TRT Side Effects: High Hematocrit and Hemoglobin

So I'thousand scanning the results of my latest blood describe and all the values are lining upwardly in the "normal" column similar adept little claret soldiers. Yep, nailed it. A testament to clean livin'. I'd pat myself on the back if my rotators weren't and then tight.

But wait, what's this? Ii turncoats have deigned to skid into the "high" cavalcade.

Yep, hematocrit and hemoglobin.

I should have known. Those ii are thick every bit thieves, and where one goes, the other ordinarily follows. Hematocrit is simply a measurement that indicates what percentage of your blood is taken up by red blood cells. The hemoglobin test simply measures the amount of hemoglobin in your blood. (Hemoglobin is an fe-based protein that transports oxygen throughout the body.)

If hematocrit goes up, then likewise, almost always, will hemoglobin.

While a lot of things can cause elevated levels of those two blood values, I've got ane behemothic, ruby-light-flashing risk factor working against me: Testosterone replacement therapy or TRT.

As terrific as it is, TRT carries with it a few possible negative side effects, and elevated hematocrit is perhaps the most serious of them.

Why is Elevated Hematocrit Dangerous?

It's simple physics. And uncomplicated plumbing. If you lot accept besides many red claret cells (high hematocrit), your blood gets thicker. Imagine replacing the motor oil in your car with maple syrup. The pickup pipe to the oil pump would tiresome or clog, and engine failure would be imminent.

That'southward almost identical to what thickened blood could do to your center. The risk of center attack or stroke escalate considerably. Engine failure becomes imminent. Piddling Bobby cries, "Why is Daddy's face in the bowl of oatmeal???"

Other possible dangers include an elevated risk of dementia and the general oxidative impairment to the system that can occur when fe levels are high (yous actually rust, in a biological sort of way).

Why Does TRT Cause Elevated Hematocrit?

While no one knows for certain why TRT raises hematocrit levels, there are a couple of decent theories. Ane is that testosterone stimulates red blood jail cell product past kick upwards the product of a kidney hormone named erythropoietin (EPO) and recalibrating EPO's set point in relation to hemoglobin.

Some other theory is that testosterone reduces hepcidin, a liver hormone that'south involved with the absorption of iron (the backbone of hemoglobin). When hepcidin levels go downwards, production of red blood cells goes up, thus thickening the claret.

(Of grade, there are diverse reasons why people can present with high levels of hematocrit even when they're non using TRT. I'll address those reasons later in the commodity.)

What are the Symptoms of High Hematocrit?

Information technology seems contradictory, but symptoms of loftier hematocrit include fatigue, weakness, low energy, dizziness, and headaches. You'd call up that having all those extra oxygen-carrying red blood cells would energize you, but it doesn't piece of work that style. Increased viscosity makes the accessibility of all that extra iron/oxygen problematic.

However, most men on TRT with elevated hematocrit levels likely wouldn't experience any of those symptoms in a higher place. Either their hematocrit levels are simply slightly higher than desired (which is still a risk factor for cardiovascular problems), or the TRT itself is energizing and overrides any feelings of fatigue that might otherwise manifest themselves.

What are Normal Hematocrit Values?

Testosterone-Blood-Tests-Are-Garbage
  • Normal hematocrit for men: 41% to 50%
  • Normal hematocrit for women: 36% to 48%
  • Normal hemoglobin for men: 13.2 to xvi.half dozen grams per deciliter
  • Normal hemoglobin for women: 11.half dozen to 15 grams per deciliter.

There's a little leeway in the men's values, however. A man, using what doctors call "strict criteria," isn't considered to be suffering from erythrocytosis until hematocrit is higher than 52% and hemoglobin is higher than 18.5 g/dl.

For some reason, women aren't granted that same leeway. Using those same strict criteria, a woman is considered to exist suffering erythrocytosis when hematocrit is at least 48% and hemoglobin is 16.5 g/dl or higher.

What Else Causes Elevated Hematocrit?

You don't take to be on TRT to develop erythrocytosis. Earlier I list other potential causes, nosotros need to differentiate between primary and secondary erythrocytosis. The erstwhile is usually a issue of a neoplasm that causes the os marrow to create besides many red (and white) blood cells. It's a doubly serious condition that requires doctoring.

The 2nd type of erythrocytosis is referred to as "secondary erythrocytosis," and it's the type associated with TRT. It'due south caused either by an increment in EPO product or a decrease in hepcidin levels.

Several things tin crusade secondary erythrocytosis. First up are weather condition that crusade oxygen impecuniousness, which in turn simulate the product of EPO:

  • Smoking
  • Severe lung affliction, such as COPD (chronic obstructive pulmonary disease)
  • Nascence defects of the heart
  • Carbon monoxide poisoning
  • High altitude

And and so at that place'south secondary erythrocytosis that isn't caused by oxygen impecuniousness. The causes include:

  • Kidney tumors, cysts, or narrowing of nephrotic arteries.
  • Tumors of the liver, brain, or adrenal gland
  • Genetic disorders
  • And, of course, TRT

Manifestly, well-nigh of the causes of erythrocytosis require medical attention. In that location are, notwithstanding, several ways to reduce erythrocytosis, TRT-induced or otherwise, and non all of them require visiting a doctor.

9 Ways to Lower Elevated Hematocrit

Your elevated hematocrit/hemoglobin might well be direct related to your TRT. If and then, there are means to accost that. However, your TRT might only be partly to blame every bit there are other conditions that can either contribute to high hematocrit/hemoglobin or fifty-fifty requite false readings.

