T Nation

RBC Count Increasing

Ok, I am a 45 year old guy that knew something was wrong around the age of 40. With everything that goes on in life I didn’t want to break down and go to the Dr to describe my problems. I finally got over it last September and got my Dr to test for low T. Sure as shit it came back low, total T 220 and free T 36.5.
She prescribed trt for me at 100mg/week. The first 3 months I was starting to feel much better. Then came my 3 month blood test. My total testosterone came back at 357 and free T 65.7, which was better and the direction I wanted to see it go. The problem is my RBC count was borderline high. When she saw that she decided to cut me back to 100mg/2 weeks.
Fast forward to my next 3 month blood test and we find that my RBC count was still climbing. Total stayed close at 353 and free went up to 94.1. With my RBC count continuing to climb she cut me back to 60mg/2 weeks.
Clearly I am moving backwards here. She even admitted to me that my current dose is less than anyone she currently has on trt.

So…besides cheating the system and donating blood every three months before my blood tests to get my RBC count down. Is there any other way of controlling it to get the Dr to raise my dosage back up?

Thanks in advance.

This is one school of thought:

Any signs or symptoms noted with this increase?

Some guys do regular blood donations. Some use lower, more frequent, dosing schedules. I’ve seen mixed results with that.

Make sure you are well hydrated prior to the test. Guys usually go first thing in the morning (especially if fasting) and since they did not eat, they have not had anything to drink either.

I like this guy. He basically said everything that my Dr is telling me she is worried about. I have also read that most trt patients do have a higher RBC count in the first 6 months and then it normalizes, this has not been the case for me. I have zero symptoms of high RBC, blood pressure has actually gotten better over the last 10 months.

I actually plan my blood tests for later in the day to try and insure a lower T count. Fasting for 8 or so hours doesn’t bother me that much. However, you are correct that with the fasting I do forget to intake plenty of water.

The time of day will not matter when measuring exogenous testosterone levels. Levels will not fluctuate throughout the day because you are injecting it, not making it. If you desire a lower level, have your blood drawn on the day of you injection, just prior to it.

Here’s a different perspective:

I realize it’s easier to watch a video that may make you feel better but the physics of the situation may not be in your favor. You’ll find quite a distribution of opinions re: Hct risk tolerance on here. Good luck with your choice.

By the way, Neal loathes being called an expert. He said “experts should be smart enough to know they aren’t experts.”

Good point, he is not an expert. He says in the video that increasing RBC does not increase blood viscosity. Sorry, but first one has to get the facts correct. Similar issue on the estrogen video about young men and their estrogen levels.

EDIT: see the problem with this video (and ones like it) are that there are laypeople who will quickly assume the guy talking in the video is an expert and then use the information to rationalize running their Hct high. For example,


Other guys read this and then you have a large misinformation cluster on this forum and ones like it.

Offer still stands for anyone expert or not to debate the points in the thread. Still waiting for @yeti308 to give me lessons on blood viscosity (never heard back). So far I haven’t had many takers. I’ll stand by my opinion that saying “erythrocytosis is harmless” is reckless and does not properly consider the various subtle mechanisms at play in the cardiovascular system. Given the vast distribution of patients and varying cardiovascular health (providers understand this), this statement will most likely also cause harm since compromised patients won’t be able to tolerate higher blood viscosity/shear stress/nonlinear impact on NO, etc that a young guy can.

There is harm when misinformation is posted on forums. I feel like the little kid trying to plug the dike around here. Every day more of the same. I would just caution the reader to do your homework before running your Hct above range and potential impacts 1, 5, 10, 20 years down the road.

I give @dbossa credit for interviewing folks like Jim Brown and at least giving viewers some different perspectives.

I put it in context that his point is TRT does not cause blood clots, strokes or heart disease. That is exactly what he stated. I was in the room with one hundred other doctors challenged to provide evidence it does. Nobody did. I have not found any.

Aside from the best available evidence in the literature are the desires and expectations of the patient and the experience of the clinician. He has decades of experience and patients that have been with him for those decades. He is not seeing heart disease in these patients. It’s difficult to move off of what you’ve personally seen in the world.

Possibly of interest, I do not ignore CBC results. Patients are treated individually and some undergo dosing changes, intermittent phlebotomy to regular phlebotomy to stopping TRT. No one size fits all approach. There are doctors that practice as such and pull patients off TRT if hct hits 51%.

Interestingly, I have two cardiologists who refer patients. They are younger docs. Started with two of my patients concurrently seeing one of them for hypertension and dyslipidemia management and one was also diabetic.

The perfect storm, overweight, out of shape old guys with low testosterone. Get them on TRT and within a year, low and behold, 30-40 lbs of visceral fat, gone. Lipids improved, insulin sensitivity improved. Blood pressure, yep, normal. Cardio is stunned, what the hell? They pretty much all say the worst thing for your heart is visceral fat. To his credit, we talk.

