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    Default Manage high red blood



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    Polycythemia is an excessive production of red blood cells. With polycythemia the blood becomes very viscous or "sticky," making it harder for the heart to pump. High blood pressure, strokes and heart attacks can occur.

    



    The association between testosterone replacement therapy and polycythemia has been reported for the past few years as this therapy has become more mainstream. In addition to increasing muscle and sex drive, testosterone can increase the body's production of red blood cells. This hematopoietic (blood-building) effect could be a good thing for those with mild anemia.

    

Although all testosterone replacement products can increase the amount of red blood cells, the study showed a higher incidence of polycythemia in those using intramuscular testosterone than topical administration (testosterone patch was the main option used -- no gels). Smoking has also been associated with polycythemia and may contribute to the effects of other risk factors.

    





    Below is an excerpt from my book, Testosterone: A Man's Guide, further detailing the prevention and management of polycythemia.

Preventing and Managing Polycythemia


    It's important to check patients' hemoglobin and hematocrit blood levels while on testosterone replacement therapy. As we all know, hemoglobin is the substance that makes blood red and helps transport oxygen in the blood. Hematocrit reflects the proportion of red cells to total blood volume. A hematocrit of over 52 percent should be evaluated. Decreasing testosterone dose or stopping it are options that may not be the best for assuring patients' best quality of life, however. Switching from injectable to transdermal testosterone may decrease hematocrit, but in many cases not to the degree needed.

    



    The following table shows the different guideline groups that recommend monitoring for testosterone replacement therapy. They all agree about measuring hematocrit at month 3, and then annually, with some also recommending measurements at month 6 after starting testosterone (it is good to remember that there is a ban on gay blood donors in the United States).



    Many patients on testosterone replacement who experience polycythemia do not want to stop the therapy due to fears of re-experiencing the depression, fatigue and low sex-drive they had before starting treatment. For those patients, therapeutic phlebotomy may be the answer. Therapeutic phlebotomy is very similar to what happens when donating blood, but this procedure is prescribed by physicians as a way to bring down blood hematocrit and viscosity.

    




    A phlebotomy of one pint of blood will generally lower hematocrit by about 3 percent. I have seen phlebotomy given weekly for several weeks bring hematocrit from 56 percent to a healthy 46 percent. I know physicians who prescribe phlebotomy once every 8-12 weeks because of an unusual response to testosterone replacement therapy. This simple procedure is done in a hospital blood draw or a blood bank facility and can reduce hematocrit, hemoglobin, and blood iron easily and in less than one hour.

    



    Unfortunately, therapeutic phlebotomy can be a difficult option to get reimbursed or covered by insurance companies. The reimbursement codes for therapeutic phlebotomy are CPT 39107, icd9 code 289.0.

    



    Unless a local blood bank is willing to help, some physicians may need to write a letter of medical necessity for phlebotomy if requested by insurance companies. If the patient is healthy and without HIV, hepatitis B, C, or other infections, they could donate blood at a blood bank.

    



    The approximate amount of blood volume that needs to be withdrawn to restore normal values can be calculated by the following formula, courtesy of Dr. Michael Scally, an expert on testosterone side effect management. The use of the formula includes the assumption that whole blood is withdrawn. The duration over which the blood volume is withdrawn is affected by whether concurrent fluid replacement occurs.

    

Volume of Withdrawn Blood (cc)=

    Weight (kg) × ABV×[Hgbi - Hgbf]/[(Hgbi +Hgbf)/2]



    Where:
    
ABV = Average Blood Volume (default = 70)
    Hgbi (Hcti) = Hemoglobin initial

    Hgbf (Hctf) = Hemoglobin final (desired);



    So, for a 70 kg (154 lbs) man (multiply lbs x 0.45359237 to get kilogram) with an initial high hemoglobin of 20 mg/mL who needs to have it brought down to a normal hemoglobin of 14 mg/mL, the calculation would be:



    CC of blood volume to be withdrawn = 75 x 70 x [20 - l4]/[(20 + l4)/2] = 75 x 70 x (6/17) = approximately 1850 cc;



    One unit of whole blood is around 350 to 450 cc; approximately 4 units of blood need to be withdrawn to decrease this man's hemoglobin from 20 mg/mL to 14 mg/mL.

    

The frequency of the phlebotomy depends on individual factors, but most men can do one every two to three months to manage their hemoglobin this way. Sometimes red blood cell production normalizes without any specific reason. It is impossible to predict exactly who is more prone to developing polycythemia, but men who use higher doses, men with higher fat percentage, and older men may have a higher incidence. It is important not to draw too much blood at once due to dramatic decreases in iron levels that could cause fatigue.

    

Some doctors recommend the use of a baby aspirin (81 mg) a day and 2,000 to 4,000 mg a day of omega-3 fatty acids (fish oil capsules) to help lower blood viscosity and prevent heart attacks. These can be an important part of most people's health regimen but they are not alternatives for therapeutic phlebotomy if the patient has polycythemia and does not want to stop testosterone therapy. It is concerning that many people assume that they are completely free of stroke/heart attack risks by taking aspirin and omega-3 supplements when they have a high hematocrit.

