T Nation

Do High Hemoglobin & HCT Levels Really Require Phlebotomy?

I wanted to hear what people thought about Dr Crisler’s recent video about not needing therapeutic phlebotomy? My RBC & HCT are creeping up and I was considering phlebotomy, but he is now saying it’s not needed.

Here’s the vid -

Thought I’d tag a few people to hopefully get some discussion going on this topic.

@physioLojik @anon10230041 @anon10035199 @systemlord @NH_Watts @KSman @bmbrady77 @charlie12 @unreal24278

He makes a good point with comparing platelet and WBC levels for verification. I live at higher elevations so my RBC is obviously going to be higher than my family’s that live down south at sea level. My HCT is at 50% right now, and I was a little concerned, but was pleasantly surprised that my platelet and WBC levels are normal.

Good discussion topic man. Thanks for sharing.


This is accurate. We rarely use it. I mean RARELY. The drawbacks are much higher than the benefits.


Its great to get your view on this Physio because I’ve read over and over on these forums about people getting blood drawn as soon as their HCT gets a little high. So glad its not recommended as standard procedure.

What if anything do you do with your patients when their RBC and/or HCT gets on the high end?

About two and a half years ago, at their national convention, the American College of Urologists came out with a position paper which stated that TRT does not cause blood clots, stroke or heart attacks. They did a meta-analysis looking at over 400 studies retrospectively and came to that conclusion. Many TRT docs are coming around to this, especially if platelets are good.

I thought, at one time, Crisler recommended phlebotomy at a hct of 55%. Pretty sure I saw a post of his on another forum.


SOMe (hint hint) people have doctors that get nervous when HCT goes above the ref range (my ref range says, FOR MEN, that hct is out of range if it’s over like 45.5 percent), I’ve argued against this before, my hct was 52 percent prior to TRT, I’ve never found it an issue, however if the doc gets nervous and wants to pull you off or further lower you’re dose despite having a normal HCT (on trt HCT has ranged from 46-49 percent), so the only thing I can do is eitber, phlebotomy which a doctor won’t give me or self medicate OR get pulled off and end up self medicating anyway, which do you think I chose?

What about supraphysiologic doses, from what I remember you’ve blasted some fairly high doses (I believe you’ve used test, EQ, tren, winny, halo, dbol and mast before (and recently deca) and totalled in the 6-900 mg range, possibly more, I’m just curious as to if you’re HCT rises to dangerous levels on blasts (I consider dangerous like 58%+). They’re talking about TRT here, I’ve always been skeptical about TRT increasing stroke risk, however I do believe higher doses do promote an increased risk of blood clots and strokes via platelet aggregation and a few other factors.

1 Like

I asked this question elsewhere, but never saw a response. I’ll try again here.

Typically we all have blood work done early morning (since we are all testing Testosterone).

Have any of you with high Hematocrit readings returned to the lab in the afternoon for another test?

It is something I want to try. I want to know if my HCT is high in the afternoon after I have my normal about of water intake.

Have not tried that and I do not know anyone who has. Dehydration can impact CBCs, but I don’t know how much.

Look at the red Crislers face is … if anyone needs to donate it’s him Lol