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Written by George N. Touliatos, MD
Elevated Hematocrit: How to Manage and Treat It
By George Touliatos, MD
Also, Watch E 154 of Ask Dr. Testosterone: Most Effective Way to Use Clen?
Q: Recently I’ve been diagnosed with elevated hematocrit. What shall I do next?
A: Androgens treat anemia. This was a classic indication of their implementation in medicine, way before synthetic EPO was manufactured. Therefore, long-term testosterone use, either as replacement therapy or by abusing steroids within a cycle, will have an impact on red bone marrow. This process is known as erythropoiesis and involves stimulation of EPO in the kidneys by androgens. The result will be secondary erythrocytosis, coming from exogenous androgen use. Erythrocytosis involves elevation of erythrocytes synthesis, therefore RBCs elevate in number and so does their percentage in blood, known as hematocrit.
For men, this reflects in hemoglobin >18ng/dl and hematocrit >54%. Hemoglobin is the protein carrier of oxygen to the tissues and myoglobin to the skeletal muscles. Hemoglobin is an accurate number that is not affected by hydration status, like hematocrit. Usually hematocrit is the result of x3 hemoglobin and in case we are dehydrated, this reflects in higher hematocrit (>x3). In other words, plasma becomes concentrated and hematocrit pseudo elevates.
The accurate medical term of elevated hemoglobin, hematocrit and erythrocytes is known as erythrocytosis. However when platelets, known as thrombocytes, also elevate this condition is known as polycythemia. This is something more critical for thrombosis or coagulation issues, since thrombocytes are responsible for the formation of thrombus. Therefore, it’s important to clarify between these two clinical cases, diagnosed by the number of platelets (>450K) and EPO levels.
Under elevated hemoglobin, we should follow certain prevention steps such as:
-Hydrate properly in order to avoid a denser blood that elevates viscosity.
-Use salicylic acid, known as aspirin, preferably film coated of low dose (100mg) with breakfast.
-Alternatively, those who face enzymatic deficiency of G6PD can use omega-3 fish oil (DHA/EPA PUFA) that has similar effects (inhibition of PGs).
-Donate blood every 90 days (12 weeks; three months) in order to relieve bone marrow. Occasionally when hemoglobin levels rise >18ng/dl, the procedure is named “therapeutic phlebotomy” because blood has to be wasted and not transfused.
-Use pentoxifylline 400mg with breakfast; this improves nitric oxide synthesis and enhances optimal blood flow. This medication isn’t a blood thinner, yet it improves circulation and avoids the risk of an incident of deep venous thrombosis.
-Skip red meat consumption in order to lower hemoglobin synthesis. Iron, cobalamin and folic acid are the main substrates for hemoglobin synthesis. Moreover, a low-protein diet might help to lower protein synthesis of hemoglobin as well.
-Quit smoking, since it kicks EPO by CO, and all smokers develop elevated hematocrit.
-Treat obstructive sleep apnea and snoring, leading to hypoxia and kicking in of EPO. Usually this phenomenon occurs when neck circumference >40cm and air forms turbulence as it passes in the pharynx to the larynx and trachea. This is treated either by a drop in bodyweight, by sleeping to the side (avoiding dropping of the jaw) or by the use of a CPAP mask while sleeping.
-Lower your TRT dose and adjust it preferably to smaller, more frequent doses, known as microdosing. This will have a lesser impact in EPO and bone marrow as a result.
Too frequent blood donation will have a rebound effect. RBC’s life span is 90 days, meaning that this “technical anemia” we provide will send a signal to the bone marrow for further production of erythrocytes, in case the drop of blood takes place sooner. Furthermore, iron gradually lowers, leading to lower ferritin stores and fatigue eventually.
Managing and treating erythrocytosis is a classic thing during androgen use and the majority of users face it, more or less. Of course, some are genetically prone to low H/H levels, such as in case of thalassemia (MCV <70)
George Touliatos, MD is an author, lecturer, champion competitive bodybuilder and expert in medical prevention regarding PED use in sports. Dr. Touliatos specializes in medical biopathology and is the medical associate of Orthobiotiki.gr and Medihall.gr, Age Management and Preventive Clinics in Athens, Greece. Heis the author of four Greek books on bodybuilding, has extensively developed articles for www.anabolic.org and is the medical associate for the book Anabolics, 11th Edition (2017). Dr. Touliatos has been a columnist for the Greek editions of MuscleMag and Muscular Development magazines, and has participated in several seminars across Greece and Cyprus, making numerous TV and radio appearances, doing interviews in print and online. His personal website is https://gtoul.com/
Also, Watch E 154 of Ask Dr. Testosterone: Most Effective Way to Use Clen?
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Elevated Hematocrit: How to Manage and Treat It
By George Touliatos, MD
Also, Watch E 154 of Ask Dr. Testosterone: Most Effective Way to Use Clen?
