Question about RBC, hematocrit, and hemoglobin levels.

[Drocc1125]

I've been on testosterone therapy for about two years due to my pituitary adenoma. I get my labwork done every three months. After my recent labs, I have levels of 50.5 hematocrit, 18.0 hemoglobin, and 5.89 rbc. Hemoglobin and RBC are a little above normal and the hematocrit is upper normal. The doctor dropped my injections to every 2 weeks instead of every 10 days as well. If it is the testosterone therapy that is causing it, how long does it take for levels to go up? What are considered dangerous levels? At what levels does blood start to clot?

[EDCG19]

Levels don't look too high in my opinion and if you're concerned about it you could start donating blood every few months. Also, what is your TRT protocol?

You inject every 10 days at what dosage? The thing with RBC and dosages is you can find something that works better for you and cut your dosage to a more frequent time. Cut the dosage to twice a week at a lower mg and that can also help with the blood work which you will be able to manage more effectively....

Many, many people start with 150-200mgs for TRT and instead of doing injecting once a week you can cut that in half.

[Drocc1125]

I was injecting every 10 days at 200mg with testosterone cypionate. The endocrinologist dropped it down to every two weeks at the same dosage. What levels are considered dangerous?

[EDCG19]

How old are you?

200mg every 10 days is going to fluctuate your levels a lot and that's where some people see issues. There's a better way to do this but it requires frequent injections. You do have room to work with here and maybe even lower your total dose to help manage your blood work. Say you want to run 150-180mgs a week and with that you can cut the dosage in half however you inject twice a week and stick to a Mon-Thu or Sun-Wed injection schedule, you don't have to do this but it helps keep the levels from fluctuating too much.

Also, imo anything over 54 for hematorcrit and over 19 for hemoglobin could be a concern.
Your levels still look alright to me, but you could be donating blood every few months and see how your levels react with that...

[Drocc1125]

I'm 28, and I've always had my injections done at the doctor's office so we'll see about getting it done more frequently. I've read about donating blood and I have an appointment for that next week. Do you know how long it takes for levels to rise? My next labs are in a few months. Should I be concerned? Thanks for the replies, you've helped put my mind at ease moreso than anyone else that I've talked to so far.

[FakeLove]

For getting the hematocrit down, I nowadays think that instead of donating, a better alternative would be to find a dosage that keeps it in range. It's doable, but requires splitting the dosage, like goalinmind suggested above.

Example: if your current 200mg per 10 days results as 50.5 hematocrit with a good trough testosterone value(?), extending it to 14 days probably helps to the hematocrit, but affects negatively to your trough T value, possibly bringing back low T symptoms. Instead, if you would do 50mg on monday, thursday, monday and thursday you probably get better T treatment results, while your hematocrit would settle in range. What makes frequent donations problematic is that they tend to lower the ferritin, which could potentially introduce new symptoms.

Naturally this would then require getting the vial for yourself, and self injections.

As of how long it takes for hematocrit come down naturally, we're talking few months since the half-life of red blood cells is relatively long.

I'm on Nebido myself, but successfully with similar principle as in the example brought down my hematocrit in range, while extending my injection frequency but still getting mid-range trough T levels.

In short:

- 1000mg of Nebido every 8 weeks resulted supra physiological T values and low-end T values at week 8, resulting 53 hematocrit.
- 250 mg of Nebido every 14 days resulted in high-end of range peak T values and mid-range trough T values, but no effect on hematocrit
- 250mg of Nebido every 19 days resulted T wise 95% of the previous, but hematocrit stabilised to 48-49

[Drocc1125]

Thanks for the response.
Is there a danger or possibility that my hematocrit level of 50.5 (or my other levels, 18.0 hemoglobin and 5.89 rbc) can rise to dangerous levels before my next labs in a few months? I am a hypochondriac and that is my main worry as of now.

[David LoPan]

I have been on TRT for over 15 years. 200mg per 14 days is to long IMO. Here is why.

Better to go 100 mg every 5 days and you would be more steady. Its is good to get a blood test on the day after the injection and then another draw on the last day. The doctor needs to get you dialed in. As times goes along you will increase up and up on your dosage. I hope you are getting HCG there as well. I have an RX for HCG at 200iU daily. What has worked best for me on HCG.

Your H&H are just something to watch. High levels and you will feel it in your cardio. Best to donate blood on a regular basis. Save a life and it will keep the H&H under control. If needed you can get an RX for a therapeutic blood draw PRN (as needed)

Do you have a full copy of blood work with your test levels and Estradiol level? What day after getting shot was blood taken?

