T Nation

Hematocrit, Hemoglobin Elevated. Now What?

I’ve been on TRT for almost a year although initially low dose creams. I switched to Test Cyp 50mg 2x/week with HCG 250 2x/week and saw a nice jump in TT to around 1,200. Followup testing a few months later, done at the same time of day and 2 days after an injection showed it had dropped to 400. My DHT and E2 had also dropped too low. My doctor bumped me up to 65mg 2x/week. I just got results from testing after 1 month at the new dose. Good news is my TT is 824 ng/dl (348-1197), my E2 is 27 pg/dl (7.6-42.6) and DHT is 55 ng/dl (30-85).

Bad news is that my Hematocrit is now 52% (37.5-51%) and Hemoglobin is 18.4 g/dl (12.6-17.7). With my thick blood from high triglycerides and family history of heart disease I don’t want to risk it turning more into sludge!! Any thoughts or ideas? My inclination is to go off the T and try HCG monotherapy since I am secondary and hopefully still have some life left in the boys. I really don’t want to have to do routine bloodletting (I have a tendency to pass out-yeah I’m a wuss)

I had the same issue at almost the exact same dosage. My doctor told me to go donate blood which I now do every 3 months and the issue has been resolved. I noticed a difference within 24 hrs with my blood pressure returning to normal numbers and the cessation of the slight pressure type headaches I had been experiencing when exercising.

Donate blood every 3 months. Which we all should be doing anyway.

I believe hematocrit under 54 is the cut-off. YMMV

[quote]Magnus157 wrote:
I had the same issue at almost the exact same dosage. My doctor told me to go donate blood which I now do every 3 months and the issue has been resolved. I noticed a difference within 24 hrs with my blood pressure returning to normal numbers and the cessation of the slight pressure type headaches I had been experiencing when exercising.[/quote]

I might be able to handle every 3 months! I have noticed that my blood pressure has been higher and I have been getting pressure in the head as well. I didn’t attribute it to that but it makes sense.

I have read some things that said just donating doesn’t help, that you need to do something like a phlebotomy exchange for volume reduction but good to know there is some proof it does work. Thanks

Donated blood this morning. The nurses and my girlfriend were cracking up at how much of a wuss I was, but I actually survived. It’s been a few hours and I feel worse now than when it was done, but I am sure it will pass. I’m not sure I will enjoy this every 2 months but it’s better than having a stroke. Thanks for the advice guys.

Avoid iron fortified foods and supplements.

[quote]KSman wrote:
Avoid iron fortified foods and supplements.


None of my supplements contain iron and i don’t eat much spinach. I don’t think I eat any fortified foods but I will be on the look out. I’m still trying to determine if HCG alone would be a better bet if I am prone to elevated hematocrit at a dose as low as 130 mg/week. Found studies showing that TRT suppresses herpcidin (iron regulating peptide)which is the link for the increase in Hematocrit. Trying to determine now if it is only supplemental T that does this or if boosting natural production would do the same.

Thanks KSman

I guess I may be stuck with donating blood!

“Significant increases in red blood cell count, hematocrit and hemoglobin levels were the only observed adverse effects of hCG injection.”

I think I am going to try HCG monotherapy. First, I haven’t found an injectable T (enanthate or cypionate) that doesn’t cause intense burning, red spots, etc for a week or two no matter where I inject it. Second, other than making it easier to pack on some muscle I haven’t experienced many other appreciable improvements. Third, although he may be wrong my doc says that HCG alone is slightly less likely to raise hematocrit and hemoglobin levels. Time to taper and see if I can plump the boys back up!

What about those that sell their plasma? Does that have the same effect in lowering their hemocrit levels?

[quote]conservativedog wrote:
What about those that sell their plasma? Does that have the same effect in lowering their hemocrit levels?[/quote]

Don’t think so. I think they keep only plasma and give you back the rest. I had a buddy in college that would sell his as often as he could walk in the door. He was so weak he would stagger and fall, but he needed that beer money!

[quote]KSman wrote:


I have an older friend near 70 and he sells his plasma to add to his retirement income. He is also on hormone replacement therapy. I told him I didn’t think that was a smart idea.

Am I wrong and why?

Nothing wrong with that if his body supports the demands that it creates. If he feels OK after the donations, that is a good sign. But it would be good to see CBC lab work.

