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Testosterone replacement therapy can be a great way to improve your health and vitality, but certain risks areassociated with it. One of the most important things you need to monitor when taking testosterone is your hematocrit levels. High hematocrit is one potential side effect of testosterone treatment that should not be ignored or overlooked, as it can lead to serious health complications if left untreated. In this blog post, we'll go over what high hematocrit is, how testosterone replacement therapy raises hematocrit levels, and how to reduce high hematocrit due to testosterone treatment so that you can benefit from all the advantages of hormone optimization safely and effectively. Table of Contents: What is Hematocrit? Definition of Hematocrit: How Does Testosterone Replacement Therapy Increase Hematocrit? a. Effects of Testosterone on Red Blood Cells: How to Lower High Hematocrit Caused by Testosterone Treatment? Monitoring and Managing High Hematocrit Levels with Testosterone Replacement Therapy Regular Blood Tests to Monitor Hematocrit Levels: Conclusion FAQs in Relation to High Hematocrit Should I worry if my hematocrit is high? What can cause high hematocrit? What are symptoms of high hematocrit? How do you treat high hematocrit levels? Conclusion What is Hematocrit? Hematocrit measures the percentage of red blood cells in your body. It’s an important indicator of overall health and can help diagnose various conditions, such as anemia or dehydration. Definition of Hematocrit: Hematocrit is a measure that reflects the ratio between the volume of red blood cells (RBC) and the total volume of whole blood in your body. The hematocrit value is expressed as a percentage, with normal values ranging from 40 to 54 percent for men and 36 to 48 percent for women. How is Hematocrit Measured? A hematocrit test measures how much space red blood cells take up in your bloodstream by spinning down a blood sample in a centrifuge machine. This separates different components within the sample, including RBCs, white blood cells (WBCs), platelets, and plasma. The amount of packed RBCs compared to other components gives you your hematocrit value. Normal ranges vary slightly depending on age and gender but generally range from 40–54% for men and 36-48% for women. Low levels could be a sign of anemia or bleeding disorders, whereas high levels might be the result of dehydration or specific cancer treatments like chemotherapy or radiation therapy. Hematocrit is an important measure of health and can be increased through testosterone replacement therapy. However, it is important to understand the potential risks associated with high hematocrit levels before beginning treatment. How Does Testosterone Replacement Therapy Increase Hematocrit? TRT has been found to have numerous health benefits, including improved energy levels, increased muscle mass and strength, and improved sexual function. One of the most important effects of TRT is an increase in hematocrit, which is the percentage of red blood cells in your bloodstream. a. Effects of Testosterone on Red Blood Cells: Testosterone helps stimulate the production of red blood cells by increasing the number of stem cells that produce them. It also increases their lifespan so they can circulate longer throughout your body before being broken down and replaced by new ones. This leads to an overall increase in hematocrit levels as more red blood cells are present in your bloodstream at any time. An increased hematocrit level can provide many benefits, such as better oxygen delivery throughout the body, improved stamina during physical activity, and reduced risk for certain diseases like heart disease or stroke due to higher amounts of oxygen-carrying red blood cells circulating through your system at all times. Additionally, some studies suggest that higher hematocrit may even improve cognitive performance since it provides more oxygen to the brain for mental processes like memory formation or problem-solving skills Testosterone replacement therapy can increase hematocrit levels, but it is important to know the potential risks associated with high hematocrit. We'll talk about lowering a high hematocrit that results from testosterone therapy in the following section. In a study done by Dr. Ramasamy and his team at the University of Miami Medical School, a total of 5,842 men who received TRT and developed polycythemia were matched and compared to 5,842 men who did not develop polycythemia. Heart problems or venous thromboembolism - VTE were more likely to happen to men with polycythemia (301 cases, or 5.15% of all cases) while they were on TRT than to men with a normal hematocrit (226 cases, or 3.87%) (OR 1.35, 95% CI 1.13–1.61, p <0.001). The same team later found out that greater changes in hematocrit predicted greater cardiovascular risks in men on testosterone therapy.   Key Takeaway: Testosterone replacement therapy (TRT) increases hematocrit levels, providing numerous benefits such as improved oxygen delivery throughout the body, increased stamina during physical activity, and better cognitive performance. How to Lower High Hematocrit Caused by Testosterone Treatment? High hematocrit levels caused by testosterone treatment can be a serious health concern. It is important to understand the causes and treatments available for this condition. Some physicians and TRT guidelines believe that stopping TRT is the best way to lower hematocrit.  But stopping TRT can have negative consequences for the quality of life, as men who do so tend to stay hypogonadal for months, and most do not return to “normal levels.”  Fortunately, there are several ways to decrease high hematocrit and potentially prevent it. How Can High Hematocrit Be Reduced Due to Testosterone Therapy? A severe health hazard might result from high hematocrit levels brought on by testosterone therapy. Understanding the underlying causes and available therapies for this illness is crucial. TRT guidelines and several doctors concur that the best strategy to reduce hematocrit is to cease TRT. However, discontinuing TRT can harm a man's quality of life because most men who discontinue TRT do not revert to "normal levels" and instead tend to stay hypogonadal for months. Fortunately, there are a number of strategies to lower high hematocrit and avoid it. Donate blood. Men on testosterone therapy can lower their hemoglobin levels with this tried-and-true method. And while you're doing it, you're helping someone else! Every donated unit of blood can reduce hematocrit by three points. Be careful not to donate more frequently than every 2.5 months, as the Red Cross advises, to prevent losing too much iron and ferritin, which can cause fatigue in men taking testosterone therapy. This iron blood test allows you to determine your iron and ferritin levels. It is advised that you donate when your hematocrit is between 51 and 52 percent. If you want to donate blood, you should avoid having a hematocrit above 53% because some organizations (like the Red Cross) would reject blood at that level. Men whose high hematocrit disqualifies them from blood donations may still donate blood if their doctors request therapeutic phlebotomy at the nearby blood center. Reduce the TRT dose. Your doctor could tell you to lower your dose if you have high hemoglobin or hematocrit levels as a result of testosterone therapy. This is not always a negative thing because some men take more testosterone than they need, which can have both long-term and short-term side effects. Make sure you drink water. It's critical to keep in mind that hematocrit is highly dependent on the amount of water you drink. This might have made things worse if you were already dehydrated when you had your blood drawn. Talk to your doctor about a repeat test if you believe you were dehydrated. Address thyroid problems. Your RBC counts can decrease with hypothyroidism (low thyroid function) and increase with hyperthyroidism (high thyroid function). Doing this could be a good idea if you have yet to examine your thyroid function. And if you can afford it, have a complete thyroid panel, including thyroid antibodies. [10] Think about testosterone applied topically to the skin. According to a research summary, intramuscular testosterone injections are the only form of testosterone that significantly raises hematocrit above normal levels. Topical testosterone creams or gels often do not have this effect. However, it does so strongly, changing up to 6% from the starting point. The testosterone gel comes in second place, with a 2.5% average increase over baseline levels. [7]. Therefore, switching to topicals may help if you are receiving intramuscular injections and experiencing high hematocrit or hemoglobin. Discuss this with your doctor. COMPOUND TESTOSTERONE CREAM AND GEL IS A CHEAP ALTERNATIVE Change from intramuscular to lower dose testosterone subcutaneous injections. 236 men participated in a study that the University of California conducted. All men's baseline values in each of the four measurement locations were noted, as well as those between 6 and 12 weeks after therapy. According to the findings, males who received subcutaneous testosterone injections (SubQ) exhibited an increase in total testosterone levels that was 14% greater than that of patients who had intramuscular testosterone injections (IM). Additionally, post-therapy, hematocrit was 41% lower in SubQ patients than in IM patients, and estradiol levels were 26.5% lower. No PSA readings were abnormally high in any group of men.  Steer clear of or consume less red meat. It's fascinating because one of the arguments used by meat eaters against vegetarians is that plant meals include a lot of "anti-nutrients" that might inhibit the absorption of or bind to minerals like iron. For instance, groups like Weston Price criticize vegetarians for consuming phytic acid. Plant foods contain phytic acid, which binds to calcium, magnesium, phosphorus, and iron. Mineral deficits may result from overuse. Dr. Bernard notes that because certain minerals, like zinc and iron, are neurotoxic at even very modest levels of tissue accumulation, they are often likely to be highly health protective for most people. Additionally, studies have demonstrated a connection between colon cancer, too much iron, and heart problems. If no other preventive measures are taken, avoiding red meats, which are heavy in iron, stands a decent chance of decreasing your hemoglobin levels and preserving your long-term health (such as by giving blood). The validity of this claim requires dietary research. Females had significantly lower hemoglobin levels, according to a study that compared vegetarians and non-vegetarians. Although it could not have been statistically significant, males had lower amounts. It was found in a more solid study that vegetarians had much lower levels of white blood cells, neutrophils, serum ferritin, and serum vitamin B12 compared to control patients. Vegetarians also had much lower levels of hematocrit and mean corpuscular hemoglobin. By the way, ferritin is a crucial indicator since it shows that tissue iron levels are lower, which suggests that there will likely be less long-term harm. It should be emphasized that this study did reveal that some vegans were iron deficient. Correct sleep apnea. Depleted oxygen saturation levels brought on by sleep apnea may encourage the body to create more red blood cells and hemoglobin in an effort to make up for the low oxygen levels in the blood during sleep. Indeed, there is research that backs this up as well.  Consider having a sleep apnea test done if your hematocrit, hemoglobin, or RBC levels are high. "One possible explanation is that repeated episodes of nocturnal hypoxia (low oxygen status) lead to a hypercoagulable state that predisposes individuals to thrombotic (blood clotting) events," a recent study stated. Research backs up a number of changes in the blood that affect hemostasis. These include higher hematocrit, blood viscosity, platelet activation, clotting factors, and lower fibrinolytic activity. Minimize inflammationInflammation can further reduce hepcidin, the hormone that controls iron absorption. It could be helpful to check for infections, CRP levels, etc., before treating the underlying reason. [13] Think about Curcumin (Turmeric).More research is being done on turmeric, or curcumin, as an anti-inflammatory and anti-cancer substance. It produces iron shortage in mice by binding to ferric iron in the stomach. According to a case study, a person consuming turmeric may have had iron deficiency anemia. Stop smoking. Smoking lowers the blood's oxygen saturation, which causes the body to create more red blood cells and hemoglobin to make up for it. [14] Talk to your doctor about Losartan, which is used to treat high blood pressure. You should think about taking Losartan if you have high blood pressure. [15] In patients with COPD and erythrocytosis, losartan can be administered safely and efficiently to normalize hematocrit, which may eliminate the requirement for therapeutic phlebotomy. Eat grapefruit. Grapefruit extract (narigin) may lower the hematocrit [16]. Although there was no discernible difference between eating half or a whole grapefruit each day, the effect of grapefruit consumption on hematocrit was statistically significant at the p 0.01 level. However, bring up with your doctor the possibility that grapefruit may elevate drug levels in the blood. Monitoring and Managing High Hematocrit Levels with Testosterone Replacement Therapy It is essential to monitor hematocrit levels while on testosterone replacement therapy (TRT). TRT can have an impact on hematocrit, which measures the quantity of red blood cells in the body. Regular blood tests should ensure that hematocrit levels remain within normal range. If high hematocrit levels are detected, some steps canbe taken to manage them. Regular Blood Tests to Monitor Hematocrit Level: It is recommended that men on TRT have their hematocrit tested every 3–6 months or more frequently if needed. This will help identify any potential issues with high hematocrit early on so they can be addressed quickly and effectively. High hematocrit may indicate an underlying medical condition such as polycythemia vera, which requires further evaluation and treatment from a healthcare provider. Adjusting Dosage or Frequency of Testosterone Injections as Needed: If high hematocrit levels are found during regular testing, adjusting the dosage or frequency of testosterone injections may help lower them back into the normal range. For example, reducing the dose or spacing out injections over longer periods of time could reduce the risk for complications associated with elevated hemoglobin and/or red cell counts due to TRT use. Additionally, lifestyle changes such as increasing physical activity level and making dietary modifications may also help lower high hematocritevels caused by TRT use. By closely monitoring hematocrit levels and adjusting testosterone dosage or frequency as needed, men can successfully manage high hematocrit levels while undergoing testosterone replacement therapy. Next, we'll discuss the key points to remember when managing this condition.   Key Takeaway: Regular blood tests should be done to monitor hematocrit levels while on TRT. If high hematocrit is detected, adjusting the dosage or frequency of testosterone injections and making lifestyle changes may help lower them back into normal range.   