Red Blood Cell Count

When elevated (polycythaemia -- common on AAS):

Lifestyle:

• Donate blood regularly (every 12 weeks) if RBC exceeds 5.8 x10^12/L
• Increase hydration to 3-4L/day -- dehydration concentrates red cells
• Consider reducing testosterone dose or dropping EQ (Boldenone)
• Grapefruit/Naringin -- may mildly reduce erythropoiesis
• Monitor haemoglobin and haematocrit in parallel -- RBC, Hb, and HCT move together

When low (anaemia):

Supplements:

• Iron Bisglycinate -- 25-50mg/day with Vitamin C 500mg for absorption (if iron-deficient)
• Vitamin B12 (Methylcobalamin) -- 1000mcg/day (if macrocytic anaemia)
• Methylfolate -- 800mcg/day (if macrocytic anaemia)

Lifestyle:

• Investigate cause: iron deficiency (from frequent blood donation), B12/folate deficiency, or bone marrow suppression
• If donating blood for high HCT, monitor iron studies -- chronic donation depletes iron and can paradoxically cause anaemia

References:

• Bachman, E., Travison, T. G., Basaria, S., et al. (2014). Testosterone induces erythrocytosis via increased erythropoietin and suppressed hepcidin. The Journals of Gerontology: Series A, 69(6), 725-735. DOI: 10.1093/gerona/glt154
• Robbins, R. C., Martin, F. G., & Roe, J. M. (1988). Ingestion of grapefruit lowers elevated hematocrits in human subjects. International Journal for Vitamin and Nutrition Research, 58(4), 414-417. PubMed: 3243695
• Camaschella, C. (2015). Iron-deficiency anemia. New England Journal of Medicine, 372(19), 1832-1843. DOI: 10.1056/NEJMra1401038
• Stabler, S. P. (2013). Vitamin B12 deficiency. New England Journal of Medicine, 368(2), 149-160. DOI: 10.1056/NEJMcp1113996