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[69.67.186.8]) by mx.google.com with ESMTPS id d75a77b69052e-50939ec44cfsi2728791cf.2.2026.03.10.15.05.37 for (version=TLS1_3 cipher=TLS_AES_256_GCM_SHA384 bits=256/256); Tue, 10 Mar 2026 15:05:38 -0700 (PDT) Received-SPF: pass (google.com: domain of bounces+tjphuhs=gmail.com@bh.mail.beehiiv.com designates 69.67.186.8 as permitted sender) client-ip=69.67.186.8; Authentication-Results: mx.google.com; dkim=pass header.i=@bhmta.beehiiv.com header.s=bh header.b=RIdYJvPW; dkim=pass header.i=@mail.beehiiv.com header.s=bh header.b=GJFFsxoz; spf=pass (google.com: domain of bounces+tjphuhs=gmail.com@bh.mail.beehiiv.com designates 69.67.186.8 as permitted sender) smtp.mailfrom="bounces+tjphuhs=gmail.com@bh.mail.beehiiv.com"; dmarc=pass (p=REJECT sp=REJECT dis=NONE) header.from=beehiiv.com X-BmtaRef: eyJfQF8iOiJcXF8vIiwicmVjaXBpZW50IjoidGpwaHVoc0BnbWFpbC5jb20iLCJ4X2xpc3RfaWQiOiJmZDQxNjMwZS1lOTFmLTQ2ZDktYTI3NC1iNzQwZGFiNzU2ZDIiLCJ4X3N1YnNjcmliZXJfaWQiOiI5YzQwZDYzOS02ZTFkLTQyOTItYTlkNy0wZTRjYmJiNWQ1ZGIifQ== DKIM-Signature: v=1; a=rsa-sha256; d=bhmta.beehiiv.com; s=bh; c=relaxed/relaxed; bh=kmLYjU9hPmtpZ31BThXrqh752L6Hi8SnH4rJKwMtNoQ=; h=from:subject:mime-version:content-type:content-transfer-encoding: list-unsubcribe:feedback-id:list-unsubscribe-post:reply-to:to:cc: content-type:feedback-id:from:subject:to; t=1773180309; b=RIdYJvPWmXRQGweF9VxZ4fU1WHW02K6nQTihQBKRXuttUsJXP2V7Xrgm0nUE5d1uqmf+LRHqb qvDcM5/SuhfokOn9n5Vljd/6r3V9nwNEr2HATPhxgWT46ty8ZZA1xXyoCNB763cju0/xeGlItSb rfOeYyGdbrYdjzUTOFbS3pctAjLaQAd8v/blph6xoWYIHUyeuRIunYgovWxp1RYyBMXBx04scw1 1YW+8OdLJ12KkUrqeZ7X2wrW/GnUztfFZFS5b6QJB/W5R73lNZPAU5auZ8IYXBlgMktf/cjTcWg tWjMBeQ9CwaP+GMTmxtE8LXOoGEZ+Z+vuWddhpv9YZ8A==; DKIM-Signature: v=1; a=rsa-sha256; d=mail.beehiiv.com; s=bh; c=relaxed/relaxed; bh=kmLYjU9hPmtpZ31BThXrqh752L6Hi8SnH4rJKwMtNoQ=; h=from:subject:mime-version:content-type:content-transfer-encoding: list-unsubcribe:feedback-id:list-unsubscribe-post:reply-to:to:cc: content-type:feedback-id:from:subject:to; t=1773180309; b=GJFFsxozCVQDSYTbZPWJOOOzVmBEaaU895jjH3wocxeG/IMFGeZXS3ZwZs/ze7AdU5YKiCDpI 11uL8g71pYd+pBA2yxoHr1GN0uN/rWsNS6MBvojDCLg1yuf46/EEklpEJ213nAWQnOI8tF22+5L DQfV7blDjpzxEsWhE13qUU0T8dxm8/WKBL+0UjK2/FHCzLz1RBWj8UjOAA7Kd8g6puXgZkkPpc4 jNtoGtYbHtciP7XLoHuKjCyhwA68nHWgTtBFNOPJ1gwBLXeVxE0z1mgJ2IEnNvYAU8uCUYfO+7B E6C9CmeqLybY2W3M/oM4ryT0ksNnV7oR06C3c6jyY5Gg==; Received: from mail.beehiiv.com by bhmta(mta13) with HTTP id <344d055c1ccd11f184521228d4c0508b> for ; Tue, 10 Mar 2026 22:05:09 +0000 Content-Type: multipart/alternative; boundary="QTQecKcjQEGwFCf0Jmw1XQ" To: "tjphuhs@gmail.com" Feedback-ID: 0e80c778-af5e-4d83-ac0e-2340b94b4c1d:newsletter:fd41630e-e91f-46d9-a274-b740dab756d2:c8f61fda6a60803 From: Hunter Williams List-Unsubscribe: , List-Unsubscribe-Post: List-Unsubscribe=One-Click Reply-To: =?utf-8?Q?Hunter=27s_Health_Hacks?