T Nation

High Hematocrit

I’ve been on trt for about 20 years all bloodwork is basically good but the last few years I can’t keep my hematocrit under control. every time I try to raise my dose it starts creeping up. It’s becoming very frustrating my doctor has no trt experience but is very open to trying different protocols. My current protocol is 70mg a week split in two. being from a small town in canada i’m very limited in good trt doctors. i was hoping someone would have any suggestions

How high is it and are you experiencing any symptoms? Also, are you getting enough benefit on 70mg a week?

Typically injections raise hematocrit the most (6%), the tropicals on average are a lot less (2.5%) because of the half-life being much shorter in comparison.

You may or may not find better success with smaller injections more frequently. The idea is if your can get away with using less testosterone to achieve similar levels, hematocrit is usually lower.

Your mileage may vary.

on 100mg once a week it sits around 54 which put me at 975 at trough dropped down to 90mg once a week came down to 52 which puts me at 600 trough but doctor still wants it lower so went down to 80mg once a week which puts me at 475 trough but hematocrit stayed at 52 so we decided to try and split dose at 70mg twice a week just started a week ago.

So won’t have any new numbers for 6 weeks. I’m not overly sensitive to protocol changes in the last 20 years I’ve spent most of that doing the old 200mg once every two weeks protocol felt great for a lot of years but started having issues when i turned 40. Tried a year of androgel that was a big failure but hematocrit did stay below 50 but that was the only benefit lol.

The last few years I’ve been trying different things but kinda spinning my wheels no problems with sexual function at any dose but just don’t feel great like i used to years ago

Have you considered donating blood?

No haven’t tried that yet had cancer was i was younger so not sure if i would be eligible.

Gidday! I’m in rural Ottawa and go to The Civic urology department for my TRT. I’m on 120mg Cyp a week and my HCT gets up to 53. He makes me do whole blood donations and it’s all good. I want to go up to 150mg a week but he says 120mg is THE MOST they ever prescribe, don’t even try me.Yikes.My latest High Lab results.

HGB 178 g/L 125 - 170 g/L H
HCT 0.533 L/L 0.380 - 0.500 L/L H

how often do you have to donate

He says I’m one of those guys who will need to donate twice a year.

Not sure about the cancer restrictions. I know they do not accept active cancer patients, but perhaps there is a time element involved.

Another option is for your doctor to write a prescription for a therapeutic phlebotomy. They simply draw your blood and dispose of it.

If you took 100mg a week EOD protocol you could still have above 50 but thats not concerning and it could make you a more efficient athlete. High elevation populations have higher HCT levels and the body adjusts. It can also lower by simply sticking with the protocol and allowing the body to adjust. Changing things wont allow any kind of homeostasis to be reached, and if you keep lowering the dose, you have less androgens with the same amount hematocrit values. So I would rather increase the dose to 100mg and see how my HCT levels look like thereafter.

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I did the 80mg once a week for a year after 100mg kept me at 54 my hematocrit stabilized at 50 tried to bump up to 90mg and 3 months later was up to 52.

Problem is my doctor likes it around 50 brought up to him before about donating blood but he’s one of those doctors that believes in dose management to control hematocrit.

Where I live there is only one doctor in the town so not a lot of options to go elsewhere lol. He is open to getting outside advice though and gave me the option of talking with defy to see what they would come up with or he offered to give me a referral to a endo that is a 4hr drive from where I’m at.

I personally feel fine with a hematocrit of 52 but try convincing a small town doctor is a different story.

And if I’m not eligible for donating which I will have to check into I’m screwed if he won’t write me a script for a therapeutic phlebotomy.

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I don’t know, but perhaps he would be willing to listen to Dr. Rouzier’s interview?

Yeah no harm in trying I think the only way out of this is going to be blood donation because I can’t keep lowering the dose to where I feel like crap all the time.

Just thought of something else that might interest you. I did some research on RBC production a while back and I noted from something I read somewhere (did not keep track of the source) that the lifecycle of a normal RBC is about 3 months, so it will take some time for hemoglobin labs to catch up to dose adjustments.

Also, one other piece of information is that a common blood pressure medication (brand name Cozaar (losartan) has a side-effect of slightly lowering RBC production through decreased erythropoietin (EPO) production. I seem to remember 5% lowering. I ran across this when I was researching BP meds. I chose lasartan because it has no sexual side-effects. The reduced EPO production is just an added benefit.

Yeah if I could start over again I would probably stayed at 90mg and pushed my doctor to donate blood to control things. Live and Learn I guess I’ve been tested for sleep apnea which was negative, I drink grapefruit juice and eat grapefruit everyday but I’m not sure if that’s helped are not.

I’m 6’1 185 pounds lift three days a week and get good cardio eat clean. So it’s not that I’m un healthy in any way. If I could just get this blood issue dealt with.

Get a prescription from your Dr. to donate blood as needed. My hematocrit was 58 after I started on T, and after I started giving blood once a month, it now sits at 46-48. I may be wrong, but I believe thats the only way to lower it while on TRT.

yes I think that will be my best option

The part of the grapefruit that lowers RBC’s is in the white part (not the fruit) I believe. @iron_yuppie said something about this before. Maybe he can chime in.