Transcription
Managing blood thickness on testosterone. This video is for every man in the world that is on testosterone and understands that there's going to be an impact on the red blood cells. Very importantly also, this video is for healthcare providers. You need to understand the science on this. And today, this presentation, we'll discuss the ideology, the causes of how this red blood cell thickness and the viscosity of the blood occurs on androgens, the mechanism of action, the risks, the symptoms, and of course, the management. For you guys, from clinical management for men like you that are that are concerned for this from testosterone to steroids, and also the healthcare providers to understand how to manage. I'm going to give a real, uh, deep dive here as far as the clinical review, including evidence-based support for this. And if you guys like these videos, please subscribe. Please stay on board here. Get so many more men. We're trying to grow this channel, right? We're trying to really get up higher and higher and higher so men in the world could have the understanding and open education from a scientific guy like me, a physician, to really, really lay it out with no bias. And as I've have taken deep dives into this stuff, guys, I studied for hours and I do this every day. I really put together a concise presentation. So I'm Dr. Thomas O'Connor, a lifelong powerlifter, board-certified physician, and published academic author. I've taken care of thousands of men on testosterone and steroids, and now I use my media appearances and this YouTube channel to provide education and harm reduction. Subscribe now so I can help you stay strong and healthy.
The red blood cells go up. Two words for it on androgens or without androgens, it's called polycythemia. It's also called erythrocytosis. Healthcare provider is hematology. This is really hematology, a subset of internal medicine dealing with blood disorders and cancers. What's happening here, guys, over decades is that more and more men on testosterone, we do see the red blood cells go up. Just the red blood cells. It doesn't affect the white blood cell line of CBC or the platelets, okay? It's, it's just the red blood cells. So they call it polycythemia. But polycythemia in the in the medical term really denotes a a condition called primary polycythemia with a lower erythropoietin designation, and this is really polycythemia vera. Now, they're they're looking at that data and the concern for blood clots and hypercoagulable states, pulmonary embolism, it's called venous thromboembolism. And they're they're transferring that concern and risk onto a secondary form of what's called androgen-induced erythrocytosis because erythrocytosis. But that's secondary. The primary is polycythemia vera. Let me go into that. Then we're going to talk about the secondary types, including the androgen type. Then we're going to come together and we're going to look at the outcomes and what you guys can do.
Polycythemia vera is very rare. It's 22 to 50 individuals per 100,000 in the population. It's a blood cancer gene mutation that turns on. It's called JAK2 gene mutation. And you'll see it with older people. It's not a young person's uh disease. It's a, it's a premalignancy, if you will, or malignancy that can lead to a, uh, leukemia. You'll see it in in lowest age is typically 50 something, average age 60, even up to 75. Men two times more than women. And you'll see in different, um, racial groups like Ashkenazi Jews and Asians. Very interesting data on this. Now, it it does increase the red blood cell line predominantly. That's how it's picked up. But on the CBC, guys, there's three things: white blood cells, red blood cells, and platelets. But it also, this polycythemia vera also hits the platelet line, not to mention the WBC line. That's how it ends up potentially in the end progressing potentially to leukemia. Now, when you look at the dangers of this, this is where they've transferred the dangers of polycythemia vera onto the dangers that are unknown from a clinical perspective with randomized outcome studies just not there. I'm going to talk about one data, two, two data, three data trials today, one mainly recently about testosterone and blood clots. Hold on, guys. But when you look at this, this is something where it's more complex. It's rare. It's not from androgens, but it looks similar. But there's the differences. You do have increase in venous thromboembolism, the blood clots with polycythemia vera, spleen enlargement, uric acid, gout, um, even the potential for peptic ulcers, and again, in the end, real malignancy, uh, leukemia type. Now, of course, they give aspirin for that. So they've transferred that information over to men on androgens. But there's really no, guys, there's no connecting the dots directly. I did the research for you guys. So looking it, understanding polycythemia vera, transferring that data inappropriately over, that we don't know the real risk. I think the risk for men having blood clots on testosterone is very rare. And I'm going to support that. I'm going to support it right here, guys.
Now, so apart from the primary type of erythrocytosis, uh, poly, the primary polycythemia, which is polycythemia vera, the blood cancer, all other secondary types, typically secondary to low oxygenation states. So you'll see this with smokers, COPD, sleep apnea. So if I have my guys like you guys and the moons are lining up and you're on androgens, it's going to increase the red blood cell lines. It doesn't affect the white blood cell and the platelet line. If someone says it does, it's not. It's wrong. Rarely and super rarely, it may affect the platelets. This comes from hematology. God never, it's going to affect the WBCs. You have something else going on, infection, God forbid, cancer. That's why you need great doctors. That's why I made the AnabolicDocApp.com for you guys to understand all this access to this. So respiratory conditions, typically low oxygen state where you're going to see an increase in erythropoietin versus the primary polycythemia vera, a decrease in EPO. This is fascinating. Now, androgen-induced erythrocytosis, let's talk about that. Now, this is where the, we don't know. We don't know technically what happens. You're on testosterone and steroids, depending on your genes, your age, sleep apnea status, and other medical issues, your red blood cells go up, hemoglobin, hematocrit. I'm going to talk about the definitional risks in the end to limit your hemoglobin, hematocrit, and iron studies. So is there an increase in real venous thromboembolism, which is which is a blood clot, DVT in the legs that goes up and causes the pulmonary embolism? Is there an increase in stroke and cardiovascular disease? It's, it's very rare, guys. It is rare. But I think it's multifactorial. It's because you have other genes for everything else and you're, you're just unhealthy, and this is, or you have some other risk for this. But let's, let's really get into this right here.
