+ 2 Sudden Hematocrit Increase!
Posting here because im over 40 (46). On March 24th my hematocrit was right at 53, I always run a bit hot between 50 and 52, so this was a little higher than the norm. Well, just had bloods done again yesterday, June 2nd, and hematocrit came back at 60!! Now I cant just run and donate, they wont allow it since the h&h is too high, need a doctor referral. I drink a shit ton of water, get my zone 2 cardio in, use my CPAP, and am only on a TRT dose of 105mg a week since last October.
Just posting to see if anyone has had a similar problem, and if there is any way to curb it before I can get to donate. Its alarming to have increased so much, and only within a couple months, with no cause that I can think of. Unfortunately, the only healthcare I currently have is through the VA, and they are fucking worthless.
So, if yall can think of anything, just shoot your ideas here. I dont want to stroke out in my sleep
EDIT: I think Junkyarddiesel nailed it. I have always used Nutrabio NAC and take one scoop am and one pm, 600mg each. Well I recently bought Nutricost NAC and continued the same protocol. I just checked the label and one scoop is 1200mg! I have been taking double for the past two weeks, leading right into my blood draw. For someone in normal range this probably wouldnt be an issue, but for someone like me who runs at the top edge of normal, it could have caused this spike.
I also looked up and read some of the studies. NAC can most definitely increase hematocrit, by up to 9%! So while its not the total cause, I think it may be reason it jumped so much so quickly. Seems I did this to myself, not reading the label and assuming the product would be dosed the same
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also tell them to check you for thalassemia, that can do all sorts of weird stuff with rbc, im not saying thats the cause of your high# but alpt of people dont even know they have minor thal. if you had major thal you would know by now.
Edit added to main post.
Thank yall for the input. And feel free to bash for not reading labels
Search this med Pentoxifylline. I heard about this med on a Podcast discussing about high Hematocrit. This wont lower high Hematocrit but this will deal with the hyper viscosity side. Not a blood thinner which is used to prevent clots. Pentoxifylline does not directly prevent clots. Instead, it makes the blood "less thick" or sticky and increases the flexibility of red blood cells. This allows the blood to flow more easily through narrowed vessels to deliver oxygen to tissues.
Thats one ill discuss with the doctor when I see him. Thanks
The VA sucks! Go to your local men's health clinic or a blood bank! PM me I have been navigating through their BS for years!
I can tell you that n-acetylcysteine had my hematocrit run absolutely wild. Didn't know what the fuck was going on and I narrowed it down and discontinued use. Donated untill I was back in range and problem was solved. Was a nightmare...
I think you might be the winner. I have always used nutrabio NAC and take one scoop am and one pm, 600mg each. Well I recently bought Nutricost NAC and continued the same protocol. I just checked the label and one scoop is 1200mg! I have been taking double for the past two weeks, leading right into my blood draw. For someone in normal range this probably wouldnt be an issue, but for someone like me who runs at the top edge of normal, it could have caused this spike.
I also looked up and read some of the studies. NAC can most definitely increase hematocrit, by up to 9%! So while its not the total cause, I think it may be reason it jumped so much so quickly. Seems I did this to myself, not reading the label and assuming the product would be dosed the same
It took like 6 or 7 weeks of discontinued use before the red blood cell problem slowed down and stopped. With that being said your still to gonna have to dump some blood.
Yeah I read that in the studies too. The washout period for NAC is very long. Doc did get back to me and scheduled the first phlebotomy
This is why I post this sort of thing. Never know when someones anecdote will be helpful. Even AI couldnt find this connection until I really pushed Claude to "dig deep"
Ive used NAC off and on for years. Currently using 1200mg a day. Never heard of this reaction but ill look into it
I used for years too with no issues. Didn't use it use it for a while and then that happened. Everyone told me I was crazy. I did research. Found studies of it driving up red cell production/hematocrit and then quit taking it. Ppl still say I'm full of shit. But I lived it. It was a fucking nightmare.