= Subject: Hematocrit on HRT X-Batch-Id: 0721a05b-c54c-4ea7-9a06-f3bab40d6221 X-Subscriber-ID: 9c40d639-6e1d-4292-a9d7-0e4cbbb5d5db sId: fd41630e-e91f-46d9-a274-b740dab756d2 x-beehiiv-ids: {"account_name":"https://huntershealthhacks.beehiiv.com/","campaign_id":"0e80c778-af5e-4d83-ac0e-2340b94b4c1d","category":"newsletter","email_generated_at":1773180307,"user_id":"fd41630e-e91f-46d9-a274-b740dab756d2"} x-beehiiv-type: newsletter x-list-id: fd41630e-e91f-46d9-a274-b740dab756d2 x-list-owner: x-newsletter: https://huntershealthhacks.beehiiv.com/p/hematocrit-on-hrt x-newsletter-id: https://huntershealthhacks.beehiiv.com/ x-newsletter-signup: https://huntershealthhacks.beehiiv.com/subscribe Mime-Version: 1.0 Date: Tue, 10 Mar 2026 22:05:09 +0000 Message-ID: <20260310.220509.d12966ed@mta13> --QTQecKcjQEGwFCf0Jmw1XQ Content-Type: text/plain; charset="utf-8" Content-Transfer-Encoding: quoted-printable Happy Tuesday! I want to start today=E2=80=99s email with a quick announcem= ent:=0A=0A=E2=80=9CIf you have attempted to view/listen to [my videos on Sp= otify](https://open.spotify.com/show/5aVo13w6OaaGoZzqoJpBkT?si=3D5lfkP_J5Sv= W3FaAtM9G18g) in the last 24 hours, you probably noticed they disappeared. = =0A=0AYesterday, my podcast was terminated from Spotify for =E2=80=9Charmfu= l and dangerous information.=E2=80=9D =0A=0AFortunately, my team of lawyers= and experts swiftly reached a resolution with them and restored the accoun= t. =0A=0AI=E2=80=99m preaching to the choir but, please make sure you are o= n the email list if you desire to stay in touch with me. Censorship is on t= he rise AGAIN!=E2=80=9C =E2=80=94 =0A=0AI just dropped a brand new video on= a topic that I honestly should have made a long time ago, and that is hema= tocrit on testosterone replacement therapy. =0A=0AHematocrit on TRT Explain= ed: (https://open.spotify.com/episode/6QngLBTnqH6oUWXQfDjqt3?si=3DtkAoRtJdR= IK9qRzZ-6FH6Q)=0A=0AThis is one of the most common things men get scared ab= out once they start TRT. =0A=0ATheir hematocrit goes up a little bit, the l= ab marks it high, and then all of a sudden they get told they need to start= donating blood every few months or that something is seriously wrong. =0A= =0AIn this new video, I wanted to slow things down and walk through what he= matocrit actually is, why testosterone raises it, when it matters, and when= I think people are overreacting. =0A=0AIf you are on TRT, thinking about T= RT, or you coach people who are using it, this is a conversation worth unde= rstanding at a deeper level.=C2=A0=0A=0A=E2=80=94=E2=80=94=E2=80=94=E2=80= =94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94= =E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2= =80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=0A=0A**Why TRT= Raises Hematocrit**=0A=0ARaising hematocrit is not some weird accident of = TRT. =0A=0AIt is a known physiologic effect. Testosterone can stimulate red= blood cell production through several mechanisms. One of the biggest ones = is that it suppresses a hormone called hepcidin, which helps regulate iron = availability in the body. =0A=0AWhen hepcidin goes down, iron becomes more = available for red blood cell production. Testosterone also influences eryth= ropoietin signaling, which is one of the body=E2=80=99s major signals for m= aking more red blood cells.