HCT: frequent bloodletting to lower HCT, could cause some problems

**Slacker78** · 03-30-2018, 05:23 AM

Hello guys, i'm noticed with short testosterone ester ( test prop ), my HCT raise up very quickly; i switched to longer ester as enanthate and i did 2 bloodletting of ~500ml of blood in 1 month to lower it. I'm on TRT, and i started a small cycle of test to give a little boost; i begun with test prop 100mg/EOD and my HCT got 50,1% in 25 days from my baseline; i did my first bloodletting and 15 days i got it at the same level; i waited to let it raise up a bit more and when it reached 52,4%, i did another bloodletting of ~600ml of blood.

I wonder if too much frequent bloodletting could cause various problems, and eventually boosting up bone narrow to answer in more aggressive manner, increasing its capacity to produce red blood cells.

Thank you so much for your suggestions.

**kelkel** · 03-30-2018, 08:30 AM

One thing to watch for will be anemia. Keep an eye on your iron.

**Slacker78** · 03-30-2018, 08:37 AM

Originally Posted by kelkel

One thing to watch for will be anemia. Keep an eye on your iron.

Ok Kel. The fact that bone narrow could boost up its normal red blood cell production activity ( in brief up-regulation ) is it possible or it's just my thought ?

**kelkel** · 03-30-2018, 09:11 AM

Out of my league with that one but I wouldn't think so. Maybe it's as simple as short estered, quicker acting test = quicker RBC production?
What was your baseline Hct?

**Slacker78** · 03-30-2018, 09:24 AM

Originally Posted by kelkel

Out of my league with that one but I wouldn't think so. Maybe it's as simple as short estered, quicker acting test = quicker RBC production?
What was your baseline Hct?

My baseline is around ~47-48%

**Lemonada8** · 03-30-2018, 10:40 AM

dude... a HCT of 50.1 isnt that alarming, neither is 52.4.... just drink more water/fluids and u should be fine... ( unless u have a hypercoagulable condition which you should be on some sort of anticoagulation medication) so doing some sort home bloodletting is unnecessary and dangerous. This also stimulates ur bodys response to ramp up the RBC production which will ultimately increase the HCT.

How are you doing this bloodletting? and how do you know how much you are getting rid of? who is doing it? where are you doing it? Who is testing ur hematocrit? how is this being tested? What method is this being taken? From a IV stick? From a finger stick?

Anyways, Test P has more testosterone per mg than Test E does. The ester attached on both forms are different is sizes which changes the metabolism rates. The enthanate is much larger which means a longer halflife but less testosterone per mg. The propionate has a shorter ester meaning the same mg amount has more testosterone and less ester.

**kelkel** · 03-30-2018, 11:07 AM

Agree with Lemonada. Really no danger in most cases until you hit 55%+

**Slacker78** · 03-30-2018, 11:17 AM

Originally Posted by Lemonada8

dude... a HCT of 50.1 isnt that alarming, neither is 52.4.... just drink more water/fluids and u should be fine... ( unless u have a hypercoagulable condition which you should be on some sort of anticoagulation medication) so doing some sort home bloodletting is unnecessary and dangerous. This also stimulates ur bodys response to ramp up the RBC production which will ultimately increase the HCT.

How are you doing this bloodletting? and how do you know how much you are getting rid of? who is doing it? where are you doing it? Who is testing ur hematocrit? how is this being tested? What method is this being taken? From a IV stick? From a finger stick?

Anyways, Test P has more testosterone per mg than Test E does. The ester attached on both forms are different is sizes which changes the metabolism rates. The enthanate is much larger which means a longer halflife but less testosterone per mg. The propionate has a shorter ester meaning the same mg amount has more testosterone and less ester.

Ah, i suspected about this could boost up red blood cells production.

My HCT was tested in a lab where i often do BW. The bloodletting is perfomed by my cousin at my home which is a nurse. He used a 16G needle connected with a flexible hose to a sterile plastic bag where before was filled by a saline solution. In 20 min, we fill the bag around ~500ml of blood.

