New articles (to me) that I am reading …
Hematocrit elevation following testosterone therapy – does it increase risk of blood clots?
Includes a chart showing the expected amount of hematocrit increase based on the type of testerosterone you are taking. Nebido
Same source as above
" A second reason that elevations in hematocrit with testosterone treatment may not be inherently dangerous is that low testosterone levels are associated with higher levels of prothrombotic factors in men, regardless of age, obesity, body fat distribution, and related metabolic parameters.[78]"
Testosterone-induced increase in hemoglobin and hematocrit is associated with stimulation of EPO and reduced ferritin and hepcidin concentrations. We propose that testosterone stimulates erythropoiesis by stimulating EPO and recalibrating the set point of EPO in relation to hemoglobin and by increasing iron utilization for erythropoiesis. Source
The normal range for EPO levels can vary from 3.7 to 36 international units per liter (IU/L). Higher-than-normal levels may mean you have anemia. In severe cases of anemia, EPO levels in the blood may be a thousand times higher than normal. Unusually low levels may be because of polycythemia vera. This is a bone marrow disorder that causes your body to make too many red blood cells. Low EPO levels may also mean you have kidney disease. Source
I have been reading about EPO and its tie to HCT/HGB. What surprises me is that low HGB is an automatic indicator of anemia; so I guess low EPO would only confirm the diagnosis. I have also read a lot about higher HGB leading to potential lung/COPD problems. “Consequently, someone who has lung or kidney disease, who smokes, or is dehydrated, may be at risk of increased hemoglobin levels.”
Another study found that EPO was not effected by increases in HCT/HGB caused by Testosterone supplementation. " Hemoglobin and hematocrit increased significantly in a linear, dose-dependent fashion in both young and older men in response to graded doses of testosterone. The increases in hemoglobin and hematocrit were significantly greater in older than young men. There was no significant difference in percent change from baseline in erythropoietin. Changes in erythropoietin levels were not significantly correlated with changes in total or free testosterone levels. Source
Many of the articles I read mention that the people visiting doctors with high HCT/HGB were experiencing SYMPTOMS such as “red face, some shortness of breath, dizziness, etc” which is an interesting point to note in cases like mine where I do not notice any symptoms.
Hematocrit may stabilize in men after 18 months of testosterone replacement. It is impossible to predict if your hematocrit will slowly decrease now that you remain on TRT. Source Nelson Vergel And The best way to bring hemoglobin and hematocrit down while staying on testosterone replacement is donating blood (unless HCT is too high, then therapeutic phlebotomy at a doctor’s office). 4-5 units every 2-3 months are usually OK for hemoglobin to drop below 17.
The statement that HCT might “stabilize” after 18 months of continued T-supplementation is one that I can only find ONE person making that statement with no supporting evidence.
I would have thought that getting rid of so much blood would have a large effect or Iron/Ferritin. Ah, here it is: “An important warning about frequent blood donations or therapeutic phlebotomies: Iron and ferritin levels can drop and make you feel tired. The Red Cross recommends no more than 1 phlebotomy every 2 months for that reason.”
This is another statement I find interesting. Men who supplement with Testosterone are 315% more likely to have increased HCT but there isn’t enough concrete data to show that it has the same affects as men who are not on T-supplementation with high HCT.
Men undergoing TRT have a 315% greater risk for developing erythrocytosis (defined as Hct > 0.52) when compared with control. Mechanisms involving iron bioavailability, erythropoietin production, and bone marrow stimulation have been postulated to explain the erythrogenic effect of TRT. The association between TRT‐induced erythrocytosis and subsequent risk for VTE remains inconclusive. Source
There are doctors (such as Neal Rouzier) who believe that the increases in HCT/HGB from T-patients is the new “normal”. He does not believe in “blood lets” in T-patients. A video interview with him is on this page.
Two tests are suggested … one is EPO (Erythropoietin) which is only $59. The second test is for “blood gases” and I am not having any luck finding online labs that do this one.
Yes, I know. I can’t write short posts. At least this isn’t twitter. I hope this helps someone as it gives me a better understanding of where I am.