Hematocrit Problems on 50mg 2x p/week versus 200mg 1x p/week? Huh? On TRT 5 years

[DTX2000]

Long story short, I am a 42 y/o male that went on TRT 5 years ago with a clinic. Started at 100 mg p/w x1 then over the first few years worked up to 200mg p/w x1 under their supervision. Felt good and on day 7 of 7 before blood work Total was around 750-800 and free T on their scale was 14-17. Their protocol mostly focused on Free being 15-18 range as the target and not so much the total T. Have been on .25 arimidex 2x a week as well so have a good feel for e2 management. At this rate I was pushing 50+ on Hematocrit so donated blood every two months. They stopped allowing their patients to self inject and I travel every week so had to do something else.

Took my last set of labs and went to an internal medicine guy they referred. He looked at the labs and continued the protocol of 200 mp test cyp 1x a week for a while then about 2 months ago we did cholesterol test and wow....my total was 172 but my good HDL was only 20.....TRI was 49. Time to lower the dosage and try to get the good HDL up! I was also pushing the limits on the hemaglobin test at the blood center so he wanted to cut the dosage down and re-test in 4 months. Went from 200 mg 1x p/w to 60 mg 2x p/w. Did a blood donation the day before my blood work so hematocrit should have dropped to high 40's.

I felt ok the first few weeks but in less than a month (versus 2 months) and I was already VERY RED, flush and thick breath when I laid down to past my hematocrit limit in less than a month....did a blood donation after 4 weeks and then dropped my dose to 50mg 2x a week. That was 3 weeks ago and I am ALREADY back to high hematocrit and going AGAIN tomorrow for a blood donation then going to test my Ferritin to see how much I have to work with.

So why would 200mg 1x cause less RBC creation than 50mg 2x a week????? Perplexed and not going back to dr for a few months. Wonder if I should go to 100 mg 1x versus the 50 mp 2x? Not messing around with high hematocrit more than I already have. Has anyone else had this same issue? Not sure why 50% total dosage cut and that weekly dosage split in two would have these results.

 

[DTX2000]

Other info. 6' 0", 198lbs. Eat healthy, workout 3-4 times a week. Blood Pressure normally 120s/70s. Have had sleep apnea for years and I do wear a CPAP to sleep the majority of the time. Normal multi-vitamins, fish oil, Vitamin E, Vitamin D and Vitamin C daily. Amino Acids pre-workout and protein post. Use 25g 1" IM injections in glutes. All other normal blood work comes back in range except RBC and Hematocrit even on donations every 2 months.

 

[Mprtz]

Welcome!

Exogenous testosterone increases erythropoiesis by suppressing hepcidin.

To my knowledge, there is not at this time an FDA approved test for hepcidin, so it's hard for use to measure just how much it is suppressed.

I think it is possible that hepcidin could be reduced to very low (crashed) levels and once it is crashed it doesn't matter how much (more) testosterone you use, it will not have any additional erythropoietic effect. Please keep in mind this is somewhat speculative on my part.

It also isn't clear how quickly hepcidin levels recover once testosterone is discontinued or decreased. RBCs also have a life of about 30 days, so between the two it could take quite some time for HCT to normalize after a change in dosage.

Do you have baseline figures for your lipids? I also continue struggle with HCT (and also started on 200mg/week and reduced it).
However, I find it a little surprising that even a high TRT dose alone could be responsible for your low HDL. Do you get adequate fats in your diet? "Eating healthy" still implies low fat to some.

 

[Alpin]

Good question...
You're saying you found this consistent throughout your TRT journey... The 2 x weekly shots raising HCT more?
U sure??

 

[DTX2000]

So on 200mg p/wk 1x I was on a blood donation schedule of roughly every 60 days and hematocrit usualy going from 47-48 post donation up to 50 or 51 after two months. This was the norma for the years I was on 200mg.

I have only been on the lower total dosage for a few months with 2x a week so have not done full labs yet since doc wanted me to go 4 months on new protocol.

Unfortunately I gave my labs to my new dr so I do not have copies however this is the first time (2 months ago to start the new protocol) that I have been told I had low HDL. My totals have ways been under 190 and the last time I remember my HDL number it was 41 but that was two years ago when my doc at the clinic changed out.

As far as diet I would say in that time I certainly did "low fat" for sure. In the past two months, I have increased eggs, olive oil, avacados, walnuts, etc plus 2 fish oil a day vs 1 do try to add "good fat" into the mix. The thought from the dkc was lower dose, 2x a week and more good fats then test again in 4 months. Sounds like a good plan but now have to do blood donations after 1 month for past 2 months. Very red, headaches, "thick" breathing and very red neck n face in workouts. Have done this for 5 years so I know the symptoms!