FAQs in Relation to High Hematocrit Should I worry if my hematocrit is high? Yes, you should be concerned if your hematocrit is high. Hematocrit is a measure of the number of red blood cells in your body and can indicate an underlying health issue. High levels may mean that there are too many red blood cells in circulation, which can lead to thickening of the blood and other serious complications such as stroke or heart attack. It's important to speak with your doctor about any concerns regarding your hematocrit level so they can determine the best course of action for managing it. What can cause high hematocrit? Dehydration, testosterone therapy, smoking, polycythemia vera (an overproduction of red blood cells), and specific medications are just a few of the things that can cause high hematocrit levels. Dehydration occurs when the body does not have enough fluids to function properly. Smoking increases the production of red blood cells in the bone marrow. Polycythemia vera is an uncommon disorder that causes too many red blood cells to be produced in the bone marrow. Certain medications, such as erythropoietin or testosterone, may also cause high hematocrit levels due to the increased production of red blood cells in response to these drugs. What are the symptoms of high hematocrit? High hematocrit is a condition where the percentage of red blood cells in the bloodstream is higher than normal. Symptoms can include fatigue, shortness of breath, dizziness, headaches, and pale skin. In more severe cases, it can lead to chest pain or heart palpitations due to an increased risk of clotting. It is important to seek medical attention if any symptoms are present, as high hematocrit levels can be indicative of underlying health conditions such as anemia or dehydration. How do you treat high hematocrit levels? High hematocrit levels can be treated by making lifestyle changes, such as reducing alcohol consumption and increasing physical activity. Additionally, medications may be prescribed to reduce the production of red blood cells or increase their breakdown. Other treatments include phlebotomy (the removal of excess red blood cells) and iron chelation therapy (the removal of excess iron). It is important to speak with a doctor about the best treatment plan for high hematocrit levels, as it will depend on the individual's medical history and current health status. Conclusion In conclusion, high hematocrit is a common side effect of testosterone replacement therapy and should be monitored closely. It's crucial to comprehend what hematocrit is, how testosterone replacement therapy raises it, and how to lower a high hematocrit that results from testosterone treatment. With proper monitoring and management of your levels with the help of your doctor or healthcare provider, you can reduce the risk of any health complications associated with elevated levels of hematocrit due to testosterone replacement therapy. Are you suffering from high hematocrit? ExcelMale is here to help. Our online men's health forum provides a wealth of knowledge and resources on testosterone replacement therapy, general health, and sexual dysfunction. Join our community today to get the support you need for managing your condition and improving your overall wellbeing. Register for this TRT forum .   REFERENCES   Secondary Polycythemia in Men Receiving Testosterone Therapy Increases Risk of Major Adverse Cardiovascular Events and Venous Thromboembolism in the First Year of Therapy GREATER CHANGES IN HEMATOCRIT PREDICT MORE FREQUENT MAJOR ADVERSE CARDIAC EVENTS IN MEN INITIATED ON TESTOSTERONE THERAPY - A LARGE CLAIMS DATABASE ANALYSIS The Journal of Clinical Endocrinology & Metabolism, Volume 95, Issue 10, 1 October 2010, Pages 4743–4747 TRANSFUSION 2008; 48: 2197-2204

High hematocrit levels, which measure the percentage of red blood cells in the blood, can be signs of several underlying health conditions and they are also a common side effect of testosterone replacement therapy (TRT). High hematocrit levels can increase the risk of developing blood clots, strokes, and other serious complications, especially for those with an underlying condition. Low red blood cell levels, also known as low hematocrit levels, can indicate conditions such as anemia, while high red blood cell levels often signal dehydration and could indicate other conditions, such as polycythemia, increasing a person’s chance of developing blood clots or experiencing blood loss. We will review the different ways to lower the hematocrit and the number of red blood cells on TRT. How to Lower the High Hematocrit Caused by Testosterone Replacement Therapy (TRT) Testosterone replacement therapy (TRT) is one of the most effective ways to combat low testosterone levels, but it's vital that you understand the risks associated with the treatment. As with any form of hormone replacement therapy, there are a few downsides to receiving regular injections of testosterone. One of the main TRT side effects is increased hematocrit, also known as erythrocytosis, which can be a sign of androgen deficiency. This article will explain why this happens, the potential long-term health consequences, and how to prevent or manage this issue. Since abnormally high hematocrit values can pose serious health problems, this article will analyze the correlation between testosterone therapy and high hematocrit. TRT, sleep apnea, smoking, and red blood cell production are contributing factors that can cause high hematocrit that can increase cardiovascular risks if not properly managed. This article explains the basics of how to manage high hematocrit while using testosterone therapy. What is hematocrit? There are several standard ways to measure red blood cells: hematocrit, hemoglobin, and RBC (red blood cell count). All of these are related, and doctors will usually look at two or more. Hematocrit, also referred to as the proportion of red blood cells, is a measurement of how much of a person's blood is made up of red blood cells, also known as whole blood. Hemoglobin, on the other hand, is a density or concentration measurement and is expressed in grams per liter or deciliter. (Hemoglobin is, if you will recall from your high school biology, the iron-based protein that transports oxygen.) RBC is a simple count and is usually expressed as the number of million red blood cells that you have per microliter. Usually, hematocrit is three times the amount of hemoglobin and can be measured through a simple blood sample test. What are the normal ranges for hematocrit?  Normal levels of hematocrit for men range from 41% to 50%. normal level for women is 36% to 48%. Why does TRT increase hematocrit? Erythrocytosis is a medical condition that appears when the body makes too many red blood cells. RBCs are responsible for transporting oxygen to organs and tissues. When there are too many, the blood can become too thick and cause cardiovascular complications. There are two types of erythrocytosis: primary and secondary. Problems with the bone marrow, such as bone marrow disease, are typically the cause of primary erythrocytosis. RBCs are made in the bone marrow, and something might trigger an increase in their production. Certain diseases or medications, such as testosterone replacement therapy, can cause secondary erythrocytosis. Some studies concluded that testosterone reduces hepcidin (a hepatic hormone), which is related to iron absorption pathways. When hepcidin is reduced, erythrocytosis is increased [1] An increase in hemoglobin (Hb) and hematocrit (Hct) is indicative of this medical condition. When the Hb is higher than 18.5 g/dL and the Hct is higher than 52% in men, the patient suffers from erythrocytosis.   What are the risks of high hematocrit? One of the primary risks of testosterone that you need to be aware of is called polycythemia or erythrocytosis. This is a condition where your body produces too many red blood cells, also known as high hematocrit levels or secondary polycythemia. Hematocrit refers to the percent of red blood cell content in your blood, also known as Hct levels. If your hemocrit levels rise, your blood will become too thick or viscous. This can, in turn, make it more likely that you will develop strokes, heart attacks, and clotting events. Polycythemia is serious and potentially life-threatening if untreated. Since the RBC count is too high in people with erythrocytosis, the blood viscosity also increases, which can lead to various potentially life-threatening medical issues such as venous thromboembolism. This essentially means that tiny blood clots separate from their original source and travel through veins and capillaries, causing blockages that result in stroke, myocardial infarction, or other complications related to reduced blood flow and blood volume. Individuals with high hematocrit levels may also be at risk for conditions such as polycythemia vera, a bone marrow disease that causes an abnormal increase in red blood cells and can lead to symptoms of polycythemia vera such as headache, dizziness, and fatigue. Other potential risks include congenital heart disease, exposure to high altitudes, and reactions to blood transfusions. It can be quite stressful for a man who has finally gotten on TRT, feels better, and then finds out that his hemoglobin is high. Of course, he can always lower his testosterone dosage to try to solve the problem, but this may not be a solution that either doctor or patient wants to pursue. Many men have found that their erectile dysfunction is greatly helped and/or morning erections and libido have returned. The last thing they want to do is lower their dose. So why even worry about a high hemoglobin or RBC count? What’s a few extra red blood cells anyway? Unfortunately, high hemoglobin (or RBCs) is a risk factor for ischemic stroke, i.e., the standard kind of stroke where there is a loss of blood supply to tissues such that permanent damage is usually incurred. [2] Of course, a stroke can be a life-changing (or life-ending) event and should be avoided at all costs. There is also a longer-term risk: elevated hemoglobin could lead to unhealthy iron store levels, which are associated with heart disease and dementia. Iron in tissues can lead to oxidative damage. Just look at what some recent studies have concluded: “Low and high hemoglobin concentrations in older persons are associated with a lower level of cognitive function in old age, particularly in semantic memory and perceptual speed.” [3] “In older persons without dementia, both lower and higher hemoglobin levels are associated with an increased hazard for developing AD [Alzheimer’s Disease] and more rapid cognitive decline.” [4] Can hematocrit stabilize in men on TRT? Hematocrit may stabilize after long-term testosterone replacement. Although there is only one study done in mice, it may explain why hematocrit may eventually decrease and stabilize in men on TRT. There seems to be an adaptive mechanism that makes red blood cell indices change while hematocrit stabilizes. In some men, red blood cell indices (MCV and MCHC) start changing after starting TRT as a way for the body to compensate for the extra production of red blood cells. There are three red blood cell indices: mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC). They are measured by a machine, and their values come from other measurements on a CBC panel. The MCV shows the size of the red blood cells. The MCH value is the amount of hemoglobin in an average red blood cell. The MCHC measures the concentration of hemoglobin in an average red blood cell. [5] Another study that followed frequent blood donors found a reduction in ferritin in them, created as a way for the body to increase iron absorption in the presence of lower hematocrit. Ferritin and hematocrit stabilized after five donations.[6] How to Lower High Hematocrit on TRT Some physicians and TRT guidelines believe that the best way to lower hematocrit is to stop TRT. But stopping TRT can have negative consequences in the quality of life, as men who do so tend to stay hypogonadal for months, and most do not return to “normal levels.”. Fortunately, there are several ways to decrease high hematocrit and also potentially prevent it from happening. Give Blood. This is a time-proven technique for men on testosterone therapy to lower their hemoglobin levels. And you are helping out someone else while you’re doing it! Every unit of blood donated can decrease hematocrit by 3 points, which is equivalent to one pint of blood. However, be careful not to donate more frequently than every 2.5 months, as the Red Cross advises, to prevent losing too much iron and ferritin, which can cause fatigue in men using testosterone therapy. You can check your iron and ferritin levels with this iron blood test. It's recommended that you donate when you are in the 51–52 hematocrit range. However, some organizations (like the Red Cross) will reject blood with a hematocrit higher than 53%, so it is good to avoid that high hematocrit level if you want to donate blood. Men who are rejected from blood donations because of high hematocrit can still give blood if their physicians call in an order for a therapeutic phlebotomy at the local blood center.   Lower Your TRT Dose. If you have high hemoglobin or hematocrit from testosterone therapy, then your doctor may require you to lower your dose. This is not always a bad thing, as some men are actually taking more testosterone than they actually need, which can lead to side effects in both the long and short term.   Drink Water. It is important to remember that hemoglobin is very dependent on your hydration levels. If you were dehydrated when you had your blood drawn, this could have made things worse. If you think you were dehydrated, discuss a retest with your doctor.   Treat Thyroid Issues. Hypothyroidism (low thyroid function) can lower your RBC counts, and hyperthyroidism (high thyroid function) can raise them, too. If you haven’t checked your thyroid function lately, this might be wise. And don’t forget to get a full thyroid panel, including thyroid antibodies, if you can afford it. [10]   Consider transdermal (topical) or oral testosterone. One research summary stated that topical testosterone creams or gels increase hematocrit, in general, less than intramuscular testosterone injections: “Intramuscular testosterone is the only form that significantly increases hematocrit above normal levels. However, it does so strongly, with up to a 6% change from baseline. The runner-up is testosterone gel, with an average increase of 2.5% over baseline levels.” [7]. Therefore, if you are on intramuscular injections and struggling with high hematocrit or hemoglobin, going on topicals may help a little. Discuss with your physician. NOTE: A cheap alternative is Compounded Testosterone Creams and Gels. Another emerging option is oral testosterone products.   Switch from intramuscular injections to lower-dose subcutaneous Subcutaneous Testosterone Injections. Two hundred thirty-two men took part in a University of California study. Baseline levels were recorded for all men in each of the four measurement areas and then again at 6–12 weeks post-treatment. The results showed that men who underwent subcutaneous testosterone (SubQ) injections had a 14% greater increase in total testosterone levels compared to the testosterone levels of intramuscular testosterone injection (IM) patients. SubQ patients also had a 41% lower hematocrit post-therapy than IM patients and 26.5% lower estradiol levels. For both groups of men, there were no elevated levels of PSA. [7]   Avoid or Reduce the Consumption of Red Meats. It is interesting because one of the criticisms that meat eaters level against vegetarians is that plant foods have many “anti-nutrients” that can slow down or bind with minerals such as iron. For example, organizations like Weston Price love to castigate vegetarians for their phytic acid consumption. Phytic acid is present in plant foods and binds to iron, magnesium, phosphorous, and calcium. It can, if overconsumed, lead to mineral deficiencies. However, Dr. Bernard points out that usually, it is likely very health-protective for most people because these minerals, as in the case of zinc and iron, are neurotoxic at even relatively low levels of tissue accumulation. Research has also shown that too much iron also contributes to heart disease, and there may be a link to colon cancer as well. [8]So, avoiding red meats, which are high in iron, stands a good chance of lowering your hemoglobin scores and protecting your long-term health unless some other preventative action is taken (such as giving blood). Actual dietary studies are required to support this statement. As a verification, one study of vegetarians and non-vegetarians found that females had significantly lower hemoglobin levels. Males had lower levels, but it may not have been statistically significant. [8] However, another study was more definitive and concluded: “It was found that hemoglobin, hematocrit, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, white blood cells, neutrophils, serum ferritin, and serum vitamin B12 in vegetarians were significantly lower than control subjects.” [11] Ferritin is a key measure, by the way, because it indicates that tissue levels of iron are lower and thus will likely cause less permanent damage. (This study did show that some vegetarians were iron deficient, as should be noted.)   