POLYCYTHEMIA update

[Punkrocker]

So if you guys read my other post, you will see that they drew some blood outta me in the ER last week lowering my hematocrit from 55% to 51% and hemoglobin from 18.2 to 16.8 now here's the problem, I still feel a bit dizzy, slight headache and pressure in my head. Blood pressure is normal range 130s over 70-80. I have been making an attempt to drink plenty of fluids as well and taking an aspirin every day until I can get drained again. I'm worried guys. Am I in a safer range now? Should I calm down? Why do I still feel symptomatic?

 

[GreenMachineX]

51% I don't believe is a problem at all; I was above 50% for months on end. Donating monthly got me down to a good place (today I was 49.5 when I walked in, not sure what I was walking out but not worried at all about that). Just keep donating monthly to get it under 50 consistently. What are you on that got it so high?

Edit: I want to clarify I don't know why you feel dizzy, but if you are on DHEA, that garbage just messed me up for a couple weeks and I just figured out that was the issue. I was speedy and lightheaded and very dizzy, and even 100mg caffeine made me feel like I was going to pass out. And daily anxiety/panic attacks.

 

[Punkrocker]

51% I don't believe is a problem at all; I was above 50% for months on end. Donating monthly got me down to a good place (today I was 49.5 when I walked in, not sure what I was walking out but not worried at all about that). Just keep donating monthly to get it under 50 consistently. What are you on that got it so high?

Edit: I want to clarify I don't know why you feel dizzy, but if you are on DHEA, that garbage just messed me up for a couple weeks and I just figured out that was the issue.

I saw my doctor Friday afternoon and got blood work again. She gave me a quick exam and didn't see anything irregular. She then gave me a CBC and ferritin. Since Monday when I got drained my hematocrit actually fell even more to 48. I am totally relieved. I still feel a slight pressure in my head and a little dizzy but I think it's starting to get better so I don't know maybe anxiety or something. Thanks for the response dude I appreciate the support

 

[trn450]

It's expected to see the blood go down a short period of time after the blood draw. After your phlebotomy session it takes a while for the fluid volumes to shift around and come into a new equilibrium. In short, when the volume of blood is lost it is later filled by primarily "water" so the existing blood is diluted.

Having said that, the process driving the polycythemia is still there.

Here is what I'd personally do if I had polycythemia and I were hypothetically on supraphysiologic levels of anabolics: I'd scale back all anabolic to just "physiologic range" of testosterone. E..g aim for a trough of like 350-400, so probably something like 100mg/wk.

After a few months at a physiologic range we should be able to see what the hemoglobin levels are under the influence of physiologic testosterone. If it's still elevated, I would look for other causes of polycythemia. It would be important to me to the confidence that I knew what was driving the polycythemia and not just assume it was the androgens.

If I came to know it was for sure the androgens and I knew all the risks, I'd proceed with caution under careful supervision and routine phlebotomy.

Another quick point: Systolic blood pressure in the 130's isn't technically "normal". It's categorized as pre-hypertension, but really these blood pressures and their negative effects work along a continuum. If you're more concerned about your health than your muscle content, I'd strive to keep blood pressure less than 120 mmHg systolic and 80 mmHg diastolic.

 

[Punkrocker]

It's expected to see the blood go down a short period of time after the blood draw. After your phlebotomy session it takes a while for the fluid volumes to shift around and come into a new equilibrium. In short, when the volume of blood is lost it is later filled by primarily "water" so the existing blood is diluted.

Having said that, the process driving the polycythemia is still there.

Here is what I'd personally do if I had polycythemia and I were hypothetically on supraphysiologic levels of anabolics: I'd scale back all anabolic to just "physiologic range" of testosterone. E..g aim for a trough of like 350-400, so probably something like 100mg/wk.

After a few months at a physiologic range we should be able to see what the hemoglobin levels are under the influence of physiologic testosterone. If it's still elevated, I would look for other causes of polycythemia. It would be important to me to the confidence that I knew what was driving the polycythemia and not just assume it was the androgens.

If I came to know it was for sure the androgens and I knew all the risks, I'd proceed with caution under careful supervision and routine phlebotomy.

Another quick point: Systolic blood pressure in the 130's isn't technically "normal". It's categorized as pre-hypertension, but really these blood pressures and their negative effects work along a continuum. If you're more concerned about your health than your muscle content, I'd strive to keep blood pressure less than 120 mmHg systolic and 80 mmHg diastolic.

