One thing nobody mentions and it’s very important. The rise in blood thickness onTRT caused by increased red blood cells and hemoglobin is OFFSET by testosterone which is also increasing nitric oxide production and hence increasing vein and vessel dilation resulting in a nil differential resistance in blood flow. Thicker blood, wider blood vessels. I’ve had HCT as high as 58 and hemoglobin as high as 19 with a resting heart rate of 53 and blood pressure averaging 100/67.
I missed this. But in regard to overconfidence and oversimplification:
“Anyone who claims to be an expert, is not an expert. An expert should be smart enough to know they are not an expert.”
Not my quote, but I like it.
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That will be impossible, since no one can know how you will respond, until you’ve responded.
By the way, the quote is from Neal Rouzier. I over heard him say it. I left out the first sentence, which was “I’m not an expert.” He almost seemed offended when called an expert. I think, after 25 years of doing this, he’s seen a lot. Then, on top of all that experience which has formed his opinions, he throws an overwhelming volume of research literature at you.
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Donations every 4 month sis not lowering your Ferritin below normal values?
For me it seems to be doing that.
I will schedule an appointment with a Hematologist…lets see what he says.
I asked my Dr. if it was OK to just get off TRT and live my life with Low T and the symptoms/side effects. He said yes, many men do, but something just doesn’t seem right. If it was diabetes I think the answer would be different. However I do feel the side effects of high hemato/hemo.
Seems I mistakened a bit what hematocrit is, but still from your materials(I will read them fully) doesnt it still appear if hemoglobin is Ok and other readings like platelets and trombociti and etc hematocrit’s value doesnt matter much?
I know a guy 2-3 months ago saw his CBP. His hemoglobin was around 165-170(16.5-17 in your values) and hct was 51. He told me he is drinking almost no water. Told him to start drinking 4l per day and after 3 weeks his HCT has fallen to 47 and hemoglobin was still above 160(dont remember exact numbers). So how does it work if they are the same?
As for the debate about whether erythrocytosis is totally harmless despite the fact I totally respect Neil Rouzier and his pioneering in the HRT realm I dont totally agree with his stance erythrocitosis is harmless no matter what. But I also believe he is a bit exaggerating that in his public speaches to prove a point and I think he is weighing every individual of his patients.
On the other hand I totally dont agree to the doctors who freak out when seeing HCT 52-53 and immediately send the patient donating blood.
I have a friend local endocrinologist who is not experienced in TRT despite his long years of practice and he will give you an ampule every 2-3 weeks. But he is very experienced in many other endocrine disorders and for the standards of the general endo who practices board medicine he is very well read and smart. And he is almost never using AI for his TRT patients except in extreme cases and he is not sending them to donate blood on borderline high HCT. In fact when I started TRT he told me not to worry about HCT and that it will settle at some point
I have a friend bosybuilder running supraphysiological doses. Now as we speak he is on 470mg test and 300 tren. He told me initially he had border line high HCT and HGB on TRT doses and now on this super high dosages he has similar CBP values. According to his experience on TRT dosages they rise initially and then settle down
Hemoglobin is SLS HCT is calc this is how the measure it in the best labs here in Bulgaria I dont know further details 
That is interesting. This goes to show how unique responses to TRT can be. At 200mg a week, my hct hovers between 53-55%. Six months after starting, I lost five inches off my waist, lost 10-15 lbs of fat, gained 5-10 lbs of muscle. BP dropped 20 points, to the point I could d/c medication I’d been on for 10 years, and, after d/c anastrozole, I saw lipids improve dramatically, total cholesterol from 205-210 to 165-170 and HDLs from 30 to 40.
I’ve seen similar results with some patients. I’ve also seen guys with 42% hct go on TRT and their hct does not increase at all and I wish it would. I’ve seen others go so high they have symptoms and get regular therapeutic phlebotomy. I’ve seen others go higher than mine and still have zero symptoms, they feel great.
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None taken.
Sounds as though you have taken his courses.
In speaking to him, and taking the classes listening to the lectures, he is pretty sarcastic, which works for me and I actually like it. I do believe he always allows for individual variations and I take the above in more general terms than absolutes. In the practice, I stay away from “never” and “always” as much as possible.
If Hct is 52% hemoglobin 17.6 and platelets 140, is blood donation needed. Also BP is 120/80 and currently using bipap for sleep apnea.