Fix Sleep Apnea. Sleep apnea can cause depleted oxygen saturation values that can enhance the body's ability to produce more red blood cells and hemoglobin as a way to compensate for the low blood levels of oxygen during the sleep cycle. And, sure enough, there are studies that confirm this as well. [12] So, if your hematocrit, hemoglobin, or RBCs are running high, think about getting tested for sleep apnea. A recent study commented that “one possible explanation is that repeated episodes of nocturnal hypoxia (low oxygen condition) lead to a hypercoagulable state that predisposes patients to thrombotic (blood clotting) events. There is evidence supporting a wide array of hematological changes that affect hemostasis (e.g., increased hematocrit, blood viscosity, platelet activation, clotting factors, and decreased fibrinolytic activity).”   Reduce Inflammation. Hepcidin, the iron absorption-modulating hormone, can be decreased even further by inflammation. Checking for infections, CRP levels, etc., and then treating the underlying cause may help. [13]   Consider Curcumin (Turmeric). Turmeric or curcumin, is increasingly studied as an anti-inflammatory and anti-cancer agent. It binds to ferric iron in the gut and causes iron deficiency in mice. A case history reported a possible case of iron deficiency anemia in a human taking turmeric. [14]    Stop Smoking. Smoking reduces the amount of oxygen in the blood and makes the body produce more red blood cells and hemoglobin to compensate for that lower oxygen saturation.[14]    Treat High Blood Pressure with Losartan. If you have high blood pressure, consider taking Losartan.[15] Losartan can be safely and effectively used to normalize hematocrit in patients with COPD and erythrocytosis, an effect that could obviate the need for therapeutic phlebotomy.    Consider Grapefruit. Grapefruit extract (narigin) may decrease hematocrit [16]. There was no significant difference between ingesting 1/2 or 1 grapefruit per day, but a decrease in hematocrit due to ingestion of grapefruit was statistically significant at the p less than 0.01 level. However, discuss with your physician the fact that grapefruit can increase the blood levels of medications. The most important message of this article is that monitoring hematocrit every few months is a smart way to minimize cardiovascular risks associated with high hematocrit. You can buy your hematocrit and related tests on DiscountedLabs.com at affordable prices. Hematocrit is included in the CBC and other panels on Discounted Labs: Get Your Hematocrit Test Now Testosterone, Hematocrit, Ultrasensitive Estradiol and Prolactin Panel Hematocrit + Total and Free Testosterone References The Journal of Clinical Endocrinology & Metabolism, Volume 95, Issue 10, 1 October 2010, Pages 4743–4747 Eur Neurol, 1996, 36(2):85-8. Neuroepidemiology, 2008 December, 32(1): 40 46, “ Relation of Hemoglobin to Level of Cognitive Function in Older Persons” Neurology, 2011 Jul 19, 77(3):219-26, “Hemoglobin level in older persons and incident Alzheimer disease: prospective cohort analysis. Endocrinology. 2015 May; 156(5): 1623–1629. TRANSFUSION 2008; 48: 2197-2204. Comparison of Outcomes for Hypogonadal Men Treated with Intramuscular Testosterone Cypionate versus Subcutaneous Testosterone Enanthate SIU Academy. Choi E. 10/10/20; 309864; BSP-06.01  International Journal of Natural and Applied Sciences Vol. 2 (3) 2006: pp. 174–177, “Comparative study of the hemoglobin concentration of vegetarian and non-vegetarian subjects in Ogun state, Nigeria” World J Gastroenterol, 2006 September 21, 12(35): 5644-5650, “Hemoglobin induces colon cancer cell proliferation by release of reactive oxygen species” Iran J Ped Hematol Oncol, 2013; 3(2):73-77, “Effect of Thyroid Dysfunctions on Blood Cell Count and Red Blood Cell Indices” J Med Assoc Thai, 1999 Mar, 82(3):304-11, “Hematological parameters, ferritin and vitamin B12 in vegetarians” Can Respir J. 2011 Nov-Dec; 18(6): 338-348, “Coagulability in obstructive sleep apnea” Am J Kidney Dis. 2012;59(3):444-451

Introduction Testosterone Replacement Therapy (TRT) is a commonly administered treatment for men grappling with hypogonadism or low testosterone levels. TRT has been shown to help ease the symptoms of low testosterone, but it also has a noticeable side effect: it raises hematocrit levels, which can cause a medical condition called erythrocytosis or polycythemia. Elevated hematocrit levels cause the blood to thicken, bringing about potential cardiovascular risks like strokes, heart attacks, and clotting events. This comprehensive guide seeks to elucidate various strategies to manage high hematocrit levels induced by TRT, fostering a well-rounded understanding for both patients and healthcare providers. Table of Contents Introduction Understanding Hematocrit and Its Normal Ranges Factors Contributing to High Hematocrit Levels in TRT When to Act on Rising Hematocrit Levels Testosterone Treatment and Blood Cell Production Managing High Hematocrit Levels Monitoring Adjusting TRT Dosage Lifestyle Modifications Sleep Apnea Management Medication and Supplements Comparative Effects of Different Testosterone Therapy Forms Therapeutic Phlebotomy Treating High Red Blood Cell Counts with Phlebotomy No Set Guidelines for Phlebotomy in Testosterone Therapy Yet Phlebotomy: A Temporary Solution? Conclusion References Footnotes Understanding Hematocrit and Its Normal Ranges Hematocrit gauges the volume of red blood cells in the blood, expressed as a percentage, illustrating the proportion of blood comprised of red blood cells. Normal hematocrit levels for men range from 41% to 50%, and for women, they range from 36% to 48%. Factors Contributing to High Hematocrit Levels in TRT Testosterone Replacement Therapy can trigger erythrocytosis, where an overproduction of red blood cells occurs. It is known that testosterone lowers hepcidin levels. Hepcidin is a hormone that is made in the liver and is closely connected to iron absorption pathways. This lowers hepcidin levels leads to erythrocytosis and raises hemoglobin and hematocrit levels. When to Act on Rising Hematocrit Levels If you're using testosterone therapy (TT) and your hematocrit—the percentage of red blood cells in your blood—reaches 54% or more, experts from the European Association of Urology (EAU) and the American Urological Association (AUA) recommend taking action. The EAU advises checking for other possible causes that might be increasing your hematocrit, which could include factors mentioned in their risk section [8]. Testosterone Treatment and Blood Cell Production Typically, the body produces more red blood cells in the first six months of testosterone treatment before this process levels off. If you stop TT, your hematocrit and hemoglobin (the protein in red blood cells that carries oxygen) usually return to normal within 3 to 12 months. Adjusting your TT dose or how it's administered might help prevent high red blood cell counts by mimicking the body's natural hormone levels more closely. Managing High Hematocrit Levels Monitoring Regular monitoring of hemoglobin and hematocrit levels is pivotal for patients undergoing TRT. It is recommended to get baseline hematocrit values before starting treatment and then to do regular measurements at 3, 6, and 12 months after starting treatment. Adjusting TRT Dosage In instances where hematocrit levels soar beyond 54%, healthcare providers might consider decreasing the TRT dosage or temporarily halting the therapy until hematocrit levels normalize. Additionally, switching to subcutaneous injections could also be contemplated as a strategy to modulate hematocrit levels. Lifestyle Modifications Adopting certain lifestyle alterations can significantly impact hematocrit levels. Hydration: Ensuring ample fluid intake to maintain high blood volume. Exercise: Engaging in regular physical activity to reduce blood thickness. Smoking Cessation: Avoiding smoking can decrease hematocrit levels Sleep Apnea Management TRT has the potential to make sleep apnea, a condition marked by intermittent breathing interruptions while sleeping, worse. Continuous Positive Airway Pressure (CPAP) devices or other medically approved treatments that help people with sleep apnea can also help people with high hematocrit levels improve their health. Medication and Supplements Medications like Losartan and supplements like Naringin have shown promise in helping manage high hematocrit levels. However, it's crucial to consult with a healthcare provider before embarking on any new medication or supplement regimen. Comparative Effects of Different Testosterone Therapy Forms While all forms of testosterone therapy, such as gels, pills, patches, and injections, are linked to increased hematocrit levels, injectable forms were once thought to have the most significant impact. Recent studies have shown that although injections like testosterone enanthate can significantly raise hematocrit compared to patches, usually no form of therapy increases hematocrit by more than 4.3%. This suggests that careful patient selection and monitoring could mitigate the risk of excessive red blood cell production. The risk does not seem to correlate with the duration of testosterone therapy but is more pronounced during the initial phase due to the abrupt hormonal shift. Typically, hemoglobin and hematocrit levels rise within the first six months of therapy and tend to normalize within a year of discontinuation. However, dosage is a critical factor, and selecting an appropriate dose requires considering individual patient factors. Therapeutic Phlebotomy Therapeutic Phlebotomy (TP) is a widely adopted procedure to manage testosterone-induced polycythemia, involving the removal of a pint of blood to diminish hematocrit levels. The frequency of  blood donations should not exceed once every 12 weeks to prevent iron loss due to frequent donations, contingent on individual responses to TRT. Treating High Red Blood Cell Counts with Phlebotomy Phlebotomy—the process of drawing blood—is a common treatment for polycythemia vera (PV) and high hematocrit caused by testosterone therapy, a condition with too many red blood cells, and there's no reason it can't be used for people with high red blood cell counts from TT [13]. A study by Marchioli and colleagues found that keeping hematocrit levels below 45% significantly reduced blood clots and other serious issues compared to allowing levels to be between 45 and 50%. While phlebotomy has been helpful in PV, its effectiveness for TT-related high red blood cell counts needs more high-quality research. An observational study by Hazegh et al. showed that men on testosterone who donated blood saw their average hemoglobin levels decrease over a year. The frequency of their donations varied widely, indicating that blood donation could be a useful strategy. There are No Set Guidelines for Plebotomy in Testosterone Therapy Yet Currently, there are no specific guidelines on how often or how much blood should be drawn if you're on TT and experiencing high red blood cell counts. Phlebotomy: A Temporary Solution? While phlebotomy can lower hematocrit levels, it may not be a permanent fix. Chin-Yee et al. evaluated patients who donated blood and found that many had high hematocrit levels even after donating. This suggests that while phlebotomy can help, it might not completely control red blood cell counts related to TT. In summary, phlebotomy can safely reduce hematocrit levels temporarily, but it should be used alongside other methods, like adjusting TT doses, to manage red blood cell counts effectively. More research is needed to define the role of phlebotomy in managing TT-related high red blood cell counts. Conclusion The meticulous management of high hematocrit levels in patients on TRT is pivotal to averting potential cardiovascular risks. A multifaceted approach can be used to effectively manage hematocrit levels. This includes monitoring, changing TRT dosages, making changes to the patient's lifestyle, managing sleep apnea, therapeutic phlebotomy, and medication or supplementation. It's incumbent upon healthcare providers and patients to collaborate and ascertain the most conducive management strategy, ensuring the efficacy of TRT while safeguarding the patient's health. References Footnotes Excel Male TRT Forum. (n.d.). How to Manage High Hematocrit Caused by Testosterone Replacement Therapy. Retrieved from Excel Male TRT Forum ↩ ↩2 Discounted Labs. (n.d.). High Hematocrit Caused by TRT: How to Lower and Manage it. Retrieved from Discounted Labs ↩ ↩2 ↩3 PubMed Central (PMC). (n.d.). Testosterone use causing erythrocytosis. Retrieved from PMC ↩ PubMed. (n.d.). Management of Erythrocytosis in Men Receiving Testosterone Therapy. Retrieved from PubMed ↩ Iron Mountain Men's Health. (n.d.). How to Lower Hematocrit While on TRT. Retrieved from Iron Mountain Men's Health ↩ American Journal of Clinical Pathology, Oxford Academic. (n.d.). Therapeutic Phlebotomy for Testosterone-Induced Polycythemia. Retrieved from Oxford Academic ↩ American Journal of Clinical Pathology, Oxford Academic. (n.d.). Therapeutic Phlebotomy for Testosterone-Induced Polycythemia. Retrieved from Oxford Academic ↩

