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  1. #1
    jch3131's Avatar
    jch3131 is offline Associate Member
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    Blood work from Subq TRT

    Hey guys, I have some bloodwork I would like for everyone to look over please. I'm almost at 4 weeks of my TRT protocol and at the time of the blood work I was at 3 weeks. My stats and protocol are:

    26 y/o
    6'5"
    230lbs
    17% BF
    20mg Test Cyp ED Subq
    100iu HCG ED
    .5mgs Anastrozole every Friday

    Been feeling tired, no energy, ED, low libido. I know that Subq works up slower than IM but I really wanted to see where I was on my estradiol with the .5mg anastrozole. I took my test at 9am on a 13 hour fast. I was a little dehydrated at the time also. My diet has been high protein also. Please take a look and tell me your thoughts.


    CBC With Differential/Platelet
    WBC 7.5 3.4-10.8 x10E3/uL 01
    RBC 5.83 HIGH 4.14-5.80 x10E6/uL 01
    Hemoglobin 18.3 HIGH 12.6-17.7 g/dL 01
    Hematocrit 54.3 HIGH 37.5-51.0 % 01
    MCV 93 79-97 fL 01
    MCH 31.4 26.6-33.0 pg 01
    MCHC 33.7 31.5-35.7 g/dL 01
    RDW 14.1 12.3-15.4 % 01
    Platelets 195 150-379 x10E3/uL 01
    Neutrophils 57 40-74 % 01
    Lymphs 34 14-46 % 01
    Monocytes 6 4-12 % 01
    Eos 3 0-5 % 01
    Basos 0 0-3 % 01
    Neutrophils (Absolute) 4.3 1.4-7.0 x10E3/uL 01
    Lymphs (Absolute) 2.6 0.7-3.1 x10E3/uL 01
    Monocytes(Absolute) 0.5 0.1-0.9 x10E3/uL 01
    Eos (Absolute) 0.2 0.0-0.4 x10E3/uL 01
    Baso (Absolute) 0.0 0.0-0.2 x10E3/uL 01
    Immature Granulocytes 0 0-2 % 01
    Immature Grans (Abs) 0.0 0.0-0.1 x10E3/uL 01

    Comp. Metabolic Panel (14)
    Glucose, Serum 78 65-99 mg/dL 01
    BUN 27 HIGH 6-20 mg/dL 01
    Creatinine, Serum 1.11 0.76-1.27 mg/dL 01
    eGFR If NonAfricn Am 91 >59 mL/min/1.73 01
    eGFR If Africn Am 105 >59 mL/min/1.73 01
    BUN/Creatinine Ratio 24 HIGH 8-19 01
    Sodium, Serum 141 134-144 mmol/L 01
    Potassium, Serum 4.4 3.5-5.2 mmol/L 01
    Chloride, Serum 101 97-108 mmol/L 01
    Carbon Dioxide, Total 22 18-28 mmol/L 01
    Calcium, Serum 10.3 HIGH 8.7-10.2 mg/dL 01
    Protein, Total, Serum 7.3 6.0-8.5 g/dL 01
    Albumin, Serum 4.8 3.5-5.5 g/dL 01
    Globulin, Total 2.5 1.5-4.5 g/dL 01
    A/G Ratio 1.9 1.1-2.5 01
    Bilirubin, Total 0.5 0.0-1.2 mg/dL 01
    Alkaline Phosphatase, S 81 39-117 IU/L 01
    AST (SGOT) 18 0-40 IU/L 01
    ALT (SGPT) 22 0-44 IU/L 01

    Lipid Panel
    Cholesterol, Total 140 100-199 mg/dL 01
    Triglycerides 95 0-149 mg/dL 01
    HDL Cholesterol 37 LOW >39 mg/dL 01
    VLDL Cholesterol Cal 19 5-40 mg/dL 01
    LDL Cholesterol Calc 84 0-99 mg/dL 01

    Thyroid Panel With TSH
    TSH 1.430 0.450-4.500 uIU/mL 01
    Thyroxine (T4) 7.4 4.5-12.0 ug/dL 01
    T3 Uptake 32 24-39 % 01
    Free Thyroxine Index 2.4 1.2-4.9 01

