TRT and High Hematocrit

Low testosterone issues, impacts on health & marriage, treatments, etc.
Hoosier52
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TRT and High Hematocrit

Postby Hoosier52 » Wed Mar 01, 2017 8:47 am

My latest labs show a 52.7 level of HCT. I'm looking for ways to lower it other than blood donation (I'm phobic of that). There is an interesting debate between Dr. Crisler and Dr. Saya on HCT levels and blood donation. Dr. Crisler says that HCT up to 55 is normal. Dr. Saya says no, it's not normal. Anything over 50 is a concern. The debate is over some new research on HCT.

I live at a mile high which also effects my HCT level. I'm taking Naringin (grapefruit extract) and drinking green tea which are supposed to lower HCT. Metaformin has also been shown to lower HCT. Dr. Saya is my doctor and he may possibly write me a script for it after I get tested for A1c. I'm also hoping to switch my BP med from Lisinopril to Losartan. Losartan also lowers HCT.

Has anyone else had problems with HCT and found ways to lower it without blood donation?

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Re: TRT and High Hematocrit

Postby doug-h » Wed Mar 01, 2017 10:01 am

I would have to back and review my medical records from quit some time ago, but I spent a couple of years living at 9500 ft, with a great deal of time at or above 11000, as well as many trips each season up fourteeners. Was working as a backcountry outfitter/climbing guide. Had a a flight physical in that time frame and mine was significantly above normal.

The only real downside is your blood tends to be thicker, and elevated risk of thrombosis, but staying hydrated helps a lot with that. I would not be terribly concerned with low to mid 50's.

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Re: TRT and High Hematocrit

Postby ledgemoor » Wed Mar 01, 2017 1:39 pm

I have always had high blood iron, and because of that have been donating frequently since my 20s. It really isn't that unpleasant. Don't be afraid to do it. I was chicken the first time too, but was embarrassed afterwards when I saw I was afraid of such a little thing. I hate to do it now because it messes up my cycling for a week or more. Opposite of blood doping :lol:. Although the last time wasn't as bad. Maybe as I continue to get in better shape....

The problem is that they may not take your blood if it is too high. Anyway, a good way to get a free test.

Just to not miss the obvious, if you are taking a multi-vitamin, make sure it is iron-free. We take the generic version of Centrum Silver.
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Re: TRT and High Hematocrit

Postby Nvr2Late » Wed Mar 01, 2017 1:45 pm

My husband had real problems with it. So much so that just a year ago, his blood pressure went through the roof, he got dizzy and lightheaded, couldn't think straight and ended up in the ER with everyone thinking he was having a TIA or worse, a stroke.

It wasn't until they drew STAT blood work that we had any clue it was happening. I've posted on it somewhere in this board, in fact. It became a real problem for him and his PCP suggested he lay off the shot for a few months. It can be managed with regular blood donations, but I'm not aware that there is another effective way to manage high HCT. I'd love to know what it would be, short of leeches :lol:

Right now, he's been off T shots for months and he's flat-lined. He's getting over the flu, and his description of his energy level and libido are "I am dead below the waist. Nothing. Not even a twitch". :( :(
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Re: TRT and High Hematocrit

Postby be64 » Wed Mar 01, 2017 10:06 pm

Don't take this as being rude. My suggestion is to man up and give blood. It seems preferable to being on some sort of drug to lower it which may also have other side effects not to mention a cost involved. I have high hematocrit due to TRT and also hemochromatosis so I give regularly. I have an appointment on the tenth for my 42nd blood donation, plus I've had five phlobotomies done in a lab and discarded. I always watch the needle go in and could probably do it myself considering the hundreds of hormone injections I've done.
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Re: TRT and High Hematocrit

Postby ledgemoor » Thu Mar 02, 2017 3:41 am

I ALWAYS watch the needle go in. For me, not knowing when it will be going in is much worse :-).
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Re: TRT and High Hematocrit

Postby Hoosier52 » Thu Mar 02, 2017 11:38 am

be64 wrote:Don't take this as being rude. My suggestion is to man up and give blood. It seems preferable to being on some sort of drug to lower it which may also have other side effects not to mention a cost involved. I have high hematocrit due to TRT and also hemochromatosis so I give regularly. I have an appointment on the tenth for my 42nd blood donation, plus I've had five phlobotomies done in a lab and discarded. I always watch the needle go in and could probably do it myself considering the hundreds of hormone injections I've done.