I already did some research after your message. Part of what NAC does is its "red blood cell protective". Meaning those cells live longer. So the old cells stick around longer while the new ones are still being produced. Like I said, id been using it basically since covid first hit, but I did change brands this year (could be a thing, maybe not). I know it probably not the main driver here, but definitely could be contributing. Thanks for sharing that info
K-Shield Advantage Blood Drawing Kit at HealthyKin.com https://share.google/HnjO2OUayJV429lMu
Brother, I'm going to be straight with you because a jump to 60 deserves directness, not forum tinkering.
A hematocrit of 60 is genuinely dangerous and this isn't a "curb it with supplements" situation. At 60, blood viscosity is high enough that stroke, clot, and cardiac event risk are meaningfully elevated this is the level where the "stroke out in my sleep" worry you mentioned isn't catastrophizing, it's the actual concern. The forum suggestions of hydration and grapefruit aren't going to bring 60 down to safe in the timeframe that matters. You need a therapeutic phlebotomy, and you need it soon, not after an 8-week supplement experiment.
The fact that the blood bank won't take you because your H&H is too high is itself the signal they're refusing because at 60 it's a medical procedure, not a donation. That refusal is telling you this needs a doctor.
On the VA being worthless I hear you, but this is exactly what the ER is for. A hematocrit of 60 is a legitimate reason to go to an emergency room. You don't need a referral, you don't need your regular VA doctor, and they can't turn you away. An ER can do a therapeutic phlebotomy that day if your numbers and symptoms warrant it. Walk in, tell them your hematocrit is 60 on recent bloodwork, that you run on the higher side normally, and that you're concerned about hyperviscosity. They'll take it seriously. This is the fastest legitimate path to getting blood off safely, and it bypasses the VA bureaucracy entirely.
Now the hopeful angle: you may have been dehydrated at the June 2nd draw, which could mean your true hematocrit isn't actually 60.
Hematocrit is a percentage the ratio of red cells to total blood volume. When you're dehydrated, your plasma (the fluid part) is reduced, so the same number of red cells makes up a higher percentage of a smaller total volume. The reading comes back inflated even though your actual red cell mass hasn't changed. Dehydration can swing hematocrit several points sometimes 3-5% or more when significant.
So part of that jump from 53 to 60 could be a hydration difference between the two draws. If you were well-hydrated in March and dehydrated on June 2nd (morning draw, no water overnight, maybe coffee, maybe fasted, maybe after training), some of that 7-point jump might be artifact rather than real erythrocytosis.
This does NOT mean ignore it. Dehydration alone rarely accounts for a full 7-point swing, so your true number is still likely elevated and still needs attention. But it means the situation might be a bit less acute than a literal 60 suggests, a properly hydrated retest is important before drawing conclusions, and it's worth telling the ER you may not have been optimally hydrated so they interpret the number in context.
How to hydrate properly before a blood test so you get an accurate hematocrit going forward:
Drink water normally the day before well-hydrated baseline, not bone dry.
Have 1-2 glasses of water (about 500ml) in the 1-2 hours before the draw. Not chugging a gallon right before (that transiently over-dilutes and isn't accurate either), just normal good hydration so your plasma volume is at its true baseline.
Don't show up dehydrated from an overnight fast. If it's a fasted draw, water is still allowed and encouraged fasting means no food, not no water. A lot of guys fast for bloods and don't drink water, showing up dehydrated. Drink the water.
Avoid before the draw: alcohol the night before (dehydrating), excessive caffeine the morning of (mild diuretic), and hard training or sauna in the hours before (fluid loss through sweat). All inflate the reading.
Don't get drawn right after a workout exercise transiently shifts fluid and raises hematocrit readings. Draw before training, not after.
Keep draws consistent over time similar time of day, similar hydration, similar fasted/fed state so your trend reflects real changes, not measurement conditions. Part of why your March-to-June comparison is hard to interpret is you may not have controlled these the same way both times.
