Haematocrit

When high

Lifestyle:

• Donate blood regularly if levels exceed 0.50 (every 12 weeks)
• Increase hydration to 3-4L/day
• Reduce testosterone dosage if persistently high
• Grapefruit/Naringin -- may mildly help lower HCT
• Monitor blood pressure -- high viscosity raises BP

Important: If donating regularly, monitor iron studies (Ferritin, Iron, Transferrin Saturation) as frequent donation depletes iron stores

TRT delivery changes (often the highest-leverage intervention):

• Reduce TRT dose -- single most effective intervention; even a 20-25mg/week reduction often drops HCT meaningfully without crashing symptoms
• Switch IM to subcutaneous testosterone -- subQ produces lower peak levels and reduces erythrocytosis incidence by ~30% at the same weekly dose
• Increase injection frequency -- E3D or EOD micro-dosing flattens peaks and reduces erythropoietic drive vs once-weekly without dose change
• Reduce or discontinue Boldenone (EQ) -- single highest-leverage compound choice; EQ is the most erythropoietic AAS in common use

Pharmacological options:

• Therapeutic phlebotomy -- 250-500mL every 8-12 weeks under haematologist supervision; preferred over Red Cross donation when public donation is refused (TRT users are blocked in some jurisdictions); allows precise volume and frequency control; one 500mL session removes ~250mg iron and drops HCT 3-5 percentage points
• Telmisartan -- 20-40mg/day; ARB with mild EPO-suppressing effect; preferred antihypertensive for TRT users; bonus PPAR-gamma activity improves lipids and insulin sensitivity
• ACE inhibitors (e.g., lisinopril 5-10mg/day) -- reduce haemoglobin by 5-10 g/L via EPO suppression; consider when telmisartan is contraindicated; cough is the main side effect
• Low-dose aspirin -- 81mg/day; does not lower HCT but reduces thrombotic risk while polycythaemic; cardiology-supervised
• All require physician oversight; monitor BP and electrolytes when starting ARB/ACE