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  #121  
Old 30 October 2018, 13:11
338winny 338winny is offline
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My 90 labs showed hematocrit at 50, the PA suggested donating blood prior to my next labs. Well, I may wait until my next labs to pursue the issue further. I've called several Red Cross centers in the area, and most do not even know what a therapeutic phlebotomy is, once I tell them, they say they don't do them. I did see on another forum, that going to a blood bank is an option, I may go that route if it is required after my next set of labs.

I hear you on wanting to avoid insurance. I am trying to get my wife to get some bloodwork done, so that she can get in on TRT. Right now, she thinks they're scammers trying to separate me from my money, and nothing more. I'm trying to convince her that the insurance companies are the scammers, and that is why most of the anti-aging doctors won't accept it. However, if I could get my insurance to cover at least some of the cost, maybe she would be more open to the idea of trt for herself.
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  #122  
Old 30 October 2018, 17:22
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Tricare pays for any of my labs...but the T is all on me. Tricare will NOT give T to women...even though it makes a difference...


But they'll sure as hell pay for Viagra...which just pisses me off. Women definitely get the short end of the stick when it comes to this sort of thing.
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  #123  
Old 30 October 2018, 22:20
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But they'll sure as hell pay for Viagra...which just pisses me off. Women definitely get the short end of the stick when it comes to this sort of thing.



Oh, the places I could run with that comment.... LOL Out of respect for my brother, Godzilla, I'm gonna let it go, but.... Damn woman.... Hahahaha
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  #124  
Old 31 October 2018, 09:34
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When it comes to an elevated H & H and needing to donate blood, Polycythemia or Erythrocytosis?

My point of discussion is that it is Erythrocytosis and not Polycythemia Vera in a patient who is on testosterone replacement therapy (TRT). For most this could just be a point of semantics and admittedly you can find in the literature where they use the terms, Erythrocytosis and Polycythemia, interchangeably or exclusively one term or the other when describing the same reaction. Probably like some on here you have to enter the octagon with your primary care provider who has high concerns for a thromboembolic event when the H & H is elevated "do I really have to donate blood". So for this reason I make the distinction and have less concern.

Most clinicians when confronted with an elevated H & H will diagnose this as Polycythemia and immediately have high concerns for an event. Polycythemia Vera (PV) which is classically defined as a combination of an increase in mostly red blood cells, white blood cells, platelets, splenomegaly, and clotting disorders. With the increase of platelets, and more importantly, the associated defect in the blood vessel wall which stimulates the clotting cascade of thrombosis there is no doubt that this puts any patient with PV at a much higher risk for stroke and etc requiring therapeutic phlebotomy. Polycythemia is often used synonymously with Erythrocytosis but Polycythemia more correctly refers to a blood cell dyscrasias where an increase in two or more hematopoietic cell lines occur and which TRT patients do not have.

TRT patients have Erythrocytosis (Polycythemia, Factitious) and is simply an increase in red blood cells due to an increased production of erythropoietin from the kidneys stimulated from testosterone therapy. This is also the same physiological response that occurs in any hypoxic state such as with smokers, COPD, Sleep Apnea, and with people who live in high altitudes. We don’t routinely phlebotomize any of these patients as part of their treatment plan because it is a normal physiologic increase in only RBCs, and not the clotting factors etc associated with Polycythemia. Millions of people worldwide live at high altitudes and have H & H counts much higher than any TRT patients but yet no treatment is required for them; studies do show though these can normalize over a long extended period of time. In fact most of our Olympic Training Centers are at higher altitudes and also what is being done in the bicycle community with their H & Hs; I’m not aware of any events.

Testosterone therapy suppresses clotting factors II, V, VII, and X. Because of this factor it is stated on the packet insert that for those also taking anticoagulant medications such as Warfarin, “testosterone may increase the effects of such medication” and monitor appropriately. Testosterone has also been shown to stimulate tissue plasminogen activator and tissue factor pathway inhibitor and inhibits plasminogen activator inhibitor type 1 release in endothelial cells.