The thing that's nagging me about your numbers raise this with whoever you see:
A jump from 53 to 60 in roughly ten weeks on a TRT dose of 105mg you've been stable on since October doesn't add up cleanly. Even accounting for possible dehydration, that delta is large and fast, and TRT at 105mg doesn't usually drive that kind of escalation when you'd been stable. Things worth having a doctor evaluate:
Is this actually polycythemia vera or another primary blood disorder rather than just TRT-driven erythrocytosis? A sudden unexplained jump like this in a 46-year-old warrants checking. A JAK2 mutation test and proper workup would distinguish TRT-driven from a primary marrow disorder. This matters if it's PV, that's a different disease with different management, and "it's just my TRT" would be the wrong conclusion.
Is your CPAP actually working / is your apnea controlled? You use it, but untreated or under-treated sleep apnea is one of the most powerful drivers of high hematocrit because of overnight oxygen desaturation. If your apnea worsened or the settings are no longer adequate, that alone could drive a climb. Worth getting the CPAP data checked and possibly a repeat sleep study.
Any new medications, illness, or change since March?
Don't let "it's just my TRT" be the default conclusion on a jump this size. It deserves an actual workup, and "the VA is worthless" can't be the reason it doesn't get one the stakes are too high.
On the self-bleed suggestions in the thread:
I get why guys do it and I get the access frustration, but at a hematocrit of 60 specifically, I'd push back on DIY phlebotomy as your primary plan. At 60, you're not just casually removing a unit the volume, the rate, and what you replace it with matter, and doing it wrong (too much too fast, no volume replacement) can cause its own problems including dangerous blood pressure swings. At a normal-high hematocrit a careful self-donation is one thing. At 60 with hyperviscosity, having it done properly with monitoring is genuinely safer. If you truly cannot access any care and you're symptomatic, that's a different calculus, but the ER is accessible to you and is the right first move before draining a bag yourself.
What you can do right now, today, while arranging the phlebotomy:
Hydrate aggressively it won't fix 60 but it reduces viscosity at the margin and buys a little safety while you get to the ER. This is where the "water water water" advice is actually useful as a stopgap, not a fix. (It's also why a rehydrated retest may read lower.)
Avoid anything that further concentrates blood or raises clot risk alcohol, long immobility, hot environments (sauna, hot tub), excessive heat.
Watch for emergency symptoms that mean go to the ER immediately rather than "soon": chest pain, shortness of breath, severe headache, vision changes, one-sided weakness or numbness, slurred speech, severe dizziness, calf pain/swelling. Any of these with a hematocrit this high is a call-911 situation.
Consider holding the TRT until this is sorted. At 60, continuing to add any erythropoietic stimulus while you wait doesn't make sense. Discuss with the doctor, but temporarily stopping while your hematocrit is dangerously high is reasonable.
Bottom line:
This isn't a forum problem. A hematocrit of 60 in a 46-year-old that jumped 7 points in ten weeks needs an ER visit for therapeutic phlebotomy and a real workup to figure out why it spiked including ruling out polycythemia vera and checking whether your apnea is actually controlled. Some of that 60 might be dehydration, which is reassuring and means a properly hydrated retest is worth getting, but it can't explain the whole jump and doesn't change that you need this properly evaluated. The VA being frustrating is real, but the ER can't turn you away and this is exactly what ERs are for.
You're right to be alarmed. The alarm is appropriate and it should translate into an ER visit, not a forum thread. Go get it handled, then get the workup to find out why it spiked.