Table of Contents High hematocrit: the main side effect of Testosterone Replacement Therapy (TRT) What are the symptoms of high hematocrit? What are factors that increase the risks of TRT polycythemia ? How to Lower Hematocrit? How to Manage Increased Hematocrit Caused by Testosterone Replacement Therapy High hematocrit: the main side effect of Testosterone Replacement Therapy (TRT) Testosterone replacement therapy (TRT) is one of the most effective ways to combat low testosterone levels, but it's vital that you understand the risks associated with the treatment. As with any form of hormone replacement therapy, there are a few downsides to receiving regular injections of testosterone. But do these risks outweigh the benefits? That's a decision you'll have to make for yourself! Note: Remember the purpose of TRT: to restore testosterone to NORMAL, healthy levels in the body. Ideally, testosterone levels should be normal after TRT. Even at normal levels, there is a risk of side effects. One of the primary risks of testosterone that is you need to be aware of is called polycythemia. This is a condition where your body produces too many red blood cells, also known as high hematocrit level. Hematocrit refers to the red blood cell content in your blood. If your hematocrit levels rise, your blood will become too thick or viscous. This can, in turn, make it more likely that you will develop strokes, heart attacks, and clotting events. Polycythemia is serious and potentially life-threatening if untreated.   What are the symptoms of high hematocrit? In recent years, there has been an increased association between TRT and polycythemia. With TRT becoming a more mainstream treatment, more people are experiencing the symptoms of polycythemia, which include: Weakness Fatigue Headache Itching redness of the skin bruising joint pain dizziness abdominal pain shortness of breath breathing difficulty when you lie down numbness, tingling, or burning in the hands, feet, arms or legs Turning very red or "flushing" after workout When polycythemia occurs, the blood becomes very thick. But instead of being able to carry MORE oxygen, the increase of red blood cells can be dangerous. The risk of clotting increases as a result of the red blood cell count increase. Note: While there is a risk of hematocrit increase, there is no proof that TRT increases the risk of clotting events. It's vital to be aware of the potential risk, so doctors need to be careful when prescribing TRT to men with high hematocrit levels, red blood cell disorders, and obstructive pulmonary disease. All of these things increase the risk of clotting events as a result of the hematocrit increase caused by TRT.   What are factors that increase the risks of TRT polycythemia ? There are a number of factors that can increase your risk of developing this problem. According to Dr. Michael Scally, polycythemia "occurs quite frequently in people who are on replacement testosterone." Age also plays a role in your polycythemia risk. Young men are far less likely to experience this problem than older men. The mode of delivery and the dose of testosterone affect the increase in your hematocrit levels. Men who receive formulations of pharmacokinetically steady-state delivery hormones are far less likely to develop the problem than men who receive intramuscular injections of testosterone. Topical preparations only cause the problem in up to 20% of cases. 5 to 15% of those who use testosterone patches develop polycythemia, while 10 to 20% of those using the testosterone gel develop the problem. Of course, the amount of testosterone delivered per day (50 to 100 milligrams) also affects the risk of developing polycythemia. Testosterone injections may increase hematocrit more than gels, patches, pellets, nasal or oral testosterone formulations.  Smaller injection doses given more frequently may increase hematocrit less rapidly than larger dose injections, but data are lacking to prove that fact. Men with sleep apnea or those who smoke are at the highest risk of high hematocrit since their bodies are trying to compensate for the decreased oxygen level by producing more red blood cells.  TRT enhances that red blood cell production.   How to Lower Hematocrit? So what can you do about the problem? Is there any way to manage it? Those undergoing TRT must be aware that polycythemia is a real risk, as do their doctors. They must keep a close eye on their hemoglobin and hematocrit levels. If hematocrit rises above 52%, further examinations may be necessary. Some doctors counsel reducing or stopping testosterone treatment. However, for those who are undergoing TRT as a means of restoring healthy hormone levels, this may not be an option. Some means of managing and reducing the risk of high hematocrit levels include: Scaling back on the amount of testosterone gel delivered per day (50mg or less) or injection dose. Changing the method of administration (using more frequent injections with smaller doses, or using a testosterone gel or cream) Making sure that you are hydrated when you get your blood drawn for lab tests Stopping smoking Getting sleep apnea diagnosed and treated with a CPAP machine to enhance oxygen saturation levels when sleeping. If these options do not work, a therapeutic phlebotomy (blood donation) may be the answer. Removing just one unit of blood can help to lower hematocrit by as much as 3%. For those with very high hematocrit levels, the therapy may continue for months, gradually reducing hematocrit to safe levels over time. Some physicians even prescribe regular phlebotomies (no more frequently that every 56 days is the safe frequency to avoid iron loss) as a means of preventing overly high hematocrit levels. While phlebotomies are not covered by your insurance, they can be performed at any blood bank. Even if your insurance company won't cover the cost, you can solve the problem by donating blood (provided you are free of hepatitis, HIV, and other blood-borne infections). Experts agree that donating every 2.5 to 3 months is safe, and it's a good way to keep your hematocrit levels under control. It is important to note that hematocrit can stabilize in men on longer term TRT, so many men do not have to donate blood after a few months on TRT. Warning: Donating more than 1 unit of blood more frequently than every 2.5 months can lower your iron and ferritin levels. This can cause fatigue. Make sure to replace the lost iron with a supplement in order to prevent anemia. You can check your iron and ferritin with this iron blood test. It's recommended that you donate when you are in the 51-52% hematocrit range. However, some organizations (like the Red Cross) will reject blood with a hematocrit higher than 53%, so it is good to avoid that hematocrit high level if you want to donate blood. Hematocrit is included in the CBC and other panels: Get Your Hematocrit Test Now Testosterone, Hematocrit, Ultrasensitive Estradiol and Prolactin Panel Hematocrit + Total and Free Testosterone   To find out more information, click  How to Manage Increased Hematocrit Caused by Testosterone Replacement Therapy

  Since abnormally high hematocrit values can pose serious health problems, this article will analyze the correlation between testosterone therapy and high hematocrit. TRT, sleep apnea and smoking are contributing factors that can cause high hematocrit, which can increase cardiovascular risks if not properly managed. This article explains the basics of how to manage high hematocrit while using testosterone. High hematocrit: Why it is important? The red cells are some of the most important components of a person’s blood. The term hematocrit refers to the percentage of red blood cells in a human’s body. For women, normal hematocrit values should be around 42% and for men, it should be around 47%. A complete blood count test will show the number of red blood cells in the blood as well as the hemoglobin values, white blood cells, and platelets. When the hematocrit is too high, meaning that there are too many red blood cells, this condition is known as polycythemia. When the hematocrit values are too low, this condition is known as anemia. Abnormal hematocrit values can put one’s life in danger if not treated promptly. Since abnormally high hematocrit values can pose serious health problems, this article will analyze the correlation between red blood cell count and various medical conditions such as obstructive sleep apnea syndrome, erythrocytosis caused by testosterone replacement therapy and why people should be careful when donating blood more than once a year. It is important to also know the red cell distribution width (RDW), which is a laboratory measuring system that analyzes the size of red blood cells. Doctors frequently examine the RDW to determine the causes of anemia and to gain more insights about the severity of different cardiovascular diseases.  Platelets are cytoplasmic fragments that quickly react when bleeding is detected in the body. They help in the coagulation process to prevent infection and initiate the healing process. The mean platelet volume (MPV) is a way of measuring the size of the platelets. Both these terms, RDW and MPV, will be used to examine the link between obstructive sleep apnea syndrome and high hematocrit values. Obstructive sleep apnea syndrome (OSAS), red blood cells and high hematocrit values OSAS is a sleep disorder that is characterized by a collapse of the upper airway while sleeping. This leads to a low quality sleep, choking sensations, and even hypoxia (low oxygen saturation). A comprehensive study performed between January 2011 and June 2014 shows that high RDW might be a reliable marker when it comes to the severity of OSAS. Hematocrit TRT Study Material and Methods 264 patients were admitted to the sleep unit to undergo a polysomnographic evaluation and were subsequently diagnosed with OSAS. 116 of these patients met the criteria of the study and agreed to participate. These patients reported frequent unpleasant symptoms such as daytime sleepiness, severe snoring at nighttime, etc. The exclusion criteria left out patients who had various types of medical conditions that might have interfered with the results of the study. For example, patients who had known cardiovascular diseases, were smokers, had diabetes mellitus, lung disease or hypertension were not included in the study. The 116 patients who participated in the study were divided into several groups, depending on the apnea-hypopnea index (AHI) which basically indicates the severity of the sleep apnea. There were 3 groups – mild (AHI between 5 and 15), moderate (AHI between 15 and 30) and severe (AHI higher than 30). There was also a control group of 62 individuals who had an apnea-hypopnea index of less than 5. The study was performed using polysomnographic methods. Researchers have attached suprasternal microphones to assess the airflow of the patients during sleep. Blood samples were also drawn using a 21-gauge needle syringe after a fasting period of 8 hours. The apnea was defined as a stop of airflow for 10 seconds or more during sleep. Hypopnea was defined as a reduction of airflow between 30% and 50% as well as a decrease in capillary oxygen saturation. Sleep Apnea and Testosterone- Study Results At the end of the study, researchers have reached the conclusion that patients with severe OSAS have a higher RDW, a higher platelet count and MPV. In addition, the hematocrit and RDW are positively correlated with apnea-hypopnea index. This means that the complete blood count is very important for patients diagnosed with OSAS. It is well known that patients with OSAS experience a state of systemic inflammation due to a variety of causes. This state of inflammation can lead to a higher secretion of pro-inflammatory cytokines such as interleukin-6, which in turn can create erythrocyte deformability and a higher level of RDW. Other studies have shown that high RDW levels are also associated with a higher-sensitivity CRP level which is a known marker of inflammation. One of the most important reasons which make this study unique and highly accurate is the simple fact that patients who suffered from serious health conditions such as coronary artery disease, diabetes mellitus, and hypertension didn’t take part in the study. It is a well-known fact that these illnesses can lead to a higher RDW level which could have compromised the results of the study. Patients who suffer from OSAS also experience hypercoagulability which is caused by high blood viscosity. Hematocrit, erythrocyte behavior, and other factors all affect blood viscosity, which is defined as the resistance of blood to external forces. It has been established that hematocrit plays an important role in the coagulability of blood and can lead to increased blood clotting. When there is an increased blood clotting in the body, the natural flow of blood can be negatively affected and multiple cardiovascular issues can appear. Researchers believe that the hypoxemia experienced by patients with OSAS is caused by a release of inflammatory factors that negatively affect the blood and can lead to hypercoagulability. It has also been found out that the total platelet count in patients with OSAS was higher in comparison with the patients in the control group or those in the mild group. This is real evidence of the correlation between platelet activation and cardiovascular diseases in patients suffering from OSAS. This comprehensive study has shown evidence that RDW, MPV, and platelet count are increased in patients diagnosed with OSAS. The RDW index is also positively correlated with oxygen desaturation index and AHI. Since RDW is included in a standard blood count measurement, it can become an inexpensive and simple tool to diagnose the severity of the OSAS in patients of all ages. As a result, patients who suffer from a severe OSAS can be given priority when it comes to treatment, improving their chances of recovery.   Understanding the occurrence of high red blood cells and hematocrit on testosterone replacement therapy   Erythrocytosis is a medical condition that appears when the body is making too many red blood cells. RBCs are responsible for transporting oxygen to organs and tissues. When there are too many, the blood can become too thick and cause cardiovascular complications. There are 2 types of erythrocytosis – primary and secondary. Primary erythrocytosis is usually caused by bone marrow problems. RBCs are made in the bone marrow and something might trigger an increase in their production. Certain diseases or medications, such as testosterone replacement therapy, can cause secondary erythrocytosis. TRT is the go-to treatment for people who suffer from hypogonadism – aka androgen deficiency. This type of treatment is increasingly popular, especially among people over 40 years of age. It can increase libido, help to maintain muscle mass, improve mood and general wellbeing. However, one of the side effects of TRT is a simple fact that it can cause erythrocytosis. An increase in hemoglobin (Hb) and hematocrit (Hct) is indicative of this medical condition. When the Hb is higher than 18.5 g/dL and the Hct is higher than 52% in men, the patient suffers from erythrocytosis. Since the RBCs count is too high in people with erythrocytosis, the blood viscosity also increases, which can lead to various potentially life-threatening medical issues such as venous thromboembolism. This essentially means that small blood clots separate from their original source and travel through veins and capillaries, causing blockages that result in stroke, myocardial infarction, or other complications. CHECK YOUR HEMATOCRIT TEST WITH A CBC PANEL Testosterone replacement therapy formulations   Testosterone replacement therapy is recommended for men who have testosterone levels lower than 300 ng/dL. It is commonly accepted that T levels decrease by approximately 1% per year after 35 years of age. TRT has been shown to improve the mood of the patients, correct insulin resistance problems, and help increase bone density and muscle mass, among other positive benefits. Getting testosterone into the body can be done in various ways. There are injections, gels, buccal patches, pellets, and others. Some formulations show results much quicker (injections, for example) and each one of them has different effects on patients, depending on the dosage, administration option, etc. TRT-induced high red blood cell volume ( high hematocrit ) When the testosterone levels increase in the body, the hemoglobin and hematocrit levels also increase. Studies have shown that people who undergo TRT have higher blood viscosity and platelet adhesiveness, which can lead to thromboembolic risks. Although there are not many studies that link TRT-induced erythrocytosis (high red blood cells) with thromboembolism, one small research performed by Krauss et al on a group of 15 men can lead to interesting conclusions. The 15 men received short-acting IM TE (testosterone injection) every 21 days and had their bloodwork and testosterone levels monitored. The researchers discovered a correlation between transient ischemic attacks and men who had a mean Hct levels higher than 48%. Although the study was performed on a small group of men, it is an important research finding because throws a spotlight on the potential side effects of TRT. Additionally, the FDA also forces companies that make testosterone products to add a warning on the label stating “possible increased risk of heart attacks and strokes in patients taking testosterone”. High hematocrit: The effects of different testosterone products Researchers have discovered that various testosterone formulations have different effects when it comes to the occurrence of erythrocytosis in patients who undergo TRT. For example, short-acting injectables such as IM TC and IM TE render an incidence of erythrocytosis higher than 40%. The other formulations have a much lower incidence and are considered safer, although testosterone is absorbed much slower into the body. Men who are prescribed and use transdermal gels such as AndroGel 1.62% have an approximately 13% chance of developing erythrocytosis, according to some studies. These types of gels can have a dose of testosterone of 20–100 mg and can be applied to the shoulder area or directly on the skin. Similarly, crystalline pellets that are implanted under the skin