Daily Injections to Manage Hematocrit - Not Working

I was basically anemic before starting TRT and it has helped it tremendously (HCT stays at 48 now vs 36 before TRT). I was overweight when I started and also had similar symptoms as you. Once I lost 30 lbs I no longer had high blood pressure, fatigue, etc. Testosterone is amazing but if you are overweight it can make you feel worse. You are putting nitrous on an engine that has been treated like shit for a long time. It’s time to rebuild that engine so you can actually make use of that new nitrous system you have without having issues (analogy for visual effect not accuracy). Lose the weight, get in shape, rebuild your body and get it running correctly and you’ll have a whole different experience with TRT.

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I had HCT of 44-45 before starting TRT and HGB of 158-160, 5 months later on TRT HCT went up to 48 and HGB to 165.
We will see how much they will raise…
My BP before TRT was a bit low now seems most of the time 120/80

It is not, and usually not related. Polycythemia vera can result in elevated platelets. So can iron deficiency anemia and leukemia, among many other causes. Aplastic anemia and chemotherapy can reduce platelets, immune conditions, malignancy, infection can be a cause along with others.

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Really nice summary showing how drastically different two individuals will respond. Before TRT I was 8-10% BF, 43-45% Hct, thought everything else was dialed in, and added very modest exogenous T. Didn’t even start on the Bossa/Nichols dosages. My takeaway is that 300-500 total T is about all I can handle long-term and no noticeable improvements except serious gain of muscle mass so went from 220 lb at 10% BF to 248 lb at 8% BF. Going down the road to more T and adding in ND and Oxandrolone only further exacerbated the issues to Hct / BP / flushing / sweating / higher pump output / exacerbated increased autonomic output. I am glad TRT has been such a positive experience for you. I’ll probably go back to hCG monotherapy since I can get same Total T / free T with that as with 60 mg/week of exogenous T or go back to 300 Total T. Live and learn and I learned a lot. Take care.

OP,

I recently sat at HCT 16.9, HBG 50.3, and was told by my Doc I could up my dose to 350mg T/week, 175 NPP/wk, and 1.5mg Anastrozole/wk. I almost immediately experienced red face, tightness in chest, elevated heart rate, shortness of breath, headache, severe fatigue, and blurred vision for 10 days. I Thought it was my body “adjusting to a different dose”. Got scared. Stopped everything. 4 days after stopping everything, no improvement whatsoever. Gave blood this morning and INSTANTLY felt better.

I know you said you don’t want to keep giving blood, but it was such a dramatic turnaround for me that I put the Red Cross app on my phone and set it to remind me to donate every 56 days (Red Cross’s Max frequency).

I don’t know if high blood volume, high HCT / HGB are a problem or not. I’ll leave that to the smart people to debate.

But when I’ve been suffering severe side effects for 2 weeks and something INSTANTLY makes me feel better, I take note.

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I would love to continue to give blood every 3 months. Like you I feel better imediately, plus I’m helping people.

But ferritin gets too low. I guess you have no issues with ferritin.

Just curios…primary physician suggested I switch to creams/gels to avoid the HCT issue, or as he put it, reduce the HCT issue?

Have any of you been successful with creams (gels might be too costly for me) and this worked to maintain proper red blood cell levels?

Red blood cells have a lifespan of like 2-3 months or something like that so once you stop doing what’s causing it it’s going to take that long for things to get back to normal (in theory at least).

Cream is great when it’s made correctly and consistently. From what I’ve heard you need to make sure it’s from a reputable source (as in a compound pharmacy that has been doing it for a while). Dr Nichols at Tier 1 has many patients on cream that are thriving so it’s definitely a good option. There’s countless threads with folks on gel that have horrible experiences so I’d stay away from them and make sure you do your homework before deciding on which cream & source of that cream you decide to go with. If you have the deneros I’d check out Dr Nichols (he’s not that expensive).

Hello. I read your reply and would like to ask you a question. Some: History first: I am also on TRT. I have been on TRT for 12 years now. My initial doctor Crisler and for 12 years I had no problems with his regiment. I was on transdermal compound gels and my T level was around 650. I am not looking for supraphysiological levels. Dr. Crisler unfortunately died a year ago so I had to switch to a new Dr. I am happy with him but he switched me to Weekly injections of Test Cypionate. The injections are easier and I feel a lot stronger etc. Anyway after a few dose adjustments (since I went really high on T) I am now in my last blood test at 940 T on the 4th day after injection. This was on 100mg injected weekly. I also do HCG and Arimidex. The problem is that my Hemoglobin is high. I am at 18.3 and I am going for a blood donation tomorrow. I hate the whole blood donating thing. I dropped my does to 60mg per week this week to see if this would make any difference 6 months from now when I have my next blood test. I am hoping I will have a response like yours and my Hemoglobin will stabilize below 17.7. How are you feeling on the 60mg per week? For me this would be the final try before I switch back to compound cream again unless I can go even lower (like 40mg per week) and still get benefits of TRT without side effects. I think frequent blood donations are way too invasive. What is your opinion about all this?

