New Hematocrit Study

[GreenMachineX]

Testosterone Therapy: An Assessment of the Clinical Consequences of Changes in Hematocrit and Blood Flow Characteristics - PubMed

TTh can effect an increased hematocrit via poorly understood mechanisms and may have harmful effects on blood flow that differ in patient subgroups. At present, there appears no scientific basis for using a hematocrit of 0.54 to modify TTh; other values may be more appropriate in particular...

www.ncbi.nlm.nih.gov

Testosterone Therapy: An Assessment of the Clinical Consequences of Changes in Hematocrit and Blood Flow Characteristics.
Review article
König CS, et al. Sex Med Rev. 2019.
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Abstract
INTRODUCTION: Clinical guidelines indicate that hematocrit should be monitored during testosterone replacement therapy (TTh), with action taken if a level of 0.54 is exceeded.
AIM: To consider the extent of changes in hematocrit and putative effects on viscosity, blood flow, and mortality rates after TTh.
METHODS: We focused on literature describing benefits and possible pitfalls of TTh, including increased hematocrit. We used data from the BLAST RCT to determine change in hematocrit after 30 weeks of TTh and describe a clinical case showing the need for monitoring. We consider the validity of the current hematocrit cutoff value at which TTh may be modified. Ways in which hematocrit alters blood flow in the micro- and macro-vasculature are also considered.
MAIN OUTCOME MEASURES: The following measures were assessed: (i) change in hematocrit, (ii) corresponding actions taken in clinical practice, and (iii) possible blood flow changes following change in hematocrit.
RESULTS: Analysis of data from the BLAST RCT showed a significant increase in mean hematocrit of 0.01, the increase greater in men with lower baseline values. Although 0 of 61 men given TTh breached the suggested cutoff of 0.54 after 30 weeks, a clinical case demonstrates the need to monitor hematocrit. An association between hematocrit and morbidity and mortality appears likely but not proven and may be evident only in patient subgroups. The consequences of an increased hematocrit may be mediated by alterations in blood viscosity, oxygen delivery, and flow. Their relative impact may vary in different vascular beds.
CONCLUSIONS: TTh can effect an increased hematocrit via poorly understood mechanisms and may have harmful effects on blood flow that differ in patient subgroups. At present, there appears no scientific basis for using a hematocrit of 0.54 to modify TTh; other values may be more appropriate in particular patient groups. König CS, Balabani S, Hackett GI, et al. Testosterone Therapy: An Assessment of the Clinical Consequences of Changes in Hematocrit and Blood Flow Characteristics. Sex Med Rev 2019;XX:XXX-XXX.
Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.
PMID
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“At present, there appears no scientific basis for using a hematocrit of 0.54 to modify TTh...”
Interesting I must say.

 

[kisaj]

There needs to be context behind the 54% cutoff as it can vary greatly purely on where someone is located. I have friends that live in the mountains that are professional skiers and mtn bikers that are in insane conditioning and run above 54% HCT due to altitude. My own doctors here at 6000' agree that unless it hits 55 and continues to climb, there is little concern.

 

[SkRaw85]

Subbed to read later

 

[GreenMachineX]

There needs to be context behind the 54% cutoff as it can vary greatly purely on where someone is located. I have friends that live in the mountains that are professional skiers and mtn bikers that are in insane conditioning and run above 54% HCT due to altitude. My own doctors here at 6000' agree that unless it hits 55 and continues to climb, there is little concern.

What I was picking up from the study was even at low altitude 54% may not matter. Is that not what you read?

 

[thebigt]

What I was picking up from the study was even at low altitude 54% may not matter. Is that not what you read?

the problem is that most primary docs who prescribe testosterone are going to go by the set protocol to cover their ass. geez, primary docs are still prescribing testosterone at every two week injections.

 

[GreenMachineX]

the problem is that most primary docs who prescribe testosterone are going to go by the set protocol to cover their ass. geez, primary docs are still prescribing testosterone at every two week injections.

True, this information was more for me though.

 

[suavmcgauv]

All this study found is that TRT will raise hct levels. It then said "An association between hematocrit and morbidity and mortality appears likely but not proven and may be evident only in patient subgroups." So, the effects of having raised hct was not what was studied, and the fact that morbidity and Mortality are associated seems to be speculatory here

 

[kisaj]

What I was picking up from the study was even at low altitude 54% may not matter. Is that not what you read?

Yes, that is what I read. My point was that the range is somewhat arbitrary because doctors acknowledge that it likely has no real health consequence taken by itself when it moves outside of "normal" range. When it continues to steadily climb and other factors like RBC increase, then it needs to be addressed.

 

[GreenMachineX]

Yes, that is what I read. My point was that the range is somewhat arbitrary because doctors acknowledge that it likely has no real health consequence taken by itself when it moves outside of "normal" range. When it continues to steadily climb and other factors like RBC increase, then it needs to be addressed.

Oh, I gotcha now. I’m still trying to decide if I’m ok with my crit going any higher than 51 like it is, but the dose I’m using just isn’t cutting it. I’d like to know what levels at 700-800 feel like consistently.

Or be able to find an herb to stack with it to enhance the effects. Tongkat from bulksupplements did that for me, but I had the strangest side effect of pulling muscles in my back twice, neck pain increased, and all other old injuries just achy.

 

[kisaj]

I use nattokinase and naringin as staples and always stay hydrated. This can help.