question from a user
What is your opinion about high hematocrit, including high RBC and high hemoglobin? There seems to be some debate about whether high values on TRT are genuine threat or not. The argument appears to be that modern medicine is assuming that the clotting risk is as dangerous as in polycythemia vera, but there might not be enough evidence to validate that assumption. Are there levels that you would consider dangerous regardless of the underlying cause? What do you think of giving blood to resolve high values?
AlphaMD's Answer
There certainly is debate regarding how relevant high hematocrit from TRT is as a risk factor. So far, there is no evidence to suggest it is as concerning as high hematocrit from other causes (ie COPD, cancer, smoking, etc).On its face, high hematocrit should still be considered a potential risk factor due to the general concept of fluid dynamics. A thicker fluid will have trouble passing through a narrowed artery. If you have a atherosclerotic narrowing of a vessel somewhere in your body, it may not cause a problem until the fluid trying to pass through gets too thick.No doctor can tell you that high hematocrit is perfectly safe, though what limited scientific data we have on it suggests the risk is nowhere near as high as we thought it was. Further study is definitely needed.Many men get symptoms of high hematocrit such as hot flashes, facial redness/flushing, and headaches. Blood donation would help with this. Because red blood cells constantly are being created, you typically need to donate every 8 weeks or so in order to keep a stable hematocrit while maintaining the same TRT dose.
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