Q: Recently I’ve been diagnosed with elevated hematocrit. What shall I do next?
A: Androgens treat anemia.
This was a classic indication of their implementation in medicine, way before synthetic EPO was manufactured.
Therefore, long term of testosterone use either as replacement therapy, or abusing steroids within a cycle, will have an impact in red bone marrow.
This process is known as erythropoiesis and involves stimulation of EPO in kidneys, by androgens.
The result will be secondary erythrocytosis, coming from androgens exogenous use.
Erythrocytosis involves elevation of erythrocytes synthesis, therefore RBCs elevate in number and so does their percentage in blood, known as hematocrit.
For men this reflects in hemoglobin >18ng/dl and hematocrit>54%.
Hemoglobin is the protein carrier of oxygen to the tissues and myoglobin to the skeletal muscles.
Hemoglobin is an accurate number that is not affected by hydration status, like hematocrit.
Usually hematocrit is the result of x3 hemoglobin and in case we are dehydrated, this reflects in higher hematocrit (>x3).
In other words, plasma becomes concentrated and hematocrit pseudo elevates.
The accurate medical term of elevated hemoglobin, hematocrit and erythrocytes is known as erythrocytosis.
However when platelets, known as thrombocytes also elevate, this condition is known as polycythemia.
This is something more critical for thrombosis or coagulation issues, since thrombocytes are responsible for the formation of thrombus.
Therefore it’s important to clarify between these two clinical cases, diagnosed by the number of platelets (>450K) and EPO levels.
Under elevated hemoglobin we should follow certain prevention steps such as
- Hydrate properly, in order to avoid a denser blood that elevates viscosity
- Use salicylic acid, known as aspirin, preferably film coated of low dose (100mg) with breakfast
- Alternatively for those who face enzymatic deficiency of G6PD, they can use fish oil (DHA/EPA PUFA)) omega 3, that has similar effects (inhibition of PGs).
- Blood donate every ninety days (twelve weeks, three months), in order to relief bone marrow. Occasionally when hemoglobin levels rise > 18g/dl, the procedure is named as ”therapeutic phlebotomy’’, because blood has to be wasted and not transfused instead
- Use pentoxifylline 400mg with breakfast that improves nitric oxide synthesis and enhances optimal blood flow. This medication isn’t a blood thinner, yet it improves circulation and avoids Deep Venous Thrombosis risk incident.
- Skip red meat consumption in order to lower hemoglobin synthesis.
Iron, cobalamine and folic acid are the main substrates for hemoglobin synthesis.
Moreover, a low protein diet might help to lower protein synthesis of hemoglobin as well - Quit smoking, since it kicks EPO by CO and all smokers develop elevated hematocrit.
- Treat Obstructive Sleep Apnea and snoring, leading to hypoxia and kick in EPO.
Usually this phenomenon occurs when neck circumference >40cm and air forms turbulence as it passes in pharynx to the larynx and trachea.
This is treated either by a drop in body weight, by sleeping to the side (avoiding dropping of the jaw), or by the use of a CPAP mask while sleeping. - Lower your TRT dose and adjust it preferably to smaller more frequent doses, known as micro dosing. This will have a lesser impact in EPO and bone marrow as a result. Mind that too frequent blood donation will have a rebound effect.
RBCs life span is 90 days, meaning that this ”technical anemia” we provide, will send a signal to the bone marrow for further production of erythrocytes, in case the drop of blood takes place sooner.
Furthermore, iron gradually lowers, leading to lower ferritin stores and fatigue eventually
Managing and treating erythrocytosis is a classic thing during androgens use and the majority of users face it more or less. Of course some are genetically proned to low H/H levels, such as in case of thalassemia (MCV<70).