Do you feel it’s necessary to donate blood on TRT? I’ve seen some dialogue saying that high rbc from TRT isn’t dangerous and is misunderstood

AlphaMD's Answer

This subject is a nuanced discussion, but I will try to simplify it for the purpose of this AMA.

High hematocrit means thicker blood. Thicker blood means there is a higher potential for decreased flow at a narrowed artery due to the basic properties of fluid dynamics.

However, in contrast, higher hematocrit means better oxygen carrying capacity, negating that potential risk of decreased flow (essentially you don’t need as good blood flow if you have more oxygen in that blood).

Prior studies have shown that higher hematocrit means hematocrit seems to come with a correlation of more heart attacks and strokes. However, every single study on the subject was on high hematocrit related to another disease (COPD, smoking, certain cancers, polycythemia Vera, and heart disease). The thing is, the underlying disease was the cause for the increased risk of heart attack or stroke, not the high hematocrit. So while there was correlation of higher risk, causation of that risk could not be attributed to the high hematocrit.

Studies done on people with high hematocrit from non-disease states (like endurance athletes or those that live at high altitudes) showed no increased risk of heart attack or stroke, and in fact, had lower risk (probably due to the greater oxygen carrying capacity). However, these people in these studies were healthier on average than us regular folks down at sea level. So again, correlation, not causation.

So basically no study has shown high hematocrit to be a direct risk factor for vascular disease, though no study has ruled it out yet either.

Logic states that the risk of high hematocrit is overblown. Basically, any doctor that adjusts a dose of TRT based on high hematocrit without taking into account whether that dose is needed for symptom relief from low T symptoms is a poor doctor.

Some people do get symptoms from high hematocrit like headaches, hot flashes, flushed appearance, etc. Those people feel better after blood donation.

Basically, whether or not you need blood donation if you have elevated hematocrit on TRT is very unique to your individual situation. No one but you and your doctor should make that decision.