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Abnormal hematologic parameters

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Jan 14, 2022
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I've been on TRT for about two years now with one 5 month cycle of 500mg test and some limited anavar use a couple times and then a short month-long run of Primo 200mg/wk in October that I stopped because I didn't feel good.

I can't make sense of my CBC results.

Before TRT:
  • RBC: 4.97
  • Hb: 15.5
  • Hct: 44.8
5 months on TRT:
  • RBC: 5.75
  • Hb: 16.8
  • Hct: 49.4
On 500mg Test:
  • RBC: 5.46
  • Hb: 17.1
  • Hct: 50.6
So far, this all seems very reasonable to me. But then things get weird.

2 months post cycle (back to TRT):
  • RBC: 5.9
  • Hb: 19.4
  • Hct: 54.2
At this point I reduced my TRT to 100mg/wk and spent the next nine months donating about 8 units of blood. I drove my ferritin into the dirt (16 ng/dL) and wound up with the following bloods, although it took all nine months to get there:
  • RBC: 5.71
  • Hb: 16.4
  • Hct: 49.3
So that's great. I have shit iron stores but at least I can blast again. So I began supplementing iron to raise ferritin and began Primo at a very modest dose (~400mg/wk) in addition to my TRT. I came off the Primo because I was getting wicked headaches and began to get eye twitches (still have those today). Primo ended on 11/10/2021 and since then TRT has been at 120mg/wk dosed every day. I also ran hCG for about two months and dropped it at the start of January after still not feeling well.

And now my most recent bloods from 12/30/2021:
  • RBC: 6.37
  • Hb: 19.4
  • Hct: 58.3
What. The. Fuck.

My PCP ran these labs when I told him I didn't feel well and he told me "everything looks good." Uhhh. OK.

So I donated another unit tonight so I don't die in my sleep, I guess, but I'm playing with fire as it relates to my ferritin which tests at 16 ng/dL in September.

Can anyone help me make sense of this last spike between September and December? I'm not sure how to proceed. Will continuing to supplement ferritin drive my RBC and Hb up even more? Would a month of Primo really cause that dramatic of a spike? Was it because I combined it with ferritin supplementation? Suggestions for next steps?
 
Iron / ferritin supplements add an inverse effect
 
Simply put, donating all that blood fucked you up.
 
Simply put, donating all that blood fucked you up.
Unjustified blood donation is one of the great disservices done to the bodybuilding world over the last decade. We have plenty of anecdotal and bloodwork evidence of the downfalls, like insufficient iron and hematocrit rebounds, but guys just won't stop. It's frustrating.
 
Unjustified blood donation is one of the great disservices done to the bodybuilding world over the last decade. We have plenty of anecdotal and bloodwork evidence of the downfalls, like insufficient iron and hematocrit rebounds, but guys just won't stop. It's frustrating.
OK - so consider me stopped. What's the next step to correcting this shit show?

I'm thinking reduce my TRT to 90mg/wk, stop iron supplementation, and pull bloods again a few times over the course of the next 6 months. In addition the vaping isn't helping matters and I have an overnight sleep study coming up in a couple weeks to check for apnea.
 
TRT increases iron absorption and directly stimulates stem cells in bone marrow to produce more blast cells that eventually become RBCs that use that extra iron you supplemented in the production of mature erythrocytes. Primo, synergistically (greater than additive) with the TRT, rather than directly elevating serum HCT/RBCs, increases erythropoiesis by increasing the responsiveness of erythropoietin-responsive cells.
 
TRT increases iron absorption and directly stimulates stem cells in bone marrow to produce more blast cells that eventually become RBCs that use that extra iron you supplemented in the production of mature erythrocytes. Primo, synergistically (greater than additive) with the TRT, rather than directly elevating serum HCT/RBCs, increases erythropoiesis by increasing the responsiveness of erythropoietin-responsive cells.

So I really did fuck this up pretty good, huh.
 
OK - so consider me stopped. What's the next step to correcting this shit show?

I'm thinking reduce my TRT to 90mg/wk, stop iron supplementation, and pull bloods again a few times over the course of the next 6 months. In addition the vaping isn't helping matters and I have an overnight sleep study coming up in a couple weeks to check for apnea.
I'm not a scientist or medical practitioner but my hematocrit stays good even on full blast so take this for what it's worth.

Leave your TRT dosage where it is. If your iron is still low don't stop supplementing with it. Stay properly hydrated 24 hours a day. If you have sleep apnea, get a CPAP and do not sleep without it. Don't be a bitch and say the mask is awkward, treat it just like the gym and get used to wearing it longer and longer until you can do it all night without issue. Check your bloods when you have all that in order.