have a T formulation of 75mg per pellet and can lead to a 35% chance of developing erythrocytosis in the long run. Studies define erythrocytosis as a hematocrit level higher than 52%. Researchers have found a possible link between high hematocrit levels and high hemoglobin levels in people who are on testosterone replacement therapy. However, more in-depth studies are needed to fully understand the molecular mechanisms that cause erythrocytosis to happen during TRT. Furthermore, some studies show that there is also a higher risk for patients who benefit from TRT to develop CV complications as a result of increased blood viscosity. It's important to also develop other treatment options for hypogonadal men, such as aromatase inhibitors, human chorionic gonadotropin, and others. Lastly, when TRT is absolutely necessary, patients might take into consideration safer testosterone products, such as undecanoates, which can be taken orally or as transdermal gels. Understanding why blood donations shouldn’t be done too frequently It is estimated that approximately 70% of the blood supply in the United States comes from repeat donors. Although donating blood is a commendable act, people should be careful when donating several times a year because they can develop iron deficiency. A plethora of men decides to donate blood to also decrease hematocrit levels. A study conducted on 235 men concluded that frequent blood donors can develop iron deficiency The group of 235 men was separated into 3 categories: – control group with no donations, group 2 with 2 donations per year and group 3 with 3 donations per year. The age of the donors was between 17 and 65 years and their hemoglobin values were higher than 12.5 g/dl. Donors who took iron supplements before were excluded from this study to avoid interfering with the results. The researchers looked at a couple of important values, such as hemoglobin and ferritin levels. Ferritin is a type of intracellular protein responsible for transporting and releasing iron throughout the body. Iron deficiency was defined as serum hemoglobin levels below 13 g/dl and serum ferritin levels below 15 μg/l. No participant in the study has donated blood in the previous 8 weeks. Researchers have found out that the patients in the case groups (2 and 3) had a decreased level of hemoglobin and ferritin in comparison with the patients in the control group. More specifically, men in group 3 had ferritin mean levels of 26 and a hemoglobin level of 13.8, those in group 2 had ferritin mean levels of 56 and hemoglobin levels of 15.4 while the control group had ferritin mean levels of 108 and hemoglobin levels of 15.9. Caution about frequent blood donations: The study presented evidence that donating blood more than once or twice per year can significantly deplete iron stores and can lead to anemia. Moreover, the medical industry relies on donations of a healthy supply of blood rich in iron, so certain donors (especially those who donate frequently) might not be eligible for repeat donations. Likewise, measuring the hemoglobin level only might not be a reliable indicator of a person being suitable for blood donation or not. The ferritin levels should also be taken into account to prevent anemia in various donors. Is supplementing with iron a solution for low iron/ ferritin caused by frequent blood donations? This is a good question, but the answer might not be that simple. It is a well-known fact that supplementing with iron should be done carefully since too much iron in the bloodstream can cause damage to organs and tissues. Additionally, those patients who have family members with cancer might not be eligible for iron supplementation. Speaking with a doctor before taking iron supplements is the best thing to do.   Buy a low cost testosterone test    References: Ohlander et al. Sex Med Rev 2018; 6:77-85 Yousef and Alkhiary, J Sleep Disord Ther 2015, 4:2

Table of Contents Sleep Apnea and Testosterone Sleep Apnea and Cortisol Health Consequences of Sleep Apnea Sleep Apnea Solutions REFERENCES: Do you snore? Do you feel fatigued every day? Do you wake up frequently throughout the night? It may be that the shallow breathing or breaks in breathing caused by sleep apnea are the reason. There are different types of sleep apnea, one of which is obstructed sleep apnea (or OSA), which is when breathing is interrupted by a physical block to airflow. With OSA, snoring is common. Sleep Apnea and Testosterone What does apnea have to do with testosterone?  Everything!  Your precious shuteye is responsible for a host of all-important physiological functions, including rebuilding your testosterone and neurotransmitters, optimizing stress hormones, and mapping memory. Therefore, any condition, such as apnea that lowers the quality or quantity of sleep, is a physical and hormonal train wreck waiting to happen. Apnea is one of the nastiest sleep disorders because it is so disruptive.  After all, what could interfere with sleep more than having your airways and oxygen blocked off? Unfortunately, one study after another has rolled out showing how complex apnea is on the body, and hormones are no exception. One early study looked at just how severe the damage can be and found that apnea sufferers went from an average low testosterone test of 391ng/dL to a much closer-to-normal 487ng/dL after corrective surgery. [1] That's a jump of 25% in testosterone after their apnea was corrected!  However, a later study of guys in their 40's, showed an astonishing 68% difference between controls and males with apnea. [2] Regardless of the exact number, you get the idea:  apnea is devastating to your most precious hormone, testosterone. However, there is actually a logical explanation for the difference in the two numbers above:  the first number comes from a comparison after apnea correction and the second before correction.  Researchers have found that guys who have had apnea for a significant amount of time are often overweight, even obese. [3]    In other words, if you've built up a big spare tire during your sufferings with apnea, CPAP or other therapy cannot get you back to where you were before because your own body is fighting against itself. The researchers found that apnea subjects appeared more like aged subjects where LH (Luteinizing Hormone) cycles at night were increased, yet without a corresponding increase in testosterone as is experienced by younger males.  Young guys get a pulse of luteinizing hormone followed by one of testosterone and so on.  This cycle is dampened increasingly in males as they age, and apnea appears to accelerate this process. In other words, once you get your apnea corrected, you must take care to also lose any excess weight in order to re-optimize your testosterone as much as possible.  The good news is that just getting treated for apnea will give you a nice jump in testosterone, and then as you lose weight and control cortisol, you should increase it even further.  Studies have even verified this in obese men with a BMI of 32, which isn't what would even called obese, by the way.  When they lost weight, they regained their testosterone. [4] Sleep Apnea and Cortisol Similarly, apnea also leads to elevated cortisol level.  One study found that subjects had 50% percent higher cortisol before CPAP when compared to after. [6] This is truly nasty:  cortisol is not something you want to be elevated by even the smallest amount.  Higher cortisol elevations, especially in the middle age and beyond years, can lead to memory damage, lowered testosterone, increased fat mass, lower immunity, poor sleep and a host of other ills.   In the last ten years, researchers have uncovered the fact that most apnea is actually lifestyle-related and not simple genetics or aging. Health Consequences of Sleep Apnea Sleep apnea has been shown to increase the incidence of these health problems: Heart Disease. Blood Glucose Control and Diabetes. If you have diabetes, sleep apnea can make it more difficult to manage your diabetes. Increased blood viscosity due to high hematocrit: As you starve your body of oxygen at night with sleep apnea, the body compensates by producing more oxygen-carrying hemoglobin and red blood cells, which increases hematocrit and blood viscosity. This can cause heart disease, high blood pressure and require frequent blood donations if you are on testosterone replacement therapy (TRT). Note: TRT can worsen sleep apnea in some men [10] Memory Loss and Dementia Risks.  Heavy snoring and sleep apnoea may be linked to memory and thinking decline at an earlier age, according to a study published in the April 15, 2015, online issue of the journal Neurology. The research also suggests that treating the disorders with a breathing machine may delay the decline. “Abnormal breathing patterns during sleep such as heavy snoring and sleep apnea are common in the elderly, affecting about 52% of men and 26% of women,” said Ricardo Osorio, MD, at the NYU Langone Medical Center. Fatigue and daytime sleepiness. Depression. Irritability.   Sleep Apnea Solutions One interesting aspect of apnea research is that researchers are finding that there are many natural solutions that can often help apnea sufferers and sometimes even cure their apnea.  This is important for several reasons.  First of all, in some cases, it shows that there is a root cause of apnea, i.e., there is not some inherent genetic weakness causing this debilitating condition but rather some lifestyle change that can help significantly.  Secondly, the medical solutions for apnea are rather invasive:  surgery (somnoplasty and snoreplasties) and/or a cumbersome CPAP machine worn through the night.  Many of those with apnea would like to avoid such solutions and find something more natural. However, it should be noted that there is one other medical procedure, the Pillar procedure, that is significantly less invasive. This is performed by a dentist and involves tiny polyester implants in the soft palate of an apnea (or snoring) sufferer.  It is actually the vibration of the soft palate that can lead to snoring and often apnea, so this can be an easy fix in some cases since it is done with minimal anesthetics. WARNING:  It is critical to get your apnea treated.  One study looked at 380 participants with moderate or severe sleep apnea over a 14-year period and found that one-third of the patients died! [9] That's in comparison to 8 percent without apnea.  Those suffering from apnea or other sleep disorders should definitely consider green tea, as they get their condition under control. The oxidative stress from apnea typically affects memory and the ability to learn. Researchers have found that green tea, at least in animals, protects the brain from oxygen-deprived states that occur in apnea and related disorders. Green tea for the rats in this study actually protected their brains and memory from the ravages of apnea sleep loss. [4] Below is a summary of additional natural solutions that researchers have found for apnea:   Weight Loss. Research shows that mild apnea can often be significantly helped or even cured simply by losing those extra pounds.  One recent study found that almost two-thirds of study participants who dropped 23 pounds through diet and exercise were actually completely cured of their apnea. [2] Therefore, assuming your apnea isn't too severe, you may want to try simple weight loss first as a solution and, as a side benefit, you may have your testosterone significantly restored as well. In other words, dropping those pounds has the potential to boost your testosterone and cure your apnea at the same time.   If your apnea is severe, however, simple weight loss will not do the trick, and you will likely end up with a CPAP (Continuous Positive Airway Pressure) These masks can be testosterone and life and saver, literally.  There are also dental mouthpieces and surgery of the throat as options as well, but these are considered less effective in most cases. Your doctor can order a sleep study for you to get tested at a sleep lab or using a home-based system. There are also telemedicine services for sleep apnea. A study done in Portugal and published in 2017 found that after people used CPAP machines for six months, their red blood cell count, hemoglobin, hematocrit, and platelet count showed a significant decrease [11]   Treat Hypothyroidism. Apnea can result from hypothyroidism, an underactive thyroid that will be unresponsive to standard treatments.  It is estimated that 2-3% of apnea sufferers fall into this category. [3]   Improve Sleep Position. Some practitioners have noticed that sleeping on the side can significantly help with apnea. Another solution is to sleep in a partial sitting position.  One study showed that half of all apnea sufferers could actually cure their condition by sleeping in this position! [5]   Avoid Alcohol at Night. If I got woken up a couple of hundred times during the night from lack of oxygen, I might want a few drinks, but researchers have found that this decidedly exacerbates apnea. [6]    Stop Smoking. Smoking makes apnea significantly worse because it inflames airway tissues and is associated with an increased incidence of this condition. [7]   Avoid Sitting for Long Periods. Sitting a lot during the day pools water and blood in the legs, and this aggregation of liquids then migrates to your neck region when you go to Sleep leading to apnea in many cases.  Keep moving throughout the day. [8] Download a step counter App to your phone, carry your phone in your pocket, and measure the total steps you take daily. If you’re sedentary, add 2,000 more daily steps so that you average at least 4,400 daily steps. While 2,000 steps equals one mile, it’s not necessary to walk it all at once. Instead, try to take extra steps over the course of each waking hour.   Monitor Your Oxygen Saturation. Use an oximeter connected to a Bluetooth enabled App to see how many times your blood oxygen level drops during your sleep cycle. Bluetooth Oximeter syncs the measurement readings to the free ViHealth app via Bluetooth automatically and securely. The app can store unlimited history data, which gives you a quick overview and helps you monitor your health.   As you can see, reversing sleep apnea can not only extend your life span but also its quality.  Giving your body the oxygen it needs will change your life!   REFERENCES:   1) Journal of Sexual Medicine, 6(11):3147-3157, Published Online: 29 Jun 2009, "Sleep Apnea is an Independent Correlate of Erectile and Sexual Dysfunction" 2) Consumer Reports on Health, Jul 2009, p. 10. 3) Am. J. Respir. Crit. Care Med., Aug 1999, 160(2):732-735, "Screening for Hypothyroidism in Sleep Apnea" 4) Amer J of Respiratory and Critical Care Med, May 15 2008, Goza 5) Am Rev Respir Dis, 1986 Apr, 133(4):662-6, "The effects of posture on obstructive sleep apnea" 6) Amer J of Medicine, Aug 1981, 71(2):240-245, "Alcohol increases sleep apnea and oxygen desaturation in asymptomatic men" 7) SLEEP AND BREATHING, 5(4):167-172, "Higher Prevalence of Smoking in Patients Diagnosed as Having Obstructive Sleep Apnea" 8) Men's Health, May 2009, p. 33. 9) Sleep, 2008 Aug , ;31(8):1079-85, "Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study" 10) The Journal of Clinical Endocrinology & Metabolism, Volume 88, Issue 8, 1 August 2003, Pages 3605–3613. “The Short-Term Effects of High-Dose Testosterone on Sleep, Breathing, and Function in Older Men” 11)  Revista Portuguesa de Pneumologia (English Edition) Volume 23, Issue 2, March–April 2017, Pages 71-78. "Hematological evaluation in males with obstructive sleep apnea before and after positive airway pressure"  