=0A=0AThat means when a guy starts TRT, it is ve= ry normal to see hemoglobin and hematocrit climb over the first few months = and then level off. =0A=0AIt usually rises, reaches a plateau, and does not= just keep climbing forever, assuming the dose and the rest of the person= =E2=80=99s lifestyle stay relatively stable. =0A=0AA lot of men see one =E2= =80=9Chigh=E2=80=9D lab value and assume something is spiraling out of cont= rol when really it may just be the expected physiologic response to treatme= nt. =0A=0A=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94= =E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2= =80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80= =94=E2=80=94=E2=80=94=E2=80=94=0A=0A**Dangerous?**=0A=0AHematocrit is not a= direct measure of danger. It is a concentration measurement. It can be inf= luenced by true increases in red blood cell mass, but it can also be influe= nced by plasma volume. =0A=0ASo if somebody is dehydrated, did hard cardio,= used the sauna, drank alcohol, or got labs done in a fasted and under-hydr= ated state, their hematocrit may look higher than it really would under mor= e standardized conditions.=0A=0AOn top of that, blood viscosity is not dete= rmined solely by hematocrit. =0A=0AInflammation matters. Insulin resistance= matters. Smoking matters. Sleep apnea matters. Fibrinogen matters. Blood s= ugar control matters. Red blood cell aggregation matters. =0A=0ASo when a m= an on TRT has a hematocrit of 52, it tells me very little on its own. =0A= =0AI want to know whether he is metabolically healthy. =0A=0AI want to know= whether his CRP is elevated, whether he has untreated sleep apnea, whether= he is obese, whether he smokes, whether he is insulin resistant, and wheth= er the lab was done under good conditions. =0A=0AThe same number can mean s= omething very different in two very different bodies.=C2=A0=0A=0A=E2=80=94= =E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2= =80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80= =94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94= =E2=80=94=0A=0A**The Big Mistake**=0A=0AWhat happens to a lot of guys is th= ey get put on testosterone, their hematocrit goes up into the low 50s, and = then their doctor immediately tells them they need to donate blood every qu= arter. =0A=0AI understand where that thinking comes from, but I think in ma= ny cases it is too aggressive and too simplistic. =0A=0AThe Endocrine Socie= ty considers a hematocrit over 54% a point for potential therapy reevaluati= on, but not every man with slightly elevated levels needs routine blood rem= oval. =0A=0AWhat I have seen over and over is that men start chasing the la= b number instead of fixing the actual drivers. =0A=0AMaybe their dose is to= o high. Maybe they are using an injection schedule that creates huge peaks.