    

Although some people may have more headaches induced by high blood pressure or get extremely red when they exercise, most do not feel any different when they have polycythemia. This does not make it any less dangerous.



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    Quote Originally Posted by Muscle mechanic View Post
    Polycythemia is an excessive production of red blood cells. With polycythemia the blood becomes very viscous or "sticky," making it harder for the heart to pump. High blood pressure, strokes and heart attacks can occur.

    



    The association between testosterone replacement therapy and polycythemia has been reported for the past few years as this therapy has become more mainstream. In addition to increasing muscle and sex drive, testosterone can increase the body's production of red blood cells. This hematopoietic (blood-building) effect could be a good thing for those with mild anemia.

    

Although all testosterone replacement products can increase the amount of red blood cells, the study showed a higher incidence of polycythemia in those using intramuscular testosterone than topical administration (testosterone patch was the main option used -- no gels). Smoking has also been associated with polycythemia and may contribute to the effects of other risk factors.

    





    Below is an excerpt from my book, Testosterone: A Man's Guide, further detailing the prevention and management of polycythemia.

Preventing and Managing Polycythemia


    It's important to check patients' hemoglobin and hematocrit blood levels while on testosterone replacement therapy. As we all know, hemoglobin is the substance that makes blood red and helps transport oxygen in the blood. Hematocrit reflects the proportion of red cells to total blood volume. A hematocrit of over 52 percent should be evaluated. Decreasing testosterone dose or stopping it are options that may not be the best for assuring patients' best quality of life, however. Switching from injectable to transdermal testosterone may decrease hematocrit, but in many cases not to the degree needed.

    



    The following table shows the different guideline groups that recommend monitoring for testosterone replacement therapy. They all agree about measuring hematocrit at month 3, and then annually, with some also recommending measurements at month 6 after starting testosterone (it is good to remember that there is a ban on gay blood donors in the United States).



    Many patients on testosterone replacement who experience polycythemia do not want to stop the therapy due to fears of re-experiencing the depression, fatigue and low sex-drive they had before starting treatment. For those patients, therapeutic phlebotomy may be the answer. Therapeutic phlebotomy is very similar to what happens when donating blood, but this procedure is prescribed by physicians as a way to bring down blood hematocrit and viscosity.

    




    A phlebotomy of one pint of blood will generally lower hematocrit by about 3 percent. I have seen phlebotomy given weekly for several weeks bring hematocrit from 56 percent to a healthy 46 percent. I know physicians who prescribe phlebotomy once every 8-12 weeks because of an unusual response to testosterone replacement therapy. This simple procedure is done in a hospital blood draw or a blood bank facility and can reduce hematocrit, hemoglobin, and blood iron easily and in less than one hour.

    



    Unfortunately, therapeutic phlebotomy can be a difficult option to get reimbursed or covered by insurance companies. The reimbursement codes for therapeutic phlebotomy are CPT 39107, icd9 code 289.0.

    



    Unless a local blood bank is willing to help, some physicians may need to write a letter of medical necessity for phlebotomy if requested by insurance companies. If the patient is healthy and without HIV, hepatitis B, C, or other infections, they could donate blood at a blood bank.

    



    The approximate amount of blood volume that needs to be withdrawn to restore normal values can be calculated by the following formula, courtesy of Dr. Michael Scally, an expert on testosterone side effect management. The use of the formula includes the assumption that whole blood is withdrawn. The duration over which the blood volume is withdrawn is affected by whether concurrent fluid replacement occurs.

    

Volume of Withdrawn Blood (cc)=

    Weight (kg) × ABV×[Hgbi - Hgbf]/[(Hgbi +Hgbf)/2]



    Where:
    
ABV = Average Blood Volume (default = 70)
    Hgbi (Hcti) = Hemoglobin initial

    Hgbf (Hctf) = Hemoglobin final (desired);



    So, for a 70 kg (154 lbs) man (multiply lbs x 0.45359237 to get kilogram) with an initial high hemoglobin of 20 mg/mL who needs to have it brought down to a normal hemoglobin of 14 mg/mL, the calculation would be:



    CC of blood volume to be withdrawn = 75 x 70 x [20 - l4]/[(20 + l4)/2] = 75 x 70 x (6/17) = approximately 1850 cc;



    One unit of whole blood is around 350 to 450 cc; approximately 4 units of blood need to be withdrawn to decrease this man's hemoglobin from 20 mg/mL to 14 mg/mL.

    

The frequency of the phlebotomy depends on individual factors, but most men can do one every two to three months to manage their hemoglobin this way. Sometimes red blood cell production normalizes without any specific reason. It is impossible to predict exactly who is more prone to developing polycythemia, but men who use higher doses, men with higher fat percentage, and older men may have a higher incidence. It is important not to draw too much blood at once due to dramatic decreases in iron levels that could cause fatigue.

    

Some doctors recommend the use of a baby aspirin (81 mg) a day and 2,000 to 4,000 mg a day of omega-3 fatty acids (fish oil capsules) to help lower blood viscosity and prevent heart attacks. These can be an important part of most people's health regimen but they are not alternatives for therapeutic phlebotomy if the patient has polycythemia and does not want to stop testosterone therapy. It is concerning that many people assume that they are completely free of stroke/heart attack risks by taking aspirin and omega-3 supplements when they have a high hematocrit.