Top US Locations for Therapeutic Phlebotomy Near Me Understanding Therapeutic Phlebotomies to Lower High Hematocrit What is High Hematocrit? High hematocrit happens when your body makes more blood cells. This makes the blood thicker. When blood is thicker, it is harder for the heart to pump. This can lead to problems like high blood pressure, strokes, and heart attacks. Testosterone Therapy and Hematocrit Levels Testosterone replacement therapy is often used to increase muscle mass and sex drive. It can also raise the production of blood cells and plasma levels. This is good for people with anemia. However, it can increase hematocrit levels, which could be risky. This risk is higher with intramuscular testosterone compared to other methods like patches. Also, factors like smoking can make this issue worse, causing high hematocrit. This condition is known as polycythemia, which means a high red blood cell count (RBC). Preventing and Managing Polycythemia   Importance of Monitoring Monitoring hemoglobin and hematocrit levels is important during testosterone therapy. Hemoglobin is responsible for carrying oxygen. Hematocrit shows the percentage of blood cell volume. A problem can occur if hematocrit levels go over 52 percent. Adjusting Therapy Adjusting how much testosterone you take or how you take it could help control your hematocrit levels. But, these changes might not always be enough. Therapeutic Phlebotomy: A Solution Therapeutic phlebotomy, which is also called bloodletting, is a medical procedure. It involves removing blood in a controlled way. The goal is to lower the levels of red blood cells in the body. Therapeutic phlebotomy is similar to blood donation. It can reduce hematocrit levels by about 3 percent for every pint of blood taken. It is essential to find a balance between how often blood is drawn and how much is taken out. This helps avoid loss of iron and ferritin, which can cause fatigue. After the procedure, you should: Stay for at least 15 minutes. Eat and drink something. Drink more fluids than usual for the next 4 hours. If there is bleeding from the blood draw site, raise your arm and apply pressure to the area. Before having the procedure, you should: Drink a lot of fluids to make up for the fluid that will be taken out. Have a good snack one hour before you arrive, like a muffin or a sandwich. Recommended Reading: High Hematocrit Caused by TRT: How to Lower It? Medical Conditions Requiring Therapeutic Phlebotomy Therapeutic phlebotomy is a medical procedure. It removes blood from the body. Doctors use this procedure to help treat different blood conditions. It can lower the chance of problems linked to too many blood cells, iron overload, or other blood issues. Here are some medical conditions that might need therapeutic phlebotomy: Hereditary Hemochromatosis (HH): This is a genetic disorder. It makes the body take in too much iron from food. This can cause iron overload. Therapeutic phlebotomy is used to remove the extra iron. This helps prevent organ damage and keeps you healthy. Polycythemia Vera (PV): This blood disorder means the body makes too many red blood cells, white blood cells, and platelets. Using therapeutic phlebotomy lowers the number of blood cells. This reduces the risk of blood clots and other problems. Secondary Polycythemia: This condition happens when the body has too many red blood cells due to low oxygen levels or other health issues. Therapeutic phlebotomy helps manage it by lowering the risk of blood clots and related problems. Porphyria Cutanea Tarda (PCT): This is a rare genetic disorder that affects heme production. Heme is important for making red blood cells. Therapeutic phlebotomy removes extra iron from the body. This prevents skin damage and other symptoms. Testosterone Replacement Therapy (TRT): Some people on TRT see an increase in red blood cell production. This can lead to high hematocrit levels. Therapeutic phlebotomy helps control these levels. It lowers the risk of blood clots and other complications. Metabolic Disorders: Certain metabolic issues, like diabetes, can increase blood cell production. Therapeutic phlebotomy helps manage these issues. It reduces the risk of blood clots and other problems. Infectious Diseases: Sometimes, therapeutic phlebotomy helps treat infectious diseases, like malaria or babesiosis. It works by removing infected red blood cells from the body. It is very important to remember that therapeutic phlebotomy must be done by a doctor in a medical place. If you have a medical condition that needs therapeutic phlebotomy, talk to your healthcare provider. They can help you find the best treatment for your situation. Guidelines for Monitoring and Donations You should have regular blood count tests after donating blood. This includes checking your hematocrit and ferritin levels. It’s usually okay to have a phlebotomy session every 2-3 months. This helps you avoid losing too much iron and ferritin. Be careful to keep an eye on your levels. If you give blood often because of high hematocrit, you can buy a blood donation panel. This panel has lab tests to tell you if you’re ready for your next blood donation. The tests include hematocrit, iron, total iron binding capacity (TIBC), and ferritin. This panel checks if: Your blood donation or therapeutic phlebotomy worked to lower your high hematocrit without hurting your ferritin or iron levels. It is safe to do another blood donation or therapeutic phlebotomy based on your ferritin or iron levels. Cautionary Measures for Maintaining Health   Risks of Excessive Donation Excessive blood donation can lower iron and ferritin levels. This may cause you to feel tired. It is generally recommended to start donating blood when your hematocrit levels are about 51–52 percent. Complementary Health Practices Baby aspirin and omega-3 fatty acids can help thin your blood and lower heart risks. However, they should not take the place of phlebotomy in treating polycythemia. Where to Get a Therapeutic Phlebotomy in the United States? Important note: Most blood donation centers need an order from a doctor if your hematocrit level is too high for a regular blood donation. The Red Cross has a list of rules to decide who can donate blood. National Organization American Red Cross: Website America's Blood Centers: Website Blood Centers of America: Website Blood Emergency Readiness Corps: Article Alaska Blood Bank of Alaska: Website Arkansas Arkansas Blood Institute: Website California Central California Blood Center: Website LifeStream Blood Bank: Website Northern California Community Blood Bank: Website San Diego Blood Bank: Website Stanford Blood Center: Website UCLA Blood & Platelet Center: Website Delaware Blood Bank of Delmarva: Website Florida OneBlood: Website SunCoast Blood Centers: Website Winter Haven Hospital Community Blood Center: Website Georgia Atlanta Blood Services: Website Shepeard Blood: Website Hawaii Blood Bank of Hawaii: Website Illinois Versiti Blood Center of Illinois: Website Rock River Valley Blood Center: Website South Bend Medical Foundation: Website Indiana Versiti Blood Center of Indiana: Website Iowa LifeServe Blood Center: Website Kentucky Kentucky Blood Center: Website Western Kentucky Regional Blood Center: Website Louisiana LifeShare: Website The Blood Center: Website Michigan Versiti Blood Center of Michigan: Website Mississippi Mississippi Blood Services: Website Missouri Community Blood Center of Greater Kansas City: Website Nebraska Nebraska Community Blood Bank: Website New York New York Blood Center: Website Ohio Hoxworth Blood Center: Website Versiti Blood Center of Ohio: Website Oklahoma Oklahoma Blood Institute: Website Pennsylvania Central Pennsylvania Blood Bank: Website Miller-Keystone Blood Center: Website Rhode Island Rhode Island Blood Center: Website South Carolina The Blood Connection: Website Tennessee Blood Assurance: Website Marsh Regional Blood Center: Website Texas Carter BloodCare: Website We Are Blood: Website South Texas Blood: Website Texas Blood Institute: Website Utah ARUP Blood Services: Website Virginia Inova Blood Donor Services: Website Washington Bloodworks Northwest: Website Wisconsin Versiti Blood Center of Wisconsin: Website Multiple States or Regions ImpactLife: Website (They serve Illinois, Iowa, Missouri, and Wisconsin) LifeSouth Community Blood Centers: Website (They serve several states) Alliance for Community Transfusion Services: Website Lifeline Blood Services: Website MEDIC Regional Blood Center: Website   Bloodworks Northwest Program for Therapeutic Phlebotomy Patients Bloodworks Northwest has a strong therapeutic phlebotomy program. It helps patients with certain medical issues, especially those with hereditary hemochromatosis. This program focuses on safely removing extra blood to control iron overload and keep good health. To use this service, patients need a valid order from their healthcare provider. The Bloodworks medical director will carefully review it to make sure it meets the medical rules. In addition to hereditary hemochromatosis, some patients may need therapeutic phlebotomy for different reasons. However, the main focus of the services is managing iron overload. Patients can make appointments at several Bloodworks centers, making it easy for them to access care in the area. Bloodworks Northwest wants to improve patient experience and health results by making the process simpler and offering clear instructions. Donor Centers Providing Therapeutic Phlebotomy Treatment When searching for donor centers that offer therapeutic phlebotomy treatment, it is important to find ones that are qualified and allowed to do this procedure. Many blood donation centers in the United States provide therapeutic phlebotomy for patients who have high hematocrit levels or similar health issues. These centers also follow donor eligibility criteria. Usually, a physician's order is needed to confirm that the treatment is right and required for the patient's health. These centers focus not only on medical care from healthcare experts but also on teaching patients about the phlebotomy process. If you need treatment, you should ask about the exact rules and needs at the center you choose. By picking the right donor center, you can get therapeutic phlebotomy in a safe and supportive place. This helps you manage your high hematocrit levels well. Service Availability and Requirements Therapeutic phlebotomy services are easy to find, but the requirements can differ based on where you go. Patients usually must get a doctor's order before making an appointment for therapeutic phlebotomy. This service is only available by appointment from Monday to Friday. The doctor’s order shows that this procedure is needed for the patient’s health. Centers may have different hours and ways to schedule appointments. Patients should call the facility they choose ahead of time. This will help them know what to expect when they visit. It’s also important to find out about any necessary preparations or documents needed for the procedure. By meeting these requirements, patients can have a smooth and timely phlebotomy experience. What Do I Need To Bring? When getting ready for a therapeutic phlebotomy appointment, patients need to bring a valid photo ID and any filled-out forms needed by the donation center. The doctor will send the required order to the place before the appointment. Still, it is a good idea for patients to check that all needed documents, including a receipt, are ready. Patients should know the guidelines given by the phlebotomy center. These can help make their veins easier to find. For example, there may be diet tips to follow before the procedure. Being prepared will help the appointment go well. This way, patients can get their treatment on time and avoid any delays. How Often Can I Give? The number of therapeutic phlebotomy sessions depends on each person's health needs and what their healthcare provider recommends. Usually, the doctor decides how often a patient should have blood withdrawals. They make this choice based on the person's hemoglobin levels and treatment goals. Patients may have appointments set every month, every three months, or depending on how they feel. Changes can be made if needed. It is very important for people to follow their doctor's advice. This helps them stay healthy and manage their hematocrit levels well. Conclusion In summary, it is important to understand and manage high hematocrit levels, especially for people receiving testosterone therapy. Checking levels regularly, having therapeutic phlebotomy when needed, and carefully managing treatment can lower risks and make the process safer. Always talk to a healthcare provider for advice that fits your needs. Further Reading How to Lower High Hematocrit - Effective Strategies Sleep Apnea: Effect on Testosterone and High Hematocrit Managing High Hematocrit Levels Induced by Testosterone Replacement Therapy High Hematocrit Caused by TRT: How to Decrease it

Nelson Vergel, author of Testosterone: A Man's Guide (Amazon.com) and founder of ExcelMale.com and DiscountedLabs.com, talks about what he thinks are the 10 most important things that all men on testosterone replacement therapy should know to maximize benefits and minimize side-effects. For questions for Nelson, please register on ExcelMale.com and post them on the forum page. For more detailed information about what blood test parameters are important to monitor while on testosterone replacement therapy, read: Testosterone Replacement Blood Test Targets and Their Management For blood tests to buy to monitor your testosterone replacement, check these lab test panels: Pre TRT Lab Test Panel TRT MALE Hormone/Wellness Follow Up Panel   Find out more about testosterone replacement therapy and what tests to perform   Video Transcript:   Hi everybody. Nelson Vergel with ExcelMale.com. Somebody gave me a really good idea on ExcelMale.com. It's a forum of over 14,000 members. We discuss everything related to testosterone replacement, nutrition, exercise, supplements, and other options like Trimix, hCG, and estradiol, et cetera. Somebody asked me, "Nelson, why don't you do a video of Nelson's Top 10 TRT Commandments?" And this is what I'm doing today. So, I'm going to include the different observations and suggestions I have after reading over 40,000 posts over the last three years on ExcelMale.com.   Testosterone is not a magic bullet.   The first one is testosterone is not a magic bullet, and I remind guys who have high expectations when they start testosterone replacement because they have low testosterone that things may improve in many ways, like improvements in sexual function and sex drive, energy, cognitive function, et cetera. But sometimes they may not improve as much as you expect because there are many factors involved, especially in sexual function, libido, and desire. I have another presentation or lecture that I did on the subject, so you can check it out on ExcelMale.com, or on the YouTube channel, also named ExcelMale.com. But there are over 12 factors involved in the sexual desire in men. Testosterone is one of them, obviously, so fixing the low testosterone issue tends to improve things in that department. However, if you're not sleeping well, if you have excessive weight, if you're drinking too much, if you have some illnesses like diabetes or cardiovascular disease, and if you're taking medications that may influence sex drive and erectile function like blood pressure medications, antidepressants, et cetera, you may not get all the benefits that one would expect from testosterone. So, check out that video, and I will get into more details on that subject.   Do not obsess about estradiol.   The second one is the second commandment: do not obsess about estradiol. Estradiol has become the hottest topic of discussion in men's health forums, and it's a topic that is filled with misconceptions and a lot of speculative information. We have data that shows that estradiol is a very important hormone in men. It is produced from the aromatization of testosterone into estradiol by aromatase enzyme in the liver and in fat cells. The body actually produces it for a good reason. There's a good reason why nature put estradiol downstream of testosterone. We need estradiol for bone health, cognitive health, sexual function, and drive, and even keeping good body composition and cardiovascular health.   