can not even in the short term.

The rest of this is just general comments directed at the forum from an anonymous T-Nation forum member. I don’t have any credentials since I am anonymous, and you should judge people’s statements on here by their validity and not their credentials. Some folks can’t do that so they should see a licensed physician since the body is a black box to them.

That’s why I’ve posted many times that mileage can and does vary and it’s irresponsible to simply state that “Hct is just oxygen in the blood”, or “erythrocytosis is harmless”. Maybe it appears that way in your particular case but there are guys who are profoundly affected in a bad way but running Hct up above “normal” range. In most cases, there is no free lunch (longevity vs performance) and the TRT dosage you may want to take will not be the dosage your heart is comfortable with.

Some ideas:

Screened for hemochromatosis?
Irregular heart rhythm?
Thyroid status?
cRP and inflammation status?
Autoimmune status?

The list can go on.

How much muscle do you want?
How long do you want to live?
etc.

I missed this. But in regard to overconfidence and oversimplification:

“Anyone who claims to be an expert, is not an expert. An expert should be smart enough to know they are not an expert.”

Not my quote, but I like it.

Thanks for sharing this. Great point. Any of the vary thoughtful practitioners I’ve spoken with use a very large margin of safety in their approach with this stuff since there is such an individual response. What are going to be the effects 6 months, 1 year, 10 years down the road? The only statement I can make on here with 100% confidence is I am not an expert. The trick is finding a practitioner who is an expert on how you will respond on Androgen Therapy :slight_smile:.

That will be impossible, since no one can know how you will respond, until you’ve responded.

By the way, the quote is from Neal Rouzier. I over heard him say it. I left out the first sentence, which was “I’m not an expert.” He almost seemed offended when called an expert. I think, after 25 years of doing this, he’s seen a lot. Then, on top of all that experience which has formed his opinions, he throws an overwhelming volume of research literature at you.

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Donations every 4 month sis not lowering your Ferritin below normal values?

For me it seems to be doing that.

I will schedule an appointment with a Hematologist…lets see what he says.

I asked my Dr. if it was OK to just get off TRT and live my life with Low T and the symptoms/side effects. He said yes, many men do, but something just doesn’t seem right. If it was diabetes I think the answer would be different. However I do feel the side effects of high hemato/hemo.

Seems I mistakened a bit what hematocrit is, but still from your materials(I will read them fully) doesnt it still appear if hemoglobin is Ok and other readings like platelets and trombociti and etc hematocrit’s value doesnt matter much?

I know a guy 2-3 months ago saw his CBP. His hemoglobin was around 165-170(16.5-17 in your values) and hct was 51. He told me he is drinking almost no water. Told him to start drinking 4l per day and after 3 weeks his HCT has fallen to 47 and hemoglobin was still above 160(dont remember exact numbers). So how does it work if they are the same?

As for the debate about whether erythrocytosis is totally harmless despite the fact I totally respect Neil Rouzier and his pioneering in the HRT realm I dont totally agree with his stance erythrocitosis is harmless no matter what. But I also believe he is a bit exaggerating that in his public speaches to prove a point and I think he is weighing every individual of his patients.

On the other hand I totally dont agree to the doctors who freak out when seeing HCT 52-53 and immediately send the patient donating blood.

I have a friend local endocrinologist who is not experienced in TRT despite his long years of practice and he will give you an ampule every 2-3 weeks. But he is very experienced in many other endocrine disorders and for the standards of the general endo who practices board medicine he is very well read and smart. And he is almost never using AI for his TRT patients except in extreme cases and he is not sending them to donate blood on borderline high HCT. In fact when I started TRT he told me not to worry about HCT and that it will settle at some point

I have a friend bosybuilder running supraphysiological doses. Now as we speak he is on 470mg test and 300 tren. He told me initially he had border line high HCT and HGB on TRT doses and now on this super high dosages he has similar CBP values. According to his experience on TRT dosages they rise initially and then settle down

What test methods were used to measured Hct and Hgb? I have no idea as there’s no theoretical basis for what you describe and you’d need to explore measurement error associated with the methods used to ascertain the parameters.

Example studies attached.

http://www.kjcls.org/journal/view.html?doi=10.15324/kjcls.2017.49.3.227

https://www.practicaldiabetes.com/article/effect-dehydration-blood-tests-2/

Good luck with your visit. For example, I currently take 60 mg per week of testosterone cypionate and maintain Hct below 50% with no measurable impact on BP. At 120 mg/week, blood pressure shoots up 20 points, redness, and heart feels like it is pounding (Hct between 50 and 53). I tried 300 mg/week for 3 weeks and woke up with atrial fibrillation, which was a wake up.

There are guys on here and plenty in the literature that can do 600 mg/week for 12 weeks without major problems (at least in the short term).

Take care of yourself as you navigate a very nonlinear space of risk vs reward. Your story is a great example of why blanket statements about “benign erythrocytosis” are harmful (even if they are potentially stated for entertainment effect).

Hemoglobin is SLS HCT is calc this is how the measure it in the best labs here in Bulgaria I dont know further details :slight_smile:

That is interesting. This goes to show how unique responses to TRT can be. At 200mg a week, my hct hovers between 53-55%. Six months after starting, I lost five inches off my waist, lost 10-15 lbs of fat, gained 5-10 lbs of muscle. BP dropped 20 points, to the point I could d/c medication I’d been on for 10 years, and, after d/c anastrozole, I saw lipids improve dramatically, total cholesterol from 205-210 to 165-170 and HDLs from 30 to 40.

I’ve seen similar results with some patients. I’ve also seen guys with 42% hct go on TRT and their hct does not increase at all and I wish it would. I’ve seen others go so high they have symptoms and get regular therapeutic phlebotomy. I’ve seen others go higher than mine and still have zero symptoms, they feel great.

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Thanks for your comments. My experience makes me grateful that I didn’t experiment with AAS until much later in life when I had some semblance of education to make sense of some of it. Even though I only carry heterozygous hemochromatosis mutation, my Hct and blood pressure response are extremely nonlinear with modest dosages. Combine that with pre-existing “normal” branch block variant, supraphysiologic dosages are clearly a no-no and modest physiologic dosages are a challenge. TRT was after everything else was dialed in.

Take care and no intended offense on my critique of Rouzier’s short video. I understand he’s trying to help and challenge conventional wisdom. As you state, he creates very nice summaries of the literature with detailed reviews. But then he goes and makes statements such that high RBC is harmless and the average 20 year old has an E2 level of 75-100 pg/mL. Surely, he must understand the first statement made in an unqualified manner is dangerous, and the second statement is not congruent with the clinical data available. These statements stick with guys who aren’t going to read the literature but will watch a 5 min video.

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None taken.

Sounds as though you have taken his courses.

In speaking to him, and taking the classes listening to the lectures, he is pretty sarcastic, which works for me and I actually like it. I do believe he always allows for individual variations and I take the above in more general terms than absolutes. In the practice, I stay away from “never” and “always” as much as possible.

If Hct is 52% hemoglobin 17.6 and platelets 140, is blood donation needed. Also BP is 120/80 and currently using bipap for sleep apnea.
Seems unusual to have platelets at low end of normal range with high hct, hgb and RBC 5.8