Q: Recently I’ve been diagnosed with elevated hematocrit. What shall I do next?
A: Androgens treat anemia. This was a classic indication of their implementation in medicine, way before synthetic EPO was manufactured. Therefore, long-term testosterone use, either as replacement therapy or by abusing steroids within a cycle, will have an impact on red bone marrow. This process is known as erythropoiesis and involves stimulation of EPO in the kidneys by androgens. The result will be secondary erythrocytosis, coming from exogenous androgen use. Erythrocytosis involves elevation of erythrocytes synthesis, therefore RBCs elevate in number and so does their percentage in blood, known as hematocrit.
For men, this reflects in hemoglobin >18ng/dl and hematocrit >54%. Hemoglobin is the protein carrier of oxygen to the tissues and myoglobin to the skeletal muscles. Hemoglobin is an accurate number that is not affected by hydration status, like hematocrit. Usually hematocrit is the result of x3 hemoglobin and in case we are dehydrated, this reflects in higher hematocrit (>x3). In other words, plasma becomes concentrated and hematocrit pseudo elevates.
The accurate medical term of elevated hemoglobin, hematocrit and erythrocytes is known as erythrocytosis. However when platelets, known as thrombocytes, also elevate this condition is known as polycythemia. This is something more critical for thrombosis or coagulation issues, since thrombocytes are responsible for the formation of thrombus. Therefore, it’s important to clarify between these two clinical cases, diagnosed by the number of platelets (>450K) and EPO levels.
Under elevated hemoglobin, we should follow certain prevention steps such as:
-Hydrate properly in order to avoid a denser blood that elevates viscosity.
-Use salicylic acid, known as aspirin, preferably film coated of low dose (100mg) with breakfast.
-Alternatively, those who face enzymatic deficiency of G6PD can use omega-3 fish oil (DHA/EPA PUFA) that has similar effects (inhibition of PGs).
-Donate blood every 90 days (12 weeks; three months) in order to relieve bone marrow. Occasionally when hemoglobin levels rise >18ng/dl, the procedure is named “therapeutic phlebotomy” because blood has to be wasted and not transfused.
-Use pentoxifylline 400mg with breakfast; this improves nitric oxide synthesis and enhances optimal blood flow. This medication isn’t a blood thinner, yet it improves circulation and avoids the risk of an incident of deep venous thrombosis.
-Skip red meat consumption in order to lower hemoglobin synthesis. Iron, cobalamin and folic acid are the main substrates for hemoglobin synthesis. Moreover, a low-protein diet might help to lower protein synthesis of hemoglobin as well.
-Quit smoking, since it kicks EPO by CO, and all smokers develop elevated hematocrit.
-Treat obstructive sleep apnea and snoring, leading to hypoxia and kicking in of EPO. Usually this phenomenon occurs when neck circumference >40cm and air forms turbulence as it passes in the pharynx to the larynx and trachea. This is treated either by a drop in bodyweight, by sleeping to the side (avoiding dropping of the jaw) or by the use of a CPAP mask while sleeping.
-Lower your TRT dose and adjust it preferably to smaller, more frequent doses, known as microdosing. This will have a lesser impact in EPO and bone marrow as a result.
Too frequent blood donation will have a rebound effect. RBC’s life span is 90 days, meaning that this “technical anemia” we provide will send a signal to the bone marrow for further production of erythrocytes, in case the drop of blood takes place sooner. Furthermore, iron gradually lowers, leading to lower ferritin stores and fatigue eventually.
Managing and treating erythrocytosis is a classic thing during androgen use and the majority of users face it, more or less. Of course, some are genetically prone to low H/H levels, such as in case of thalassemia (MCV <70)
George Touliatos, MD is an author, lecturer, champion competitive bodybuilder and expert in medical prevention regarding PED use in sports. Dr. Touliatos specializes in medical biopathology and is the medical associate of Orthobiotiki.gr and Medihall.gr, Age Management and Preventive Clinics in Athens, Greece. Heis the author of four Greek books on bodybuilding, has extensively developed articles for www.anabolic.org and is the medical associate for the book Anabolics, 11th Edition (2017). Dr. Touliatos has been a columnist for the Greek editions of MuscleMag and Muscular Development magazines, and has participated in several seminars across Greece and Cyprus, making numerous TV and radio appearances, doing interviews in print and online. His personal website is https://gtoul.com/
Also, Watch E 154 of Ask Dr. Testosterone: Most Effective Way to Use Clen?
DISCUSS ON OUR FORUMS
SUBSCRIBE TO MD TODAY
GET OFFICIAL MD STUFF
VISIT OUR STORE
ALSO, MAKE SURE TO FOLLOW US ON:
YOUTUBE
Click here to view the article.
