Hematocrit woes

Pharma / TRT
1

Hello… again. I am getting pretty desperate about my hematocrit situation and wanted to restart my old thread from scratch. Below I have provided every value I think you will require to give some advice. I am willing to try damn near anything at this stage. And have pursued all advice given previously from this forum (listed below). I have been on doc prescribed TRT for about a decade. In my mid 40s. I split the dosage 2x weekly and take anastrozole the day after one of the doses. I tried doing 3x weekly shots and it had no effect. I go to one of those clinics that focus only on this stuff.

My values were stable for a very long time but the last year my RBC and associated values continue to climb despite lowering my testosterone dosage. I have changed nothing about my diet and if anything have improved it. I also have high Free T (I know this value is different between labs) compared to my Total T (for reference my value is 160 and this lab says it should fall between 35.0-155.0 (pg/mL). This ongoing situation has held for many months, and I do a full blood donation after every draw (resulting in low ferretin, but VERY high iron and saturation %!)

These blood values climb back up only one month after the blood donation! For reference, Memorial Blood Centers will not even allow donations more frequently than 80 days.

In previous post and attempts to remedy this per this forum’s advice I have added Naringin (grapefruit extract") to my daily routine, IP6 before bed, cut down red meat, only one cup of coffee daily, light alcohol, and have always been a 4x weekly lifter and train BJJ 2x weekly. I am well hydrated. I sleep well. Point being I am at a loss for what I can do here and am worried they will keep lowering my dosage of TRT until it’s pointless and at which point my system will basically go into rapid aging, etc. My doc doesn’t seem to have a lot of solutions here. They just keep going for blood draws.

Recent Labs:

F TESTOSTERONE, TOTAL, MS 592 250-1100 (ng/dL) Z3E
F TESTOSTERONE, FREE 160.5 H 35.0-155.0 (pg/mL) Z3E
F ESTRADIOL 15 < OR = 39 (pg/mL) CB
|F|PROTEIN, TOTAL|6.7|6.1-8.1 (g/dL)|CB|

|F|ALBUMIN|4.2|3.6-5.1 (g/dL)|CB|
|F|GLOBULIN|2.5|1.9-3.7 (g/dL (calc))|CB|
|F|ALBUMIN/GLOBULIN RATIO|1.7|1.0-2.5 ((calc))|CB|
|F|BILIRUBIN, TOTAL|0.8|0.2-1.2 (mg/dL)|CB|
|F|BILIRUBIN, DIRECT|0.1|< OR = 0.2 (mg/dL)|CB|
|F|BILIRUBIN, INDIRECT|0.7|0.2-1.2 (mg/dL (calc))|CB|
|F|ALKALINE PHOSPHATASE|52|36-130 (U/L)|CB|
|F|AST|16|10-40 (U/L)|CB|
|F|ALT|21|9-46 (U/L)|CB|
|F|WHITE BLOOD CELL COUNT|5.0|3.8-10.8 (Thousand/uL)|CB|
|F|RED BLOOD CELL COUNT|5.63|4.20-5.80 (Million/uL)|CB|
|F|HEMOGLOBIN|17.0|13.2-17.1 (g/dL)|CB|
|F|HEMATOCRIT|50.6 H|38.5-50.0 (%)|CB|
|F|MCV|89.9|80.0-100.0 (fL)|CB|
|F|MCH|30.2|27.0-33.0 (pg)|CB|
|F|MCHC|33.6|32.0-36.0 (g/dL)|CB|
|F|RDW|13.0|11.0-15.0 (%)|CB|
|F|PLATELET COUNT|205|140-400 (Thousand/uL)|CB|
|F|MPV|12.2|7.5-12.5 (fL)|CB|
|F|IRON, TOTAL|226 H|50-180 (mcg/dL)|CB|
|F|IRON BINDING CAPACITY|421|250-425 (mcg/dL (calc))|CB|
|F|% SATURATION|54 H|20-48 (% (calc))|CB|
|F|FERRITIN|13 L|38-380 (ng/mL)|CB|

Supplements:

GABA 500mg
Anastrozole 1 MG take 0.25mg of a tablet Orally once weekly
Phosphatidylserine 300mg
DHEA 25 MG 1 Capsule Orally every other 3 day
Vitamin D3 5000 UNIT
Ashwagandha
Bromelain
L-Tyrosine 500 MG 1 capsule Orally once a day
Pantothenic Acid
Alpha Lipoic Acid 200 MG
NAC
Magnesium
Turmeric
Fish Oil
Aspirin 81 MG
Multivitamin
Thyroid Nutrients
Cortisol Manager
L-Optizinc
Alproic Acid
Saw Palmetto
#90 Capsule with no refill(s)
Testosterone Cypionate 200 MG/ML 0.35 mL Intramuscular twice weekly

Diet (this is pretty consistent M-Th. Weekends vary)

FOOD

Nonfat/lowfat greek yogurt
Mixed berries
Walnuts
2 eggs
Spinach
5 cherry tomatoes
Half avocado
Brown Rice
Chicken breast/Fish/ground Bison/grass fed beef
Broccoli
Chicken/Salmon/Steak etc.
Greens
Sweet potatoes
Kombucha
Occasional substitutions but this schedule holds 80% of the time or more

I’m eager to hear any advice other than “did you ask your doc”? Thanks.

2

Cases of erythrocytosis on the new oral testosterone capsules is unlikely to occur, maybe give this a try.

Jatenzo, Orlando and Kyzatrex have an half-life of 6 hours. These orals are dosed twice daily.

Kyzatrex is the best option if paying cash only, averaging $159 per month.

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3

Interesting. I haven’t heard about any of this previously and will look into it. Thank you.

4

My hematocrit is 51% on Jatenzo @237 mg twice daily, the recommended starting dosage, with peak levels 988 ng/dL, 552 ng/dL midpoint and 289 ng/dL trough.

I never felt right on injections, daily, EOD, 1-2 weekly.

A new oral testosterone undecanoate therapy comes of age for the treatment of hypogonadal men

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5

And they are not considering that a problem?

6

It’s only a problem if you’re having a problem. I don’t have any blockages, narrowing of the arteries or heart disease. In other words, I don’t have any comorbidities.

I have had my hematocrit at 57% and had no symptoms, in fact, I felt amazing.

My endocrinologist spoke with a hematologist and didn’t recommend any blood donations when my hematocrit was at 55% as long as I didn’t have any symptoms.

If being over 50% bothers you, go to lab company with a 52% cut off.

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7

I don’t know that it necessarily bothers me, but I see a lab value in red on my report and that does concern me. I have had a couple of problems I thought may be related this last year. One was difficulty swallowing that comes and goes. Sort of a getting chicken and rice stuck in the throat and larger fish oil pills, that sort of thing. And a lot of breathing issues, upper chest constriction, air hunger sort of stuff and gassing out easily when by all metrics I SHOULD be in good cardiovascular shape. As far as finding another lab goes, the lab is the one the clinic uses, and the application of the TRT is their call. If they decide to keep lowering my dose based on these values concerning them what can I really do?

8

I’m surprised @systemlord missed this one.

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9

Yeah it’s low but I don’t think it’s an issue. I always feel tired and sore, probably from the combination of too much physical activity and city driving. So I don’t believe I am any more irritable and fatigued than normal. I could be wrong. To be completely honest fatigue and anxiety have pretty much defined my life the last 2 years. I believe I did a TBD 30 days before those labs.

10

It’s already been discussed in a previous thread.

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11

I keep looking into Total vs Free T and seeing basically the same answers merely describing the relationship but never outright saying if it’s good or bad to have high free T.

So when I look at these results…

F TESTOSTERONE, TOTAL, MS 491 250-1100 (ng/dL)
F TESTOSTERONE, FREE 144.3 35.0-155.0 (pg/mL)
F SEX HORMONE BINDING GLOBULIN 18 10-50 (nmol/L)

My interpretation is I have somewhat low SHBG, which results in a mid Total T level, and higher Free T. But is that a good relationship?

12

You’re not going get a definitive answer. This is where genetics are at play.

Some guys can handle very high Free T (30-50 ng/dL) and then there are guys that can’t.

13

Please explain. I have never read anything explaining HOW high Free T can be a problem and might manifest symptomatically. I keep googling and it’s always so vague.