Lab work should I be concerned?

[readalot]

I don't know what you are trying to get at. E2 is one of the theories behind why haematocrit rises when you use exogenous androgen. The lowering MCH and MCV and increasing RDW tells me some erythropoiesis is happening. Testosterone has a few more theories, one of which you posted. There are studies that show E2 promoting haematopoietic stem cell proliferation. you can google them. He asked What he should be concerned about and has been told.

Pubertal upregulation of erythropoiesis in boys is determined primarily by androgen

To study the relative roles of androgens and the growth hormone–insulin-like growth factor I (GH-IGF-I) system in the regulation of erythropoiesis in …

www.sciencedirect.com

Study design
We treated 23 boys with constitutional delay of puberty with low-dose testosterone (T), in combination with either a potent aromatase inhibitor, letrozole (Lz; 2.5 mg/d), or placebo (P). The study design was randomized, double-blinded, and placebo-controlled between the treated groups. Treatment with T + Lz was associated with high T and low IGF-I concentrations, whereas treatment with T + P resulted in moderately increased T and high IGF-I concentrations.

https://www.sciencedirect.com/science/article/abs/pii/S0960076008002914

Circulating T alone is capable of and sufficient to influence erythropoiesis, especially at supraphysiological dosage, while circulating E2 have not the same effect on erythropoietic parameters, suggesting the hypothesis that the erythropoietic changes induced by androgens are not mediated via its aromatization to estrogens.

Aromatase Inhibitor-Induced Erythrocytosis in a Patient Undergoing Hormonal Treatment for Breast Cancer

Aromatase inhibitors (AIs) are most commonly used for breast cancer patients with hormone receptor positive disease. Although the side effect profile of aromatase inhibitors is well known, including common side effects like arthralgia, bone pain, arthritis, hot flashes, and more serious problems...

www.hindawi.com

Had to attach this...

Crack plus AI not a great combo.

At the time of consultation, she reported feeling well except for intermittent headaches and difficulty sleeping. She denied neurologic, cardiovascular, and respiratory symptoms. She had no erythromelalgia or constitutional symptoms. She also had no evidence of bleeding diathesis or recent infections. She smoked crack cocaine about twice per week and also endorsed drinking about 3 to 12 ounces of beers daily. She had a 2-pack-year smoking history but quit 1 year prior to consultation. She endorsed using marijuana.

T vs DHT

https://journals.physiology.org/doi/prev/20140729-aop/epdf/10.1152/ajpendo.00184.2014

 

[Middus]

You aren't a native english speaker right? The way in which this sentence is worded it sounds like "estradiol is What stimulates rbc's" as in, estradiol is The primary reason why rbc's and htc elevate on cycle. Do you understand now why @readalot was concerned?

Nah, It's not really about native speaking (Anglophone WA, England and US). I was trying to avoid running useless commentary while assessing the results as a whole. I eventually ended up deleting some of what I wanted to say and left that there. Didn't want to go and start typing alarmist stuff about the profile approaching secondary polycythemia, and how rising E2 in the midst of exogenous Androgens can lead to that. Just simply said watch E2, and why, because E2 has (also) been shown to be a contributing factor.
All this talk because i didn't add 'also', and bruv interpreted it as 'main reason'.
Prolonging discourse like this just lengthens threads, and invited others to flex pedagogical ability, without actually helping OP.

 

[buck]

While your AST/ALT are out of range they are nothing that any Dr. i have dealt with would worry about. I would donate blood to keep RBC and hemo in check as that is what i have always done. Others will have a different opinion.

 

[Middus]

Pubertal upregulation of erythropoiesis in boys is determined primarily by androgen

To study the relative roles of androgens and the growth hormone–insulin-like growth factor I (GH-IGF-I) system in the regulation of erythropoiesis in …

www.sciencedirect.com

https://www.sciencedirect.com/science/article/abs/pii/S0960076008002914

Aromatase Inhibitor-Induced Erythrocytosis in a Patient Undergoing Hormonal Treatment for Breast Cancer

Aromatase inhibitors (AIs) are most commonly used for breast cancer patients with hormone receptor positive disease. Although the side effect profile of aromatase inhibitors is well known, including common side effects like arthralgia, bone pain, arthritis, hot flashes, and more serious problems...

www.hindawi.com

Had to attach this...

Crack plus AI not a great combo.