Seems unusual to have platelets at low end of normal range with high hct, hgb and RBC 5.8
I was basically anemic before starting TRT and it has helped it tremendously (HCT stays at 48 now vs 36 before TRT). I was overweight when I started and also had similar symptoms as you. Once I lost 30 lbs I no longer had high blood pressure, fatigue, etc. Testosterone is amazing but if you are overweight it can make you feel worse. You are putting nitrous on an engine that has been treated like shit for a long time. It’s time to rebuild that engine so you can actually make use of that new nitrous system you have without having issues (analogy for visual effect not accuracy). Lose the weight, get in shape, rebuild your body and get it running correctly and you’ll have a whole different experience with TRT.
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I had HCT of 44-45 before starting TRT and HGB of 158-160, 5 months later on TRT HCT went up to 48 and HGB to 165.
We will see how much they will raise…
My BP before TRT was a bit low now seems most of the time 120/80
It is not, and usually not related. Polycythemia vera can result in elevated platelets. So can iron deficiency anemia and leukemia, among many other causes. Aplastic anemia and chemotherapy can reduce platelets, immune conditions, malignancy, infection can be a cause along with others.
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OP,
I recently sat at HCT 16.9, HBG 50.3, and was told by my Doc I could up my dose to 350mg T/week, 175 NPP/wk, and 1.5mg Anastrozole/wk. I almost immediately experienced red face, tightness in chest, elevated heart rate, shortness of breath, headache, severe fatigue, and blurred vision for 10 days. I Thought it was my body “adjusting to a different dose”. Got scared. Stopped everything. 4 days after stopping everything, no improvement whatsoever. Gave blood this morning and INSTANTLY felt better.
I know you said you don’t want to keep giving blood, but it was such a dramatic turnaround for me that I put the Red Cross app on my phone and set it to remind me to donate every 56 days (Red Cross’s Max frequency).
I don’t know if high blood volume, high HCT / HGB are a problem or not. I’ll leave that to the smart people to debate.
But when I’ve been suffering severe side effects for 2 weeks and something INSTANTLY makes me feel better, I take note.
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I would love to continue to give blood every 3 months. Like you I feel better imediately, plus I’m helping people.
But ferritin gets too low. I guess you have no issues with ferritin.
Just curios…primary physician suggested I switch to creams/gels to avoid the HCT issue, or as he put it, reduce the HCT issue?
Have any of you been successful with creams (gels might be too costly for me) and this worked to maintain proper red blood cell levels?
Red blood cells have a lifespan of like 2-3 months or something like that so once you stop doing what’s causing it it’s going to take that long for things to get back to normal (in theory at least).
Cream is great when it’s made correctly and consistently. From what I’ve heard you need to make sure it’s from a reputable source (as in a compound pharmacy that has been doing it for a while). Dr Nichols at Tier 1 has many patients on cream that are thriving so it’s definitely a good option. There’s countless threads with folks on gel that have horrible experiences so I’d stay away from them and make sure you do your homework before deciding on which cream & source of that cream you decide to go with. If you have the deneros I’d check out Dr Nichols (he’s not that expensive).
Hello. I read your reply and would like to ask you a question. Some: History first: I am also on TRT. I have been on TRT for 12 years now. My initial doctor Crisler and for 12 years I had no problems with his regiment. I was on transdermal compound gels and my T level was around 650. I am not looking for supraphysiological levels. Dr. Crisler unfortunately died a year ago so I had to switch to a new Dr. I am happy with him but he switched me to Weekly injections of Test Cypionate. The injections are easier and I feel a lot stronger etc. Anyway after a few dose adjustments (since I went really high on T) I am now in my last blood test at 940 T on the 4th day after injection. This was on 100mg injected weekly. I also do HCG and Arimidex. The problem is that my Hemoglobin is high. I am at 18.3 and I am going for a blood donation tomorrow. I hate the whole blood donating thing. I dropped my does to 60mg per week this week to see if this would make any difference 6 months from now when I have my next blood test. I am hoping I will have a response like yours and my Hemoglobin will stabilize below 17.7. How are you feeling on the 60mg per week? For me this would be the final try before I switch back to compound cream again unless I can go even lower (like 40mg per week) and still get benefits of TRT without side effects. I think frequent blood donations are way too invasive. What is your opinion about all this?