As long as I can remember my blood pressure has always been anywhere from 120-140 over 70-80 depending on what time of day it is, if I'm relaxed or tired or if I worked that day etc...As far as high levels of testosterone goes, I do 200mg of cyp weekly. My trough is around 800 and peak probably 1400 or 1500. But it's the hcg that Jacks up my hematocrit I know for a fact! Last summer I ran 800mgs of test for 2 months and my crit was 46. I go back to 200mg weekly along with hcg and BOOM increased hematocrit to 50℅ at my next blood test.

 

[trn450]

Blood pressure will surely vary throughout day, and depending on stress level. But, if it's up more than it's down, in the long run you're still at risk of developing complications of hypertension. Just something to consider.

If you think it's the hCG, why not just get rid of the hCG? I'd rather have little, soft balls than secondary polycythemia that I'm constantly needing phlebotomy for. ^_^

 

[Punkrocker]

Well actually hcg is responsible for pregnenolone, dhea, adrenaline, utilizing your excess cholesterol thus vastly improving your lipid panel. So yeah, we need hcg. I was doing 500iu every 3 days. Next time I run it I'll do 250iu every 3 days and see if that's better.

 

[trn450]

Was your lipid panel terrible to begin with?

At 200 mg/wk, I doubt you'd have a significantly altered cholesterol panel. There have been admittedly short studies, but doses up to 600mg/wk weren't producing significantly terrible outcomes on lipid panels in otherwise healthy individuals without additional hormones/supplements confounding the blood-work.

Additionally, there is a leap of faith in assuming that any changes that come from hCG that are reflected in your lipid panel are technically doing anything other than artificial improvements. We've known for quite some time, for example, that while Niacin can improve HDL profiles it doesn't do anything that we have been able to identify in terms of actually improving outcomes.

While I understand the desire to pre-empt any potential problems, the alternative to this is that every pharmacologic addition is more potential cascades of problems.

Again, in my own case as both a professional and someone who has central (secondary) hypgonadism on TRT, I take a very minimalist approach. But, ultimately the decision is made between you and your care provider.

 

[Punkrocker]

Was your lipid panel terrible to begin with?

At 200 mg/wk, I doubt you'd have a significantly altered cholesterol panel. There have been admittedly short studies, but doses up to 600mg/wk weren't producing significantly terrible outcomes on lipid panels in otherwise healthy individuals without additional hormones/supplements confounding the blood-work.

Additionally, there is a leap of faith in assuming that any changes that come from hCG that are reflected in your lipid panel are technically doing anything other than artificial improvements. We've known for quite some time, for example, that while Niacin can improve HDL profiles it doesn't do anything that we have been able to identify in terms of actually improving outcomes.

While I understand the desire to pre-empt any potential problems, the alternative to this is that every pharmacologic addition is more potential cascades of problems.

Again, in my own case as both a professional and someone who has central (secondary) hypgonadism on TRT, I take a very minimalist approach. But, ultimately the decision is made between you and your care provider.

Currently my total cholesterol is 172 with an hdl of 71 and my ldl is 90 I believe. I got great cholesterol which is why I don't wanna mess it up. I was under the assumption that HCG is absolutely necessary when on testosterone therapy because of the vital hormones such as pregnenolone DHEA Etc

 

[trn450]

Your cholesterol is excellent.

I won't give you medical advice, but I would say if I were in your shoes I'd want to see what my levels were off of hCG to see if they're still good (although I wouldn't need them to be "exactly" as good).

Hypothetically speaking, even if the panel did change from good to bad, a few months would be unlikely to produce any negative side effects of consequence as atherogenesis is a slow process. And, if symptoms peak up that are undesirable and I felt generally unwell while off of hCG, starting up again is easy.

 

[Punkrocker]

Your cholesterol is excellent.

I won't give you medical advice, but I would say if I were in your shoes I'd want to see what my levels were off of hCG to see if they're still good (although I wouldn't need them to be "exactly" as good).

Hypothetically speaking, even if the panel did change from good to bad, a few months would be unlikely to produce any negative side effects of consequence as atherogenesis is a slow process. And, if symptoms peak up that are undesirable and I felt generally unwell while off of hCG, starting up again is easy.

Well I'm definitely gonna be off the hcg for at least the next month or 2 that's for sure. Gonna just play it by ear I guess but as far as I have read, hcg seems to be vital in trt. Or so I thought...

 

[trn450]

I understand. I'm familiar with the pathways and the hypothetical arguments.

Having said that, you can just repeat tests at the end of those 2 months and see where you're at if you're already planning some time off. I'd be interested in seeing the results.

 

[Punkrocker]

For sure bro. I'll post them for everyone to see. As of right now I'm just doing 200mg of cypionate every Friday along with some anastrozole. I'll check my crit in a month or 2 and see where I'm at.