[Drocc1125]

These labs were taken a day or two I believe after an injection of 200 mg.

[Drocc1125]

Is there a danger or possibility that my hematocrit level of 50.5 (or my other levels, 18.0 hemoglobin and 5.89 rbc) can rise to dangerous levels before my next labs in a few months? I am a hypochondriac and that is my main worry as of now. And I will be donating blood every couple months starting this week.

[TRA]

I've been on testosterone therapy for about two years due to my pituitary adenoma. I get my labwork done every three months. After my recent labs, I have levels of 50.5 hematocrit, 18.0 hemoglobin, and 5.89 rbc. Hemoglobin and RBC are a little above normal and the hematocrit is upper normal. The doctor dropped my injections to every 2 weeks instead of every 10 days as well. If it is the testosterone therapy that is causing it, how long does it take for levels to go up? What are considered dangerous levels? At what levels does blood start to clot?

Just keep your crit below 50 and you should be good. Can do that with regular blood donations, otherwise they will start to decrease/discontinue your test. Make sure you hydrate like crazy before your labs for your TRT too, so it dilutes the crit a little.

Most of the studies on Hct levels and clotting have to do with stroke and I haven't seen much useful information in the way of cut offs for clotting that is helpful for AAS users.

[Drocc1125]

Is there a danger or possibility that my hematocrit level of 50.5 (or my other levels, 18.0 hemoglobin and 5.89 rbc) can rise to dangerous levels before my next labs in a few months? I am a hypochondriac and that is my main worry as of now. And I will be donating blood every couple months starting this week.

[TRA]

Is there a danger or possibility that my hematocrit level of 50.5 (or my other levels, 18.0 hemoglobin and 5.89 rbc) can rise to dangerous levels before my next labs in a few months? I am a hypochondriac and that is my main worry as of now. And I will be donating blood every couple months starting this week.

If you are starting this week with donations you should be fine.

[jasondd1]

My hemo was on the high normal end before trt I'm on 60 mg test cyp a week I donate every 8 weeks and Im consistently between 55-58. Been that way for 4 years and I'm not dead yet. Ive always thought this was a overblown fear

[FakeLove]

Is there a danger or possibility that my hematocrit level of 50.5 (or my other levels, 18.0 hemoglobin and 5.89 rbc) can rise to dangerous levels before my next labs in a few months? I am a hypochondriac and that is my main worry as of now. And I will be donating blood every couple months starting this week.

Don't worry, on short term it wouldn't even matter if that would be the case. If you now already switched to 200mg / 14 days, just do 50mg x 4 during that 14 days and see the results in two months. You can also donate once now and see if hematocrit then settles in range. If you donate now and it's in the range in two months = problem solved.

Also, if possible see the trough T just before pinning the next 50mg. If you pin on monday and draw bloods on thu morning just before pinning, and get approx. mid-range levels and don't have low T symptoms, you're good. That's how your doc should be running your personal treatment plan.

But 200mg once every 14 days won't work.

[almostgone]

If you split your injections up into 2x/week, you also may be able to lower your dose. When I went from weekly injections to 2x/week, I was able to decrease my dosage and still stay slightly above the upper end of the range for my free T.

[anoxicblaze]

I have seen two doctors and a blood specialist in the last two months. It will shock people here to read that all three of them consider my hematocrit of 61% nothing to be concerned about. I pushed for three separate opinions due to my surprise at the first doctor's thoughts.


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[EDCG19]

I have seen two doctors and a blood specialist in the last two months. It will shock people here to read that all three of them consider my hematocrit of 61% nothing to be concerned about. I pushed for three separate opinions due to my surprise at the first doctor's thoughts.


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Glad to hear it, you at least using low dose aspirins? Hows the BP ?

[Drocc1125]

Thank you all for the reassurance. It is greatly appreciated. Should I start taking aspirin to help out as well?

[kelkel]

What you need to do is find a doctor who understands hormone replacement therapy and get on a better protocol as discussed by the guys above. Your doc simply does not understand hormones as evidenced by his initial protocol of every 10 day injections and now extending it to 14. He's clueless. Keep reading on this forum and self-educate. Let your doctor know what you want to do. If he won't help, find another.

[anoxicblaze]

Glad to hear it, you at least using low dose aspirins? Hows the BP ?