    Testosterone, Free/Tot Equilib
    Testosterone , Serum 546 348-1197 ng/dL 01
    Testosterone,Free 16.60 5.00-21.00 ng/dL 02
    % Free Testosterone 3.04 1.50-4.20 % 02
    Prostate Specific Ag, Serum 0.8 0.0-4.0 ng/mL 01
    IGF-1
    Insulin -Like Growth Factor I 242 98-282 ng/mL 02
    Estradiol, Sensitive
    Estradiol, Sensitive 17 3-70 pg/mL 02
    Sex Horm Binding Glob, Serum
    Sex Horm Binding Glob, Serum 14.5 LOW 16.5-55.9 nmol/L 01

  2. #2
    jasondd1 is offline Member
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    3 weeks isn't enough time. Wait at least 6 and maybe more since sub q

    And why the ai?

  3. #3
    jch3131's Avatar
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    Quote Originally Posted by jasondd1 View Post
    3 weeks isn't enough time. Wait at least 6 and maybe more since sub q

    And why the ai?
    As stated above in my post, I know the release time is slower and I had bloodwork done to see where I was at the current time. Being new to TRT its a good idea to get BW more regular to help me find my sweet spot easier.

    I have had estrogen issues in the past and was prescribed the AI. I had to start somewhere so I started at .5mg. If I end up responding well to Subq and it keeps me from needing an AI then I will come off it.

  4. #4
    Rusty11's Avatar
    Rusty11 is offline Senior Member
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    It's time to pay attention to your Hct and Hgb. These are quite high. Do a google search. You really should donate blood soon. Much higher and the blood bank will deny you. Talk to your dr. or just go down and do it.

  5. #5
    Spartans09's Avatar
    Spartans09 is offline Member
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    Your blood is getting very thick which can be dangerous. The condition is called testosterone induced polycythemia. You need probably 2 blood donations in a 1 week period. This will require a prescription for a therapeutic phlebotomy. The Red Cross will reject you flat out. Please read below.

    1 phlebotomy will decrease hematocrit by closer to 6-10%. Please see the information below from Dr. Scally. There is also a formula to calculate if interested.

    Checking for Increased Blood Thickness (Polycythemia)

    In addition to increasing muscle and sex drive, testosterone can increase your bodyís production of red blood cells. This hemopoietic (blood building) effect could be a good thing for those with mild anemia. An excessive production of red blood cells is called polycythemia; itís not a good thing. With polycythemia the blood becomes very viscous or ďstickyĒ making it harder for the heart to pump. High blood pressure, strokes, and heart attacks can occur. This problem is not that common in men taking replacement doses of testosterone but more common in those taking higher bodybuilder doses.
    Itís important to have your doctor check your bloodís hemoglobin and hematocrit.. Hemoglobin is the substance that makes blood red and helps transport oxygen in the blood. Hematocrit reflects the proportion of red cells to total blood volume. The hemoglobin and hematocrit should be checked before starting testosterone replacement therapy, at three to six months and then annually. A hematocrit of over 54 percent should be evaluated. Discontinuation of testosterone may be necessary but there is another option.
