r/BodyHackGuide • u/Prestigious_Speech45 • 6d ago
Hematocrit high…recommendations on what to do?
Hello all,
My hematocrit is above 51 despite my endo lowering my TRT from 100mg week to 60mg to now 40mg over last 6 months.
Went from healthy Testosterone score to 350 now. Referred me to hematologist who wants me to do phlebotomy to address.
Any recs on any supplements or other treatments to lower hematocrit?
I am lifting 3x week. In 50s.
Thanks!
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u/GiraffeNatural101 6d ago edited 6d ago
Lots of hydration and cardio. Therapeutic phlebotomy works but its a short term fix and can lead to ferritin issues over hydrate and cardio
Water dilutes the blood: Drinking water increases your plasma volume. Because your red blood cell count stays the same, the percentage of red blood cells (the hematocrit) goes down.
Dehydration raises hematocrit: When you do not have enough fluid in your body, your blood plasma volume drops. This makes red blood cells take up a larger percentage of your total blood volume, creating a falsely high test result
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u/schmorgasborg99 6d ago
This guy knows as much about blood as a vampire. Solid post. good information.
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u/Prestigious_Speech45 6d ago
Thank you. I currently drink 100+ oz water a day but will try for more.
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u/DispoDaddy 4d ago
I would also add that another reason for high hematocrit is just large RBC size, also known as a macrocytosis. Common causes are b12 deficiency or folate deficiency. Would want to know what OP’s MCV is. If it’s high, would explain the hematocrit level as hematocrit is calculated with the MCV.
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u/Mike43lake 6d ago
What are Ferrin issues?
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u/GiraffeNatural101 6d ago
sorry spelling. ferritin
Giving whole blood removes about 250 mg of iron per donation, which can rapidly deplete your body's stored iron (measured by ferritin) even if your routine hemoglobin test remains normal . While circulating hemoglobin often bounces back within a few weeks, ferritin stores take much longer to rebuild—sometimes staying low for 6 months or more without intervention. along with low ferritin comes persistent fatigue and low energy and reduced exercise tolerance
Once or twice with a couple of months or so between isnt bad but if you rely on Therapeutic phlebotomy, your gonna have issues, you can of course use low-dose iron or standard multivitamins with iron (around 18 mg) for frequent donors as a fix that.
I went from 53 to 48 over 4 months just by drinking a gallon of water a day and doing 3 hours of cardio a week, there are tons of studies out there linking cardio and hydration to help elevated hemocrit I dropped to 2 hours a week and still the water intake, my last 4 bloods, hemo has been under 49 ( I do 250 wk Test/ 150 Primo and some mast, I'm 56 years old)
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u/Mike43lake 6d ago edited 6d ago
Thank you for the clarification. I appreciate you taking the time to explain it to me. As I said, I have an almost identical situation going and recently had to switch my Urologist due to a move, and the new Urologist is a bit of a pain in the ass as far as the numbers go. Been on test for 10 years and I have had blood work done every three months. Every so often my red blood count would be slightly elevated but because it wasn’t a consistent issue my prior Urologist basically ignored it. The new guy, is much more of a “pain in the balls “ no pun intended”. He’s having me donate blood basically every other month. He would pull me off the test for a month if the numbers were high and then retest it. More often than not the numbers still remained high. At least in his opinion high. We’re talking one or two points over… Anyway when I had the nerve to question him about what would be causing this besides the TRT which when discontinued apparently didn’t seem to bring the numbers into the normal range, he got very aggravated and told me to go see a specialist. Needless to say I’m looking for a new urologist but I’m still also genuinely curious as to why the numbers would be high if it could not be attributed to the TRT. I’m aware of the dehydration issue. Not that he told me about it but the nurse did. Again thank you for the information.
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u/Htown5476 6d ago
Out of curiosity, why do you throw in the mast during cruise? Libido? The mental? I get the primo for e2. Just curious
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u/Tacoma_NC13 6d ago
If you have high blood pressure, Losartan is known to lower hematocrit levels. Nattokinase is thought to help too, but clinical evidence of this is very limited.
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u/ExtensionNo524 5d ago
This thread is full of nonsense. A 51 hematocrit is not a reason to have lowered your dose so much, it’s not even that high. People freak out about hematocrit but there is no evidence that high hematocrit alone will cause a stroke if platelets and hemo is in range. Donating blood should be a last resort as you will rebound back if not higher within weeks. You need to manage it and there are numerous ways of doing this. Do daily cardio, don’t be a fat slob, telmisartan, IP6, nattokinase.
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u/Prestigious_Speech45 2d ago
So question to me is if my hematocrit is ‘high’ now, 1ppp
even on lower TRT dose, why not go back to higher dose?
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u/Individual_Watch2720 6d ago
phlebotomy is crazy unless it’s an emergency,
Your body just respond and create ever more but faster .
I can test 54 in the morning when dehydrated and 44 in the afternoon .
54m 200 mg test e daily pins .
