T Nation

RBC/Hematocrit


#1

Is there any reason a rise in RBC/Hematocrit would be delayed from high TT? Is it FT that causes the rise instead?

35yo, low body fat, very athletic/active. Sleep isn't the best one night out of three, but I do pretty well the other two.

I know you guys normally look for ranges but for the purposes of this thread (trending) they don't seem as important. Also, all blood draws were done exactly halfway between injections. I also do my injections IM Every other day.. this works best for my schedule and avoids nodules in the fat.

11/10 100mg/wk t-cyp, 250iu EOD HCG, no adex
TT>1500
E2 76.2 (7.6-42.6)
RBC 5.31
HTC 46.6

11/26 100mg/wk t-cyp, 250iuEOD HCG, .25 EOD adex
TT>1500
E2 47.3
RBC 5.61
HTC 48.6

12/4 100mg/wk t-cyp, 250iu EOD HCG, .25ED adex
TT>1500
E2 20.3
RBC 5.48
HTC 48.8

About this point I realized I'm responding well to the HCG and 100mg/wk of t-cyp was too much, so I dropped it to 50/wk. Also dropped adex to EOD

12/18 50mg/wk t-cyp, 250iu EOD HCG, .25EOD adex
TT 979 (348-1197)
E2 21.8 (7.6-42.6)
RBC 5.64 (4.14-5.8) (trending upward)
HTC 50.8 (37.5-51) (also trending upward)

Note that TT is down from before, but RBC/HTC are going up. Things feel pretty dialed at this point. Also, I haven't given blood since before therapy started in october.

This next draw was for a doctor's visit, and used a different lab, so I'm including ranges. At the initial consult they mentioned wanting E2 in the 30s.. so to placate them for this draw the 2 doses of adex before the draw were of the smaller "chunks" that result from cutting up the tablets.

1/2/2015 50mg/wk T-cyp, 250iu EOD HCG, .2mg Adex EoD (leading up to blood draw)
TT 788 (292-1052)
E2 44 (<63)
RBC 6.07 (4.1-5.7)
HTC 51.5 (37-49)
Bonus FT 12.5 (4.8-25)
SHBG 57 (17-66)

Do we have any idea why RBC/HTC would start getting bad after TT levels have come down? Is there some kind of delay in rise of these markers? Are they instead tied to Free testosterone numbers that my cheap blood labs aren't reporting?

Also any idea why my SHBG is so high and FT down? What gives? Though not a lot, I eat a fair amount of carbs. Would E2=44 cause near-top-of-range SHBG?

I plan to give blood soon (and drink a bunch of water first so they don't reject me as having polycthemia) And am weighing the pros-cons of paying for more expensive blood work to look at SHBG/FT at least a couple times.

Any other thoughts?


#2

SBGH goes up with high E2

Liver values?

RBC/HCT trends up during TRT that’s expected.

Nettle root might help.


#3

Didn’t get recent liver values… should have some before long with upcoming physical at work… why do you ask? Contribute to SHBG?

Will look into nettle root.

No thoughts on RBC/HTC rise being delayed? Seems TT >1500 would have those numbers skyrocketing… but the dramatic rise came after?


#4

T+SHBG is not bio-available to T receptors, only FT works there. So at first one might think that only FT would be a factor in your problems. But that thinking might be too simplistic, but I don’t have any better ideas. You may be having a slowly progressing increase in RBC that does not really care about your adjustments and the RBC increase is perhaps relentless for the T levels that you are working with. Perhaps the lower T dose will lead to lower RBC, but that may take time to reverse then fall.

I also think that there is reason to look at liver function.

SHBG is getting out of hand.

Take fish oil and aspirin to improve blood flow.


#5

I have the same issue. My RBC, hemoglobin, and hematocrit have been high my last two blood draws. Donating blood helps lower these. But the blood bank will not do without a script, they dump the blood, and it costs $20. I am insured through the “Clinic” and looked into them doing it since I need a script either way. My wife said if this continues and is documented they might try to force another med on me. So now I do not know what to do. I do take fish oil and aspirin. Look into donating.


#6

No need to be concerned with 51.5 hct other than monitoring. You can go as high as 54 and be safe as long as you don’t have vascular or coagulation pathologies.

I wouldn’t consider phlebotomy until i’ve been consistently above 54%, have been well hydrated at each blood draw, and have seen no change by lowering the testosterone dose.

Withdrawing blood is going to set in motion MORE erythropoesis, cause you to deplete iron stores that can be difficult to restore, and many other factors not readily explained in this context. I view it as last resort and more of a “I’m doing these roids no matter what” kind of view on TRT(or cycling which I don’t condone).


#7

Went to donate blood today. Tried to get plenty of water and HTC came in at 51. Will do another set of (cheap) labs soon to see how things are going.

The issue with 51.5 is it is trending upward, which is making the doctor nervous, so they lowered Testosterone by 25%, (though they thought I’m taking more than I am… the 200mg/mL thing vs 100mg really seems to be screwing them up) as well as halved the Arimidex, despite the numbers posted above (TT=780 E2=44 Free testosterone=12.5). The test script is still for more than I’m actually taking… but what worried me is they halved the adex, to a point that I don’t have enough to maintain the E2=22 I was running before, even with only 50mg/wk of t-cyp.

The other issue with allowing it above 51 but below 54 is donating is an easy way to modulate things… and they will refuse if HTC gets too high. I didn’t ask about their limit today, but anecdotally I’ve read around online and some places refuse at 53. I don’t want to lose this as an option. My doctor didn’t come out and say “go donate blood” but they did mention it as an option… and were quick to counsel me not to say it is to get my HTC/RBC down.

I’m not worried about iron, as I’ve had somewhat elevated ferritin numbers for years… though these are trending downward slowly as I eat less red meat.