T vs DHT

I am not going to go back and forth with you. You are taking things in isolation and assume every other thing is controlled for. I would suggest you look at studies in NORMAL individuals. You're posting things in people with deficiencies and undergoing replacements. This is not exactly a normal healthy individual loading on testosterone.
An example of a difference in Health and Pathology is Tesamorelin. The normal folks who take tesa will tell you Fast for so and so before and fast for so and so after. Meanwhile the folks on HIV therapy taking egrifta were given none of such instructions and achieved the desired fat recomposition. (I'm using normal and healthy interchangeably here).
Pathologic states and Healthy states may induce different results

 

[Middus]

Pubertal upregulation of erythropoiesis in boys is determined primarily by androgen

To study the relative roles of androgens and the growth hormone–insulin-like growth factor I (GH-IGF-I) system in the regulation of erythropoiesis in …

www.sciencedirect.com

https://www.sciencedirect.com/science/article/abs/pii/S0960076008002914

Aromatase Inhibitor-Induced Erythrocytosis in a Patient Undergoing Hormonal Treatment for Breast Cancer

Aromatase inhibitors (AIs) are most commonly used for breast cancer patients with hormone receptor positive disease. Although the side effect profile of aromatase inhibitors is well known, including common side effects like arthralgia, bone pain, arthritis, hot flashes, and more serious problems...

www.hindawi.com

Had to attach this...

Crack plus AI not a great combo.



T vs DHT

https://oss.jomh.org/files/article/20240130-192/pdf/JOMH2023081701.pdf

 

[Jin23]

Nah, It's not really about native speaking (Anglophone WA, England and US). I was trying to avoid running useless commentary while assessing the results as a whole. I eventually ended up deleting some of what I wanted to say and left that there. Didn't want to go and start typing alarmist stuff about the profile approaching secondary polycythemia, and how rising E2 in the midst of exogenous Androgens can lead to that. Just simply said watch E2, and why, because E2 has (also) been shown to be a contributing factor.
All this talk because i didn't add 'also', and bruv interpreted it as 'main reason'.
Prolonging discourse like this just lengthens threads, and invited others to flex pedagogical ability, without actually helping OP.

We don't know you. There is a huge influx of complete noobs and semi knowledgeable members, who are just smart enough to be dumb enough, on the forum lately. Seriously, it's getting pretty bad, so we automatically just assume the worst. You seem intelligent enough to understand this concept, right?; that newcomers must act somewhat different then established members - so I'm decoding your semi rant just as unnecessary exposition to your brain cells and as hubris. Take it easy.

 

[Middus]

We don't know you. There is a huge influx of complete noobs and semi knowledgeable members, who are just smart enough to be dumb enough, on the forum lately. Seriously, it's getting pretty bad, so we automatically just assume the worst. You seem intelligent enough to understand this concept, right?; that newcomers must act somewhat different then established members - so I'm decoding your semi rant just as unnecessary exposition to your brain cells and as hubris. Take it easy.

I was asked a question and I answered it. I do not know anyone here, however I have a healthy grasp of chem-path and how to marry it with med hx. It is what it is. One mans explanation is another mans rant.

 

[DECLAN]

OP, if you use the search function, you will find the numerous threads discussing this common side effect of ped use.

Like many here, I am also in the process of finding the right protocol to control this problem. For some people, donating is enough, for some of us its not. Doctors can’t even agree or recommend a proper solution for it, my urologist just ordered me to stop trt till the numbers return to normal.

Now, after researching, all I found are studies not replicated again, even logs from fellow ped users are rare. All we have are recommendations from vets and anecdotal reports which vary widely.

You can research further and decide on what to use yourself, however, if you are looking for a study that says which drugs or supplements actually work; you have to try it yourself to know what can work for you.

 

[Jin23]

I was asked a question and I answered it. I do not know anyone here, however I have a healthy grasp of chem-path and how to marry it with med hx. It is what it is. One mans explanation is another mans rant.

It was a rant. Look at you wining and explaining yourself out of it:

All this talk because i didn't add 'also', and bruv interpreted it as 'main reason'.
Prolonging discourse like this just lengthens threads, and invited others to flex pedagogical ability, without actually helping OP.

Instead of just saying my bad, should have worded it better. Ego my friend isn't a signifier of high intelligence.

 

[Bumpygooch]

2 pages of replies, only 2 mentions of donating. Regardless of whether or not it’s the long term fix, it is the immediate fix to mitigate those numbers. For some, it’s the only solution. Been to a hematologist for this purpose, no underlying medical condition. Told me to donate as frequently as I needed to keep it under control. Supplementation did nothing. There was a stretch not long ago where I had to donate every 4 weeks. My last donation was about 2 weeks ago, almost 7 weeks from previous donation, my HGB was 15. So, I can stretch to 8 weeks now. That’s on about an 800mg/week total load. Sometimes it’s just cyclical. Your liver enzyme numbers are insignificant, really.

