So the scam here is that they want your Dr to write a script. They will then bill your insurance and THEN sell your blood so they can double dip. Some try this with HRT and some if any doctor for any reason (temporary, one off or constant regardless) has ever written a script for you to donate. I have a pretty desirable blood type (call that profitable for them) and when they pulled this, I flat out called them out on it because I know the economics of their scam. They literally wouldn't look me in the eye. I told them to never call me again and that for the rest of my life they'd never get a drop. Done.

Anyway all test and derivatives can increase RBC and Crit. Look at your pre HRT baseline to see how much higher it is now. The condition is called testosterone induced polycythemia. Different degrees for different people but generally dosage dependent and phlebotomy is best way to fix it. Sleep apnea is a major contributor as well. Also would want to know how iron/ferritin levels are impacted.

Look up power red donation at the red cross. I've been doing it for the last 4 years. They hook you up to a machine and take a pint of blood out. The machine separates the reds and returns the rest with some added saline. The cycle continues once more and you're done. You'll have donated 2 units of RBC's but not actually lose any blood volume. It's a great way to keep H&H in check and help out the community. The only downside is you can only donated every 112 days or approximately 4 months. The entire process take about 45 mins or less.

Your doc can write you a script for pheblotomy.
More frequent injections by splitting your dose will help.
Drink a gallon or more a day and definitely drink a shit ton prior to donate. It will bring it down some.
There's a supplement called narigan it can lower it as well but has interactions with certain meds.

Buddy you need to remember that RBC count and Haemoglobin levels are two totally different things. You can have a high blood cell count BUT low Haemoglobin levels still. RBC levels dictate how thick your blood is not the Haemoglobin level. Haemoglobin is the protein found within each Red Blood cell that transports dissolved oxygen from the lungs around the various organs of the body to make them work High Haemoglobin levels mean you have the ability to transport huge amounts of oxygen around the body at any given time and you will get your breath back much sooner and muscles will be energised and recuperated a lot faster. However there are upper and lower levels of this which you need to be mindful of. 130 to 180 are our upper and lower limits in the UK (your 13 to 18) and you are outside upper levels.

Iron, Vitamins B9 (Folic acid) and B12 and B1 are the main vitamins and minerals which allow your bone marrow to produce normal sized, healthy HGB levels. Are you taking in any of these things excessively? Do you consume a lot of Red meat? These are the areas you need to bring down and control to prevent this from happening again - A blood test will show the areas which are high or sometimes low if you have B12 deficiency like I had early this year.

Bro! 1). Your doctor can write a prescription for the clinic to donate and dispose of the blood. (Best option)

2). You don’t have to tell them anything you don’t want to tell them. For crying out loud, my questions ask if I slept with a prostitute.. I haven’t but if I did, what’s the difference if I get laid every night by a new chick.

3) try a different clinic! I have never been told that they would not take my blood due to TRT- and yes I’m honest.

4). A doctor can prescribe a blood thinner and you can take a low dose of Tylenol to help thin it.

Also read below, great suggestions from the groups

Staying optimally hydrated, cardio and grapefruit juice can lower hemacrit. Also if you smoke I would knock that on the head too as this can raise it too.

If your doc is keeping you within normal range high RBC should not be an issue. Get an endo doc.

First advice, see your PCM about WHY your numbers are high. People can throw out 100 ideas of why, but you won’t know until they test you. It could be from bone marrow to diet (HIGHLY UNLIKELY OF DIET). No one on this website can give you and answer of why you’re sitting at 18.4. In all reality that’s not incredibly high.

Second advice, do not take something on your own to thin the blood. I cannot stress that enough. That is incredibly dumb and leads to a way different set of problems.

Bottom line: talk to doc