All well respected doctors specializing in HRT see it important to check their client’s hemoglobin (HGB) and hematocrit (HCT) levels on lab test results under a complete blood count (CBC) before and while on testosterone replacement therapy. In this short article we are going to explain why, and also why you should be interested in and informed of these markers and their relevance as well.
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. With testosterone replacement therapy and the corresponding elevation of testosterone after, red blood cell production typically goes up. For men that may be anemic, this is great. For some others, and although rare, they may respond a bit much with excessive production of red blood cells leading to elevated levels of hemoglobin and hematocrit under their complete blood count (CBC) signaling a concern for what is called Polycythemia.
What is Polycythemia?
Polycythemia is simply an increased number of red blood cells in the blood. Another easy way of looking at this is that the viscosity of the blood becomes very thick. What this means is that it is much harder for the heart to pump around a bunch of thick “sludge” which becomes stressful on the heart and circulatory system over time and may be associated with heart attack, stroke and other complications if not addressed. Easier for a pump to push clean water through a long garden hose versus trying to effectively pump dirty, thick motor oil through it; wouldn’t you agree? I think the motor on that pump would have a shorter life span if always pumping thick sludge…
In polycythemia, the levels of hemoglobin, hematocrit or the red blood cell (RBC) count may be elevated when measured in the complete blood count (CBC), as compared to normal. Hemoglobin levels greater than 16.5 g/dL (grams per deciliter) in women and greater than 18.5 g/dL in men suggest polycythemia. In terms of hematocrit, a value greater than 48 in women and 52 in men is indicative of polycythemia.
What is The Best Way to Reduce or Control, Hemoglobin and Hematocrit Levels?
One of the easiest ways to address this is simply donating blood. This safely and instantly drops numbers quite nicely into safer zones. If this concerns you and you’re healthy and without HIV, hepatitis B, C, or other infections, you could donate blood at a blood bank. In addition, you’re doing a good deed by helping to save a life. It should be mentioned that gay men are not allowed to donate, and in these cases a simple request for therapeutic phlebotomy with your primary care physician should be done. A phlebotomy letting out one pint of blood will typically lower hematocrit by several percentage points.
The frequency of donating blood or 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 clear reason. It is very difficult to predict who is more prone to developing polycythemia, but men who use higher doses of testosterone, men who use injections over creams, and older men may have a higher incidence.
Many respected doctors specializing in HRT will often recommend a baby aspirin (81mg) a day along with 2-4 grams of omega 3 fatty acids from fish oils. This helps to “thin” the blood out. It should be noted that this should not take the place of phlebotomy if concerns of polycythemia and very high hemoglobin is present.
Summary
Hopefully, this gives some clear and easy to understand insight as to what hemoglobin, hematocrit and red blood cells and their importance of being monitored are in relationship to any HRT program you may be engaging in. You are here visiting us today for a reason. You are likely a bit ahead of most in regards to addressing and wanting to take care of your health and well-being. Looking for and finding the right answers can be quite a task but we are here to assist you with finding the right solution to look and feel your best.
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