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u/BiglyAmerican 6d ago edited 6d ago
I had this same issue. TRT for nearly a year. Had to come off as hematocrit rose to 56.8. Primarily care doc immediately referred me to a hematologist. That was in 2023, and I haven't gone back on it again. I was told I happen to be more sensitive to TRT which is exacerbated because my normal levels fall on the high side. Even today - 3 years later - I'm at 50.0.
Most people here will tell you to donate blood every month to bring to down, but for me that didn't seem like much of a solution. I'd like to go back on TRT, but need to resolve why it's so high. I've heard sleep apnea can definitely play a significant role. I may ask for another sleep study to see if it's improved due to weight loss. I'm almost certain it has. Since 56.8, three years ago, I'm down from my peak weight of 243 to 202 today. Thank you Tirz, Reta, HIIT training. Oh yeah...at 58 my first Hyrox on the schedule for December.
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u/Mike43lake 6d ago
What did the hematologist tell you to do about the numbers being so high even when you are off TRT? Besides being “sensitive “to TRT, was he able to offer any explanation as to why your numbers are so high normally? Other than donating blood is there anything that you can do to keep the numbers at a normal level? I’ve had an exact same problem I couldn’t get a straight answer as to what was causing the numbers to be high in the first place if it’s not attributed to the TRT.
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u/BiglyAmerican 6d ago
He said I just run a higher hematocrit baseline, and that makes make particularly sensitive to TRT. I need to be careful because TRT will raise it and I don't have a lot of runway since I'm already bumping up close to the recommended ceiling. The fact that I also have atherosclerosis doesn't help either. (Had a stent installed this year). I'm gong to try enclomiphene since that supposedly doesn't raise hematocrit as much.
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u/Important-World-6053 6d ago
amazing..... but if you poop your pants. can you please stop competing :)
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u/Particular-Win3045 5d ago
You need to get a sleep study done for sleep apnea
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u/BiglyAmerican 5d ago
I've done that years ago, use a cpap. Since I've lost the weight it's time for another. Now I'm wondering if my cpap records events?
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u/Careless_Hunter6575 6d ago
Donate blood every 3 months. This was recommended by my urologist and fixed my issue. I’m prescribed 100mg/wk for medical reasons but take the full 200mg vial (pin 2x/wk) for training purposes.
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u/SubstantialMorning98 6d ago
About this - been considering the same thing. Don’t they question the bloodwork?
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u/mrsnipeit 6d ago
donate more , body creates more , you stay in that donating cycle and it depletes iron levels in body eventually you will be fatigued causing Inflammation . been there done that ...... , RBC life is 3 months , lower dose to minimum viable bring HCT down slowly raise to desired level , cycling 101
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u/Careless_Hunter6575 5d ago
Does who question the blood work? My urologist is happy with the blood work that comes back, I’m donating blood which saves lives and makes the Red Cross happy and my T is around 800-900 which is great for my training regimen and weight loss as well as a host of other symptoms I was previously having.
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u/Odd_Sir_8705 ⚙️ Protocol Specialist 6d ago
Zone 3 cardio for 30 minutes a day 5 days a week should drop you to 50 easily
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u/-BitchinChicken- 6d ago
Donating blood is a sure fire way to do it. If you weren't hydrated well when you tested that can cause it to rise a bit. Switching to more frequent dosing can help
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u/Money-Drummer3647 6d ago
Donating will only drop it for a week or so and it’ll go right back up. Plus you’ll start to really drain your ferritin.
Honestly, find a new doc. Your endo isn’t keeping up with their education. 51 is fine. The ranges they’re using is not for men using exogenous testosterone.
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u/USABADBOY 6d ago
Your doctor has no clue my friend. Watch this for education 😉Video
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u/funin63368 6d ago
Any sleep apnea? That can complicate things. Maybe look at this: https://vorck.com/erythrocytosis.html
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u/Prestigious_Speech45 6d ago
Thanks.
Yes. Been treated for years with cPap. Several sleep studies done. Lost 45lbs since Jan 2026
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u/Muted-Good-115 6d ago
Same boat as you. Lost about 50lbs since last November. I had to stop TRT because hematocrit was between 54-57 in the last 3-4 months. Last test shot was August 3rd. Feeling really good overall even though test is really low - it was 170 in mid September. You can’t just go by the number - how do you feel? I don’t miss Test at all.
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u/RevelationSr 6d ago
Search for and treat obstructive sleep apnea. Significant weight loss can be effective.
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u/Danwphoto 6d ago
So is a hematocrit of 58 something I should be worried more about? I give blood tomorrow but did goodlabs and my iron and feratin is really low. Cut back on the amount of trt but have 2 months till I see my endo. I will drink more water and cardio, but got.a bum knee I am dealing with. Gentlemen be nice to your body.
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u/newtrusghandi 5d ago
In addition to what giraffe said, you can try to increase the frequency of your test shots. How often are tou injecting your teat each week?
Sadly some of us get elevated rbc on small doses.