Thanks for the question and background. Currently injecting 70 mg TC once per week and just recently added back u-hCG at 400 IU twice per week (which has also helped with mood and well-being). I’ve tried to be meticulous over last year as I recovered from A-FIB episode. 70 mg TC every week puts me at 900-1000 ng/dL peak and 400-500 ng/dL trough.

If a picture is worth at least a few words then here you go (some data points from another lab omitted):
image

On >=120 mg/week of TC I was routinely above 51% Hct (17 g/dL hemoglobin). I can now manage my Hct at 46-48% no problem and am getting the benefits of TRT without the ridiculous sides. Of course doesn’t apply to everyone, but for some subset of the TRT population they need to realize there is a huge difference in the ratio of rewards/sides in going from say 80 mg/week of TC to 125-150 mg/week.

That’s why I maintain that starting dose should be closer to 100 mg/week of TC rather than 150 mg/week (@dbossa, let me know Danny when you officially lower your mean recommended starting dose of TC down to 125 mg/week :-). Good job going from 200 to 150 mg/week and I know you will eventually get down to the 100-125 range.)

I’m with you, frequent blood donations just aren’t workable. I love donating, but a 1 unit whole blood donation uses a 16 g needle (harpoon). If you want to go up to 18 g needle, you need to do a double red donation, which while wonderful and live-saving for the recipient, also pumps a bunch of DEHP (xenoestrogen plasticizer) back into your bloodstream (damned if you do and damned if you don’t!).

Be methodical and titrate your dosage understanding it will take 3-6 months to pick up the difference on CBC. If you have a knowledgeable hematologist, they can order a reticulocyte test to get a sneak peek in advance but you need a baseline while you are on the higher dose that is causing issues. Take care and I wish you well on your journey.

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Thank you for the reply. I will do 60mg per week with two HCG injections at the end of the cycle. I already started this week and we will see how it goes. Another alternative my doctor offered was 40mg twice a week (one shot every 3.5 days). I will try the single shot first and see how I feel. Also I will discontinue my arimidex pills since at his low dose I doubt there will be an estrogen conversion issue. Anyway if this still does not work I will switch to transdermal creams which I know for sure worked for me for 10 years. I am in for the long run and not looking to become a body builder. I understand why some guys do these crazy high doses. If I wanted to build muscle like that I would too. :slight_smile:

How’s your protocol? Were you able to control your hematocrit?

Gels are just as bad. I used Androgel for 12 yrs or so. I had to give blood every 2 or 3 months. Hct was 52-53 with a t level of only 350-600.
Trying pinning now.

I have switched to micro-dosing. I am now doing 11-12 mg a day (between 0.05 and 0.06 ml) using a 27 gauge sub-q injection. I am also micro-dosing 0.08 ml of HCG daily and stopped arimidex. My last blood work I was at 48.5 Hematocrit 16.5 Hemoglobin and 780 ngdl of T. But this was after I dropped my Hematocrit low with 2 blood donations. I have another blood test coming up in 4 months to see if the Hamatocrit stays below 50. I feel great for now. We will see what happens in 4 months.

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I never had that problem with gels and I used it for 10 years. I guess we are all different…

Yep, we are all different. Im currently at 220mg/wk. Daily injections. But I always make sure to drink a glass of water when I wake up, and hydrate continuously throughout the day. Its prolly not making a difference but I tested last two times at 48-49% HCT with 1500TT. So yes, were all very different

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Delete this.

It’s weird. I just gave blood today and my HGB was 16.4. (Before giving). It was always above 18 on gel. I’m pinning 200g cyp OAW. This is the best I’ve felt in 20 years.

How long have you been on 200g? Is OAW Every week or Every Other Week? If you are on 200mg per week I can guarantee you that you will eventually have increased hemoglobin.
I am microdosing right now in what amounts to 80 mg a week and I am at 780-850 testosterone ngdl and feeling great. My blood pressure is much better than before when I was doing 200mg a week and I feel more energetic and just as strong as before. For my body 80mg a week (11mg daily is perfect). The natural production of testosterone of a healthy male is 6-10 mg a day.