Now i did it twice in 1 month... but as you telling this could worse the situation i suppose. Now what should i do ? Should i stop the cycle and returing to my TRT test dose ? What risks could i run now ? Give some tips... i don't want having my HCT boosting up more than previous value now ( 52,4% ). If it could be, i will stop the cycle and will wait a stabilization....

**Slacker78** · 03-30-2018, 12:07 PM

No suggestions it about ?

**Lemonada8** · 03-30-2018, 12:47 PM

Originally Posted by Slacker78

Ah, i suspected about this could boost up red blood cells production.

My HCT was tested in a lab where i often do BW. The bloodletting is perfomed by my cousin at my home which is a nurse. He used a 16G needle connected with a flexible hose to a sterile plastic bag where before was filled by a saline solution. In 20 min, we fill the bag around ~500ml of blood.

Now i did it twice in 1 month... but as you telling this could worse the situation i suppose. Now what should i do ? Should i stop the cycle and returing to my TRT test dose ? What risks could i run now ? Give some tips... i don't want having my HCT boosting up more than previous value now ( 52,4% ). If it could be, i will stop the cycle and will wait a stabilization....

how are they testing it at the lab? are they doing a IV stick or a finger stick test? if they are doing a finger stick it will be higher artificially anyways due to the method.

I agree with kelkel except my line of intervention is 60% but we have different resources and different envrioments available which account for that difference. So I would agree with his recommendation of 55%.

are you taking any medications? Do you have any other comorbid conditions? are you staying hydrated? are you taking any medications (diuretics in particular) other than the TRT? What is ur normal TRT dose? what is ur cycle dose of Test P you are taking? How old are you? have you had this issue before while on TRT? What are the other values of the CBC, including the hemoglobin values, wbc, RBC, retic count *if gotten*, RDW, MCV, Platelets? What other bloodwork do you get? How often are you getting lab work? What symptoms are you having while on cycle that you dont have on TRT?

Some articles to ponder over...

https://academic.oup.com/jcem/article/93/3/914/2598663
https://academic.oup.com/jcem/article/82/6/1661/2656202
https://academic.oup.com/jcem/article/85/8/2670/2851433

Sry was gettin new drivers license

... lolz gotta give me some time to respond haha

**Slacker78** · 03-30-2018, 05:14 PM

[QUOTE=Lemonada8;7369739]how are they testing it at the lab? are they doing a IV stick or a finger stick test? if they are doing a finger stick it will be higher artificially anyways due to the method.

I agree with kelkel except my line of intervention is 60% but we have different resources and different envrioments available which account for that difference. So I would agree with his recommendation of 55%.

are you taking any medications?

Proton Pump Inhibitor 10mg/ED

Do you have any other comorbid conditions?

No.

are you staying hydrated?

Yes.

are you taking any medications (diuretics in particular) other than the TRT?

No, just Adex in TRT at 0.25/Week

What is ur normal TRT dose?

100mg of Test Enanthate E5D

what is ur cycle dose of Test P you are taking?

100mg EOD of Test Prop, but keeping my TRT weekly dose

How old are you?

40 years old.

have you had this issue before while on TRT?

Yes, i've noticed my HCT tend to raise up when i started time ago a cycle with Test Prop at the same dosage. In cycle with just 250mg of Test Enanthate and 300mg of Deca at week, i detected just small increasing.

What are the other values of the CBC, including the hemoglobin values, wbc, RBC, retic count *if gotten*, RDW, MCV, Platelets?

RBC: 5.360.000 mmc - ( 4.000.000 - 6.000.000)
WBC: 5.650 mmc - ( 4.000 - 1.0000 )
HB: 16,7 g % - ( 12 - 17 )
MCV: 97,9 fl ( 80 - 100 )
MCHC: *31,9 % ( 32 - 36 )
Platelets: 236.000 mmc ( 140.000 - 450.000 )

What other bloodwork do you get?

lipids, liver enzymes, thyroid, kidneys, iron, PSA and is all ok ( i did PSA after 4 months of TRT and it's at 0.05 )

How often are you getting lab work?