His hormone levels will support some of this as well.


 I have been dealing with this elevated Hemoglobin for a couple years and the docs kept lowered my T dose to a point to where there was no benefit.  I tried the creams and injections and both elevated the hemoglobin.  At 1 point I was at 19.6.  I finally got so sick of feeling bad and depressed because of low T I told my doctor, I don't care what my hemoglobin level is I want the injections and asked for a script for a Therapeutic Phelobotomy anytime the hemoglobin was above 15.1.  The doc gave it to me and I took it to the donation center.  

 When I got there the 1st time my blood pressure was really high and hemoglobin was 19.6.  They refused to draw until my BP went down.  (I had not been taking my BP medicine.)  Went back a few days later and hemoglobin was 19.3 and BP was within acceptable ranges so they took 500 ml.  At this point I was going to take control of the situation by doing the following:  every week I was going to have my hemoglobin checked by a fingerstick.  If it was above 15.1, I was going to donate not matter what.  

To make a long story short, I ended up donating 4 straight weeks and my hemoglobin levels dropped something like this: 19.6, 19.3, 17.5, 16.3. I felt good about this pattern and the 5th week I was 14.9 so I did not donate. I kept monitoring the hemoglobin level every week and ended up getting drained a couple more times but it seems like the pattern now is donate about every 6 weeks. My last check was 2 weeks ago and I was at 13.9 so the pattern appears to be OK at this point.
My weekly dose of T is about 100ml. So far so good.


Givng blood is good however it is replaced rather quickly and the law only allows you to give a pint every 8 weeks or R2 (which is where they take the red blood cells of two pints and put the plasma and saline back in to keep the blood volume up), that you can do only every 16 weeks.

One thing you can do is ask the doctor to check your INR. That test in essense shows how quick your blood will clot. If your hematocrit is high and the INR is low it means you clot quickly. If the INR is high you don’t clot quickly. Your doctor will know the number levels that are appropriate for you.
If your blood clots quickly you could take low dose warfarin which is a blood thinner. Has no known side effects.

My hematocrit has always run max normal (around 52 and BTW - your hematocrit is always 3 times your hemoglobin). I do the R2 every 8 weeks but I take a low dose warfarin pill each day and I’m good with no worries for clots.
Hope that helps.

I meant to say “I do the R2 every 16 weeks” instead of 8.

I too have elevated hematocrit. I am 72 years old and on 140 mg testosterone cypionate once a week for over 2 years. It is the best dosage for me. I feel great and my strength and conditioning is where it was at when I was 50. My belly fat and man-boobs are gone. The hematocrit issue did bug me. It was up to 54%. My BP was going up and I was starting to feel congestion in my lungs and a slight cough.

I didn’t notice any head ache. Headache and lung congestion are common symptoms of high hematocrit. My family Dr begged me to get off of T. After explaining to him all of the other health benefits I have experienced I told him I will not go off of T ,he went ballistic. I told him that I will simply donate blood to lower it. When I went to the donation center I noticed a that I could also have a procedure where they took twice the blood cells of a normal blood donation.

They tested my hemoglobin and found it high, and I was eligible for a double red blood cell donation. The procedure was a little longer than a regular donation. I gave the red blood cells and about a day later the lung congestion was gone and my blood pressure went down about 10 points, both numbers. About 4 weeks later I had blood work done again and my hematocrit was down to 46 %. My doctors were happy. :slight_smile:
There is one downside. For the about first 2 weeks after giving the double red blood cells it felt like I was skiing at 10,000 ft. My body had become so used to the large amount of red blood cells and high hemoglobin that it took time to adjust to the new oxygen carrying capacity.

I couldn’t do a hard workout at the gym. When you do double red blood cells you need to plan your active life around this issue. BTW since being on T, on my lipid panel, all of the cholesterol’s have markedly been reduced including triglyceride. The ratios are still excellent and triglyceride which was always high is now well with in the acceptable level. So in my opinion giving blood to lower hematocrit is a good idea. BTW, my red blood cells were going directly to a cancer patient. You help your self and another person. How nice is that!

I have a quick question: Has anyone else with high Hematocrit also had elevated Biliruben? Did lowering the Hematocrit also lower the Biliruben?