Long story short, I need to get going, we discuss all of this and hct and blood viscosity. The diabetic guy tends to run higher, 52-54%, 50% if he does hydrate well. The guy was not concerned, said the heart is a muscle and the increased oxygen is likely a good thing and patient is certainly better off with 53% hct and no dyslipidemia, normal glucose, normal BP and no meds. Not even close. He told a colleague and that guys sends patients.

On the other hand, take a guy whose BP is up, not feeling well, sluggish, hct 57%, that’s not going to fly. No one size fits all. Individual differences. That’s my position, for whatever it’s worth.

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It’s worth a lot in my book. That’s why I have stated on here based on my limited interaction with you I think you are a conscientious and caring provider. Thanks for taking the time to share your thoughts. We agree all of these details can’t be properly fleshed out in a 3 min video.

And just so the reader understands:
increased RBC count ----> increased Hgb / Hct —> increased blood viscosity (for same plasma viscosity)

The tradeoff between increased whole blood viscosity due to increased Hct vs the benefits that @highpull just described is what needs to be analyzed. Heck, I could even imagine reduced inflammation from fat loss causing a decrease in plasma viscosity which would partially compensate for the increased Hct.

I don’t think 10 years down the road a heart attack will be blinking with a neon sign “TRT was here!” Blood pressure increase usually a good indicator of systemic vascular resistance, which to your credit, you pay attention to.

Just a question based on your experience below, would you raise your hand now during Dr. Rouzier’s lecture?

A couple of thoughts.

First thought, when you post labs, you need to post the units and the normal ranges for the lab. You cannot (should not) compare results from one laboratory to another. For example, Your total T of 220 (ng/dL) does seem rather low for any lab, but I would kill for a Free T level of 36.5 (pg/mL) without TRT. Something does not make sense with those lab results.

Second thought, is that we need to understand your frequency of injection. Is that 100mg once per week? Hopefully not 100mg once per 2 weeks on your new protocol. I strongly suggest an injection frequency of at least twice per week at whatever dose. I much prefer and every 3 day protocol for various reasons, but breaking the dose up will help to smooth out the peaks and the low points of blood T levels and it’s the peaks that drive most of the side-effects. Perhaps if you level them off, you may slow down the RBC production, which is driven more by conversion to DHT than T. Oh, I’d also check your DHT levels. I suspect they are high.

Third thought, is that donating blood is not cheating the system. For some guys it’s just what they need to do to keep RBC levels in check. Also, before you go in to have your labs, you should make sure that your are FULLY hydrated. I’ve found that the difference between being fully hydrated and not can make a point or two difference in hemoglobin levels. Many docs combine lipid panels with CBC panels. Lipids need to be done while fasting, so they are usually done first thing in the morning. However, I find it impossible to drink enough fluids in the morning prior to the labs to get fully hydrated, so I request that my CBC labs be drawn in the late day.

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Excellent point, I completely forgot my testes were turned off at the moment.

I will see if I can grab my labs tonight when I have more time.

Current dose and frequency is 60mg every other week.

She pulls lipid panels, CBC panels and T all in the same draw. Five or so separate vials all while fasting.

:flushed: interesting

Just get a new doctor who realizes your rbc is not going to kill you.

When you had normal T levels your RBC was at your bodies status quo. It loweeed with low t. With T it will go back into a range your body needs. Unless there are underlying illnesses I wouldn’t be so worried about it.

Right? It is almost useless.

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Here are the numbers.

Total T is a scale from 250-827ng/dl, my value was 353ng/dl
Free T is a scale from 46-224pg/ml, my value was 94.1pg/ml

Blood work attached.


These are my most recent test results

Excellent point and both of those cardios rely more on inflammation markers than lipids for assessing cardiovascular risk.

It would be nice if there was a study following TRT patients over 20-30 years. Difficult to adjust for con-founders over that long of a period and probably cost prohibitive. Who would fund it? Wishful thinking.

I do know quite a few of guys who have been on TRT for 20+ years since retiring from competitive weightlifting, powerlifting or bodybuilding. They stopped PEDs but stayed on testosterone, a “maintenance” dose, which is usually 200mg once a week. They are doing well and some phenomenally so. Some are current patients. Can’t turn that into scientific data though. Looking back, I wish I was one of them.

No. The question was can anyone provide any evidence from the published literature that proves TRT causes blood clots, strokes or heart attacks (or maybe disease, not sure of the exact word). I cannot and apparently no one else in the room could either.

I’m guessing that is “Bioavailable” T, not Free T. Bioavailable includes loosely bound to albumin. For my laboratory, the range is 41 - 231 ng/dL.

Attached is what they gave me.

I’d be interested in hearing from other guys that have used QUEST laboratory on the techniques used for this test. It clearly states “Free T” in his report, but the normal range is much higher than the 2 labs i usually use (LabCopr and Pacific Diagnostics) for Free T using either the Direct method or the LC/MS method. However the range is very close to what i get for “Bioavailable T”. My experience is that Bioavailable T parallels Free T quite well and is a good lab for assessing usable T, so it’s not to say it’s a bad test methodology, it’s just that QUEST seems to be using a confusing name compared to other labs.