A lot of men tend to freak out when they start testosterone and they think everything is related, all the side effects are related to high estradiol. Biggest problem I see is that very few men are actually testing their estradiol. Doctors are not monitoring estradiol levels, and if they are, they're using the wrong tests. They're using the immunoassay instead of the liquid chromatography/mass spectrometry assay. The former basically overestimates estradiol. Secondly, water retention and/or nipple sensitivity may have nothing to do with estradiol blood levels. So, men are jumping into starting treatment with an AI, when in fact their estradiol is under 40 picograms per milliliter, and they don't really need to be taking it.   Many crash their estradiol blood levels under 20 mg and they started losing sex drive and they start even getting fatter, because it's being studied in research that that's the case. So, do not obsess about estradiol. Estradiol is not an evil hormone. Estradiol is in our body for a reason. Do not over treat with anastrozole. I'm telling doctors, be very careful. They are giving people high doses, over 1mg a week of anastrozole to men. I'm also really concerned that many clinics out there, and I hope they're listening to me, are starting men on anastrozole at baseline when the fact is, they should have waited or they should way until follow up, after six or eight weeks follow up, and test the men's estradiol after they start testosterone replacement. And then, and only then, determine whether or not they have high estradiol over 40.   And as our testosterone blood levels increase, so does estradiol. Only 0.4% of testosterone becomes estradiol, so it's only logical that we should have higher estradiol when we have obviously higher testosterone levels because of injections or gels or creams or pellets. So that's my biggest concern out there. Estradiol is not an evil hormone and we need it. Do not obsess. Do not put all your ... do not blame it on all the side effects, especially if you're not testing the blood levels.   Monitor your hematocrit.   Your hematocrit. Monitor your hematocrit, is number three, very closely during the first six to eight months. Hematocrit is the proportion of the blood, the blood volume, that is made up of red blood cells. Testosterone replacement increases the production of red blood cells, which is a good thing if you have anemia. However, overproduction of red blood cells and an increase of hematocrit obviously, can increase the viscosity of the blood, and that can lead to cardiovascular risks and events. So, doctors pretty much monitor this parameter using a very cheap panel called the CBC, the cells and chemistry, cell count and chemistry profile. Very cheap. I think you can buy it on discountedlabs.com for $29, and that includes hematocrit. As your hematocrit starts climbing up closer to 52, it is time for you to go and donate blood at a blood center. What I'm seeing, I'm seeing a few problems there. I'm seeing men waiting too long so they get to 53, 54 in hematocrit and they get rejected for donations because the Red Cross and different blood centers have a limit of 53. So do not wait too long, otherwise you are not going to be able to donate blood for free.   If you do wait that long and your hematocrit is 53, 54, 55, whatever,. I've seen guys walking around with a 65, which is crazy. That's when doctors don't monitor that. Very upsetting. Anyway, if you get to those high levels, you're rejected by the nation and you will need an order from your doctor, like a prescription. Your doctor calls in any blood center and you may have to pay for the phlebotomy. It's called a therapeutic phlebotomy. You would probably have to pay. Many centers charge over $100. So, do not wait too long. Do not donate blood or do therapeutic phlebotomies more frequently than every three months, because that has been shown to decrease iron levels and ferritin, which may make you fatigued. So, if you are by any chance one of those unlucky men that really produces a lot of red blood cells, you may have your doctor check your iron or ferritin after you donate blood. If they are low, you can take an iron supplement for a few weeks until it's normalized.   The high hematocrit issue does not happen to everybody. Most men have a bump around three to four points higher. Most of the time, hematocrit stabilizes after 18 months. For instance, I've been using testosterone for over 34 years, and I've only donated blood once, and usually it's within the first six months that you know whether or not your hematocrit will be increasing. After six months, chances are... unless you increase the dose of testosterone, obviously, that you will stay pretty much stable there. So, it's not a long-term concern.   Inject testosterone using easier methods: subcutaneous or shallow IM.   Okay, the next commandment is exploring easier ways to inject, subcutaneously, shallowly, or IM, which is shallow intramuscular injections. The old way of injecting testosterone with a big old syringe of one and a half inches on your glutes or quads is pretty much gone. There is no need to suffer through painful injections with big needles anymore. We have good data that shows that subcutaneous injections under the skin with a very tiny, half-inch, 27-gauge, or even 29-gauge syringe are enough to get the body to absorb and get the blood levels up. So, there is no need to suffer. I inject in the shoulders at 90 degrees with a 27-gauge, one-inch... I'm sorry, half-inch syringe, and it's basically painless. Also, inject twice a week instead of injecting once a week. We are moving from the world where doctors were prescribing testosterone at 200 mg every two weeks to 100 to 150 mg, depending on the blood levels that you need, every week to 50 to 75 mg every two weeks. So, there are clinics that are prescribing it once a week, but there's nothing wrong with that. I really believe so. But many clinics are now splitting the dosage in two and also bringing in something called hCG, which I will talk about.   So, do not suffer. Do not dwell anymore with big needle syringes. You can inject under the skin. You can inject shallow, at half an inch, anywhere in the quads, delts, or even the glutes. And that will basically ensure that most of us adhere to a long-term therapy like testosterone replacement. As you all know, testosterone replacement is a long-term commitment—a lifetime commitment. Never cycle testosterone on and off.   The next commandment is obviously to never cycle testosterone replacement on and off. This is a lifetime commitment. If you stop testosterone replacement, your blood levels will crash. You will not produce testosterone for a while. People tend to email me to ask me how many weeks they're going to be in that situation. It is impossible to predict, impossible to predict. Some studies on bodybuilders have shown that it takes probably as long as you were on testosterone to get back to your baseline. Remember, all of us who started testosterone replacement had low testosterone at baseline. That's why we got into testosterone replacement. So even if your body tends to readjust after a few weeks and bring you back to what you used to be, you're probably going to have low testosterone. So, that's a discussion that I don't see doctors doing very well with patients that are about to start therapy. The fact that it is a commitment. No, you're not going to die if you stop testosterone. It is true that you're going to have a rough time with low libido, energy, and cognitive function for a few weeks, but things will move on and you'll basically go back to where you used to be before testosterone. Know your TRT blood tests.   The next one is knowing your blood tests and your schedule for blood testing. Yes, your doctor is supposed to remind you when you're supposed to get blood tests done, but it's not brain science; it's not rocket science. On ExcelMale.com, on discountedlabs.com, which is my company, my lab test company, you can get tests online anywhere in the United States, with exception to New York State, New Hampshire, and Massachusetts. Basically,  the northeastern states have passed legislation to limit options for consumers there, but in most states, you can go to discountedlabs.com, order your test there, pay by credit card or PayPal, and then we will email you the results after five to seven days when you give your blood at the lab or location closer to you.   You can check the scheduling for testosterone blood testing and monitoring on ExcelMale.com, also through one of my videos that I made on that subject, and also on the blog page of discountedlabs.com. But know, at least, that you have to have certain blood levels tested at baseline. The doctor will probably have you come in six to eight weeks later, just to see if a dosage is good enough for you. We'll ask you about all your symptoms to see if they're getting better. They may check not only hematocrit, estradiol, or other hormones but also see whether you need a readjustment or treatment with anastrozole, like I said before. So, it is also important to tell the doctor when you got your blood test done, your blood draw, because some guys forget that you should be getting your blood drawn right before your next injection. I'm talking about injections. Gels and creams are different because, since we're using the same dosage every day, it doesn't really matter when you get the blood drawn.   Do not change more than one variable at a time. The next one is do not change more than one variable at a time, and I do remind everybody on ExcelMale. We are all kind of our own guinea pigs. Everybody has to experiment on themselves. Every time we start something, we can change the dosage, the frequency, or other things, but we cannot change more than one variable if you want to measure the impact of that change on your quality of life. And that's one of the biggest problems I'm seeing. Some guys start changing things around and then they forget what worked and what didn't. I know it's a basic concept, but we all get very impatient, and that's another thing I'm seeing: the expectations are not well-described by doctors at baseline. So, we start changing things around without telling the doctor, and then obviously everybody's lost. You and the doctor are lost.   So, one variable at a time. It takes a while to do that. To be a good guinea pig with good experimentation, good dosage adjustment, et cetera, it takes a while. It takes like six months average to get to that point where you say, "Okay, I'm pretty much in the dosage I need to be, frequency I need to be, anastrozole dosage if I need, hCG," which I'll be speaking about hCG, et cetera, et cetera. So, don't be impatient. I know most of us who are getting onto testosterone replacement are a little desperate. We are not feeling that great; our relationships are hurting because of sexual dysfunction or things like that, and we need a quick fix. It is not a quick fix. It takes a while, but generally, you will have good results if you do it well   You can’t change what you don’t measure.   The next one is that you can't change what you can't measure. I remind people, even I forget how I felt last week. And when you're going to the doctor, you haven't seen the doctor in eight weeks or 12 weeks, and the doctor asks you how you have been feeling? You're pretty much are going to say how you've been feeling the past few days, since you remember that. So, I kept that in mind and we created an app, available on the Apple Store or on Google Play, called TRT Analyzer. That app basically sends you a text message or a message during the day to ask you how you felt, and there are different variables like fatigue, exercise intensity, libido, if you had a morning erection, et cetera. And then you can graph. Inside the app, there's a graphing option and you can actually email the graphs to your doctor, even print them, and bring them to your next office visit. That will show basically what happened in the last 12 weeks or eight weeks that you haven't seen the doctor.   So, doctors love it because it helps them. It helps them. They actually score with the graph on every single parameter. So TRT Analyzer. Download it for free. There's been over 600 downloads this month, so we're very happy. Another site that I created is called myhealthgraphs.com. Myhealthgraphs.com. We'll probably be changing it into an app too. But it's a website. It's not an app. It's a website where you can add your blood test results, whatever you're following: testosterone, estradiol, hematocrit, et cetera, and it will also plot values for your doctor to see too. Doctors are busy. Doctors need people who save them time. Doctors tend to treat patients that save them time better than those that do not save them time. Doctors are human beings. They are really busy with a lot of pressure, and we walk into a doctor's office expecting the doctor to remember everything we told them last time. Even though it's written, some of them don't even have time to read the notes that they made from last time.   So, be a good patient and monitor everything; chart everything. Bring your reports on how you feel to the doctor. Believe me, you're going to get treated better than those who do not. The same doctor can treat two different patients differently just based on that behavior. I wish I had data to show, but it's my speculation.   Protect your testicles.   The next commandment is protecting your testicles, fertility, and upstream hormones. Talk to your doctor about hCG, or human chorionic gonadotropin. I made a video also on hCG, so check it out also on ExcelMale.com or the ExcelMale YouTube channel. But the thing about testosterone replacement when we started was that our testicle Leydig cells shut down. They don't produce testosterone anymore and they also start decreasing their production of sperm and our fertility gets really impacted, especially if we are obviously looking forward to having another kid with your wife or your girlfriend. So, that's a concern. Many doctors wrongly make patients stop testosterone replacement when they want to have a kid, which is a horrible thing to do. Instead, we have now some data from Baylor College of Medicine, Lipshult’s team, that shows that using testosterone and hCG together can prevent not only the atrophy of the testicles, or the shrinkage of the testicles, but also improve fertility.   Lately, we have gotten some data on the fact that hCG can reactivate all the hormones that are upstream of testosterone that were shut down by testosterone replacement. Testosterone replacement is obviously a good thing to do, but it shuts down LH, FSH, pregnenolone, progesterone, and even DHEA in many cases. So, all those hormones upstream tend to be reactivated by the effect of hCG. I'm going to get into many details on that because I have a video in which, actually, I think I drew a diagram on a whiteboard so that you can understand more of what I am trying to say. Because a lot of doctors say, "No, I don't prescribe hCG. I think there's no use for that," and I think after you watch that video, you will be able to negotiate with your doctor about the use of hCG in a much more educated fashion.   Don’t stay behind on TRT advances.   The next commandment is: don't stay behind on advances. Actually, that's the last commandment—the 10th one. And this is an evolving field—testosterone replacement and men's health in general. We don't only talk about testosterone on ExcelMale.com. We talk about thyroid hormones, about DHEA, about pregnenolone and progesterone, about supplements, about exercise, about, you name it, diet, even some cognitive practices, et cetera. It's really amazing how many studies are coming through every week, and even for me, I read everything that I can every day. Even before going to bed, I print out a few papers. Even for me, it's hard to keep up, and I know that if I'm not staying current, I may be missing things that are coming through in the field and obviously will not be able to help others with my information. But don't stay behind on advances. Register on ExcelMale.com and learn more, because an educated patient pretty much gets a lot better care.   So, thank you so much for watching this video.  Subscribe to the ExcelMale YouTube channel and register on ExcelMale.com. Thank you.    