FYI, have had some reflux and burping issues (prob from high hematocrit) so doc ordered abdominal sonogram and endoscopy and no major issues there.

Maybe my body will catch up on this lower more frequent program but I at risk of ferritin crashing which I can promise you was WAY worse than low T ever was. Was so out of it with a Ferritin reading of 5 I almost lost my job. #Brain_Dead

 

[Mprtz]

Interesting, would you mind sharing what symptoms besides brain function you ascribe to the low ferritin?

I've been struggling to keep my HCT down... was at 55 a while ago. I didn't really notice any symptoms, maybe a bit of reduced circulation (tingling) in hands and feet. BP still pretty ok, and not noticeably red.

 

[luckypaul]

I have a prescribed blood drop whenever my hematocrit gets above 48. Your doc should refer you to a hematologist if your hematocrit rises that high on a trt dose . Is it just rbc count only?

 

[DTX2000]

My previous clinic did RBC + Total T + Free T + E2 every 90 days then a "full workup" with liver panel and cholesterol twice a year. The Hematocrit was usually up over 50 when I could "feel it" was was red when doing the blood work and would come down a few points after (went and did my own labs after).

With low Ferritin I had a VERY hard time paying attention and as odd as it sounds, had a very hard time converting my thoughts into speech. Words would come out jumbled and felt very very foggy and very hard to have any thought process. I am in a client facing role which made this real bad. Boss asked if I had a drinking problem and a few long term buddies thought I started drugs (at 40 years old....). Got on iron supplements w/ VitC and stayed on that regimen for over a year until I was back up in the 40-50 range. Bad bad news so make sure your dr tests for it or you go pay to get it done if you donate frequently. There is no way to derive your Ferritin level from Iron level or Hematocrit or Hemo results so get it checked!

I did another donation today as a matter of fact (twice in 3 weeks) so praying not to drop out of range again but had to shed some RBCs. Hoping that these lower more frequent doses kick in and smooth things out.

 

[Alpin]

My previous clinic did RBC + Total T + Free T + E2 every 90 days then a "full workup" with liver panel and cholesterol twice a year. The Hematocrit was usually up over 50 when I could "feel it" was was red when doing the blood work and would come down a few points after (went and did my own labs after).

With low Ferritin I had a VERY hard time paying attention and as odd as it sounds, had a very hard time converting my thoughts into speech. Words would come out jumbled and felt very very foggy and very hard to have any thought process. I am in a client facing role which made this real bad. Boss asked if I had a drinking problem and a few long term buddies thought I started drugs (at 40 years old....). Got on iron supplements w/ VitC and stayed on that regimen for over a year until I was back up in the 40-50 range. Bad bad news so make sure your dr tests for it or you go pay to get it done if you donate frequently. There is no way to derive your Ferritin level from Iron level or Hematocrit or Hemo results so get it checked!

I did another donation today as a matter of fact (twice in 3 weeks) so praying not to drop out of range again but had to shed some RBCs. Hoping that these lower more frequent doses kick in and smooth things out.

And that is the problem with effective TRT!!!!
IMO....
If I want levels of 800 + TT I will need to donate E2M....and I'll be at 51% HCT (by the blood centres tests)...it would hit my ferritin hard. I would be at 17 for Ferritin a couple week after donating and would feel very cold, difficulty thinking as u mentioned.
I cruise at 600-700 TT which is ok and I donate E4M when my HCT hits 49%....it doesn't hit my ferritin as hard.
Ppl say get on iron supplements if your ferritin is low, problem is as a TRT individual the body takes that iron and turns it into hemoglobin ...my ferritin stores never climb above 41 on TRT...
I know its the body constantly feeding on it building hemoglobin.

 

[Alpin]

I have a prescribed blood drop whenever my hematocrit gets above 48. Your doc should refer you to a hematologist if your hematocrit rises that high on a trt dose . Is it just rbc count only?

Over here my doc said deal with it by donating frequently...
You're lucky!!
A hematologist will tell you to come off TRT ....
A GP can't prescribe a therapeutic phlebotomy here.

 

[Mprtz]

I tried iron supplementation too... a spectacular failure as it seemed to accelerate rising HCT much more than bringing up ferritin.

About a year ago I developed an arrhythmia (PCVs) and I believe that low ferritin (measured at 11 at the time) might have been the cause.

I've cut down on whole blood donations since then and rely more on platelet apheresis to help lower my HCT. My last two platelet donations had me at 46 and 47 on the ultracrit respectively (well hydrated), though I've come to believe that the ultracrit machines tend to read lower than a serum CBC.

I suspect that doing APLT every two weeks would be an effective strategy, but very time consuming.