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More injections = Higher hematocrit?

nothuman

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https://www.auajournals.org/doi/full/10.1016/j.juro.2016.02.1856

"Although the rate of erythrocytosis is comparable among BIW and QW dosing, more frequent dosing of injectable T is associated with a higher maximum Hct and a higher incidence of erythrocytosis. These data suggest that dosing frequency, rather than total T dose, is an important factor in development of erythrocytosis in men on injectable TTh."

Here is a three year old study I missed showing maximum hematocrit higher with 2 weekly injections vs 1 weekly injection...So according to this, wouldn't daily dosing be even worse?

I've seen a handful of people claim daily injections keeps hematocrit lower but I have only ever noticed the exact opposite. Perhaps it is because they lowered their total weekly dose alongside the daily injections.

I think it's time we have an important RESPECTFUL discussion on what people who have done the more traditional method (less injections) who have switched to more frequent injections (ED or EOD) and what have they noticed from their hematology panel.
 
The cohorts were separated into 27 men on 200mg of T once weekly (QW) and 28 men on 80-160mg of T twice weekly (BIW)
QW: 200mg per week
BIW: 240mg per week on average (they don't mention the average dose anywhere, so I assume it's the midpoint of their range)

BIW group has higher HCT --> likely due to higher weekly dosage

In addition, it's an observational cohort study, so no causal inference can be made. People were not randomly assigned one of the treatments, and therefore we cannot assume that potential confounding factors are the same across groups. In fact, the researchers didn't even make an effort to include control variables in their statistical analysis. Neither did they compare and factor in actual T levels. The study is useless trash, unfortunately.

Of course we can still have a discussion about whether frequent dosing is better or worse for HCT levels, based on theoretical considerations and accumulated anecdotal evidence. Personally, I'm agnostic. I don't see any reason to think that, holding constant weekly dosage, one is better than the other in this respect.
 
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QW: 200mg per week
BIW: 240mg per week on average (they don't mention the average dose anywhere, so I assume it's the midpoint of their range)

BIW group has higher HCT --> likely due to higher weekly dosage

In addition, it's an observational cohort study, so no causal inference can be made. People were not randomly assigned one of the treatments, and therefore we cannot assume that potential confounding factors are the same across groups. In fact, the researchers didn't even make an effort to include control variables in their statistical analysis. Neither did they compare and factor in actual T levels. The study is useless trash, unfortunately.

Of course we can still have a discussion about whether frequent dosing is better or worse for HCT levels, based on theoretical considerations and accumulated anecdotal evidence. Personally, I'm agnostic. I don't see any reason to think that, holding constant weekly dosage, one is better than the other in this respect.

I’m not as good as you are in respect to reading between the lines when it comes to these things. I wasn’t able to catch the weekly dose difference here. Like you said, however, this should still be worthy of a discussion as I’d like to hear personal experiences. Pretty sure we’ve all started with 2x weekly injections prior to doing daily injections.
 
Here is another study that seems to indicate that daily injections may indeed lower hemoglobin as compared to less frequent, higher dose protocols:

Daily subcutaneous testosterone for management of testosterone deficiency

"Testosterone replacement inhibits hepcidin activity, thereby leading to increased iron absorption and increased erythropoiesis. It is plausible that smaller daily testosterone injections, resembling physiologic secretion, do not affect hepcidin activity to the same degree that is seen with supra-physiologic testosterone level from weekly IM injections"

Not familiar with the publication, so take it for what it is.

Anecdotally, it seems that most guys who have switched to daily injections do succeed in lowering HGB/HCT. Most guys seem to claim that they feel better mentally and physically on daily injections too.

A recent report from a guy on a TRT forum:

"I moved to ED injections from E3.5 in an effort to see if it would help control my HCT and Hb which have been higher than top of the range for about 15 years now. Other than that I was pretty dialed in and feeling good on the E3.5 protocol.

Started the ED protocol on 9/15/2018, just over 6 months ago. I feel just as good as I did on the E3.5 protocol and have seemed to get my HCT and Hb down under the top of the range. For approximately 14 years my HB averaged 18.5 and my HCT has averaged 54.5.

Since going to ED injections my Hb has averaged 17.5 and my HCT 50.5. While I would like to see them even lower, it is a big improvement for me. Also, for 14 1/2 years I donated blood every two months to keep my Hb and HCT at those high levels. Since going to every day I have not donated blood at all.

Another benefit is that over the years of donating blood every two months I had completed deleted my iron and ferritin levels. Now, I have ferritin levels of 153 and iron sitting at 135. Greatly improved.

I don't have a problem sticking myself everyday, especially when I feel real good, all my "key indicators" are in a nice spot. For me, sticking myself daily is just part of my morning routing when I get up, shower and shave.

Most people wouldn't have tried ED when they were already dialed in like I was (except for the HCT and Hb). They probably would have left it alone because it can bee very difficult to get yourself in a place where you feel dialed in. But I figured I didn;t have anything to lose, I could always go back to E3.5 if I wanted to.......but I don't."


Occasionally, I see a report from a guy who switched from say 1x week to daily and kept total weekly dose the same who claims that HGB/HCT went up. I think in these cases SHBG might come into play. Maybe guys with super high SHBG don't burn through the T fast enough, so the daily doses compound/build up and result in overall higher levels?

Anyway, no horse in this race - just interested in the topic as well. I actually just recently started a little n=1 experiment to see how it affects me.
 