Thats the thing, I always plan my labs under the same conditions, and am always hydrated. So unfortunately, that kinda rules out the lowhanging fruit of determining cause here. I do agree that I need to get the phlebotomy swiftly, and then determine cause. If I cant get help through the VA this morning ill go the ER route. It is quite concerning, 7 points in 8 weeks is crazy
Brother, your answer actually makes this more important, not less. If you genuinely control your draw conditions and you're consistently hydrated, then we can't write any of that 7-point jump off as measurement artifact which means it's a true rise, and a true rise of that size and speed on a stable 105mg TRT dose is the kind of thing that needs an actual diagnosis, not a TRT adjustment.
Here's the reasoning that should drive your urgency: 105mg of testosterone weekly, stable since October, does not suddenly start driving your hematocrit up 7 points in 8 weeks. TRT-driven erythrocytosis tends to be gradual and to plateau it doesn't accelerate out of nowhere months into stable dosing. So when a number behaves in a way the obvious cause (your TRT) doesn't explain, and you've ruled out the artifact explanation (dehydration), you're left looking for a cause that isn't the TRT. That's exactly the situation where you don't want to assume "it's just my testosterone" and move on.
The things that genuinely need ruling out, in rough order of importance:
Polycythemia vera or another myeloproliferative disorder. This is the one I'd push hardest on. A sudden unexplained acceleration in red cell production in a 46-year-old, not explained by a stable TRT dose, is a textbook reason to check for PV. The test is a JAK2 V617F mutation analysis it's a specific blood test, and roughly 95%+ of PV cases carry that mutation. If it comes back positive, that changes everything: PV is a clonal blood disorder, managed differently (regular therapeutic phlebotomy, sometimes hydroxyurea, low-dose aspirin, hematology follow-up), and it carries its own clot/stroke risk independent of the AAS conversation. Critically, PV can hide behind TRT a guy on testosterone sees high hematocrit and assumes it's the TRT, when actually he's developed an independent blood disorder that the high-hematocrit-from-TRT masked. Your stable dose plus sudden jump is exactly the presentation where this gets missed if nobody checks. Ask specifically for a JAK2 test and an EPO (erythropoietin) level in PV, EPO is typically low (the marrow is overproducing independent of the EPO signal), whereas in secondary erythrocytosis (TRT, apnea, hypoxia) EPO is normal or high. That EPO level helps distinguish the two.
Worsening sleep apnea despite the CPAP. You use it, but "using it" and "it's actually controlling your apnea" aren't the same. If your apnea has progressed, if your pressure settings are no longer adequate, if you've gained weight, or if the machine/mask isn't sealing properly, you could be desaturating overnight despite compliance, and overnight hypoxia is one of the strongest drivers of erythrocytosis. Pull your CPAP's compliance and efficacy data (the machine logs your AHI apnea-hypopnea index and you want to see it's actually low, not just that you're wearing the mask). If your AHI on the machine is creeping up, that could be your cause, and it's fixable with a titration study and settings adjustment. This is worth checking because it's a real and correctable driver that fits the timeline if your apnea changed.
Other secondary causes worth a look: any new respiratory issue, anything causing chronic hypoxia, kidney issues (rarely, certain kidney problems overproduce EPO), or testosterone levels running higher than intended (if your actual serum testosterone is higher than a 105mg dose should produce bad dosing, a compounding error, or accumulation that could drive more erythropoiesis than expected; worth checking your actual total testosterone level alongside everything else).
So the workup you want to ask for, beyond the phlebotomy: JAK2 mutation test, serum EPO level, a check of your actual total testosterone, iron studies, and a real look at your CPAP efficacy data (AHI), possibly a repeat sleep study. That panel distinguishes "this is PV" from "this is uncontrolled apnea" from "this is more TRT effect than expected" three very different situations with three different management paths.
The sequence is right the way you laid it out: get the blood off first (ER if the VA stalls this morning and don't let them stall it, 60 is an emergency room appropriate number), then pursue the cause. But push for the actual diagnostic workup, because "high hematocrit, let's phlebotomize and send you home" without finding out WHY it jumped would be incomplete care. The phlebotomy treats the immediate danger; the workup tells you whether you've developed something that needs ongoing management.