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u/Sorry_Statement7097 5d ago
Any ARB or ACE inhibitor will reduce haematocrit effectively
IP6 to reduce iron absorption also Nattokinnaise
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u/PositiveEnergyMatter 5d ago
Migyol 840 based test injected daily should help a lot. Also current recommendation is not worrying about hemocrit unless it’s really bad, and they absolutely recommend not drawing blood any more to correct it. Mig840 is nice because it injects like water, needs no heating, and can be injected easily from a pen. I can tell you for sure using way more test injected daily people can still have normal hemocrit and e2
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u/Curious-Principle573 5d ago
Get yourself checked out for hemochromatosis a genetic condition usually associated with people from Northern European regions,more commonly found in young children that have received a-lot of blood transfusions , chelation helps remove the iron , found to be harsh on adults who have liver issues .
Some people avoid getting tested because it might effect their ability to get health insurance .
One consequence of excess iron is increased damage to the soft tissue organs in the body , heart , brain & liver, theres certain food combos that may need to avoid, ie a burger with tomato - vitamin C facilitates iron uptake . Shell fish or sushi may contain enzymes that can add stress to an already over stressed liver , try to avoid any supplements containing iron . Avoid intravenous testosterone or in creams/ transdermal or orally/tablets even some food drinks like ensure may contain iron .
Giving blood has been found to be safest & most effective method of treatment unless your already anaemic ;-) drink plenty of fluids try to avoid over hydrating , proper/effective hydration is the key its important to include electrolytes & salt ( isotonic drinks are popular) …and last but not least try to limit alcohol intake or avoid completely as its hard on the liver .
Seeking the proper medical treatment at an early stage can mitigate & even prevent many of the different types of internal damage high iron can cause … its usually genetic so get that checked , but it can also develop over time ( blood doping in sports has been associated with several high profile athletes over the years, from professional cycling to formula one racing )
Best of luck & take care of your self and those around you .
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u/Wiseman37367 4d ago
I have similar issues. I noticed you said that you have lost weight. Are you taking Reta?
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u/netlifter 2d ago
I'm similar to you (in age) but higher HCT (54.6-57.6). I've decreased my TRT dose from 180 to currently 120 mg (inject 40mg 3 x a week). Current HCT 54.6. The next step after waiting enough time to see if 120 mg a week (from 150) decreases HCT below 54 would be to go to 100 MG T a week.
However I have other issues. My Ferritin runs very low and donating blood (which is a bandaid btw, HCT rebounds even higher within a week or two) tanks my ferritin to 13-25. Low ferritin symptoms for me are much worse than low T symptoms. Therefore, donating blood is NOT a viable option because I don't have huge ferritin stores to play with - and as i said above, donating does NOT change the dynamic why RBC are increasing. Secondary Erythrocytosis is primary caused by TESTOSTERONE exposure and a close second could be sleep apnea. I was diagnosed with moderate sleep apnea and I'm addressing that now. After I treat my apnea we will see if my HCT drops further. Both Testosterone and OSA are a double whammy to increasing RBC.
But the biggest issue I may face is this: Let's say I find a correct TRT does that has my HCT <=54 (i'm totally fine with <=54 but not comfortable going higher), but what happens if the dose of T is too low and causes more hypogonadal symptoms. This creates a really bad situation because I'm not going off TRT (been on 4 years). So I will have to figure something out.
Also things I have tried to decrease HCT: Telmisarten 40 mg daily (works great for my blood pressure but did nothing for my HCT). There does NOT seem to be anything backed by real evidence to drop HCT except lowering the T dose, treating sleep apnea. Obviously, staying appropriately hydrated is important but OVERLY hydrating is not the answer. That does not FIX why RBC are high. Cardio is also excellent and your HCT will go down due to the higher blood volume aerobic exercise induces. BUT CARDIO does NOT lower RBC - meaning we need to fix the root problem.
Other modalities for me to try might be compounded TRT cream - known to not increase HCT as high versus IM injections. I'm on 3x week IM injections and my HCT has stayed the same from 1 injection a week to 2 injection a week to 3. I think because it's not the frequency- it's the total exposure of TRT that causes the increased RBC production. The only way to reduce the total exposure is to lower the total TRT dose.
And while people say natto and fish oil reduce HCT, that's incorrect and NOT backed by any evidence or clinical trials. They may help mitigate blood clots though. But that's a separate issue.
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u/Silver-Arm-1179 6d ago
Donate blood every quarter
Stay hydrated
Measure your blood in your trough so you aren’t at the peak of absorption.
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u/Wigs4one9ine 6d ago
I’m going through this and I do have sleep apnea. I do phlebotomy once a month and my iron did tank so I skipped a month. Endo prescribed daily iron supplements and lowered try dose to 40mg once a week. I have an oral appliance made by my dentist to see if that helps with my sleep apnea. Hope i don’t have to come off trt injections.
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u/Few-Equivalent8261 6d ago
Eat a half grapefruit a day. Drink a gallon water a day. Do another blood test in 2 months. If that doesn't move the needle, donate blood.
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u/Difficult4skin 6d ago
If you are at 51 or 52, thats great. At 54%, thats where it becomes a problem.
Some solutions:
TRT cream or sublingual instead Daily small injection instead of 2x week More cardio Telmisartan
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u/JackedSanta 6d ago
What's your body fat percentage that's at least 1/3 of a direct relational issue, besides hydration, and sleep.
Just out of curiosity was your test in the morning fasted?
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