Twice at month.

What symptoms are you having while on cycle that you dont have on TRT?

Blood pressure is ok, i check often it ( 120-130 : 80-75 ). I just feel a bit of anxiety and sometimes a little of stronger heart palpitations, but nothing more.

I think that being i'm on TRT from 4 months to now and i started a small Test-only cycle, this could be the cause associated to Test Prop.

I tested my HCT since i started to getting in the cycle, and i saw an increased progression from week in week ( around ~0.7-8% of HCT ) of HCT, HB and RBC, in a linear fashion.

I did 2 bloodletting of ~500ml each one in 1 month; after the first one, i re-tested my HCT and after a week i got it at 50%; after 10 days, i re-tested and i got it at 51,9; after other 10 days, i re-tested and i got it at 52,4.

So i did another bloodletting yesterday to lowering it.

Now, i expected to have stimulated it too much, so the next blood work i will do in 10 days, i guess it will around ~50-51 again or upper.

I removed Test prop and switched to Test Cypionate ( or Enanthate ) at 500mg/week. But now i wonder, what could be the best solution, as to stopping the cycle, going in my TRT dose and waiting an adjusting.

I'm afraid my bone narrow to begin to produce too much RBC and too much quickly and loosing the control of it

**Lemonada8** · 03-30-2018, 06:18 PM

polycythemia vera is a common condition with tesosterone replacement therapy... it seems that this is occuring with you. U have a slightly high MCV, i would suggest supplementing some B12 and folate (with a multivit) there might be a slight deficiency there with the amount of blood ur pumping out.

also what PPI are you taking at 10mg? all the ones i know of are taken at 20mg minimum... unless they are a OTC dose.. and 500mg/week is a high dose per week for a TRT dose... that could be the base of ur issue there...

**Slacker78** · 03-30-2018, 06:26 PM

Originally Posted by Lemonada8

polycythemia vera is a common condition with tesosterone replacement therapy... it seems that this is occuring with you. U have a slightly high MCV, i would suggest supplementing some B12 and folate (with a multivit) there might be a slight deficiency there with the amount of blood ur pumping out.

also what PPI are you taking at 10mg? all the ones i know of are taken at 20mg minimum... unless they are a OTC dose.. and 500mg/week is a high dose per week for a TRT dose... that could be the base of ur issue there...

I take ppi at 20mg, sorry, I wronged.
I do sometimes b12 injection IM of 1000 mcg/week.

500mg/week of Test E is MY CYCLE dose, non TRT.

Now I wonder... I did 2 bloodletting... should I stop the cycle and wait, or should I continue, observing HCT ?

**Lemonada8** · 03-30-2018, 07:03 PM

I would stop the cycle and just let the HCT stabilize... IMO

**Iron Frenchie** · 03-30-2018, 07:20 PM

Originally Posted by Slacker78

I take ppi at 20mg, sorry, I wronged.
I do sometimes b12 injection IM of 1000 mcg/week.

500mg/week of Test E is MY CYCLE dose, non TRT.

Now I wonder... I did 2 bloodletting... should I stop the cycle and wait, or should I continue, observing HCT ?

I would continue and just watch it. I just went in to give blood and my hemoglobin was 19.1. I go in every 56 days so I might need to do some bloodletting.

**Slacker78** · 03-31-2018, 12:58 AM

Originally Posted by Iron Frenchie

I would continue and just watch it. I just went in to give blood and my hemoglobin was 19.1. I go in every 56 days so I might need to do some bloodletting.