As to the liver values… interesting. They didn’t run AST/ALT with the most recent labs, but from 12/18
AST 23 (0-40)
ALT 25 (0-44)
How bad are these? I have learned better than to trust lab ranges considering TT=350 is considered “normal”. Also, I rarely drink alcohol.
SHBG may have been high from the month before where TT was in excess of 1500, and I’ve read it can take a while to come down… how long? The SHBG=57 lab draw was right at about a month after I lowered the Test dose from 100 to 50mg/wk. The 12/18 draw showed TT=979…
Other than high SHBG, what is giving you guys the idea liver may not be healthy? Is RBC/HTC contributing?


#8

Those are good liver values. They won’t be concerned about anything until it’s double-triple the upper norm. Several medications and other things can cause liver panel results to be a good 50% over the upper limit. A B-complex supplement never hurts. I take a complex 50 because I just want my bases covered rather than going overboard with a 150.


#9

So any ideas on elevated SHBG? Still coming down from TT>1500?


#10

[quote]bloc wrote:
So any ideas on elevated SHBG? Still coming down from TT>1500?
[/quote]

It’s likely but more likely from the elevated E2. How long were you at that level (which was ridiculously high btw) before the October labs? Without any history it looks like you just started about 12 weeks ago.


#11

Why are they wanting to lower anastrozole? If E2 was good and T is reduced, you would reduce anastrozole by the same factor as T. I still think that you should aim for E2 in lower 20’s. Maybe less T and higher FT proportion would be beneficial.

You should not be eating iron fortified foods. Prepared breakfast cereals have added iron with the assumption that children are eating them. Vitamins for males should not have any iron.

With EOD injections, we know that HTC is not driven by T spikes.


#12

I was at TT>1500 for about a month. This was with the standard protocol listed in the stickies. Apparently I respond well to HCG… lowered T to 50mg/wk and ended up at TT=979/E2=21.8… which was perfect and felt great. Yes, started about 12 weeks ago. I didn’t bother putting full history as I was asking about RBC/HTC trending only… but this is what happens I guess.

I made that exact argument to the doc about lowering adex. Saying TT is normal, E2 is too high, why lower T 25% and AI 50%? Makes no sense. They relented a little (3mg/month) but wouldn’t let me stay where I was at (.875mg/wk… .25 EoD). From talking to other patients of his, he REALLY doesn’t like arimidex. “It is a CANCER drug.” Sadly I feel like I’m going to need to let my E2 get pretty high right before the next consult to have them raise dose. And even then he may respond with “we need to lower the testosterone.” I really dislike the idea of having to tweak numbers to get the doctor to do what they should be doing in the first place. That said, while they were open to HCG, it seems like they don’t prescribe it to TRT guys a lot, so maybe they aren’t used to the higher E it can cause.

One bright spot is it is the HTC/RBC that had them concerned… I think if I fix that they won’t be as spooked and may let me raise the AI and test to more reasonable levels.

I am not eating iron fortified foods. Mostly paleo plus some white rice and cheese. I just had a stint of eating a lot of lean beef combined with a dose of high vitamin C (which helps iron absorption) every single day for over a year a while back, and my ferritin went up into the 300s. Last time I checked it was down to 175 but I’d still like it a lot lower. Point being iron loss isn’t something I’m concerned about just yet with regard to phlebotomy.


#13

Understood. Its a doctor problem.

T cyp has a slower T release and will be smoother than prop. Less T spikes will be best for E2 levels, perhaps that does not apply to how your body reacts.


#14

[quote]KSman wrote:

You should not be eating iron fortified foods. Prepared breakfast cereals have added iron with the assumption that children are eating them. Vitamins for males should not have any iron.

[/quote]

Donating blood lowers iron and ferritin stores. If you donate often, these might stay low. Wouldn’t supplementing something like ferrous gluconate be beneficial?

While men, as a population, don’t need iron, it seems like it might help those on TRT who donate often to keep blood levels in check.

-Jim


#15

I’m wondering if the Hcrit issue isn’t a ‘lagging indicator’. It may be that the high numbers you are seeing are a product of the time that you spent with the excessively high testosterone numbers and while your testosterone numbers that you’re seeing now are more representative of where you want to be, it may take a bit for the RBC count to drop and stabilize at it’s lower value.

Of interest, what ‘cheap labs’ are you doing? Could the difference in labs be an issue?


#16

“cheap labs” just means the “hormone panel for females” from privatemdlabs… which costs about $53 with a coupon online.

They are still using CPL (Clinical Pathology Labs) for collection/actual testing but discounting things.


#17

The trouble with supplementing iron is it has poor absorption and is highly irritating to the GI. It just isn’t effective and getting it through a focused diet high in iron takes time.

Donating just shouldn’t be acceptable as a long term plan. If it has to be done for safety until you can balance hormones, fine but not because you want to run TT >1500 or something. I feel it’s a quick fix with too many risk factors. Not just infection which is probably rare for healthy adults but paradoxical blood cell production, elevated abnormal/immature cell forms, leukemia or disorders of cell production. You’ve already got Testosterone on board increasing erythrocyte formation and then you through erythropoeitin on top of that due to the sensed blood loss.


#18

Oh trust me, I don’t want to HAVE to donate often long-term, though I actually would prefer to considering the studies that correlate it with better health and a personal opinion on high iron levels being responsible for oxidation that contributes to a bunch of other problems.

I also DO NOT want to be TT>1500… that is just where I ended up with the standard protocol listed here. Perfectly happy with the T=979 I ended up after cutting the testosterone dosage. Hopefully keeping things at that level will calm down the blood thickening enough

Either way… I did donate a pint… so when I find a time to get some labs done I’ll update with results.