Hematocrit and Hemoglobin Too High

I’ve been on testosterone cypionate for about 3 years now. I was originally on 200mg/week, the urologist noticed that my estrogen was high at around 64 I think and put me on 1mg arimidex EOD. At some point I switched to 100mg/biweekly and after I did this at some point I started noticing really high blood pressure and the next lab showed my hemoglobin/rbc/hematocrit was too high. My urologist suggested donating blood every three months, which I did and the levels went down and so did my blood pressure. I also lowered my dose to 70/every three days so about 150 a week and half an arimidex every three days for a while, I am now at 60mg/every three days with no arimidex. But then the levels started increasing faster and faster after the first few donations every three months. The last couple donations had to be at 2 months because my levels and BP were already high (sooner than before) and this time my BP is very high and levels too high even before the two month limit I have to wait before they let me donate again. I also have been increasing nicotine (vaping) consumption the last few months due to stress.

Is it possible that it could be cause or made a lot worse from vaping nicotine throughout the day due to blood flow being diminished? Or is there some mechanism where your body gets used to donating blood and starts raising the levels faster? I’m scared that its currently too high of a level to be allowed to donate already, before the next date I am allowed to which is in a week since my BP was 154/104 when I checked earlier and if they don’t allow it, the only option I assume is a therapeutic phlebotomy which my urologist said might make my insurance refuse to pay for my TRT if they know it causes this.

There is your problem, this is causing the thicker blood forcing you to alter your TRT protocol.

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I get a phlebotomy every 30 days and my insurance has no problems with it. I know some doctors refuse to treat men with TRT who smoke.

You’re not nicotine defeient, so stop.

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So you think the likely culprit is nicotine? I hope that’s the case since I’m attempting to quit right now. Worried that it’s not the reason and it could be from donating too much somehow making my body think I need more faster each time.

Absolutely, vaping reduces the amount of oxygen in the blood by 20 percent therefore increasing hematocrit. The same thing occurs in sleep apnea patients, oxygen is decreased and blood parameters increased.

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Some people just seem to have this issue and there’s nothing they can do about it. From what I can tell it’s one of the more common reasons for people having to get off TRT.

Quitting smoking is worth a try although I don’t imagine vaping quite as bad as smoking

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Do you think its possible that getting rid of the cause will slowly lower it or is that impossible without blood donation/phlebotomy?

You might be able to stop the phlebotomy after a time, but not right away. Withdrawal will not be easy and you might even experience ED for awhile, common when one stops smoking/vaping.

I know quitting smoking isn’t easy, saw a friend fail multiple times and witnessed the agony first hand. I withdrew from clonazepam after 30 years, so I know a thing or two about how hard it is to come off an addictive substance.

As things got worse, my resolve got stronger for wanting to come off do to how what this drug was doing to me.

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Thanks for your help, I appreciate it. I’ll keep sticking to no nicotine and hopefully it won’t get so high next time I can donate. I did try to quit and got three weeks in before giving up but that wasn’t for an immediate health issue, so hopefully I’ll have better resolve this time around.