T Nation

Hemoglobin 19.1, Donate Blood?

All my numbers look perfect except my Hemoglobin is the highest it’s been at 19.1, hematocrit 56 and RBC 6.94. I don’t have any side effects. Other than anxiety reading online posts about this. Should I donate blood even though my ferritin is lower range at 29? Is flying in a commercial airline dangerous with these numbers? Can anyone here confirm they flew with high hematocrit? Thanks guys.

I can not answer your question as I know nothing about your history. But my guess is when this thread gains traction, you will be told “yes”.

But here is a thread for you to look over.

That’s my old thread lol. Just ended up doing a donation today. First one ever. How much does your hemoglobin drop after a donation?

I agree with these guys in the video. But even they must have an upper limit no?

We no longer confuse Polycythemia Vera with trt-driven Erythrocytosis, which is harmless and actually good for your endurance, etc.

Unless your platelets are rising - in which case there is an increase in clotting factors, etc. - there is no reason whatsoever to donate, unless you want to.

If your iron stores are low, please do NOT donate until they are at a normal level; and even then, only if you wish to.

Look into the work of Dr. Neal Rouzier. This should be a sticky. This issue comes up a lot.

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Looks like all 3 of those are above range.

My cardiologist told me he gets concerned when hemoglobin gets to 18.

I understand if hct is in the low 50s, but u also have high RBC and hgb

If you are running over the range free t , you might want to rethink that.

Look into the work of Dr. Neal Rouzier.

I saw his video. ALL THREE ARE WAY HIGH.
Different specialist have different views. You can’t dismiss the thinking of a cardiologist in a top heart hospital in the country.

Many doctors - even “top cardiologists” - proceed by non-evidence-based medicine.

Ask him why he believes that hemoglobin above 18 is “concerning.”

I didn’t ask. I would think he would look at the bigger picture and look at other data in the CBC. Or run additional tests.

But I agree. We have a valid reason -trt- that causes these values to run higher. It is not because of disease like sickle cell.

I’d ask him directly. A good doctor will take your question seriously and provide reasons based in evidence.

Don’t think that he’s “thinking of the bigger picture” or whatever. Doctors for the most part are very busy; and this is especially true at a “top heart hospital” etc. And what they do, very often, is administer protocols, which may or may not be sound.

I can’t link to the post here but if you go to ExcelMale and search for “systemic vascular resistance response,” you read my brain dump ( multi-post contribution) on why running a high hematocrit (and potentially blood viscosity) is a bad idea. The message Rouzier disseminates is misleading and potentially dangerous. A real concern is that Hct is correlated but not a quantitative proxy for blood viscosity.

You may not be feeling any discernible side effects now but physics dictates that your heart will work harder long term. How much harder and what risk you are comfortable with is what you have to decide. Check out the “Bill, Joe, Jay” example for why you are flying partially blind unless you know your plasma viscosity. I can understand why all this information may too much for most, but you might as well be informed and there’s a lot of conflicting information out there. I cringe at someone walking around with Hct of 55 thinking, hey I’m fine. Hence I spent the time to provide the information for those that seek to be well informed. I wish you the best.

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Also, forgot to mention, educate yourself to not fall for this message that secondary erythrocytosis from TRT is harmless, whereas PCV is the real danger. Correct that the two terms are often confused even by medical professionals. See my post on other site. But False that secondary erthrocytosis is harmless.

It may be harmless in a small fraction of people with very low plasma viscosity, but there’s a good cross section of individuals where running high Hct may be harmful. As always, devil is in the details and you have to decide how much a functional heart is worth to you. Not trying to scare, but want you to have the facts. Good luck!

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For millennia, large populations of people at high elevations have lived with erythrocytosis & high RBC levels. And there is zero evidence that they have higher mortality rates; actually, quite the opposite.

High RBC - by itself - does NOT mean increased viscosity. Please provide evidence showing otherwise.

High RBC with high platelets, on the other hand, is indeed a cause for concern precisely because of increased clotting factors.

Read the post with all the data. I hope it helps you. Hct is directly correlated with serum viscosity. Platelet count is typically invoked when discussing clot formation risk. That’s an additional topic.