= Maybe they have untreated sleep apnea. Maybe they are inflamed and insulin= -resistant. Maybe they got their labs after sauna and cardio and came in de= hydrated. =0A=0AThose are the kinds of things I would want to address first= . I would much rather adjust the testosterone protocol, improve metabolic h= ealth, and get more consistent lab conditions before I default to pulling b= lood out of the body on a regular basis.=0A=0A=E2=80=94=E2=80=94=E2=80=94= =E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2= =80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80= =94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=0A=0A**U= nintened Consequences**=0A=0ARoutine phlebotomy is not free. =0A=0AEvery ti= me you remove whole blood, you remove a meaningful amount of iron from the = body. Over time, that can drag ferritin down, lower iron stores, worsen fat= igue, impair cognitive performance, and leave people feeling terrible. =0A= =0AA lot of guys on TRT are walking around tired, flat, and run down becaus= e they have been donating blood constantly in response to numbers that were= never interpreted correctly in the first place.=0A=0AThere is also a rebou= nd effect. =0A=0ABlood donation can temporarily stimulate erythropoietin as= the body tries to replace what was lost. =0A=0AMeanwhile, testosterone con= tinues to push the system toward red blood cell production through hepcidin= suppression and related mechanisms. =0A=0ASo you can end up in this weird = push-pull cycle where you are constantly removing blood while still maintai= ning the physiologic drivers that made it rise in the first place. =0A=0AIn= many cases, it is solving the wrong problem while creating a new one.=C2= =A0=0A=0A=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2= =80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80= =94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94= =E2=80=94=E2=80=94=E2=80=94=0A=0A**Beyond the Numbers**=0A=0AA metabolicall= y healthy man on TRT with good insulin sensitivity, low inflammation, norma= l blood pressure, no smoking, and no sleep apnea is not the same as a guy w= ith obesity, diabetes, high CRP, poor sleep, and untreated breathing issues= . =0A=0AThose are two completely different risk profiles, even if the hemat= ocrit number is identical.=0A=0AThis is why I always come back to context. = =0A=0ALook at fasting glucose. Look at fasting insulin. Look at A1c. Look a= t CRP. Look at fibrinogen if you can. Look at blood pressure. Look at sleep= apnea status. Look at hydration. Look at whether the person did hard train= ing, sauna, or cardio the day before labs. =0A=0AAnd then look at the testo= sterone protocol itself. =0A=0AShort-acting injectables and protocols that = produce larger peaks are associated with greater erythrocytosis than steadi= er delivery methods. =0A=0ASometimes the smartest move is not donating bloo= d. Sometimes it is lowering the dose, splitting injections more frequently,= or changing the route of administration.