T Nation

Secondary Polycythemia High Hematicrit


Been on TRT 3.5 years, dialed in dose, (200mg a week eod injections, TT 650-750 steady, E2 at 21-24) balanced all aspects, feeling great and all labs beautiful. Secondary polycythemia is a every 6 weeks to 3 month issue. I have a standing order for therapeutic phlebotomy and keep it in check. I have a Dr willing to approve 2 or three treatment’s in a month to six weeks if hematocrit elevates too high. I take B12 injections from a deficiency going back 4 years. Wondering if the B12 (1000 mg a week) can be adding to the quick rise in Hem.? also are there any other dependable diet, nutrition or supplement tricks that work to keep the Hem. down? Thanks @KSman


Im new to the TRT scene here, but I definitely have some secondary polycythemia going on. I donate the excess every 60 days. Curious what your hematocrit and hemoglobin values are that you get standing orders. Thats crazy! As far as keeping them down,Ive been told on here that iron in your multivitamins as a male is no no, and avoiding iron when you can like in pasta, cereal, breads, etc. Maybe someone else can chime in and add some stuff.

Also crazy that 200mg a week only gets you to TT of 650-750. Good luck bro.


My script is for 300mg a week but I cut it to 200 since that is where I feel the best and least sides. I’m a hyper metabolizer for sure, at 6’6" and 380#. 50 years old but still benching 525#, squat 600# for 8-10 reps, and deads around 600# (real bad knees limit my squats and pulls) My dr sets my hemoglobin at 17 and above I can get therapy and that is typically when my hematocrit is at about 54. Dr says he can justify therapy for any hematocrit over 47, but that is not truly necessary. I know without blood work when I need it, feel pretty bad.


I have similar issues, so I asked a Phlebotomist about any recommendations. They said start away from nuts, which are my favorite snack, and drink tea. After a little research, discovered that green tea keeps the body from observing all the iron from your food.


Interesting on the green tea.


If you are having a lot of blood removed, you are loosing iron. Then the implications if dietary iron may be different. What changes do you see to ferritin?

Low B-12 can be from low stomach acid or use of heart burn medications and then there can be risks of poor mineral absorption and mineral deficiencies which can in turn lead to other health problems. See magnesium below.

Do you track your blood pressure at home? That might be indicative of when you need phlebotomy. If high hematocrit reduces or contributes to low blood flow in the kidneys, increased erythropoietin (EPO) production may result. So the condition could be self amplifying in some cases. Any condition that reduces blood oxygenation or blood flow is a contributor.

You can use mini aspirin to improve blood flow. Do not expect major effects, may help keep things from getting worse. Fish oil is also a blood thinner. Arterial muscle tone is important and a magnesium deficiency would make that worse. Most are magnesium deficient. If legs or feet can cramp or you are able to deliberately make a muscle lock up, you are deficient.

Dehydration is a problem as it can cause periodically reduced blood flow that might cause the kidneys to produce more EPO.

While TRT is associated with this problem and may be the trigger, there are other factors.

Elevated blood pressure may be a cause in itself as micro-circulation in the kidneys could be affected. This ties into many aspects of aging and health.


Great reply KSman, I know nothing about ferritin, I take 1000mg a day of magnesium because it does help with my cramps (I get terrible leg cramps often) I drink between 1-2 gal H2o a day depending on if training days or hot days I tend to drink the higher. I take 2000 mg of fish oil and 1500 mg a day of Curcumin (turmeric root extract). will do the mini aspirin (I’ve thought that may help flow too). Had sleep study last week "Severe sleep apnea. 55 interruptions an hr, Dr said that could be a major contributing factor. (like you said low oxygenation…) start with CPAP next week. BP was 217/122 before blood drain and 159/78 immed after. I also take 15mg a day of Mobic which I do have concern with (hard on liver and kidneys) but necessary to still walk and lift.


I expect that you might have felt immediately better as blood volume was restored via absorbed water, better blood flow to the brain.

The BP-EPO and apnea-EPO connections seem feasible.

Meloxicam/Mobic is fantastic. The warning a general to NSAIDs. 15mg is trivial compared to the mg loads of ibuprofen or naproxen that probably do not work properly at any dose and they can create problems with kidney specific labs [me]. $40/year cash price a Walmart/SAMs, they will fill if doc specifies filling all at once.

With your blood removal, you need for iron has increased. See my earlier related comments.

Checking BP at home?

Note that high BP increases EPO that increases HTC that increases BP …
This situation is going to require careful management.


I have a good GP that is great with the TRT and general understanding of “Optimization” and quality of life with my male hormone replacement protocols. Mobic same here $10 for 90 day supply @ Wal-Mart. Yes on BP 2-3x a day at this point, wife and I are in medical field and son is a nurse so got that covered. I have a leg cuff (22" biceps) and mine and my sons readings are always lower then dr’s office (their cuff is small and pops off 2or 3 times before they get it, but still higher than expectable Back on my diet from Amit Sipir (He is awesome with proper diet) and will be losing weight which will help… He helped me loose 60# in 2015/2016 so just doing same approach. Thanks for input will keep you posted as I progress.


Keep track of the issues re EPO that I pointed out. Whatever you are doing needs to be measured up against getting EPO reduced.