Don't think it's a "man up" problem. Soloed an aircraft on my 16th birthday...Have a black belt in Shotokan. MY issue goes back to a bad experience as a child in the hospital with a blood draw. I know combat vets who are afraid to sleep at night...I don't think they are cowards.

I think part of the fear is the unknown. One phlebotomist friend told they use a 7 inch needle. Dr. Saya has told me it's some type of IV catheter where the use a needle to insert a soft tube and then pull the needle out and leave the tune in. He also said not everyone does it that way.

I had blood drawn and told the lady about my fear and that I was doing self- injections for TRT. She said she could take blood from someone but would be scared to death to self-inject. Everybody has something they are uneasy about.

If I knew for sure what type of needles were used and I knew and trusted the person doing it and I didn't have to be in a room with other people (seeing the blood run out of them), I could probably stomach it.

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Re: TRT and High Hematocrit

Postby doug-h » Thu Mar 02, 2017 12:34 pm

We all have a fear of something.

Still, those same vets who are afraid to sleep at night, will saddle up and deploy again if called to. Sometimes the best way to handle fear is to just face it down. (Actually had this discussion with someone just the other night)

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Re: TRT and High Hematocrit

Postby ledgemoor » Thu Mar 02, 2017 1:42 pm

One phlebotomist friend told they use a 7 inch needle.
Dude, someone's messing with you. All they have ever used on me is a 16-ga needle an inch or two long. They only insert about a three-eights or a half-inch of it. Just enough to get thru your skin and the vein wall.

16-ga is a lot bigger than we use for injections, and it does hurt, but usually not much. There should be no discomfort after it is inserted. If it is AT ALL uncomfortable, tell them. You really shouldn't even feel it. If you can feel it, they will move it a bit so that it is not touching a nerve.

I think part of the fear is the unknown.
Go watch.

Hey, you've had blood drawn for lab tests, right? It is only slightly more painful than that (bigger gauge needle).
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Re: TRT and High Hematocrit

Postby be64 » Thu Mar 02, 2017 10:36 pm

I would describe the needle as being the size of a basketball pump needle but sharp, inserted about half way. As far as the man up part, what I mean is just get over it, it's not a big deal and certainly better than the alternative of high hematocrit or stopping TRT.

By the way, my son and I have Taekwondo blue belts and we have a tournament coming up which I am nervous about. We spar with light contact and no pads. In class we are gentle, but in a tournament it's gets more aggressive and I don't want to get hurt.
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Re: TRT and High Hematocrit

Postby Nvr2Late » Fri Mar 03, 2017 10:16 am

Seriously. You can develop real and life threatening issues from polycythemia.

Testosterone Replacement Therapy and Polycythemia
By Nelson Vergel, B.S.Ch.E., M.B.A.

Polycythemia is an excessive production of red blood cells. With polycythemia the blood becomes very viscous or "sticky," making it harder for the heart to pump. High blood pressure, strokes and heart attacks can occur.

The association between testosterone replacement therapy and polycythemia has been reported for the past few years as this therapy has become more mainstream. In addition to increasing muscle and sex drive, testosterone can increase the body's production of red blood cells. This hematopoietic (blood-building) effect could be a good thing for those with mild anemia.

Although all testosterone replacement products can increase the amount of red blood cells, the study showed a higher incidence of polycythemia in those using intramuscular testosterone than topical administration (testosterone patch was the main option used -- no gels). Smoking has also been associated with polycythemia and may contribute to the effects of other risk factors.
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Re: TRT and High Hematocrit

Postby doug-h » Fri Mar 03, 2017 11:01 am

Nvr2Late,

I would hope that anyone taking supplementary T has a good dialog going with his care provider, to ensure that risk factors are properly managed. A high hematocrit level in and of itself is not harmful, but yes, there are other risk factors that should to be monitored.

The number he posted is on the high end of normal range, for an adult male living at sea level. Barring any complications arising from it, I wouldn't worry. I would make sure I stayed hydrated, monitor my blood pressure, and follow my doctors guidance. As there appears to be some debate as to what the defenituon of normal is, I would also strongly consider my own perceptions as to whether or not I am experiencing any adverse effects. In the case of your Husband, there was definitely a problem.

I would venture to guess that you won't find an active male living at high altitude, that does not exhibit numbers similar to that.