=C2=A0=0A=0A=E2=80=94=E2=80=94=E2= =80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80= =94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94= =E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=0A= =0A**Final Thoughts**=0A=0AIf a man is on a true therapeutic dose of testos= terone, is metabolically healthy, and his hematocrit is under 54%, I usuall= y am not very concerned. =0A=0AI=E2=80=99m paying attention, but I am not p= anicking. =0A=0AIf it is in the 50 to 52 range, I especially am not panicki= ng. =0A=0AOnce you start getting into the mid-50s, I think it deserves more= attention. Once you are getting up around 56 or beyond, I think that is wh= en it becomes much more reasonable to actively troubleshoot and intervene.= =0A=0ABut even then, I would still start by asking better questions before = defaulting to blood donation. =0A=0AIs the dose too high? Is the administra= tion too infrequent? Is there sleep apnea? Is the person dehydrated? Are th= ey inflamed? Are they insulin resistant? Have they been doing sauna and car= dio before labs? =0A=0AI really believe many men would feel and function be= tter if we stopped reacting to hematocrit in isolation and started interpre= ting it in the context of the whole person. =0A=0AI hope it gives you a muc= h more grounded framework for thinking about this whole issue!=0A=0ABest,= =0A=0AHunter Williams=C2=A0=0A=0A=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80= =94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94= =E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2= =80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=E2=80=94=0A=0A**Further Reading*= *=0A=0A* [https://pubmed.ncbi.nlm.nih.gov/20660052/](https://pubmed.ncbi.nl= m.nih.gov/20660052/)=0A=0A* [https://www.nejm.org/doi/full/10.1056/NEJMoa22= 15025](https://www.nejm.org/doi/full/10.1056/NEJMoa2215025)=0A=0A* [https:/= /www.endocrine.org/-/media/endocrine/files/cpg/testosterone-therapy-plenary= -6-1-18_online.pdf](https://www.endocrine.org/-/media/endocrine/files/cpg/t= estosterone-therapy-plenary-6-1-18_online.pdf)=0A=0A* [https://www.cmaj.ca/= content/189/41/e1286](https://www.cmaj.ca/content/189/41/e1286)=0A=0A* [htt= ps://pmc.ncbi.nlm.nih.gov/articles/PMC5690890/](https://pmc.ncbi.nlm.nih.go= v/articles/PMC5690890/)=C2=A0=0A=0A* [https://pmc.ncbi.nlm.nih.gov/articles= /PMC4599554/](https://pmc.ncbi.nlm.nih.gov/articles/PMC4599554/)=C2=A0=0A= =0A=0A=E2=80=94=E2=80=94=E2=80=94=0A=0AYou are reading a plain text version= of this post. For the best experience, copy and paste this link in your br= owser to view the post online:=0Ahttps://huntershealthhacks.beehiiv.com/p/h= ematocrit-on-hrt --QTQecKcjQEGwFCf0Jmw1XQ Content-Type: text/html; charset="utf-8" Content-Transfer-Encoding: quoted-printable Hematocrit on HRT
New video is live!  ‌=  ‌ ‌ ‌ ‌ ‌ R= 04; ‌ ‌ ‌ ‌ ‌ &= #8204; ‌ ‌ ‌ ‌ ‌= 0;‌ ‌ ‌ ‌ ‌ ‌&= #160;‌ ‌ ‌ ‌ ‌ ̴= 4; ‌ ‌ ‌ ‌ ‌ &#= 8204; ‌ ‌ ‌ ‌ ‌ = ;‌ ‌ ‌ ‌ ‌ ‌&#= 160;‌ ‌ ‌ ‌ ‌ ‌= ; ‌ ‌ ‌ ‌ ‌ = 204; ‌ ‌ ‌ ‌ ‌ = ‌ ‌ ‌ ‌ ‌ ‌= 60;‌ ‌ ‌ ‌ ‌ ‌=  ‌ ‌ ‌ ‌ ‌ R= 04; ‌ ‌ ‌ ‌ ‌ &= #8204; ‌ ‌ ‌ ‌ ‌= 0;‌ ‌ ‌ ‌ ‌ ‌&= #160;‌ ‌ ‌ ‌ ‌ ̴= 4; ‌ ‌ ‌ ‌ ‌ &#= 8204; ‌ ‌ ‌ ‌ ‌ = ;‌ ‌ ‌ ‌ ‌ ‌&#= 160;‌ ‌ ‌ ‌ ‌ ‌= ; ‌ ‌ ‌ ‌ ‌ = 204; ‌ ‌ ‌ ‌ ‌ = ‌ ‌ ‌ ‌ ‌ ‌= 60;‌ ‌ ‌ ‌ ‌ ‌=  ‌ ‌ ‌ ‌ ‌ R= 04; ‌ ‌ ‌ ‌ ‌ &= #8204; ‌ ‌ ‌ ‌ ‌= 0;‌ ‌ ‌ ‌ ‌ ‌&= #160;‌ ‌ ‌ ‌ ‌ ̴= 4; ‌ ‌ ‌ ‌ ‌ &#= 8204; ‌ ‌ ‌ ‌ ‌ = ;‌ ‌ ‌ ‌ ‌ ‌&#= 160;‌ ‌ ‌
=