Here I am addressing directly the concept of Hct being the major input variable determining serum viscosity. The other key input variable is plasma viscosity which is often correlated with cRP and other inflammatory protein markers in the plasma. I understand it’s a complicated topic so read the post if you’d like to educate yourself. I’ve already been told by the Moderator that we can’t link directly to other sites. I’d be willing to contribute the content to this site if T-Nation folks are interested… @Chris_Colucci. I’d recommend you edit your last post, it’s factually incorrect.

I will absolutely read it, if I can find it.

If you would like to education yourself, I suggest listening to Rouzier’s lectures - not his interviews - at the AMMG CME Conferences.

Still, I have to ask you:

  1. how would you explain this: “For millennia, millions of people at high elevations have lived with erythrocytosis & high RBC levels. And there is zero evidence that they have higher mortality rates; actually, quite the opposite.”

  2. And for the millions now who live at high elevations and have, therefore, high red blood cell counts - often far higher than the average TRT patient: so, should we be carting them off *en masse" *to give blood every month? If not, why not?

What I notice which is very interesting, the higher the RBC rises, the lower the platelets go for me. So for my highest recorded RBC, I also have the lowest recorded platelets. It’s the like body adjusts accordingly. I donated 488 ml yesterday anyways. What’s the best time to run another blood test now? 72 hours after donation the numbers should reflect new hct/rbc/hg?

Good questions and I’ve heard this argument. You are suggesting/asking if hypoxia-induced erythrocytosis is a perfectly valid proxy for secondary erythrocytosis caused by exogenous testosterone supplementation at more or less sea level. These are very different beasts. In the former a human’s body is compensating for reduced oxygen partial pressure by increasing RBC to improve oxygen transport to peripheral tissues. Hence, the body adapts to satisfy its oxygen requirement. There’s a bunch of changes that happen, this article is a good introduction:

Erythrocytosis: the HIF pathway in control

In the later case, your body has enough RBC to satisfy its oxygen requirements. Now you add in exogeneous testosterone and let’s say increase Hct from 45 to 55 (example). You are now forcing your body to operate with more RBCs than its oxygen consumption constraint requires. Comparing living at high altitude with sea-level TRT use ignores the multitude of regulatory processes that happen with hypoxia-induced erythrocytosis. So my answer is this is a false comparison but it sounds good to most laypeople.

Hence, the appropriate design of experiment with valid controls would be +/- TRT to induce +X% increase in Hct for folks living at sea level and repeat this at high altitude.

However, it’s not as if there isn’t plenty of work on this at sea level. There are plenty of observational studies that indicate a U-shaped relationship of mortality with Hct:

A U-shaped relationship between haematocrit and mortality in a large prospective cohort study

Hematocrit Predicts Long-Term Mortality in a Nonlinear and Sex-Specific Manner in Hypertensive Adults

Finally, I’ve read some of the literature regarding no link between high altitude living and mortality. My recollection is there isn’t a strong/almost no correlation but there’s also confounding effects. Clearly humans have evolved to successfully live at altitude. Hence through selective pressure we’ve evolved to do it since it’s been happening for a long time (>10,000 years). TRT-induced erythrocytosis is recent phenomenon (happening for less than 20 years realistically) and not the same as hypoxia-induced erythrocytosis (it does not invoke the entire HIF pathway). Given enough time I’m sure we’ll adapt to that. But for now it may be worth the caution to not run your Hct up unnecessarily given we know:

  1. Increased Hct increases blood viscosity (real break point is about 50-52%, see my other post on the ExcelMale site)
  2. Increased blood viscosity increases circulatory load on heart (see figure below, see stipulations/fine print)
    Effect of Hematocrit on Blood Pressure Via Hyperviscosity
  3. Increased blood viscosity increases shear stress on blood vessel lumen
  4. Increase blood viscosity may increase risk of thrombus formation:
    Elevated hematocrit enhances platelet accumulation following vascular injury

I saw your original post in this thread at the other site so hope you find the other multi-thread post on this topic at the other site. I can’t find any other post over there with the words “systemic vascular resistance response.”


Testosterone use causing erythrocytosis

Your approach may vary depending on your objective function: a competitive racer may have a very different short term goal than a health enthusiast whose primary goal is long-term compression of morbidity with reasonable life span. My motivation is purely educational because your provider may not know or have enough time to spend with you to share these considerations. Take care.