There is a point when phlebotomizing is very appropriate, especially if you have a lot risk factors and don't diet and exercise, but my level of concern for a thromboembolic event is not at the same level that has been expressed.
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  #125  
Old 31 October 2018, 11:08
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Nice! ^ :thumbsup:
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  #126  
Old 31 October 2018, 14:01
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Originally Posted by Global Med View Post
When it comes to an elevated H & H and needing to donate blood, Polycythemia or Erythrocytosis?

My point of discussion is that it is Erythrocytosis and not Polycythemia Vera in a patient who is on testosterone replacement therapy (TRT). For most this could just be a point of semantics and admittedly you can find in the literature where they use the terms, Erythrocytosis and Polycythemia, interchangeably or exclusively one term or the other when describing the same reaction. Probably like some on here you have to enter the octagon with your primary care provider who has high concerns for a thromboembolic event when the H & H is elevated "do I really have to donate blood". So for this reason I make the distinction and have less concern.

Most clinicians when confronted with an elevated H & H will diagnose this as Polycythemia and immediately have high concerns for an event. Polycythemia Vera (PV) which is classically defined as a combination of an increase in mostly red blood cells, white blood cells, platelets, splenomegaly, and clotting disorders. With the increase of platelets, and more importantly, the associated defect in the blood vessel wall which stimulates the clotting cascade of thrombosis there is no doubt that this puts any patient with PV at a much higher risk for stroke and etc requiring therapeutic phlebotomy. Polycythemia is often used synonymously with Erythrocytosis but Polycythemia more correctly refers to a blood cell dyscrasias where an increase in two or more hematopoietic cell lines occur and which TRT patients do not have.

TRT patients have Erythrocytosis (Polycythemia, Factitious) and is simply an increase in red blood cells due to an increased production of erythropoietin from the kidneys stimulated from testosterone therapy. This is also the same physiological response that occurs in any hypoxic state such as with smokers, COPD, Sleep Apnea, and with people who live in high altitudes. We don’t routinely phlebotomize any of these patients as part of their treatment plan because it is a normal physiologic increase in only RBCs, and not the clotting factors etc associated with Polycythemia. Millions of people worldwide live at high altitudes and have H & H counts much higher than any TRT patients but yet no treatment is required for them; studies do show though these can normalize over a long extended period of time. In fact most of our Olympic Training Centers are at higher altitudes and also what is being done in the bicycle community with their H & Hs; I’m not aware of any events.

Testosterone therapy suppresses clotting factors II, V, VII, and X. Because of this factor it is stated on the packet insert that for those also taking anticoagulant medications such as Warfarin, “testosterone may increase the effects of such medication” and monitor appropriately. Testosterone has also been shown to stimulate tissue plasminogen activator and tissue factor pathway inhibitor and inhibits plasminogen activator inhibitor type 1 release in endothelial cells.

There is a point when phlebotomizing is very appropriate, especially if you have a lot risk factors and don't diet and exercise, but my level of concern for a thromboembolic event is not at the same level that has been expressed.

Okay Doc, can you translate that to Knuckledragger-ese?

What I THINK you said, was that if you are doing TRT your Doc could easily misdiagnose your bloodwork and most likely you DONT need to go offload a pint of blood over it.
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  #127  
Old 31 October 2018, 14:02
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Originally Posted by 338winny View Post
My 90 labs showed hematocrit at 50, the PA suggested donating blood prior to my next labs. Well, I may wait until my next labs to pursue the issue further. I've called several Red Cross centers in the area, and most do not even know what a therapeutic phlebotomy is, once I tell them, they say they don't do them. I did see on another forum, that going to a blood bank is an option, I may go that route if it is required after my next set of labs.

I hear you on wanting to avoid insurance. I am trying to get my wife to get some bloodwork done, so that she can get in on TRT. Right now, she thinks they're scammers trying to separate me from my money, and nothing more. I'm trying to convince her that the insurance companies are the scammers, and that is why most of the anti-aging doctors won't accept it. However, if I could get my insurance to cover at least some of the cost, maybe she would be more open to the idea of trt for herself.