    

Although some people may have more headaches induced by high blood pressure or get extremely red when they exercise, most do not feel any different when they have polycythemia. This does not make it any less dangerous.



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    Great information. I donated blood just the other day. Iron was a little hight.
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    I go every 3 months
     

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    I did double red tue. I have an appointment with a hematologist tomorrow
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    A lot will if you tell them your on T. I go to the blood bus or dont sat I'm on T
    Quote Originally Posted by jolter60401 View Post
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    I would never tell them i was donating test and tren hahaha.it was too high when they pricked my finger
    Quote Originally Posted by muscle1031 View Post
    A lot will if you tell them your on T. I go to the blood bus or dont sat I'm on T

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    Quote Originally Posted by jolter60401 View Post
    I would never tell them i was donating test and tren hahaha.it was too high when they pricked my finger
    I think if its above 17 it cant go through machine.

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    Quote Originally Posted by muscle1031 View Post
    I think if its above 17 it cant go through machine.

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    20 is the Red Cross cut off for some reason. I got that warning when I was 19.3
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    Quote Originally Posted by Dieselmatt View Post
    20 is the Red Cross cut off for some reason. I got that warning when I was 19.3
    With standing order cut off is minimum Dr puts to allow to lower too.

    I had min at 15 at first never can get down even every 3 weeks

    He lowered to 13 then I get it down but I gotta go till it's 13.5 then do it.

    Now my order is as needed when I am high I go 2 weeks in s row and if not down skip week and do it again.

    No matter what is in studies when I Lower my iron stores I don't have to go for 3 months.

    My iron stores are high.
    Every 6 months I have to do tibc and feriten

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    They have 2 numbers hemoglobin which is the number that should be 14 to 18 for males and 12 to 16 for females.

    You can multiply that number by 3 and it will.gave you your hematocrit.

    When I went to get on trt from my general practitioner he told me that he was more concerned over the hematocrit than the hemoglobin and that it had to be a 50 or lower which means I would have to be at around a 16.6 or lower.

    If you donate to much you can have ferritin problems as from what Doc says it can take a longggggg time to fix.

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    My doc is fine with me at 50 I came in at 58 one time and had to go 3 straight weeks stopped test for 3 months felt like shit
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    I had to come off in a bit also for about 2 weeks and I donated back-to-back and I didn't feel too great either
    Quote Originally Posted by IronJulius View Post
    My doc is fine with me at 50 I came in at 58 one time and had to go 3 straight weeks stopped test for 3 months felt like shit
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    Quote Originally Posted by muscle1031 View Post
    They have 2 numbers hemoglobin which is the number that should be 14 to 18 for males and 12 to 16 for females.

    You can multiply that number by 3 and it will.gave you your hematocrit.

    When I went to get on trt from my general practitioner he told me that he was more concerned over the hematocrit than the hemoglobin and that it had to be a 50 or lower which means I would have to be at around a 16.6 or lower.

    If you donate to much you can have ferritin problems as from what Doc says it can take a longggggg time to fix.

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    I am required to test feritin iron very 6 donations by bank.
    One time I had to take iron
    FERGON it spiked everything from 13.5 hemo to 19 in 6 weeks with deca.
    Never taking again.
    I have high iron most if time and i have JAK 2 gene mutation with secondary polycythemia as well.
    My hematacrit is 47-52.
    My hemo gets to 20 with hema at that range 47-52
    My blood is thick and dehydration will or can cause hema to spike with high hemo
    Coconut water lots if potassium keep hematcrit lower.
    My bank checks hemo and hema with prick
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    Quote Originally Posted by Muscle mechanic View Post
    I am required to test feritin iron very 6 donations by bank.
    One time I had to take iron
    FERGON it spiked everything from 13.5 hemo to 19 in 6 weeks with deca.
    Never taking again.
    I have high iron most if time and i have JAK 2 gene mutation with secondary polycythemia as well.
    My hematacrit is 47-52.
    My hemo gets to 20 with hema at that range 47-52
    My blood is thick and dehydration will or can cause hema to spike with high hemo
    Coconut water lots if potassium keep hematcrit lower.
    My bank checks hemo and hema with prick
    Dam that's crazy

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    Quote Originally Posted by muscle1031 View Post
    Dam that's crazy

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    Check this out it was years ago gotta get print out if total history

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    I was 24 at red cross last time. 4 weeks after last pin. Hope it gos down naturally lmao
     

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    I just saw a hematologist, getting tested for gene mutation but if it’s normal he told me secondary polycythemia is ok just keep donating when I can an hct of 18-19 is ok
     

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    Quote Originally Posted by Dieselmatt View Post
    I did double red tue. I have an appointment with a hematologist tomorrow
    Haha, I was supposed to do double red Tuesday too. I had to cancel because I've been sick all week. But, I try to do the double donation whenever I can.
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    Great Information.
    Get It Done!

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