Well, you'd first have to ask yourself is there a need to decrease HCT. If you lived at 4000m with a HCT of 60 you would be considered normal and no one would be discussing treatment. Should there be a different normal for people on exogenous androgens? Again, we are talking about the same condition here, secondary polycythemia. In every other instance of secondary polycythemia increased HCT is seen as normal. I've heard people like Nelson Vergel equate EPO use and stroke to androgens based on HCT numbers and this is just pure horseshit. One is a natural adaptation, one is not.
That being said, there is really nothing you can do but remove the cause. Dante has a great post on his Instagram I would refer you to if you haven't read it. It has a picture of an IP-6 bottle from Swanson. There are two applications that were quite brilliant in their inception. I haven't seen them work personally but I trust Dante and there really is nothing else. Hydrate as you said, low dose aspirin, BP control, the obvious countermeasures. But it's the same as at altitude, the only way to really change it is move to sea level or quit androgens.
The Canadians have guidelines that call for cessation of T at HCT of 54. Doctors, instead of losing patients, have started therapeutic phlebotomy instead despite zero evidence that it does anything positive. "Our findings raise concerns about the persistent risk of vascular events in these donors, particularly when coupled with the misperception by patients and health care providers that donation has reduced or eliminated the risks of TRT-induced polycythemia."
Transfusion. 2017 Mar;57(3):578-581. doi: 10.1111/trf.13970. Epub 2017 Feb 1.
Blood donation and testosterone replacement therapy
Again, if there is risk, phlebotomy won't help. If increased HCT bothers you, quit androgens or get over it.
Personally I take IP-6 at 2 gms qd, low dose ASA, ARB & PDE5 inhibitor.
Rex.
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