Nope! I asked that very question. There was kind of a smirk and a "no. If you needed any medication I can assure you we would prescribe it". Then there was a short speech about people googling and not listening to experts.


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[anoxicblaze]

But I bought some anyway ;-)


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[marcus300]

I have seen two doctors and a blood specialist in the last two months. It will shock people here to read that all three of them consider my hematocrit of 61% nothing to be concerned about. I pushed for three separate opinions due to my surprise at the first doctor's thoughts.


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That's dangerous and would seek another doctor who knows what he is doing

[anoxicblaze]

That's dangerous and would seek another doctor who knows what he is doing

A fourth??? But one is literally a blood doctor!


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[Drocc1125]

What you need to do is find a doctor who understands hormone replacement therapy and get on a better protocol as discussed by the guys above. Your doc simply does not understand hormones as evidenced by his initial protocol of every 10 day injections and now extending it to 14. He's clueless. Keep reading on this forum and self-educate. Let your doctor know what you want to do. If he won't help, find another.

I get my injections done at the doctor's office. I'll talk to my primary about getting it done more frequently. Would once a week 100mg help you think?

[almostgone]

I have seen two doctors and a blood specialist in the last two months. It will shock people here to read that all three of them consider my hematocrit of 61% nothing to be concerned about. I pushed for three separate opinions due to my surprise at the first doctor's thoughts.


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A fourth??? But one is literally a blood doctor!


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51% is the upper end of the normal range for most labs.. Some of us run higher at around 53%, but 61% is ridiculous.

https://www.mayoclinic.org/tests-pro...s/rsc-20205482

[anoxicblaze]

What can you do though if every doc disagrees?


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[almostgone]

What can you do though if every doc disagrees?


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Call a few Dr.offices and ask them what they consider to be a safe range for your Hct. Once you find one that gives a proper answer, set up an appointment.

[almostgone]

You're from the UK, right? Show your Dr. this:

Haematology Reference Ranges - GHNHSFT


Edit: Are you sure they told you 61%? Could it have been 51% and you misunderstood?

[kelkel]

I get my injections done at the doctor's office. I'll talk to my primary about getting it done more frequently. Would once a week 100mg help you think?

Well, it's better than every 10 or 14 days. Look at the graph in post 8 which gives you an idea of the hormonal roller coaster that long gaps in injections put you on. Who wants that? 50 mgs twice per week (self injections) or at a minimum probably every 5 days at 100 mgs. Either one will work much better than what you're on now. Just check bloods in 4 weeks and adjust if needed. If your doc won't listen find another one.

Where are you from?

[almostgone]

Oh, crap. My apologies to Drocc. I didn't realize your thread had gotten sidetracked by someone else and I was responding to them. Sorry!

[Beetlegeuse]

The principle effect of EPO, the drug that has turned pro cycling (and many other sports) on its ear, is that it stimulates production of red blood cells and dramatically increases hematocrit levels. Lance Armstrong's dope doctor, Michele Ferrari, was pilloried in the press for claiming that EPO was no more dangerous that orange juice, which also necessarily would mean that high hematocrit is harmless. A book published last year titled Spitting in the Soup: Inside the Dirty Game of Doping in Sports supports Ferrari's claim. The upshot of the research in that book concludes that there is ZERO medical evidence that anyone ever has been harmed by taking EPO, which implies that all that extra hematocrit does no harm.

When EPO first hit the streets (late '80s, early '90s) there was a rash of deaths of young competitive bicyclists, who died from heart failure while self-administering illegally-obtained EPO. Both the press and the sports authorities immediately jumped to the conclusion that they died from having too high of a hematocrit level, which either overstressed the heart or caused clotting. The press did it because sensational news sells newspapers and the sports authorities did it because it suited their anti-doping agenda.

A verbatim excerpt from the linked story:

...[T]he story of EPO killing loads of cyclists became a “flagship myth” for anti-doping interests. It was a story manufactured and spread by the press with the intent of scaring athletes....

When the truth was that every single one of those young cyclists who died "mysteriously" while taking EPO also had had a not-so-mysterious pre-existing heart ailment, which explained the cause of their deaths without the need for supernatural intervention. Any connection to EPO was purely a case of Post Hoc, Ergo Propter Hoc. Unfortunately, the myth deliberately begun by the press seems even to have influenced the medical community.

In the 1960s, Finnish crosscountry skier Eero Mäntyranta won seven olympic medals (three gold) with a natural Hct of 60-65 caused by a genetic mutation. He lived to the age of 76.