 

[DECLAN]

2 pages of replies, only 2 mentions of donating. Regardless of whether or not it’s the long term fix, it is the immediate fix to mitigate those numbers. For some, it’s the only solution. Been to a hematologist for this purpose, no underlying medical condition. Told me to donate as frequently as I needed to keep it under control. Supplementation did nothing. There was a stretch not long ago where I had to donate every 4 weeks. My last donation was about 2 weeks ago, almost 7 weeks from previous donation, my HGB was 15. So, I can stretch to 8 weeks now. That’s on about an 800mg/week total load. Sometimes it’s just cyclical. Your liver enzyme numbers are insignificant, really.

You have to be careful with blood donations too, there are lots of vets who crashed their feritin which made them feel worse.

So, again it’s individual. For some it works, for others it creates another problem. In my case, donating every 3 months few days before blood test didn’t keep my rbc, h and h low consistently. 4 donations and results are half good, half elevated.

Now, after reading threads upon threads of different guys who shared what worked for them, as well as discussions by people who worked with various currents I am following Doggcraps protocol, using IP6 and nattokinase. I also added naringin and grapefruit seed extract.

I have a test scheduled in a 2 weeks, I should know if it lowers mine. If not I will try Enarapril which is a bp med that other bodybuilders said worked for them.

 

[Burly]

Do you do cardio and drink enough water daily ?

 

[Middus]

2 pages of replies, only 2 mentions of donating. Regardless of whether or not it’s the long term fix, it is the immediate fix to mitigate those numbers. For some, it’s the only solution. Been to a hematologist for this purpose, no underlying medical condition. Told me to donate as frequently as I needed to keep it under control. Supplementation did nothing. There was a stretch not long ago where I had to donate every 4 weeks. My last donation was about 2 weeks ago, almost 7 weeks from previous donation, my HGB was 15. So, I can stretch to 8 weeks now. That’s on about an 800mg/week total load. Sometimes it’s just cyclical. Your liver enzyme numbers are insignificant, really.

This was what I wanted to avoid. Some people just want to start unhelpful side arguments.
I believe Declan has given the OP the best advice. I was going to add that for some people, blood donation can also trigger more rbc synthesis, which will not ease HCT worries. There's nothing set in stone no golden rules per mitigation. Essentially monitor your values and try what others have done to bring values back to normal and see if it works for you.

 

[readalot]

I am not going to go back and forth with you.

Ok.

Some of your test is being converted to estrogen

True

rbc count isn't worrisome

How about the Hgb/Hct without knowing anything about this guy?

don't know what you are trying to get at.

The dude is running 500 mg/week of androgens (250 test / 250 drostanolone) and you mention his E2 may be the issue. A newbie may conclude from your comments that he can just drop his E2 with an AI and voila problem solved. No it won't.

I provided plenty of info on how the human body responds to supraphysiolgic androgen use.

Sorry if I misunderstood your point. I probably misunderstood that your comments were providing false hope and rationalizing drug abuse when they actually weren't. My bad.

If OP is having shortness of breath or other blood hyperviscosity symptoms he should donate short term. Longer term you gotta lower your dose unless you find the polypharmacy system that works for you, or your confident your plasma viscosity will allow you to run higher Hct.

That is all.

 

[Bumpygooch]

This was what I wanted to avoid. Some people just want to start unhelpful side arguments.
I believe Declan has given the OP the best advice. I was going to add that for some people, blood donation can also trigger more rbc synthesis, which will not ease HCT worries. There's nothing set in stone no golden rules per mitigation. Essentially monitor your values and try what others have done to bring values back to normal and see if it works for you.

The issue is everything everyone claims to mitigate the issue is anecdotal. Telmisartan, naringin, nattokinase, I’ve taken it all, none of it has worked. The only thing proven to mitigate it is donating, whether or not that actually creates a cascade of new events is anecdotal as well. I’ve donated on a Thursday, labs on Monday had my HCT back at 53, that was at 200mg/week total load. This time with an over 800mg/week load, after 7 weeks, my HGB was 15(HCT 45). The reason I’d suggest donation for you immediately is you may lose the option soon if your HGB gets any higher. Then your options are a script for a therapeutic phlebotomy or a deli container in your bathroom with tubing you bought off Amazon watching a YouTube video.