I want to know whether he is metabolically healthy. =

This is one of the most common things men get scared= about once they start TRT.

March 10, 2026   |   Read Online

Hematocrit on HRT

New video is live!

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Happy Tuesday! I want to start today=E2=80=99s email with = a quick announcement:

If yo= u have attempted to view/listen to my videos on Spotify in the last 24 hours, you probably noticed the= y disappeared.

Yesterday, my po= dcast was terminated from Spotify for =E2=80=9Charmful and dangerous inform= ation.=E2=80=9D

Fortunately, my= team of lawyers and experts swiftly reached a resolution with them and res= tored the account.

I=E2=80=99m = preaching to the choir but, please make sure you are on the email list if y= ou desire to stay in touch with me. Censorship is on the rise AGAIN!

I just dropped a brand new video on a topic that I honestly should have = made a long time ago, and that is hematocrit on testosterone replacement th= erapy.

 

Hematocrit on TRT Explained

The Hunter Williams Podcast =C2=B7 Episode

open.= spotify.com/episode/6QngLBTnqH6oUWXQfDjqt3?si=3DtkAoRtJdRIK9qRzZ-6FH6Q

<= /td>
 

Their hematocrit goes up a little bit, the lab marks it high, and then all= of a sudden they get told they need to start donating blood every few mont= hs or that something is seriously wrong.

In this new video, I wanted to slow things down and walk thro= ugh what hematocrit actually is, why testosterone raises it, when it matter= s, and when I think people are overreacting.

If you are on TRT, thinking about TRT, or you coach peopl= e who are using it, this is a conversation worth understanding at a deeper = level.=C2=A0

<= table class=3D"j" role=3D"none" width=3D"50%" border=3D"0" cellspacing=3D"0= " cellpadding=3D"0" align=3D"center">
 

<= span style=3D"font-size:1.5rem;">Why TRT Raises Hematocrit

Raising hematocrit is not some weird = accident of TRT.

It is a = known physiologic effect. Testosterone can stimulate red blood cell product= ion through several mechanisms. One of the biggest ones is that it suppress= es a hormone called hepcidin, which helps regulate iron availability in the= body.

When hepcidin goes d= own, iron becomes more available for red blood cell production. Testosteron= e also influences erythropoietin signaling, which is one of the body=E2=80= =99s major signals for making more red blood cells.

That means when a guy starts TRT, it is very normal= to see hemoglobin and hematocrit climb over the first few months and then = level off.

It usually ris= es, reaches a plateau, and does not just keep climbing forever, assuming th= e dose and the rest of the person=E2=80=99s lifestyle stay relatively stabl= e.

A lot of men see one =E2= =80=9Chigh=E2=80=9D lab value and assume something is spiraling out of cont= rol when really it may just be the expected physiologic response to treatme= nt.

 

Dangerous?

Hematocrit is not a direct measure of danger. It is a concen= tration measurement. It can be influenced by true increases in red blood ce= ll mass, but it can also be influenced by plasma volume.

So if somebody is dehydrated, did hard cardio= , used the sauna, drank alcohol, or got labs done in a fasted and under-hyd= rated state, their hematocrit may look higher than it really would under mo= re standardized conditions.

On top of that, blood viscosity is not determined solely by hematocrit.

Inflammation matters. Insulin= resistance matters. Smoking matters. Sleep apnea matters. Fibrinogen matte= rs. Blood sugar control matters. Red blood cell aggregation matters.

So when a man on TRT has a hemato= crit of 52, it tells me very little on its own.

I want to know whether his = CRP is elevated, whether he has untreated sleep apnea, whether he is obese,= whether he smokes, whether he is insulin resistant, and whether the lab wa= s done under good conditions.

The same number can mean something very different in two very different = bodies.=C2=A0

=
 

= The Big Mistake

What happens to a lot of guys is they get put = on testosterone, their hematocrit goes up into the low 50s, and then their = doctor immediately tells them they need to donate blood every quarter.