One practical note on the VA: if they're slow on the phlebotomy this morning, the ER is the right move and you can also ask the ER to run the JAK2 and EPO while they have your blood that way you're starting the workup at the same time as getting the immediate treatment, rather than waiting on the VA to eventually order it. Frame it to the ER as "hematocrit 60, concerned about hyperviscosity, and it jumped 7 points in 8 weeks on a stable dose with no obvious cause can we rule out a primary erythrocytosis while we're at it." That gets you both the treatment and the start of the answer.
You're taking this seriously and that's exactly right. A controlled, consistent measurement showing a true 7-point jump in 8 weeks is a genuine signal that something changed, and the job now is finding out what with PV and worsening apnea as the two leading candidates to rule in or out. Get the blood off, get the JAK2 and EPO, check the CPAP data. Don't let it get written off as "just your TRT," because the pattern doesn't fit that, and the things it could be instead are things you want caught early.
I totally agree with you. Personally, I consume a half gallon within three hours of waking up and no Alcohol ever!
What up, BIG….IHMO there really isn’t such a thing as a “sudden” hematocrit increase.
Hematocrit is usually the body’s response to a chronic stressor or combination of stressors. Hormones, sleep disorders, hydration status, cardiovascular health, inflammation, altitude, smoking, genetics… it’s a multifactorial issue.
Something changed between 53 and 60. The question is what.
You’ve already got a lot of the basics covered. Hydration, CPAP, cardio and TRT awareness are all good things.
From what I’ve seen over the years, keeping hydration high can make a bigger difference than most people think. Same with fasted cardio, managing sleep apnea properly, keeping blood pressure under control and improving overall cardiovascular health.
Telmisartan, Nebivolol, Cialis, Nattokinase and similar damage-control tools can also help create a healthier environment overall, although none of them are a magic bullet for hematocrit by themselves.
As for blood donation, it definitely works for quick relief and can drop hematocrit fairly quickly. The problem is your body doesn’t know the difference between a blood donation and blood loss. It just sees less blood volume and often responds by increasing RBC production again over time.
If they won’t let you donate, I’d look into therapeutic phlebotomy. Honestly, at 60%, that’s probably the route I’d be pursuing while also trying to identify the root cause.
I wouldn’t panic, but I also wouldn’t ignore it. A jump from 53 to 60 deserves some attention, especially considering you’re only on 105 mg TRT.
Just my miserable two cents, BIG. Not a doctor.
Totally agree. The fact that nothing with my protocols and routines has changed is the most concerning. Phlebotomy will remove some current risk, but for sure need to find the root cause. Trying to get help from the VA now, at least to let some blood out
You can purchase all the supplies for a blood donation like the bag and needle and all and drain it yourself
That sounds pretty diabolical not gonna lie
I have done it a few times when on accutane. There are videos on how to.
How do you figure out how much you need to drain?
It’s the standard donation bag 1 pint you feel it up and usually after that you’re good for a while. Do blood work a couple days after
Copy that. Might just get a kit to have on standby for situations like this
Blood doesnt bother me, but i dont know man. It seems simple but id fuck it up LOL
There use to be guys on here that did Self Bleeds to control it - look up Giardap who did a forum post on it. ONLY attempt it though if you are confident and don't get freaked out by the sight of blood easily lol I tried it years back and did a right fuck up of it all lol.
Leech Blood Therapy is also something if you can do at home
Hydrate up big time. Water, water, water.
Always. Its not hydration. I have a routine for everything, and water (and electrolytes) tracking is one of them. 1.5 gallons a day minimum without fail
If you have insurance, you can get a phlebotomy as needed. Just need a script from your doctor
Research the use of Naringin or grapefruit to help lower Hematocrit. The studies seem to be mixed. I just came back with high hematocrit and super high iron and I am just now giving it a shot. I'll let you know how I do in about 8 weeks. I figured it can't hurt.