 

[readalot]

The only thing proven to mitigate it is donating

Donating short term and lowering dose longer term. The ferritin issue has already been hit on. If that tanks then MCHC will drop and Hct /Hgb ratio will skew even worse.

Hct is but one parameter in the equation. Plasma viscosity the other big part of whole blood viscosity. I provided this link to OP. Maybe he will check it out...

Grapefruit vs. Hematocrit

In your research, have you come across any promising ways to lower H/H in steroid users? @readalot any data on enarapril’s effects on lowering H and H?

thinksteroids.com

 

[Bumpygooch]

Donating short term and lowering dose longer term. The ferritin issue has already been hit on. If that tanks then MCHC will drop and Hct /Hgb ratio will skew even worse.

Hct is only part of the equation. Plasma viscosity the other big part of whole blood viscosity. I provided this link to OP. Maybe he will check it out...

Grapefruit vs. Hematocrit

In your research, have you come across any promising ways to lower H/H in steroid users? @readalot any data on enarapril’s effects on lowering H and H?

thinksteroids.com

Reducing dose is where I drew the line. My HGB was as high as 20 on only 175mg/week. I chose more frequent donations. There are 2 blood banks near me, of course they don’t share records, so, I bounced back and forth 4 weeks apart. This was approved by the hematologist as there was no real corresponding iron/ferritin concern. You can see my most recent HGB/HCT results before donation on over 800mg/week load. I’ll grab the numbers from the ER the other night, HCT was still in the mid 40s almost 2 weeks after most recent donation. I think this is even more highly individualized than we may have thought, and I think it may be cyclical as well. My opinion anyway from 5 years of playing with my blood.

 

[DECLAN]

The issue is everything everyone claims to mitigate the issue is anecdotal. Telmisartan, naringin, nattokinase, I’ve taken it all, none of it has worked. The only thing proven to mitigate it is donating, whether or not that actually creates a cascade of new events is anecdotal as well. I’ve donated on a Thursday, labs on Monday had my HCT back at 53, that was at 200mg/week total load. This time with an over 800mg/week load, after 7 weeks, my HGB was 15(HCT 45). The reason I’d suggest donation for you immediately is you may lose the option soon if your HGB gets any higher. Then your options are a script for a therapeutic phlebotomy or a deli container in your bathroom with tubing you bought off Amazon watching a YouTube video.

I wish donations is all we need to do to control this. Maybe for you it does but for some, me included it doesn’t. Even hematologist don’t recommend it because of the catch 22 effect on rbc production and how it lowers feritin to dangerous levels.

Sadly, even lowering the dose doesn’t help for some either, there are people on real trt dose who still have this problem. My urologist actually asked me stop all together to mitigate the issue.

This is what I personally know for sure, I have never had issues on elevated H and H back when I am doing the old school time on time off after PCT method 10-15 years ago. This problem only occurred after a year on trt.

 

[readalot]

Sadly, even lowering the dose doesn’t help for some either, there are people on real trt dose who still have this problem.

Yes lowering the Test dose does include lowering it to Zero or to actual TRT. Hemochromatosis (homozygous and sometimes heterozygous carriers) plus AAS can be trouble. But some can do TRT plus regular phlebotomy.

Figure - PMC

Hereditary hemochromatosis is a genetic disease that progresses silently. This disease is often diagnosed late when complications appear. Hypogonadotropic hypogonadism (HH) is one of the classical complications of hemochromatosis. Its frequency is ...

www.ncbi.nlm.nih.gov

 

[Bumpygooch]

I wish donations is all we need to do to control this. Maybe for you it does but for some, me included it doesn’t. Even hematologist don’t recommend it because of the catch 22 effect on rbc production and how it lowers feritin to dangerous levels.

Sadly, even lowering the dose doesn’t help for some either, there are people on real trt dose who still have this problem. My urologist actually asked me stop all together to mitigate the issue.

This is what I personally know for sure, I have never had issues on elevated H and H back when I am doing the old school time on time off after PCT method 10-15 years ago. This problem only occurred after a year on trt.

Which is why I qualified as being highly individual. I provided my own personal anecdotes, along with the advice of my hematologist. I provided my own personal dosages and responses to those dosages. The fact that my numbers were somewhat uncontrollable at a TRT dose while being in the mid level of the reference range on a test dosage of more than double the highest TRT dosage correlates to nothing that makes any sense. This is a complete YMMV scenario and almost anything anyone says about themselves will not apply to anyone else, short of donating(temporarily), and/or coming off completely. I think that’s the only logical conclusion that can be drawn here. This is almost quite literally a poke and hope as you go.