Here is another study that seems to indicate that daily injections may indeed lower hemoglobin as compared to less frequent, higher dose protocols:

Daily subcutaneous testosterone for management of testosterone deficiency

"Testosterone replacement inhibits hepcidin activity, thereby leading to increased iron absorption and increased erythropoiesis. It is plausible that smaller daily testosterone injections, resembling physiologic secretion, do not affect hepcidin activity to the same degree that is seen with supra-physiologic testosterone level from weekly IM injections"

Not familiar with the publication, so take it for what it is.

Anecdotally, it seems that most guys who have switched to daily injections do succeed in lowering HGB/HCT. Most guys seem to claim that they feel better mentally and physically on daily injections too.

A recent report from a guy on a TRT forum:

"I moved to ED injections from E3.5 in an effort to see if it would help control my HCT and Hb which have been higher than top of the range for about 15 years now. Other than that I was pretty dialed in and feeling good on the E3.5 protocol.

Started the ED protocol on 9/15/2018, just over 6 months ago. I feel just as good as I did on the E3.5 protocol and have seemed to get my HCT and Hb down under the top of the range. For approximately 14 years my HB averaged 18.5 and my HCT has averaged 54.5.

Since going to ED injections my Hb has averaged 17.5 and my HCT 50.5. While I would like to see them even lower, it is a big improvement for me. Also, for 14 1/2 years I donated blood every two months to keep my Hb and HCT at those high levels. Since going to every day I have not donated blood at all.

Another benefit is that over the years of donating blood every two months I had completed deleted my iron and ferritin levels. Now, I have ferritin levels of 153 and iron sitting at 135. Greatly improved.

I don't have a problem sticking myself everyday, especially when I feel real good, all my "key indicators" are in a nice spot. For me, sticking myself daily is just part of my morning routing when I get up, shower and shave.

Most people wouldn't have tried ED when they were already dialed in like I was (except for the HCT and Hb). They probably would have left it alone because it can bee very difficult to get yourself in a place where you feel dialed in. But I figured I didn;t have anything to lose, I could always go back to E3.5 if I wanted to.......but I don't."


Occasionally, I see a report from a guy who switched from say 1x week to daily and kept total weekly dose the same who claims that HGB/HCT went up. I think in these cases SHBG might come into play. Maybe guys with super high SHBG don't burn through the T fast enough, so the daily doses compound/build up and result in overall higher levels?

Anyway, no horse in this race - just interested in the topic as well. I actually just recently started a little n=1 experiment to see how it affects me.

Awesome man, glad you shared this. I never saw this study before.
 
I'd like to try ed pinning once I get back on trt but I'll probably try it with a different ester as all I've been on is cyp and it may have been an issue? Maybe different quicker esters are right for me, only time will tell once I do go back on trt

Sent from my Pixel 3 XL using Tapatalk
 
It's not about the dosing frequency, it's about the testosterone levels. Considering this, I would say that in this study, more frequent injections mean more supraphysiological testosterone spikes, so it makes sense it would increase RBCs. Unless you are doing around 10mg at a time, you are going to get a supraphysiological free testosterone spike from any injection. I think that is why daily injections work so well.

Note that, nothing, in 30 years of bodybuilding, has worked as well at lowering my hematcrit as daily 10mg injections have. As long as I do cardo, I don't even go over 48, even why cycling precontest.
 
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It's not about the dosing frequency, it's about the testosterone levels. Considering this, I would say that in this study, more frequent injections mean more supraphysiological testosterone spikes, so it makes sense it would increase RBCs. Unless you are doing around 10mg at a time, you are going to get a supraphysiological free testosterone spike from any injection. I think that is why daily injections work so well.

Note that, nothing, in 30 years of bodybuilding, has worked as well at lowering my hematcrit as daily 10mg injections have. As long as I do cardo, I don't even go over 48, even why cycling precontest.

Yea I saw you mention that so I was really hopeful lowering my dose and doing 20mg daily injections would help lower mine, but it definitely didn't. So now I started doing 10mg the other day like you're doing. Hopefully that lowers it a little.

Figured I'd add 2iu gh to protect against muscle loss just in case.
 
Yea I saw you mention that so I was really hopeful lowering my dose and doing 20mg daily injections would help lower mine, but it definitely didn't. So now I started doing 10mg the other day like you're doing. Hopefully that lowers it a little.

Figured I'd add 2iu gh to protect against muscle loss just in case.

Is low does GH effective at keeping muscle mass when on a diet?
 
I'm on doctor prescribed TRT and no changes I've made in dosing protocol ever changed my hemoglobin or hematocrit more than maybe a point at best. Even the occasional 8 week bump in dosage from 140mg/wk to 400mg/wk did little to nothing to raise it. Daily subq or im injections vs eod vs 2 x/wk etc. = little to no change for me. What has made a significant difference is being diagnosed with severe sleep apnea and getting on a BIPAP machine and listening to a cardiologist friend of mine who prescribed me an albuterol inhaler with daily deep breathing like you would between rest pause sets of DC training). It took several months but my hemoglobin eventually came down from 19-21(depending on hydration) down to 16's consistently and my hematocrit used to stay around 55, now is 48. Like anything else this is what made a significant difference for me but you may have a different condition or set of variables that may yield a different outcome.

I'm reading more and more that more doctors believe not to be concerned about high hemoglobin induced by TRT. But I'm sure that it means that the TRT is THE ONLY reason for the increase and not other variables that may harm your health... Hard to say.
 

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