How come you cant just use an IV set and drain off a pint into a cup, dump it in the commode and flush it?
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  #128  
Old 31 October 2018, 22:20
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Not only did I serve and live with Poly at "The Ranch", but he also helped me get the ball rolling as far as TRT goes.

After I got my first labs done, through my wellness center at work for free, and found out I had low T, I went to see a Urologist in the area who was well versed in the protocol. I got lucky as all this is covered through my insurance. He has let me call the shots as far as how I wanted to go about this. Injections instead of gels or pellets. Bi-weekly shots, now 3x times a week, to help control estradiol instead of taking more meds. So I have been lucky when it comes to finding a Dr. who is knowledgeable, and lets me in on the decision making process.

I am over 6 months in and it has made a big difference in my quality of life. Sleep, energy, anxiety issues have all gotten better. There is a ton of information out there, do your research and find what works best for you. I did have a rise in Hematocrit, and decided to give blood to err on the side of caution. I also was not able to donate blood because I lived in Europe for awhile during the mad cow craze. I did find a way to get a cheap therapeutic phlebotomy done through One Blood, but I am debating whether to continue doing this after reading some of the recent comments here.

And as I have read and been told, treat the symptoms not the numbers. Once you are dialed in, your quality of life will only get better.
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  #129  
Old 1 November 2018, 04:58
338winny 338winny is offline
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Global Med - excellent write up. Thank you. I have been reading up on it a bit, and your info squares with what is out there. I am going to wait until my 6-month labs are done, and then see where I am at. My doc has a cut off of 54 for hematocrit. At this point I am not stressed over it, but I like to be proactive. I will bring up the information in your post, at my next consult.
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  #130  
Old 1 November 2018, 05:09
338winny 338winny is offline
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Originally Posted by Sharky View Post
How come you cant just use an IV set and drain off a pint into a cup, dump it in the commode and flush it?
Shoot, you want me to become a topic in the lounge? Headline, "Man tries to drain cup of his own blood. Drains all of it instead". Seriously though, I don't think I would do well trying to pierce my own veins. I just don't understand why the Red Cross is such a clusterphukk, when it comes to this. For now, I am waiting until my next labs. If it turns out my doc will require me to get rid of some blood, my plan is to show up in person, to a local blood bank and request it. Perhaps by calling the Red Cross, I am making it too easy for them to blow me off.
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  #131  
Old 1 November 2018, 07:37
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A Doc can write an Rx for a therapeutic phlebotomy, that's how they deal with hemochromatosis. But again, not a Doc, and don't have blood issues.

Also - I had to look this up - never knew about this in relation to donating blood:

http://uk.businessinsider.com/mad-co...16-9?r=US&IR=T
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  #132  
Old 1 November 2018, 07:38
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Originally Posted by Toad View Post
Not only did I serve and live with Poly at "The Ranch", but he also helped me get the ball rolling as far as TRT goes.

After I got my first labs done, through my wellness center at work for free, and found out I had low T, I went to see a Urologist in the area who was well versed in the protocol. I got lucky as all this is covered through my insurance. He has let me call the shots as far as how I wanted to go about this. Injections instead of gels or pellets. Bi-weekly shots, now 3x times a week, to help control estradiol instead of taking more meds. So I have been lucky when it comes to finding a Dr. who is knowledgeable, and lets me in on the decision making process.
Sweet! Glad it worked out. We certainly weren't "Low T" at the Ranch! LOL
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  #133  
Old 1 November 2018, 08:53
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Poly, I was advised to take DIM daily to control Estrogen, what is your understanding of that?
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  #134  
Old 1 November 2018, 09:36
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Poly, I was advised to take DIM daily to control Estrogen, what is your understanding of that?
Di-Indole Methane is a metabolite of Indole-3-Carbinol - it's all in Broccoli, Cauliflower, Cruciferous etc... It *may* (check PubMed) influence the *type* of Estrogen produced, not the total amount. There are something like 40 types of Estrogen produced by the body - Estrodiol is just used as a surrogate marker for overall levels.

