Age: 66
Height: 5'7"
Weight: 177 lb
Body fat: ~11–13%
Looking for thoughts from Nelson and the experienced TRT guys regarding what appears to be delayed TRT-induced erythrocytosis and whether my first move should be dose reduction, therapeutic phlebotomy, or both.
Test E started 9/25/2025 at 100 mg/week, administered daily subQ.
I gradually titrated upward and reached 175 mg/week on 3/21/2026, administered IM EOD, using a 1" 25G needle in the delts.
I've remained at 175 mg/week since then.
Current hormone results — 7/22/2026
Symptomatically, TRT has been excellent: morning erections every day, high libido, and no noticeable adverse effects until the recent BP issue.
What happened
Over the last several weeks, my normally controlled BP inexplicably increased in both systolic and diastolic pressure, despite no change in my antihypertensive regimen.
My previous baseline was generally around the 125–130/70–75 range. More recently I'm repeatedly seeing readings in the 140s, sometimes higher.
I initially couldn't identify an explanation.
What now seems particularly interesting is that the BP increase preceded the CBC finally becoming overtly abnormal.
My RBC/Hgb/Hct had remained technically within range on previous testing, but looking retrospectively at the longitudinal Quest graphs, all three had clearly begun creeping upward during 2025–26.
The 7/22/26 CBC was still approximately:
Possible dehydration confounder
I may have been somewhat dehydrated during the latest draw, so I'm not assuming the entire Hct of 57.3% represents increased red-cell mass.
That draw also showed:
Nevertheless, even allowing for some hemoconcentration, going from an Hct around 47% in July to a measured 57.3% in August obviously got my attention.
Dose reduction vs therapeutic phlebotomy?
My thought is to reduce testosterone from:
175 → 150 mg/week IM, still divided EOD
and then follow RBC/Hgb/Hct and BP together.
At the same time, with a measured Hct of 57.3%, I'm wondering whether I should also have a therapeutic phlebotomy rather than waiting for the lower testosterone exposure to gradually bring it down.
My concern with phlebotomy is that my iron/ferritin stores were already on the low side on previous bloodwork. I don't want to get into a cycle of repeatedly dumping blood, driving ferritin/iron down, while leaving the underlying androgenic stimulus unchanged.
So my questions are:
LAB HISTORICAL GRAPHS
Height: 5'7"
Weight: 177 lb
Body fat: ~11–13%
Looking for thoughts from Nelson and the experienced TRT guys regarding what appears to be delayed TRT-induced erythrocytosis and whether my first move should be dose reduction, therapeutic phlebotomy, or both.
TRT history
I initially used enclomiphene, subsequently transitioned to compounded testosterone cream, and then switched to injectable testosterone enanthate.Test E started 9/25/2025 at 100 mg/week, administered daily subQ.
I gradually titrated upward and reached 175 mg/week on 3/21/2026, administered IM EOD, using a 1" 25G needle in the delts.
I've remained at 175 mg/week since then.
Current hormone results — 7/22/2026
- Total testosterone: 947 ng/dL
- Free testosterone: 186.2 pg/mL
- Bioavailable testosterone: 358.6 ng/dL
- SHBG: 26 nmol/L
- Albumin: 4.2 g/dL
- Estradiol: ~46 pg/mL
- DHT: ~34 ng/dL
- Prolactin: ~8 ng/mL
- DHEA-S: ~400 mcg/dL
- LH: <0.2 mIU/mL
- FSH: <0.7 mIU/mL
- PSA: ~1.2 ng/mL
Symptomatically, TRT has been excellent: morning erections every day, high libido, and no noticeable adverse effects until the recent BP issue.
What happened
Over the last several weeks, my normally controlled BP inexplicably increased in both systolic and diastolic pressure, despite no change in my antihypertensive regimen.
My previous baseline was generally around the 125–130/70–75 range. More recently I'm repeatedly seeing readings in the 140s, sometimes higher.
I initially couldn't identify an explanation.
What now seems particularly interesting is that the BP increase preceded the CBC finally becoming overtly abnormal.
My RBC/Hgb/Hct had remained technically within range on previous testing, but looking retrospectively at the longitudinal Quest graphs, all three had clearly begun creeping upward during 2025–26.
The 7/22/26 CBC was still approximately:
- RBC: ~4.9
- Hgb: ~15.4
- Hct: ~47%
- RBC: 6.02 M/µL
- Hgb: 18.7 g/dL
- Hct: 57.3%
- Hct was verified by repeat analysis
Possible dehydration confounder
I may have been somewhat dehydrated during the latest draw, so I'm not assuming the entire Hct of 57.3% represents increased red-cell mass.
That draw also showed:
- BUN: 27
- BUN/Cr ratio: 26
- Urine specific gravity: 1.029
- Creatinine eGFR: 78, whereas mine is normally in the 90s
Nevertheless, even allowing for some hemoconcentration, going from an Hct around 47% in July to a measured 57.3% in August obviously got my attention.
Dose reduction vs therapeutic phlebotomy?
My thought is to reduce testosterone from:
175 → 150 mg/week IM, still divided EOD
and then follow RBC/Hgb/Hct and BP together.
At the same time, with a measured Hct of 57.3%, I'm wondering whether I should also have a therapeutic phlebotomy rather than waiting for the lower testosterone exposure to gradually bring it down.
My concern with phlebotomy is that my iron/ferritin stores were already on the low side on previous bloodwork. I don't want to get into a cycle of repeatedly dumping blood, driving ferritin/iron down, while leaving the underlying androgenic stimulus unchanged.
So my questions are:
- Would you first repeat the CBC well hydrated before doing anything invasive?
- If Hct remains >54%, would you reduce to 150 mg/week and phlebotomize, or see what dose reduction alone does?
- Is 150 mg/week a sufficient reduction from 175, given that my TT/FT at 175 are 947 / 186.2, or would you reduce further?
- For guys who developed TRT-induced erythrocytosis, did lowering Hct also produce a meaningful reduction in blood pressure?
- Has anyone seen erythrocytosis emerge this abruptly after being on injectable TRT for many months, particularly after several months at a stable higher dose?
LAB HISTORICAL GRAPHS