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Re: TRT and High Hematocrit

Postby Hoosier52 » Fri Mar 03, 2017 11:28 am

Here's and interview with Dr. John Crisler on HCT and blood donations. He says anything 55 and under is pretty much unnecessary

http://www.trtrevolution.com/new-data-m ... n-crisler/


Also, some your comments on my aversion to blood donations remind me of Job's friends - "Miserable comforters are ye all" :lol: I say that in a light-hearted way.

I have a Defy consult next week. In addition to HCT #'s my sensitive estradiol was 14. That's too low and I have had aches in my joints. The good news, my PSA was down a full point from 3 months ago.

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Re: TRT and High Hematocrit

Postby be64 » Fri Mar 03, 2017 12:00 pm

It seems to me that the estradiol number can move about quite quickly. My number can be high or low depending on when the test was done in relation to when I took arimidex. If I test low I could probably just skip a dose or two and it would be back up to normal. Going a week or two without arimidex and my number would be high.
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Re: TRT and High Hematocrit

Postby Hoosier52 » Fri Mar 03, 2017 1:28 pm

For me, TRT is a balancing act if you are doing injections. I've heard that the gels and creams don't create the same side effects. I probably tested a day before I should have. My total T was over 1000. I injected on Sat. PM and took the AI on Sun. PM then had the blood drawn on Tuesday AM. Probably should have waited until Wed AM.

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Re: TRT and High Hematocrit

Postby Hoosier52 » Wed Mar 08, 2017 2:24 pm

Had my consult with Defy today. Looks like they will prescribe Metaformin to see if it lowers my hematocrit. Also lowering AI as my estrogen is too low. I'll also be increasing my HCG from 300 to 400 units twice a week.

Has anyone noticed that HCG increases sensitivity? My orgasms are sensational since I've been on it. Lots of post-orgasm tremors and near convulsing.

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Re: TRT and High Hematocrit

Postby Nvr2Late » Wed Mar 08, 2017 9:17 pm

Given my husband's reaction to the T injections, (we're resuming them now, but more frequently and at a smaller dose each time ~ .25 ml per dose twice a week). Yay, Medicaid, they paid for it! I for one am very grateful. Our MB has suffered mightily the past couple of months. But we're going to ask him to be switched to Androgel or Testim after these vials are gone. I just don't think it's worth it for us to keep on with the injections.

The other thing, I may have posted on somewhere, is that our local blood bank is run by a paranoid freak who gives my DH a terrible time with therapeutic phlebotomies. If he needs one done quickly, she refuses because she's afraid he's going to have a cardiac event on her premises. Otherwise they usually schedule out a week to 10 days for them, making it a real problem if he begins to feel the symptoms of polycythemia coming on. Plus he has to pay out of pocket $44 each time for the privilege :roll:

I would hope that anyone taking supplementary T has a good dialog going with his care provider, to ensure that risk factors are properly managed. A high hematocrit level in and of itself is not harmful, but yes, there are other risk factors that should to be monitored.
doug-h: you might hope that, but you'd be surprised. Our PCP knows a good bit about TRT but not as much as many others. Not all of them are Crislers, unfortunately. We read up on it frequently just so we know when our doc is off base and when he's right.

Also, out of curiosity, I wonder how you come to the conclusion that high HCT is not harmful in and of itself. My reading has indicated the exact opposite of that.
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Re: TRT and High Hematocrit

Postby Hoosier52 » Wed Mar 08, 2017 9:35 pm

I don't have the link, but Dr. Crisler did a radio segment regarding research by one doctor asserting the high hematocrit is not the big problem generally thought. I found it on the ExcelMale website. Dr. Crisler has changed his view of blood donation because of it. He and Dr. Saya had quite a lively debate about it. You may be able to Google it and find it, too.

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Re: TRT and High Hematocrit

Postby Hoosier52 » Wed Mar 08, 2017 9:37 pm

Regarding blood donations, I wouldn't say anything about having high hematocrit or having issues because of it. Just be a good person wanting to donate to help others.

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Re: TRT and High Hematocrit

Postby Nvr2Late » Wed Mar 08, 2017 9:52 pm

It's too late for him to walk in and act like a regular good citizen. They have his name on file as having secondary polycythemia. They also now insist on a twice yearly renewal of a prescription for therapeutic phlebotomy. Truly, our local Community Blood Center is one of those places where the good they do is swallowed up in paranoia and red tape. It's the strangest thing. And sadly, they are the only game in town. Trust me, I've made those calls.

However, for those reading along, let my husband's situation be a cautionary tale! Do NOT mention T therapy or polycythemia. They won't even use his blood. They dump it.
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