Haemoglobin

When high

Lifestyle:

• Donate blood regularly (every 12 weeks) if levels exceed 175 g/L
• Increase hydration (3-4L/day)
• Consider reducing testosterone dosage
• Grapefruit/Naringin -- may mildly help
• Monitor blood pressure alongside -- high viscosity raises BP

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 -- meta-analyses show 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 trough swings, often reduces HCT vs once-weekly without total 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 (rather than Red Cross donation) -- 250-500mL every 8-12 weeks under haematologist supervision when donation is refused (TRT users are blocked from public donation in some jurisdictions); allows precise volume and frequency control
• 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) -- well-documented to 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