    Many patients on testosterone replacement who experience polycythemia do not want to stop the therapy due to fears of re-experiencing the depression, fatigue and low sex-drive they had before starting treatment. For those patients, therapeutic phlebotomy may be the answer. Therapeutic phlebotomy is very similar to what happens when donating blood, but this procedure is prescribed by your physician as a way to bring down your blood levels of hematocrit and viscosity.
    A phlebotomy of one pint of blood will generally lower hematocrit by about 3 percent. I have seen phlebotomy given weekly for several weeks bring hematocrit from 56 percent to a healthy 46 percent. I know physicians who prescribe phlebotomy once every six weeks because of an unusual response to testosterone replacement therapy. This simple procedure is done in a hospital blood draw facility and can reduce hematocrit, hemoglobin, and blood iron easily and in less than one hour. Unfortunately, therapeutic phlebotomy can be a difficult option to get reimbursed or covered by insurance companies. Your doctor may need to write a letter of medical necessity for it. If you are healthy and without HIV, hepatitis B, C, or other infections, you could also donate blood at a blood bank (a great way to help others!).
    The approximate amount of blood volume that needs to be withdrawn to restore normal values can be calculated by the following formula, courtesy of Dr. Michael Scally, an expert on testosterone side effect management. The use of the formula includes the assumption that whole blood is withdrawn. The duration over which the blood volume is withdrawn is affected by whether concurrent fluid replacement occurs.
    Volume of Withdrawn Blood (cc)=
    Weight (kg) ◊ ABV◊[Hgbi- Hgbf]/[(Hgbi+Hgbf)/2]
    Where:
    ABV = Average Blood Volume (default = 70)
    Hgbi(Hcti) = Hemoglobin initial
    Hgbf(Hctf) = Hemoglobin final (desired);
    So, for a 70 kg (154 lbs) man (multiply lbsx0.45359237 to get kilogram) with an initial high hemoglobin of 20 mg/mL who needs to have it brought down to a normal hemoglobin of 14 mg/mL, the calculation would be:
    CC of blood volume to be withdrawn = 75x70x[20ól4]/[(20 + l4)/2]
    = 75x70x(6/17) = approximately1850cc;
    One unit of whole blood is around350 to 450 cc; approximately4 units of blood need to be withdrawn to decrease this manís hemoglobin from 20 mg/mL to 14 mg/mL.
    The frequency of the phlebotomy depends on individual factors, but most men can do one every two to three months to manage their hemoglobin this way. Sometimes red blood cell production normalizes without any specific reason. It is impossible to predict exactly who is more prone to developing polycythemia, but men who use higher doses, men with higher fat percentage, and older men may have a higher incidence.
    Some doctors recommend the use of a baby aspirin (81 mg) a day and 2,000 to 4,000 mg a day of omega-3 fatty acids (fish oil capsules) to help lower blood viscosity and prevent heart attacks. These can be an important part of most peopleís health regimen but they are not a replacement for therapeutic phlebotomy if you have polycythemia and do not want to stop testosterone therapy . It amazes me how many people assume that they are completely free of stroke/heart attack risks by taking aspirin and omega-3 supplements when they have a high hematocrit.
    Although some people may have more headaches induced by high blood pressure or get extremely red when they exercise, most do not feel any different when they have polycythemia. This does not make it any less dangerous. If you are using testosterone on your own you need to let your doctor know. Your physician may already suspect some sort of anabolic use if lab results reveal elevated hemoglobin and hematocrit.