Depending on your situation, here are several ways to address high levels of hematocrit/hemoglobin:

i Apply a lower dose of testosterone

This is the most obvious solution to elevated hematocrit, but information technology's probably too the least popular. Hardly whatever man wants to use less testosterone and give up any of the increased free energy, sexuality, and muscularity that the hormone has gifted him. But truth exist told, a lot of men are probably taking more they need. The standard TRT clinic dosage is 200 mg. a week, which is, bluntly, equivalent to a mild steroid cycle.

2 Switch to subcutaneous injections

A study conducted by the Department of Urology at University of California found that subcutaneous (subQ) injections (under the skin rather than into the muscle) led to higher levels of free T, along with prove of subQ existence physiologically superior to IM shots in several other important ways.

Men who received subQ injections of testosterone exhibited the following:

  • 14% greater total testosterone levels than those receiving IM injections.
  • 41% lower hematocrit than those receiving IM injections.
  • 26.5% lower estradiol than those receiving IM injections.
  • No rise in PSA (the IM method didn't raise PSA either).

The second effect is the kicker. Since subQ injections led to a 41% reduction in hematocrit levels, you could theoretically apply the same dosage you apply for intramuscular injections. Of course, given that subQ injections led to a 14% increase in total T, you might just utilize a lesser dosage anyhow and further reduce hematocrit while retaining all the positive effects of your TRT.

iii Consider another mode of TRT

Studies accept shown that testosterone creams and gels raise hematocrit less than intramuscular testosterone injections.

iv Donate claret

This is the standard get-to treatment for high hematocrit. Every pint donated has been shown to decrease hematocrit by about 3 points. Unfortunately, y'all'd likely have to continue to periodically donate claret if yous hadn't adopted whatsoever other hematocrit-lowering strategies.

That being said, there'due south some testify that hematocrit levels stabilize after altruistic blood 5 times. Whether that's universally truthful is unlikely.

You can donate blood to places similar the Red Cross or have your doctor perform what'due south known every bit a "therapeutic blood draw." Be careful not to donate too often, though. Giving a pint of blood more than every two and a half months or and so may atomic number 82 to long stints of fatigue.

5 Hydrate

High hematocrit readings sometimes occur because the patient was just dehydrated, making it appear that the concentration of blood-red claret cells was higher than information technology really was.

Of form, one simple mode to determine whether your high hematocrit was caused past dehydration is to do a little simple math: hematocrit must ever be 3 times the value of hemoglobin. If it's lower (Hct<iii x Hb), you're over-hydrated. If it'southward higher (Hct>3 x Hb), you lot're dehydrated. Either way, you're getting a false value considering of your hydration status.

vi Avert or reduce red meat consumption

Ruddy meats are loftier in heme iron (the type of iron found only in animal tissues), which is more efficiently absorbed than non-heme atomic number 26 (the type found in whole grains, nuts, seeds, legumes, and leafy greens), and ingesting information technology tin raise hemoglobin and, subsequently, hematocrit.

seven Address sleep apnea

Slumber apnea is a medical condition where patients endure from fragmented sleep. They literally stop breathing from 10 to l seconds multiple times throughout the night.

As a result of this interrupted animate/sleep, patients feel poor oxygen saturation, which forces the trunk to produce more red blood cells and more hemoglobin.

8 Accept curcumin

Evidence suggests that curcumin binds to ferric acid in the digestive system, thus reducing hemoglobin levels. Be sure to use micellar curcumin which is 95 times more bioavailable than regular curcumin with piperine.

Micellar Curcumin Buy Now

9 Utilize Losartan to care for high blood pressure

If yous've got high hematocrit/hemoglobin AND have high blood force per unit area, inquire your doc to consider switching your high blood pressure medicine to Losartan. It's been used by physicians since the early 2000s to bring downwardly hematocrit in kidney transplant patients and patients with chronic obstructive pulmonary illness (COPD).

How Do I Know for Sure if I Have High Hematocrit?

The just style to decide whether you have high hematocrit/hemoglobin is to have your doc order a standard blood chemistry panel. If you're a exercise-it-yourself kind of guy, plenty of online organizations will society the examination for y'all without having to pester your doctor.

For case, yous can buy a Consummate Blood Count/Chemistry/Lipid Panel Blood Examination from Life Extension for $26.95. They'll email you the lab order, and then you can take information technology to your nearest LabCorp or equivalent to have your blood drawn. A few days later, they ship you the results in an email.

Yous may balk at this, but it'due south a smart affair to exercise. There's likewise much irony (and tragedy) in getting your muscularity, libido, and overall joie de vivre upwardly to snuff only to die from molasses-thick blood.

References

  1. Bachman E et al. Testosterone Induces Erythrocytosis via Increased Erythropoietin and Suppressed Hepcidin: Evidence for a New Erythropoietin/Hemoglobin Set Point. J Gerontol A Biol Sci Med Sci. 2014 Jun;69(6):725-35. PubMed.
  2. Choi EJ et al. Comparison of Outcomes for Hypogonadal Men Treated with Intramuscular Testosterone Cypionate versus Subcutaneous Testosterone Enanthate. J Urol. 2022 Mar;207(3):677-683. PubMed.
  3. Hanneke JC et al. Erythrocytosis in the general population: clinical characteristics and association with clonal hematopoiesis. Blood Adv. 2020 Dec 22;4(24):6353-6363. PubMed.
  4. Luoma TC. Luoma'south Large Damn Book of Noesis. Harper Collins, Moose Jaw, Saskatchewan, 12th Edition, 2019.
  5. Wang AYM et al. Effects of losartan or enalapril on hemoglobin, circulating erythropoietin, and insulin-like growth factor-1 in patients with and without posttransplant erythrocytosis. Am J Kidney Dis. 2002 Mar;39(three):600-8. PubMed.