I will see the next BW in 7 days and based on those results, i will decide if stopping it and returning to TRT dose, or continue. I Hope, returning to TRT low dose, to get a stabilization on lower HCT values, even though i think that while i will be on TRT, i will never go under ~50, because that seems to be the HCT level my body adjusted on TRT.

**almostgone** · 03-31-2018, 08:53 AM

Originally Posted by Slacker78

Hello guys, i'm noticed with short testosterone ester ( test prop ), my HCT raise up very quickly; i switched to longer ester as enanthate and i did 2 bloodletting of ~500ml of blood in 1 month to lower it. I'm on TRT, and i started a small cycle of test to give a little boost; i begun with test prop 100mg/EOD and my HCT got 50,1% in 25 days from my baseline; i did my first bloodletting and 15 days i got it at the same level; i waited to let it raise up a bit more and when it reached 52,4%, i did another bloodletting of ~600ml of blood.

I wonder if too much frequent bloodletting could cause various problems, and eventually boosting up bone narrow to answer in more aggressive manner, increasing its capacity to produce red blood cells.

Thank you so much for your suggestions.

I usually run a total iron panel including serum iron, TIBC, and ferritin levels if I have to phlebotomize more than normal.
Short esters do exacerbate the problem.

**Lemonada8** · 03-31-2018, 09:52 AM

One thing i did think of last night... ur hemoglobin is still normal while hematocrit is elevated... I think ur a lil dry also... usually hematocrit is 3x hemoglobin... 3x 16.7 is 50.1 and 52.4 / 3 is 17.4... now thats just a estimate, however ur blood is still a little concentrated more than normal.. Id suggest drinking at least a gallon of water a day. And add in a supplement of B12 and folate. Ur MCV is still on the larger size (97), this is not macrocytosis yet but is getting there, esp with the amount of blood ur are pumping out. U said u are getting B12 shots, why is that? U said u dont have any other comorbid conditions, yet you are getting B12 shots... So you must be having some other condition to warrant those shots...

**Slacker78** · 03-31-2018, 10:06 AM

Originally Posted by Lemonada8

One thing i did think of last night... ur hemoglobin is still normal while hematocrit is elevated... I think ur a lil dry also... usually hematocrit is 3x hemoglobin... 3x 16.7 is 50.1 and 52.4 / 3 is 17.4... now thats just a estimate, however ur blood is still a little concentrated more than normal.. Id suggest drinking at least a gallon of water a day. And add in a supplement of B12 and folate. Ur MCV is still on the larger size (97), this is not macrocytosis yet but is getting there, esp with the amount of blood ur are pumping out. U said u are getting B12 shots, why is that? U said u dont have any other comorbid conditions, yet you are getting B12 shots... So you must be having some other condition to warrant those shots...

I do B12 shots, simply as supplement being all benefits it carries. I do just 1000 mcg and not every week... 1-2 at month precisely...is it bad ? I'm starting to drink water more by now... even it's my habit to drink a lot of water, but maybe in this period, i'm drinking less as it could be needed.

**Mr.BB** · 03-31-2018, 05:34 PM

Originally Posted by Slacker78

Hello guys, i'm noticed with short testosterone ester ( test prop ), my HCT raise up very quickly; i switched to longer ester as enanthate and i did 2 bloodletting of ~500ml of blood in 1 month to lower it. I'm on TRT, and i started a small cycle of test to give a little boost; i begun with test prop 100mg/EOD and my HCT got 50,1% in 25 days from my baseline; i did my first bloodletting and 15 days i got it at the same level; i waited to let it raise up a bit more and when it reached 52,4%, i did another bloodletting of ~600ml of blood.

I wonder if too much frequent bloodletting could cause various problems, and eventually boosting up bone narrow to answer in more aggressive manner, increasing its capacity to produce red blood cells.

Thank you so much for your suggestions.

Yes. Excessive bloodletting will cause iron deficiency, which is a strong risk factor for blood clots.