I believe chronic dehydration and sleep apnea are 2 of the biggest factors contributing to high hematocrit that often get overlooked.

You didn't list your platelet levels - what are they and what was the reference range? Platelets are the number to look at if you're concerned with clots. High hematocrit is rarely an issue when other blood markers are in range. Think of sherpas, bodybuilders in Colorado, etc.

Finally, you keep saying you 'don't feel well' but aren't elaborating on what that means. Barring an undiagnosed medical issue, my first thought when someone on TRT or supraphysiologic testosterone says that is their estrogen is off.
 
I'm not a scientist or medical practitioner but my hematocrit stays good even on full blast so take this for what it's worth.

Leave your TRT dosage where it is. If your iron is still low don't stop supplementing with it. Stay properly hydrated 24 hours a day. If you have sleep apnea, get a CPAP and do not sleep without it. Don't be a bitch and say the mask is awkward, treat it just like the gym and get used to wearing it longer and longer until you can do it all night without issue. Check your bloods when you have all that in order.

I believe chronic dehydration and sleep apnea are 2 of the biggest factors contributing to high hematocrit that often get overlooked.

You didn't list your platelet levels - what are they and what was the reference range? Platelets are the number to look at if you're concerned with clots. High hematocrit is rarely an issue when other blood markers are in range. Think of sherpas, bodybuilders in Colorado, etc.

Finally, you keep saying you 'don't feel well' but aren't elaborating on what that means. Barring an undiagnosed medical issue, my first thought when someone on TRT or supraphysiologic testosterone says that is their estrogen is off.

Platelets are good to go: 214. And you're absolutely right about hydration. I am rarely "dehydrated" but I suspect the way E2 impacts water retention may lead to low plasma volume, which is essentially dehydrated plasma. I have absolutely no evidence to back that claim up; it's just conjecture. For example, I pissed for nearly two days straight when I came off hCG recently and my blood pressure didn't move. I would think if my plasma volume had reduced by that same amount I would have wound up dehydrated.

My point is I think you can drink a gallon of water a day and E2 and other hormones can prevent a lot of that from sitting as part of plasma volume.

I like the advice. Keep TRT where it is (I feel good right now aside from the twitching which is probably life stress), continue to supplement Iron, and pull bloods again in 4 weeks to reassess. I have more cutting to do anyway. I'll keep this thread updated for posterity.
 
Platelets are good to go: 214. And you're absolutely right about hydration. I am rarely "dehydrated" but I suspect the way E2 impacts water retention may lead to low plasma volume, which is essentially dehydrated plasma. I have absolutely no evidence to back that claim up; it's just conjecture. For example, I pissed for nearly two days straight when I came off hCG recently and my blood pressure didn't move. I would think if my plasma volume had reduced by that same amount I would have wound up dehydrated.

My point is I think you can drink a gallon of water a day and E2 and other hormones can prevent a lot of that from sitting as part of plasma volume.

I like the advice. Keep TRT where it is (I feel good right now aside from the twitching which is probably life stress), continue to supplement Iron, and pull bloods again in 4 weeks to reassess. I have more cutting to do anyway. I'll keep this thread updated for posterity.
I wouldn't continue with the iron, your ferritin levels will normalize after the phlebotomy.
 
To me, this whole thing is a case study on why blasting and then 'going back'to TRT' is no picnic either because:
1) Most "TRT" doses are already way too high as 'replacement' and
2) People don't understand the ramifications of offloading blood unsupervised.

Dude, I have 2ndary polyscythemia, I've been where you are. Those numbers are textbook. Just keep REAL test replacement levels going and wait out the next 6 months taking iron-rich foods and a normal vitamin supplement (eg, not 10,000% RDA). Drink a LOT of fluids.

Thats it. Don't touch anything else. That's it.
 
To me, this whole thing is a case study on why blasting and then 'going back'to TRT' is no picnic either because:
1) Most "TRT" doses are already way too high as 'replacement' and
2) People don't understand the ramifications of offloading blood unsupervised.

Dude, I have 2ndary polyscythemia, I've been where you are. Those numbers are textbook. Just keep REAL test replacement levels going and wait out the next 6 months taking iron-rich foods and a normal vitamin supplement (eg, not 10,000% RDA). Drink a LOT of fluids.

Thats it. Don't touch anything else. That's it.

By replacement levels do you mean like 90mg/wk? I’m at 120mg/wk right now.
 
