Bloodwork Concerns!!!

[jhatx]

Back in March 2019 my bloodwork came back with high RBC, Hemoglobin, and Hematocrit.

RBC 6.11 x10e6/uL 4.14 – 5.80
Hemoglobin 18.3 13.0 -17.7
Hematocrit 55.6 37.5 – 51.0

Only other thing that was off was a Lymph count at 4.1. The test clinic recommends therapeutic phlebotomies and over about a 3 month period I do 5 of them.
Fast forward to October and I have more bloodwork done here are the results of the CBC:
CBC, Platelet Ct, and Diff 01
WBC 12.2 High x10E3/uL 3.4 - 10.8 01
RBC 5.93 High x10E6/uL 4.14 - 5.80 01
Hemoglobin 14.3 g/dL 13.0 - 17.7 01
Hematocrit 46.6 % 37.5 - 51.0 01
MCV 79 fL 79 - 97 01
MCH 24.1 Low pg 26.6 - 33.0 01
MCHC 30.7 Low g/dL 31.5 - 35.7 01
RDW 17.8 High % 12.3 - 15.4 01
Platelets 225 x10E3/uL 150 - 450 01
Neutrophils 37 % Not Estab. 01
Lymphs 54 % Not Estab. 01
Monocytes 7 % Not Estab. 01
Eos 2 % Not Estab. 01
Basos 0 % Not Estab. 01
Neutrophils (Absolute) 4.5 x10E3/uL 1.4 - 7.0 01
Lymphs (Absolute) 6.6 High x10E3/uL 0.7 - 3.1 01
Monocytes(Absolute) 0.8 x10E3/uL 0.1 - 0.9 01
Eos (Absolute) 0.3 x10E3/uL 0.0 - 0.4 01
Baso (Absolute) 0.0 x10E3/uL 0.0 - 0.2 01
Immature Granulocytes 0 % Not Estab. 01
Immature Grans (Abs) 0.0 x10E3/uL 0.0 - 0.1 01
Estradiol 19.7 pg/mL 7.6 - 42.6 01

I have an appointment at my regular doctors office in November to discuss my concerns. I am told that the anemia looking items are due to all of the blood donations and will work their way out on their own. I am also told that I always have borderline high lymph count and not to worry.

In December I go in for my annual physical and BW. Everything is about the same with minor improvement. I meet with a different doctor and he tells me he is very concerned with my bloodwork with my Lymphs at 5.6 and WBC at 11.4. He believes I may have CLL and refered me to a hematologist / oncologist. Of course, I can’t see him for a few weeks so I sit in a mental hell.

Over the last 5 – 6 months I have been in a crazy depression, anxiety, dark place like I have never been before. So lots of extreme stress.

Any ideas or thoughts???????

[Gallowmere]

My best advice would be to calm the fuck down and try to disconnect from it until you have an actual diagnosis on what’s up.
The biggest concern for RBC/hemo/hcrit being high is an increased risk of CV event. Guess what is going to make that far worse. Freaking out about shit you can’t control and don’t even have a concrete answer on.

[Youthful55guy]

First thought is an undiagnosed chronic infection.

Did you actually do 5 therapeutic phlebotomies in a 3 month period? If so, that's probably the source of your low hemoglobin/hematocrit, not CLL. That's a pretty aggressive blood draw schedule and might be the source of you feeling down.

First thing I'd do while waiting for your appointment is start an iron supplement. Putting that much of a stress on your blood system can through off thyroid hormones, which may be another source of feeling down and depressed. I'm willing to bet that your ferritin levels are through the roof too.

[jhatx]

I did have 5 therapeutic phlebotomies over a 3.5 month period. It was recommended by the TRT clinic and I followed their advice. The stress / anxiety was self induced by some personal things I did.

I asked my doctor if I should take an iron supplement and told it wasn't necessary.

Between the mental stress and phlebotomies I'm sure I have beet up my body.

Hopefully not too serious.

[Youthful55guy]

I did have 5 therapeutic phlebotomies over a 3.5 month period. It was recommended by the TRT clinic and I followed their advice. The stress / anxiety was self induced by some personal things I did.

I asked my doctor if I should take an iron supplement and told it wasn't necessary.

Between the mental stress and phlebotomies I'm sure I have beet up my body.

Hopefully not too serious.

A typical therapeutic phlebotomy takes 1 pint of blood. So, 5 pints in 3.5 months is a huge blood loss in such a short amount of time. Your body is struggling to replace the lost RBCs, that requires iron. Your body will pull it from reserves and that affects other systems of the body (e.g., thyroid hormones). In this case, I would ignore your doctor's advice. Here's an interesting journal article of a randomized clinical trial of iron supplementation after standard (1 pint) blood donation.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094173/

The bigger question is, why are your hemoglobin levels so high in the first place. What is your TRT dose/protocol? What are you levels of Total and Free T? What are your DHT levels? Conversion of T to DHT is what mostly drives high RBC production in patients on TRT.

[jhatx]

I am currently doing about 130mg of test split 2x per week. Back in March my test was at 620 and free at 20.

I dont have DHT in my bloodwork.

Thanks for the article. I am sure all of plubotomies helped destroy me. They were actually larger than one pint. The donation center lets you take more for therapeutic so I said OK thinking more is better.......

Starting irod supps tonight!

[Youthful55guy]

I am currently doing about 130mg of test split 2x per week. Back in March my test was at 620 and free at 20.

I dont have DHT in my bloodwork.

Thanks for the article. I am sure all of plubotomies helped destroy me. They were actually larger than one pint. The donation center lets you take more for therapeutic so I said OK thinking more is better.......

Starting irod supps tonight!

That's a very reasonable T-dose and protocol and your Free T indicates you at about a perfect level. My goal is to maintain it around 21 to 22 pg/mL, which is about the upper 75th percentile of a 35-40 year old healthy male. This is also consistent with the Life Extension Organization recommendation for Free T. Total T is a worthless lab.

You probably want to monitor DHT. It's what drives RBC production more than T. There's a good recent article showing supporting this. The article also shows that guys on TRT generally have high DHT and high RBC labs. While guys using finasteride have more normal DHT levels and more normal hemoglobin production. The downside to controlling DHT with finasteride is that it disqualifies you from blood donations for 4 weeks after discontinuation. This would not be a problem if controlling your DHT with finasteride also successfully controlled hemoglobin production, but if you ever needed (or wanted) to donate blood, you would need to come off of finasteride for 4 weeks.

[jhatx]

So high DHT might be what made me have to start shaving my head after being on TRT for a few years?

[Youthful55guy]

So high DHT might be what made me have to start shaving my head after being on TRT for a few years?

DHT is the hormone that (among other things) promotes hair loss in men if you are genetically programmed for it. The higher the DHT, the faster the hair loss. One of my regrets of TRT (being over 7 years into it) is that I did not monitor DHT until recently, and that I listened to the anti-finasteride people who say it screwed up their sex life. Those of us on TRT generally have higher levels of T and this drives faster conversion to DHT. DHT is what drives many of the side-effects. The goal is not to crush DHT with finasteride, but rather to titrate the dose to keep DHT into the normal adult male range.