Monitor your iron, but if your hematocrit is not really much above 52%, and only for a few weeks it's not really that bad.
Of course if on trt you are not being able to manage the red blood cells (hematocrit > 54%) then you should bloodlet but only while your iron is in good values.

Lots of cardio, good hidration and better diet can improve your hematocrit situation. You can also try oxygen therapy to reduce the polycythemia.

**Slacker78** · 04-01-2018, 01:34 AM

Originally Posted by Mr.BB

Yes. Excessive bloodletting will cause iron deficiency, which is a strong risk factor for blood clots....

Blood Clots ? Gosh.. ! Why iron deficiency could increase this risk ? I think being i drained a lot of blood, it would be useful eat foods rich of iron and maybe taking some iron supplement... isn'it ?

**Mr.BB** · 04-01-2018, 12:04 PM

Originally Posted by Slacker78

Blood Clots ? Gosh.. ! Why iron deficiency could increase this risk ? I think being i drained a lot of blood, it would be useful eat foods rich of iron and maybe taking some iron supplement... isn'it ?

If you think that the iron is important for life and most of iron is in the blood, so your body will want to protect iron by reducing blood loss. How does the body prevent blood loss? Increasing coagulation factors seems the logical thing to do, unfortunately that will also help with blood clots.

If you want a more scientific answers google blood clot risk factors, blood factor viii, and low iron.

**Slacker78** · 04-01-2018, 12:13 PM

Originally Posted by Mr.BB

If you think that the iron is important for life and most of iron is in the blood, so your body will want to protect iron by reducing blood loss. How does the body prevent blood loss? Increasing coagulation factors seems the logical thing to do, unfortunately that will also help with blood clots.

If you want a more scientific answers google blood clot risk factors, blood factor viii, and low iron.

Ok. As what I did with my elevated blood drain, do you suggest me to take an iron supplement for now ?

**Mr.BB** · 04-01-2018, 12:16 PM

Originally Posted by Slacker78

Ok. As what I did with my elevated blood drain, do you suggest me to take an iron supplement for now ?

If your iron is low of course you should suppletment it, although there is only so much iron your body can absorb.

**Slacker78** · 04-01-2018, 12:34 PM

Originally Posted by Mr.BB

If your iron is low of course you should suppletment it, although there is only so much iron your body can absorb.

I think i will need it, as the amount of blood i drained. Do you know some good tablets/brand could i assume ?

**Mr.BB** · 04-01-2018, 12:36 PM

Originally Posted by Slacker78

I think i will need it, as the amount of blood i drained. Do you know some good tablets/brand could i assume ?

Ferrograd

Edit: do some iron bloodwork before taking it, its cheap. Total iron and ferritin.

**hammerheart** · 04-01-2018, 01:51 PM

Originally Posted by Slacker78

I think i will need it, as the amount of blood i drained. Do you know some good tablets/brand could i assume ?

Solgar gentle iron (ferrous bisglycinate) is what I use and the only one that doesn't bother GI , it's very well absorbed and doesn't show up in the toilet, so to speak.

**Slacker78** · 04-02-2018, 11:32 AM

However, i was thinking about AAS increase iron availbility in blood. As far as i know, AAS suppress hepdicin release from liver which in turn, allow more ferroportin to pull out iron from deposit cells and injecting it in blood stream. For this matter AAS seems to stimulate RBC production from bone narrow. According to this, a bloodletting in presence of AAS supraphysiological dose ( so during a cycle ), could be more critical as this could be an additional factor which tends to increase the iron stocks depletion, already affected by the bloodletting feedback stimulation... isn't it ?

**Slacker78** · 04-05-2018, 07:07 AM

Update:

My HCT lowered to 44,8%; HB 14,5; RBC 4.870.000; MCV 92.

Total Iron is 63 mcg/DL ( 50 - 175 ).

Tomorrow i will have ferritin, but i suspect, given low side of total iron, i will be low too. I will begin to take Ferrograd 1 tablet/ED.

I can continue my cycle so