Mäntyranta wasn't the only one because there still are a few professional athletes who have a natural hematocrit in excess of 50. The World Anti-Doping Agency uses 50 as its limit but athletes can get an exemption if it can be medically proven their high Hct is naturally-occurring.

In 1995, legendary cyclist Marco Pantani raced (while juiced on EPO) with an Hct as high as 60. And performing Herculean feats of anaerobic stamina, to no ill effect. Records still exist of several tests results from that year and Pantani's Hct was mid-50s or higher in every one of them (he did die young -- aged 34 -- but due to a cocaine overdose, nothing to do with EPO).

Bjarne Riis still is the official winner of the 1996 Tour de France but he raced with an EPO-boosted Hct as high as 64.

Before there was a direct test, cycling used an arbitrary Hct limit of 50 as an indicator that a rider was on EPO. But if he was over that number, the only penalty was a one-month suspension "for rider health." So when riders knew their Hct was too high, when the drug guys came to test them, they'd run and hide while they took an IV of normal saline, which would dilute their RBC concentration and lower the Hct. But they'd soon piss off the excess water, which would restore the desired elevated Hct levels. The bottom line is that practically every rider in the Tour de France was riding a bicycle 120 miles a day, five to six hours a day, every day for three weeks (except one or two rest days), with a hematocrit in excess of 50 to no ill effect.

Probably about the mid-1970s, before EPO and before the doping authorities gave any thought to monitoring Hct as a doping control, cyclists began drawing some of their own blood to be refrigerated and re-administered just before a race. They would piss away the excess plasma but retain the red blood cells, which boosted their Hct levels. Long after his record had been broken, Francesco Moser (now aged 66 and still in perfect health) admitted he had used a blood transfusion in 1984 (just three or perhaps as little as two years before EPO arrived) when he broke the world 1-hour cycling record (31.6 miles). It was just the opposite practice of donating blood to lower Hct. This went on until EPO arrived, which proved more effective and less logistically challenging than transfusions.

So for going on 40 years, endurance athletes (and cyclists in particular) have been doing literally anything and everything they could to get an Hct of more than 50, but there has been absolutely no noticeable health backlash.

The story I linked to above mentions the case of two South Korean men who were hospitalized for heart attacks. Both were cigarette smoking diabetics with high blood pressure. And they accidentally were administered almost a 10-times overdose (9.63x) of EPO ...and nothing happened.

Facts like this make it awfully hard to argue with Ferrari's assessment of the "dangers" of EPO.

I suspect the 50 Hct limit was based on a Bell curve of population 'norms' or some other arbitrary benchmark, because I can find no credible medical information that a high hematocrit ever hurt anyone.

Despite that, I still think it's a good practice for everyone to take a baby aspirin every day (except, of course, anyone who already has a problem with bleeding or a condition causing their blood to be too thin). There's too much mounting evidence that it pays long-term medical benefits, even if you're already perfectly healthy.

[kelkel]

Great write up Beetle! The epo myth is reminiscent of Lyle Alzado and steroid dogma.

[Drocc1125]

Well, it's better than every 10 or 14 days. Look at the graph in post 8 which gives you an idea of the hormonal roller coaster that long gaps in injections put you on. Who wants that? 50 mgs twice per week (self injections) or at a minimum probably every 5 days at 100 mgs. Either one will work much better than what you're on now. Just check bloods in 4 weeks and adjust if needed. If your doc won't listen find another one.

Where are you from?

California

[Drocc1125]

I donated blood today and my hematocrit level was 56. Two weeks ago it was 50.5 when I did my labs. Is there a reason why it jumped up like that? I got my injection yesterday if that means anything.

[kelkel]

Could just be due to hydration levels.

[Drocc1125]

I drink maybe ten bottles of water a day consistently. I do however drink 1-2 coffees or highly caffeinated teas a day. Could that have effected it? I drank a tea around an hour before my donation.

[kelkel]

Not really. Also remember the testing method used (capillary) at donation centers is really just a "ballpark" reading or their terminology would be an estimate. It's not exact.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633672/

[Drocc1125]

I understand that. So the labs I took at labcorp are more accurate? I understand it's not exact since it's just a little machine at the donation center but isn't 5.5 points a lot for it to jump?

[kelkel]

Yes, Labcorp would be more accurate. Yes again, 5.5 pts is a big swing which makes me think maybe they should have squeezed a little more out or there's an issue with their machine.