  6. #6
    jch3131's Avatar
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    Quote Originally Posted by Spartans09 View Post
    Your blood is getting very thick which can be dangerous. The condition is called testosterone induced polycythemia. You need probably 2 blood donations in a 1 week period. This will require a prescription for a therapeutic phlebotomy. The Red Cross will reject you flat out. Please read below.

    1 phlebotomy will decrease hematocrit by closer to 6-10%. Please see the information below from Dr. Scally. There is also a formula to calculate if interested.

    Checking for Increased Blood Thickness (Polycythemia)

    In addition to increasing muscle and sex drive, testosterone can increase your bodyís production of red blood cells. This hemopoietic (blood building) effect could be a good thing for those with mild anemia. An excessive production of red blood cells is called polycythemia; itís not a good thing. With polycythemia the blood becomes very viscous or ďstickyĒ making it harder for the heart to pump. High blood pressure, strokes, and heart attacks can occur. This problem is not that common in men taking replacement doses of testosterone but more common in those taking higher bodybuilder doses.
    Itís important to have your doctor check your bloodís hemoglobin and hematocrit.. Hemoglobin is the substance that makes blood red and helps transport oxygen in the blood. Hematocrit reflects the proportion of red cells to total blood volume. The hemoglobin and hematocrit should be checked before starting testosterone replacement therapy, at three to six months and then annually. A hematocrit of over 54 percent should be evaluated. Discontinuation of testosterone may be necessary but there is another option.
    Many patients on testosterone replacement who experience polycythemia do not want to stop the therapy due to fears of re-experiencing the depression, fatigue and low sex-drive they had before starting treatment. For those patients, therapeutic phlebotomy may be the answer. Therapeutic phlebotomy is very similar to what happens when donating blood, but this procedure is prescribed by your physician as a way to bring down your blood levels of hematocrit and viscosity.
    A phlebotomy of one pint of blood will generally lower hematocrit by about 3 percent. I have seen phlebotomy given weekly for several weeks bring hematocrit from 56 percent to a healthy 46 percent. I know physicians who prescribe phlebotomy once every six weeks because of an unusual response to testosterone replacement therapy. This simple procedure is done in a hospital blood draw facility and can reduce hematocrit, hemoglobin, and blood iron easily and in less than one hour. Unfortunately, therapeutic phlebotomy can be a difficult option to get reimbursed or covered by insurance companies. Your doctor may need to write a letter of medical necessity for it. If you are healthy and without HIV, hepatitis B, C, or other infections, you could also donate blood at a blood bank (a great way to help others!).
    The approximate amount of blood volume that needs to be withdrawn to restore normal values can be calculated by the following formula, courtesy of Dr. Michael Scally, an expert on testosterone side effect management. The use of the formula includes the assumption that whole blood is withdrawn. The duration over which the blood volume is withdrawn is affected by whether concurrent fluid replacement occurs.
    Volume of Withdrawn Blood (cc)=
    Weight (kg) ◊ ABV◊[Hgbi- Hgbf]/[(Hgbi+Hgbf)/2]
    Where:
    ABV = Average Blood Volume (default = 70)
    Hgbi(Hcti) = Hemoglobin initial
    Hgbf(Hctf) = Hemoglobin final (desired);
    So, for a 70 kg (154 lbs) man (multiply lbsx0.45359237 to get kilogram) with an initial high hemoglobin of 20 mg/mL who needs to have it brought down to a normal hemoglobin of 14 mg/mL, the calculation would be:
    CC of blood volume to be withdrawn = 75x70x[20ól4]/[(20 + l4)/2]
    = 75x70x(6/17) = approximately1850cc;
    One unit of whole blood is around350 to 450 cc; approximately4 units of blood need to be withdrawn to decrease this manís hemoglobin from 20 mg/mL to 14 mg/mL.
    The frequency of the phlebotomy depends on individual factors, but most men can do one every two to three months to manage their hemoglobin this way. Sometimes red blood cell production normalizes without any specific reason. It is impossible to predict exactly who is more prone to developing polycythemia, but men who use higher doses, men with higher fat percentage, and older men may have a higher incidence.
    Some doctors recommend the use of a baby aspirin (81 mg) a day and 2,000 to 4,000 mg a day of omega-3 fatty acids (fish oil capsules) to help lower blood viscosity and prevent heart attacks. These can be an important part of most peopleís health regimen but they are not a replacement for therapeutic phlebotomy if you have polycythemia and do not want to stop testosterone therapy . It amazes me how many people assume that they are completely free of stroke/heart attack risks by taking aspirin and omega-3 supplements when they have a high hematocrit.
    Although some people may have more headaches induced by high blood pressure or get extremely red when they exercise, most do not feel any different when they have polycythemia. This does not make it any less dangerous. If you are using testosterone on your own you need to let your doctor know. Your physician may already suspect some sort of anabolic use if lab results reveal elevated hemoglobin and hematocrit.
    Thanks for the info Spartan, I tried the formula but my results came in g/dL and the formula wants mg/mL. Is there a conversion I can use? When I saw that it came back high I knew I had to donate blood and that my thick blood is probably a big reason for my ED. I will be going Friday to donate and will be talking to my doctor about starting the Phlebotomy treatments. Thanks again.

  7. #7
    Baxter35's Avatar
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    Your E2 is low enough you might want to try going without the AI for a while to see where your counts land without it. Some guys report feeling much better when their E2 is higher within the range.

  8. #8
    The_Crawfish is offline Associate Member
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    1 gram/dl = 10 milligrams / mL

  9. #9
    kelkel's Avatar
    kelkel is offline HRT Specialist ~ AR-Platinum Elite-Hall of Famer ~ No Source Checks
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    Dumping blood is great advice. Do it asap. Hydrate better immediately as well.
    Get off the AI as stated. Even if your E2 doubled you'd still be in a great place.
    -*- NO SOURCE CHECKS -*-

  10. #10
    jch3131's Avatar
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    I went and donated blood with an Apheresis Machine. So they took double red blood cells and 420ML of blood total. The Phelbotomist said it would lower my Hemoglobin better than a normal donation. I am hydrated again. Spoke to my doctor and of course he advised the donation, also he told me to cut my Test dose in half for the next 4 weeks and also take .5mg of anastrozole EOW and re-test at 4 weeks. I will follow his directions and after 4 weeks I will probably end up dropping the AI all together. I am not thrilled about cutting the test dose but he said after 4 weeks when he sees what my bloodwork looks like I will go back to ordinary dose.

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