TRT Blood Work Tests For Monitoring Men on Testosterone Therapy Before undergoing testosterone replacement therapy (TRT), it’s vital to obtain a number of blood tests, which require a blood sample. The main blood tests to measure are total and free testosterone, hematocrit, PSA, estradiol, HDL cholesterol and others. Pre-treatment testing provides doctors with baseline values to diagnose hypogonadism (low testosterone) and assess overall health. Baseline tests are also conducted during TRT as well, ensuring that doctors can adjust TRT dose and catch side effects before they become an issue. Hematocrit Test PSA Test Estradiol Test Blood Pressure Estimated Glomerular Filtration Rate eGFR Liver Enzymes Test TSH Test Free T3 Test Total Testosterone Test Free Testosterone Test Ferritin Test HDL Cholesterol Test Click here for the Pre- TRT panel and the TRT panel (after 6-8 weeks on TRT) But do you know why these tests are needed or what they mean? Below, you’ll find some of the main blood tests that have been shown to be affected by TRT, so doctors measure them before and during therapy to prevent or manage side effects: Understanding Testosterone Blood Tests A testosterone blood test is a crucial diagnostic tool used to measure the level of testosterone in your blood. Testosterone, produced by the adrenal glands and gonads (testes in men and ovaries in women), plays a vital role in the development and maintenance of male reproductive tissues, bone density, and muscle mass. This test is commonly employed to diagnose and monitor conditions related to abnormal testosterone levels, such as hypogonadism (low testosterone) and hyperandrogenism (high androgen levels). There are several types of testosterone blood tests, each serving a unique purpose. The total testosterone blood test measures the overall amount of testosterone in your blood, including both bound and free testosterone. The free testosterone test measures the testosterone that is not bound to proteins in the blood, making it readily available to the body’s tissues. Additionally, the bioavailable testosterone test measures the testosterone that is available to the body’s tissues and is not bound to sex hormone-binding globulin (SHBG). Understanding these different tests helps in accurately diagnosing and managing conditions related to testosterone levels. Why Monitor Testosterone Levels on TRT? Testosterone replacement therapy (TRT) is a medical treatment designed to increase testosterone levels in individuals with hypogonadism. Monitoring testosterone levels on TRT is essential to ensure the treatment’s effectiveness and safety. Here are some key reasons why monitoring testosterone levels on TRT is crucial: Ensuring Normal Testosterone Levels: The primary goal of TRT is to elevate testosterone levels to within the normal range. Regular monitoring helps ensure that the treatment is effective and that testosterone levels are neither too high nor too low. Adjusting Dosage: Monitoring testosterone levels allows healthcare providers to adjust the TRT dosage as needed, ensuring optimal treatment outcomes. Identifying Side Effects: TRT can cause side effects such as acne, hair loss, and mood changes. Regular monitoring helps healthcare providers identify these side effects early and adjust the treatment plan accordingly. Monitoring Long-term Effects: TRT can have long-term effects on the body, including changes in bone density and cardiovascular health. Regular monitoring helps healthcare providers track these changes and make necessary adjustments to the treatment plan. By keeping a close eye on testosterone levels, healthcare providers can ensure that TRT is both effective and safe for the patient. Hematocrit Test Hematocrit refers to the proportion or percentage of red blood cells present in your total blood volume. Your red blood cells are responsible for transporting oxygen and nutrients throughout your body. Without enough red blood cells (a condition known as anemia), your body suffers from oxygen and nutrient deprivation. On the flip side, too many red blood cells cause high hematocrit that can turn your blood into a thick slurry that can seriously affect your circulation. A normal hematocrit for an adult male is anywhere from 42 to 54%. If your hematocrit results are lower than 41%, it means you have low proportion of red blood cells. Over 55%, and you have too many. One of the primary side effects of TRT is the production of too many red blood cells, leading to high hematocrit. High hematocrit can be lowered by blood donation or therapeutic phlebotomies (ordered by your doctor if you are not allowed to donate blood at a blood bank due to exclusion criteria). Just be careful: Do not donate blood more frequently than every 2 months since this can deplete your iron stores and make you tired. This test is included in CBC (chemistries and blood count) panel.   PSA Test Prostate-specific antigen, or PSA, is a protein that is produced in your prostate gland. It's designed to liquefy semen, which is necessary for the free swimming of sperm in ejaculate. It may also help to dissolve the cervical mucus to allow the sperm to enter the uterus for the purposes of impregnation. Normal PSA levels for men under 40 range between 0 and 2 ng/mL, while PSA levels for men older may raise slowly. A PSA test helps to detect extra-high levels of this protein. High PSA levels are the result of disruptions of the cellular structure of the prostate gland, which can be caused by a number of diseases--including cancer or an infection. Benign prostate hyperplasia, urinary retention, and prostatitis can be the cause of high PSA, but your doctor will want to monitor your PSA levels just to be sure the problem isn't a serious one. If PSA levels are high, your doctor may recommend a prostate exam or even a biopsy to determine the cause of your elevated PSA levels. TRT is contraindicated for men with PSA greater or equal than 4. Estradiol Test Estradiol is the primary female sex hormone, but did you know that the male body produces it from testosterone? It is produced in fat and liver cells from testosterone via the aromatase enzyme. Due to several factors like fat content, liver disease, medication effects and genetics, some men may produce more estradiol from testosterone than other men. New information has shown that men require a special estradiol test called sensitive estradiol test. The regular test used for women may overestimate estradiol in men due to interference of inflammatory markers like C-Reactive Protein (CRP). For the average man, estradiol levels should remain lower than 50 pg/mL, although there is little evidence of what the top of the estradiol test is in men who do not have low testosterone. If estradiol levels are higher than 50 and you start showing symptoms of high estradiol (gland growth under nipples, too much water retention), it may be necessary to take an estrogen blocker (aromatase inhibitor) . However, taking aromatase inhibitor like anastrozole should be done with careful monitoring of sensitive estradiol blood test since overdosing can cause health issues in men. A few of the reported effects of low estradiol levels include: joint pain, eye fatigue, loss of erections, limited sensitivity in the penis, sleepiness, and excessive urination. Long term low estradiol can decrease bone density. A few of the reported effects of high estradiol levels (in the presence of low testosterone) include: soft erections, water retention, excessive sweating, insomnia, bloating, hot flushes, brain fog, and high blood pressure. Blood Pressure The term "blood pressure" refers to the pressure in your arteries during the beating of your heart. There are two numbers: 1) The top number, or systolic, tells you the pressure in your arteries when the muscles of your heart contract. 2) The bottom number, or diastolic, tells you the pressure in your arteries when your heart relaxes and refills with blood in the pause between heartbeats. Healthy blood pressure is lower than 120/80. If your blood pressure rises anywhere from 121/81 to 139/89, you are pre-hypertensive. Crack 140/90, and you suffer from hypertension. Anyone over 180/100 is in serious hypertensive crisis. TRT can increase water retention, sodium uptake and hematocrit is some men, factors that can increase blood pressure. If your blood pressure rises too much, it can place excess strain on your blood vessels and potentially cause a crack. Should the blood vessels crack, the resulting clotting (your body's attempt to stop internal bleeding) can interfere with healthy blood flow--potentially leading to heart attacks, strokes, peripheral arterial disease, and other cardiovascular problems. Estimated Glomerular Filtration Rate eGFR Your glomerular filtration rate (GFR) is an indication of your kidney function. The higher your GFR, the more blood passes through the glomeruli (the filters in your kidneys that remove waste from your blood) every minute. A healthy GFR is anywhere from 90 to 120 mL/min/1.73 m2. Senior citizens will often have lower GFR levels, due to the fact that kidney function decreases with age. Note: It's important to understand that each lab has its own measurements, so what is "healthy" to some may be low with others. If your GFR drops below 60 and remains at that low level for more than 3 months, it's an indication of chronic kidney disease. Liver Enzymes Test Your liver is responsible for a number of important functions, such as breaking down nutrients, producing the proteins that clot your blood, and eliminating toxins. The enzymes produced by your liver are responsible for carrying out these functions. However, if the liver suffers damage, those enzymes tend to leak into your bloodstream. High levels of liver enzymes are a good indicator that your liver has been damaged ALT and AST are the two most common liver enzymes. AST should be anywhere from 10 to 40 units per liter of blood, and ALT should be from 7 to 56 units in every liter of blood. Be aware that exercise may increase these two enzymes in a non-clinically significant way. Only oral testosterone replacement has been shown to increase liver enzymes. TSH Test Thyroid-stimulating hormone, or TSH, is a hormone produced by your pituitary glands in order to stimulate your thyroid gland to produce T3 and T4 hormones. These thyroid hormones play a role in your body's metabolic function. Normal TSH levels should be between 0.5 and 3.5 U/ml (different guidelines show different upper TSH levels). Many educated doctors test for free T3 and free T4 (the unbound thyroid hormones) when TSH is over 3 since they believe this will provide a better picture of thyroid health. If TSH levels are low, it's an indication of hyperthyroidism. If TSH levels are very high, it's an indication of hypothyroidism. Free T3 Test Free T3 refers to unbound T3 (thyroid) hormone in your bloodstream. T3 is the more important of the thyroid hormones, but it can only be produced from T4. This means your body needs to produce T4 then turn it into T3. Once the T3 is unbound from the protein molecules, it can then be used by your body to stimulate metabolic function in all your cells. Normal Free T3 levels are anywhere from 230 to 620 pg/d. If free T3 is low, your doctor may test for thyroid antibodies to ensure that you do not have an autoimmune disease called Hashimoto's. Total Testosterone Test Total testosterone test measures refer to all of the testosterone circulating in your body. Some testosterone circulates freely, while some is bound to protein molecules. The whole point of TRT is to increase your testosterone levels. A normal testosterone range is anywhere from 350 to 1070 ng/dL. Low testosterone can cause low mood, sex drive, fatigue and other symptoms. In some men, too much testosterone in the body can lead to excessive estradiol, acne, oily skin, hair loss, testicular shrinking, and increased blood viscosity due to high red blood cells. Free Testosterone Test Free testosterone refers to the testosterone circulating in your body that is NOT bound to protein molecules like albumin and sex hormone binding globulin. It is believed that your body is more easily able to use free testosterone. It usually runs at about 2 percent or higher of total testosterone. Testosterone Test Results and Interpretation Testosterone test results are typically reported in nanograms per deciliter (ng/dL). The normal range for testosterone levels varies depending on age, sex, and the laboratory performing the test. Here are some general guidelines for interpreting testosterone test results: Normal Testosterone Levels in Adult Men: 300-1,000 ng/dL Normal Testosterone Levels in Adult Women: 15-70 ng/dL Low Testosterone Levels: Less than 300 ng/dL in men or less than 15 ng/dL in women High Testosterone Levels: Greater than 1,000 ng/dL in men or greater than 70 ng/dL in women It’s important to note that testosterone levels can fluctuate throughout the day and may be influenced by various factors such as sleep, stress, and exercise. Therefore, a single testosterone test result may not provide a complete picture of an individual’s overall testosterone levels. Healthcare providers may recommend repeat testing to confirm the results and monitor changes in testosterone levels over time. Understanding your testosterone test results and their implications can help you and your healthcare provider make informed decisions about your treatment plan. Ferritin Test Ferritin is a protein that is responsible for storing iron and releasing it when your body needs to produce red blood cells. If you suffer from an iron deficiency, your ferritin level are likely to be low. Ferritin levels also fall when you give blood (a common method of lowering hematocrit). Normal ferritin levels for men is anywhere from 30 to 300 ng/mL. However, if ferritin levels are too low (after a blood donation), your body is unable to store iron, meaning it will not be able to produce new red blood cells. If you are considering donating blood to lower your hematocrit, it's a good idea to check your ferritin levels first. Your body needs enough of this protein to reproduce the red blood cells you are donating HDL Cholesterol Test High density lipoprotein, also known as HDL cholesterol, is the "good" type of cholesterol. It's responsible for counteracting the effects of low-density lipoprotein, or LDL cholesterol. Low HDL and high LDL may lead to a wide range of cardiovascular problems, including blocked arteries, stroke, heart attack, and peripheral arterial disease. According to experts, even a 5 mg/dL decrease in HDL cholesterol can increase your risk of coronary heart disease by as much as 25% Normal HDL cholesterol levels are anything above 40 mg/dL. Unfortunately, decreased HDL is a known side effect of TRT in some men using higher testosterone doses. Your doctor will monitor HDL cholesterol via a lipid panel in order to ensure that you are not at risk for heart disease. Educate yourself about testosterone replacement side effects