DIM/I3C/Cruciferous may influence the production of "good" Estrogens, and inhibit the "bad" ones.

DIM dose for men is usually 200mg, check if different for women. I3C is usually cheaper (check Swanson's) and is probably fine. BulkSupplements on Amazon has bulk DIM.

I just go to Sam's and get those giant bags of Broccoli Florets

Grape Seed Extract also has some human data for Estrogen Control as well - and it's cheap from BulkSupplements.
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  #135  
Old 5 November 2018, 10:23
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Okay Doc, can you translate that to Knuckledragger-ese?

What I THINK you said, was that if you are doing TRT your Doc could easily misdiagnose your bloodwork and most likely you DONT need to go offload a pint of blood over it.
Sharky, Yes. The challenge is trying to convince your family Doc that you don't need it. Why it is so important in so many ways to see someone that knows what they are doing in this. I usually use a C-Reactive Protein test to see where anyone sits with inflammation, it is a generic test for inflammation, along with their risk factors. The more inflammation one has, not dieting or exercising etc, the more crucial it is to watch and abide by the H & H for stricter phlebotomy rules.

Last I knew they would not let you donate blood if it is a "therapeutic" draw but really nothing is wrong with your blood, just too many RBCs. I got turned away my last time for being on antimalarials.
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  #136  
Old 7 November 2018, 12:33
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Anastrozole (Arimidex)? If your nipples start lighting up on fire, make sure you can get an Aromatase Inhibitor fast. What about HCG?

When is your next scheduled blood draw to check all levels at that dosage? Make sure they are pulling Estrodiol using LC/MS/MS (The "Sensitive" Test).
Doctor visit yesterday.

Blood results after 11 weeks of Cypionate 200MG (I split the shot @ 100MG every Mon and Thurs):

Free and total testosterone: 787 (264-916 range)
Prostrate-Specific Ag, Serum: .6 (0.0-4.0 range)
Estradiol, Sensitive: 64.1 (8.0-35.0 range)

She says right now lets do another 10 week @ 200MG and review blood results to determine if HCG is an option. She doubts it but doesn't rule it out completely.

Estradiol too high - I am now on Anastrozole 1MG tablets (take 1/2 with the Mon shot, 1/2 with the Thurs shot.)

All in all I knew the shots were working before I saw her!

One of the interesting things about the program is I get my blood tested every 3 mos. I lost a kidney in 2014 so she checks those kidney levels as well, but another thing she told me was a few mos back they caught Prostrate Cancer in one patient super early because of these blood tests.
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  #137  
Old 8 November 2018, 12:23
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Pretty decent - man, at 200mg I'd be over 1500 LOL! The variety of the human body is amazing.

HCG is to prevent Testicular Atrophy, since the negative feedback loop is preventing Leutinizing Hormone (LH) production. Also, aside from the cosmetic reason, there are LH receptors all over the body, in addition to the Testes Leydig Cells - the body *wants* LH. She doesn't need to look for a reason to Rx it, you're on exogenous Testosterone - there's your reason.

Edit: What was Free T? You didn't list it. They're two separate tests (it's actually derived from Total Test and SHBG - so if you didn't get SHBG tested, you won't have Free Test - which is actually the more important number).
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  #138  
Old 8 November 2018, 18:37
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Edit: What was Free T? You didn't list it.
Free Testosterone (Direct): 19.7 (6.8-21.5 range)
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  #139  
Old 9 November 2018, 08:28
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Free Testosterone (Direct): 19.7 (6.8-21.5 range)
Nice.
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  #140  
Old 9 November 2018, 14:09
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Sitting in the VA clinic waiting for the Doc and looking at my blood test results. I specifically asked him to check T levels. Mine are at 257. Will see what he says, but that would explain a lot of my issues I think.
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