Originally Posted by
Spartans09
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 body’s 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; it’s not a good thing. 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. This problem is not that common in men taking replacement doses of testosterone but more common in those taking higher bodybuilder doses.
It’s important to have your doctor check your blood’s 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[20—l4]/[(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 man’s 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 people’s 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.
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