By replacement levels do you mean like 90mg/wk? I’m at 120mg/wk right now.
Personally, I take 100 mg/wk and end up doing maybe 3 phlebotomies a year tops now. That keeps my hemoglobin between 15 and 16. Ive got a blood clot disorder so keeping it in line is probably a bit more important than for the regular population. I had the same experience as you with running cycles and then cruising. Id cycle and then cruise for an equal amount of time as what the cycle was, thinking my hematocrit/hemoglobin would come back down to normal. Nope. I was cruising on 250 mg/wk test. Not sure what your original trt dose was. Many times my hemoglobin would increase during the cruise even though the dose was a lot lower than before. Not exactly sure why.

With you not feeling well and having the blood irregularities, you might want to reconsider what you are doing. How important is it to you to run gear?
 
With you not feeling well and having the blood irregularities, you might want to reconsider what you are doing. How important is it to you to run gear?
That’s a good question and one I’ve thought about recently. If I can get these parameters back in line I would like to run one or two more low cycles for some extra mass and then stay on TRT. I’ll be 40 years old soon. Im never going to be massive, and that’s OK. All I really want is to have a high degree of cardiovascular fitness and be near peak natural musculature/strength. Im only using gear because I came off of several years of hard, bed-rest recovery from a failed lumbar fusion. I’ve come a long way since then, but I feel the time crunch - I’m not getting any younger so I was hoping gear could accelerate the process a few years. Thus far it’s just been a fight with blood markers.
 
I would say go just TRT for a decent period say 5-6 months.

Get tested for all the clotting disorders and if you are GTG then you don't have to worry about your H&H running a bit high.
 
Do you think the best course of action to unwind this is low-dose TRT and time?
Best thing one can do is to do aerobic Training (Cardio). Sadly most go way to intense and end up in the anaerobic zone. The aerobic zone will lead to more blood volume and by using the oxygen it will lower hematocrit and hemoglobin over time. The anaerobic zone will do the opposite, blood volume is slightly reduced over time and hk and hg will go up.

And donating too much blood will cause a dramatic rebound as soon as you throw in iron supplements and guys usually end up having much higher HK/hg/rbc than before.
 
I've been on TRT for about two years now with one 5 month cycle of 500mg test and some limited anavar use a couple times and then a short month-long run of Primo 200mg/wk in October that I stopped because I didn't feel good.

I can't make sense of my CBC results.

Before TRT:
  • RBC: 4.97
  • Hb: 15.5
  • Hct: 44.8
5 months on TRT:
  • RBC: 5.75
  • Hb: 16.8
  • Hct: 49.4
On 500mg Test:
  • RBC: 5.46
  • Hb: 17.1
  • Hct: 50.6
So far, this all seems very reasonable to me. But then things get weird.

2 months post cycle (back to TRT):
  • RBC: 5.9
  • Hb: 19.4
  • Hct: 54.2
At this point I reduced my TRT to 100mg/wk and spent the next nine months donating about 8 units of blood. I drove my ferritin into the dirt (16 ng/dL) and wound up with the following bloods, although it took all nine months to get there:
  • RBC: 5.71
  • Hb: 16.4
  • Hct: 49.3
So that's great. I have shit iron stores but at least I can blast again. So I began supplementing iron to raise ferritin and began Primo at a very modest dose (~400mg/wk) in addition to my TRT. I came off the Primo because I was getting wicked headaches and began to get eye twitches (still have those today). Primo ended on 11/10/2021 and since then TRT has been at 120mg/wk dosed every day. I also ran hCG for about two months and dropped it at the start of January after still not feeling well.

And now my most recent bloods from 12/30/2021:
  • RBC: 6.37
  • Hb: 19.4
  • Hct: 58.3
What. The. Fuck.

My PCP ran these labs when I told him I didn't feel well and he told me "everything looks good." Uhhh. OK.

So I donated another unit tonight so I don't die in my sleep, I guess, but I'm playing with fire as it relates to my ferritin which tests at 16 ng/dL in September.

Can anyone help me make sense of this last spike between September and December? I'm not sure how to proceed. Will continuing to supplement ferritin drive my RBC and Hb up even more? Would a month of Primo really cause that dramatic of a spike? Was it because I combined it with ferritin supplementation? Suggestions for next steps?
I know this is old but just saw it. This pretty much describes my exact story as well at one point in time. I drop down to TRT, saw a boost in hematology, then donated all the time as a panic move, which only tanked ferritin an didn't decrease hematology.

I have sat between 19-20 hemoglobin the last number of years no matter what I do. I learned to live with it because the alternative is becoming testosterone deficient. Luckily, all my other risk factors for blood clots are optimal so I don't worry about it anymore. Average moronic doctors love to try to put fear of death into my soul whenever they run my CBC but they are uninformed.
 

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