T Nation

Hematicrit Levels

hello new to forum, I’ve been on TRT for little over a year I used to go to a T clinic but for cost and insurance purposes I started going to my PCP. I was pretty stable with my T and Low t when I started going to my PCP but my hematicrit levels would always elevate to where I have to give blood. I get an annual exam at work and it was determined my iron was real low and I was feeling really tired.

i went to Dr and tested low in iron and ferritin levels. he put me on iron pills to bring them up but I believe my body isn’t producing the iron fast enough from donating. I donate atleast every 3 to 4 mths. he switched me to twice a week on my injections but I don’t think it’s working all this trouble is making think I should just get off altogether cause im not seeing the worth over the cost and he says just stop cold turkey. 1ml of test from once a week to twice a week and just started .5 once a week because of my hematicrit. i also take e2 blocker anastrozole

any suggestions on what I should do

If you are unknowingly suffering from sleep apnea this will increase hematocrit levels. Sometimes injecting multiple times a week can lower hematocrit levels do to lowering your peaks and also keeping E2 levels more stable.

Also higher total and free estradiol levels are associated with high hematocrit. A phlebotomy will lower hematocrit levels to a greater degree (3%) than simply donating blood.

Have you considered phlebotomy?

Have you had a sleep study done while on TRT?

no I haven’t but it’s in the works on the sleep study. what exactly do you mean phlebotomy. i give blood. I’m not understanding

it sounds as if your talking about seeing a phlebotomy to give blood more regularly. but doing so I think is the reason I had to take iron pills to bring my iron back up.

A therapeutic phlebotomy involves the same procedure as blood donation, the primary difference is the frequency of how often we give blood. My advice is to get your iron and ferritin up to a healthy level and then get a therapeutic phlebotomy instead of blood donation.

Lots of guys on TRT that have high red blood cell counts get therapeutic phlebotomy, otherwise they wouldn’t be able to remain on TRT.

ok I’ll check into that thanks

I have the same issue that you have but I have also been diagnosed with sleep apnea. I use a cpap daily and taking fish oil helps keep my hemocrit and hemoglobin stay in range but my RBC continues to run high. I get my own CBC every 4 weeks and decide based on my those levels and my ferritin level if I need to donate. I supplement with iron every other day. Before I started trt years ago I had problems with anemia and had all the internal bleeding test done and they found no issues. It’s work, but when I weigh the pros and cons to how I use to feel and how I feel now, it’s a no brained.

There are some articles floating around regarding the use of Losartan to control H/H in certain patients. Losartan is a Bp med.

Your FT:TT suggests low SHBG which means less non-bioavailable SHBG+T so TT looks lower. Suggest that you test SHBG.

Your posted labs do not show any signs of low iron. Based on labs it appears that you could reduce iron intake.

When doing labs, do not be dehydrated as that thickens the blood. A mini aspirin per day will help your thicker blood flow easier as that makes the walls of blood cells slip by each other easier.

What is your blood pressure.
Do you feel blood pulsing in your ears or neck?

Males typically do not need any iron as the body hordes it effectively. When males do need more iron they should be tested for a GI blood loss with an occult blood test to see if any blood traces in poop. Any digestive issues or food sensitivities?

Post current ferritin!
When you donate blood, levels drop then recover. Your ferritin and RBC lab results depend on lab timing.

Please post TRT protocol in mg’s, not volumes.

If injecting 1ml of 200mg/ml test that is your problem. T peak values will drive RBC as well. If injecting once per week, T levels get very high then drop, FT–>E2 rates and serum E2 levels are changing a lot. So any given lab test become sort of meaningless and your lab levels are more driven by lab timing than anything else.

Please self-inject 50mg T subq twice a week.
Always do labs halfway between injections to eliminate lab changes driven by timing changes. Labs at time of office visit can be wrong time. You should do labs at your convenience to have lab results to discuss with you doctor when you see him.

Self-injected T should be quite inexpensive.

Age? [fertility concerns]
Other health issues?

Are you taking heart burn meds? Those can lead to multiple mineral and vitamin deficiencies.

What are your E2 lab results?

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Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

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I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

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