I understand where that thinkin= g comes from, but I think in many cases it is too aggressive and too simpli= stic.

The Endocrine Society= considers a hematocrit over 54% a point for potential therapy reevaluation= , but not every man with slightly elevated levels needs routine blood remov= al.

What I have seen over a= nd over is that men start chasing the lab number instead of fixing the actu= al drivers.

Maybe their do= se is too high. Maybe they are using an injection schedule that creates hug= e peaks. Maybe they have untreated sleep apnea. Maybe they are inflamed and= insulin-resistant. Maybe they got their labs after sauna and cardio and ca= me in dehydrated.

Those ar= e the kinds of things I would want to address first. I would much rather ad= just the testosterone protocol, improve metabolic health, and get more cons= istent lab conditions before I default to pulling blood out of the body on = a regular basis.

<= td class=3D"dd" align=3D"left" style=3D"padding:0px 15px;text-align:left;wo= rd-break:break-word;">

A lot of guys on TRT are walking around tired, flat,= and run down because they have been donating blood constantly in response = to numbers that were never interpreted correctly in the first place.=

=

Look at fasting glucose. Look at fasting insulin. Lo= ok at A1c. Look at CRP. Look at fibrinogen if you can. Look at blood pressu= re. Look at sleep apnea status. Look at hydration. Look at whether the pers= on did hard training, sauna, or cardio the day before labs.

Sometimes the smartest move is not donating blood. Some= times it is lowering the dose, splitting injections more frequently, or cha= nging the route of administration.=C2=A0

= =
 

Unintened Consequences<= /p>

Routine phlebotomy is not free.

Every time you remove whole bl= ood, you remove a meaningful amount of iron from the body. Over time, that = can drag ferritin down, lower iron stores, worsen fatigue, impair cognitive= performance, and leave people feeling terrible.

There is also a rebound effect.

Blood donation can temporaril= y stimulate erythropoietin as the body tries to replace what was lost.

Meanwhile, testosterone continu= es to push the system toward red blood cell production through hepcidin sup= pression and related mechanisms.

So you can end up in this weird push-pull cycle where you are constan= tly removing blood while still maintaining the physiologic drivers that mad= e it rise in the first place.

In many cases, it is solving the wrong problem while creating a new one.= =C2=A0

 

Beyond the Numbers

A metabolically healthy man on TRT with good insul= in sensitivity, low inflammation, normal blood pressure, no smoking, and no= sleep apnea is not the same as a guy with obesity, diabetes, high CRP, poo= r sleep, and untreated breathing issues.

Those are two completely different risk profiles, even if the= hematocrit number is identical.

This is why I always come back to context.

<= span style=3D"font-size:1.5rem;">And then look at the testosterone protocol= itself.

Short-acting injec= tables and protocols that produce larger peaks are associated with greater = erythrocytosis than steadier delivery methods.

=  

Final Thou= ghts

If a man is on a tr= ue therapeutic dose of testosterone, is metabolically healthy, and his hema= tocrit is under 54%, I usually am not very concerned.

I=E2=80=99m paying attention, but I am not panic= king.

If it is in the 50 to= 52 range, I especially am not panicking.

Once you start getting into the mid-50s, I think it deserves= more attention. Once you are getting up around 56 or beyond, I think that = is when it becomes much more reasonable to actively troubleshoot and interv= ene.

But even then, I would = still start by asking better questions before defaulting to blood donation.=

Is the dose too high? Is t= he administration too infrequent? Is there sleep apnea? Is the person dehyd= rated? Are they inflamed? Are they insulin resistant? Have they been doing = sauna and cardio before labs?

I really believe many men would feel and function better if we stopped r= eacting to hematocrit in isolation and started interpreting it in the conte= xt of the whole person.

I h= ope it gives you a much more grounded framework for thinking about this who= le issue!

Best,

Hunter Williams=C2=A0

 
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