So the mechanism of action for the hypercoagulable state, it's a thrombotic event that we know, right? It's called Virchow's Triad, hypercoagulable state that's causing something for the blood to to coagulate to form an embolus, a clot, and that's why this thickness, right? So it's this viscosity, potentially stasis, then a wall injury. That's a Virchow's Virchow's Triad that leads to this blood clot condition. Now, when you look at testosterone, you do get increases of hemoglobin, hematocrit, some men depending on their genes and sleep apnea and other drugs, and that's Test and Deca and Epo and Tren and all these other, you know, compa-pharmacy. You get you get hyperviscous states, that's viscosity, thickness of the blood. And anything over 18 and 54 has needs to be dealt with, guys. I, I agree that it could go up to 18 and 54. You need to know your parameters over in Europe and over in Asia, over the Middle East, Central, South America, all over the world because there's different, there's different conversions. You're basically moving decimals around. But if you understand this, you're going to really, really understand what to do for yourself. But it's possible, and we, we do see that with the thickness of the blood, the viscosity, the hypercoagulable state, and that potential where it's you have so many red blood cells going into such a small area, the capillary bed, on top of other conditions, it's a low flow state. And that's where the potential is for worsening the heart. It just, it's another moon, guys, for worsening heart disease, cerebrovascular accidents, strokes, even even blood clots in the red artery, super rare. And of course, the biggest thing is here, is it a polycythemia that leads to increase in blood clots for a blood clot in the lower leg that goes up to a pulmonary embolism, and you can die? It's very, there's a lot of pieces in this. So what are the risks of hypercoagulable state apart from this? That if you have, it's another moon that comes in. You see, you're on androgens, but you have these other risks, and then boom, you have a blood clot. And I've seen this for years.
So what are the risks? Hypercoagulable genes, number one is genetic, guys. Here they are: Factor V Leiden, Protein C, Antithrombin III deficiency, Prothrombin Gene G20210A, hyperhomocysteinemia, MTHFR, and even Sickle Cell. I want to make sure I'm really scientific for the healthcare providers that are here, and for you guys that are geeky like me that love this stuff. Next risks for blood clots apart from being on androgens: immobilization. If you're, that's the flying in the plane, if you're booted, you have a leg injury, if you're sick, obesity. Just being obese, being in the hospital, being sick in the hospital, we give DVT prophylaxis, right? When I was a, back in the hospital days, I used to go to hospitals. If you didn't give DVT prophylaxis or consider that, that's a lawsuit. That's a risk for the for the hospital. They're going to throw you off staff, guys. I'm not kidding. Then of course, there's also the vaccine, the COVID, and the COVID illness itself, which can lead to a hypercoagulable state. I do agree, guys. It's not, it's not political, it's just true. And is it because why we see maybe an uptick in in the deaths of men that are using steroids that otherwise look good? It's possible, right? Blood clots, and not not to mention sudden cardiac death and and the cardiomyopathies. It's very complicated, guys, but it is rare, but it's possible.
Okay, now when I talk about the testosterone and data on risks of blood clots, this is for you. This is the data. This is the, this is the biggest article in the world, JAMA, November 11, 2019. Title: Association of TRT with Risks of Venous Thromboembolism Among Men With and Without Hypogonadism. See, so these are men mainly that are hypogonadal. Average age of the man was 57. There was a huge study, almost 40,000 men. It's a case-crossover study, so it's not perfect. Now, they looked at in this study and they have identified and their conclusion was that there is a slight uptick in blood clots, which is DVTs in the legs and pulmonary embolisms, one or the other, if not both, and in the first six months of starting the testosterone. Now, good caregivers know that. But hold on. So after six months, a year later, am I at no risk at all? Absolutely not, because I've seen, I've seen men that have had blood clots on testosterone. But it wasn't related to the increase in the red blood cell thickness. I don't think so. I think it's immobilization, booted, I think it's genes, I think it's other risk factors and illness. I want you guys really to to bring this information to your doctors. This is the study. This is the JAMA study. And then in that study, I'll let you guys read it and find it. There's two other references that indicate that they did their research and there was conflicting data for TRT testosterone. None of this is really steroids causing blood clots. There was just two studies. One was saying there was no data for it. One showed like this, that there might be some data supporting it. That's it. So if, if I'm in the court of law with with all my data right up to point right here, I'm not winning the case. I'm not winning the case because it's, it's flawed, and it's, it's not prospective, randomized, double-blinded, and it's not running for a long time. Six months, but it's potentially risky, guys. It's potentially risky. And I agree with that because I do see men in my in my clinic with blood clots or they've come in with blood clots, and I hear the history, or they've had blood clots under my care. But it's very, very rare. And is it related to this red blood cell stuff? It's very complex. There's no, in my opinion, from looking at the data, there's no direct correlation. But it doesn't mean that it can happen. And it doesn't mean that you let your red blood cells and thickness get out of whack. That's just not right. And you, you're going to have symptoms from that.
So let, let's really talk about that. So when you look at the symptoms of having polycythemia, first off, definitional. Some labs are going to say greater than 17 grams per deciliter, greater than 49 or 50. Some labs will say 18. Greater than 18. So if you're between 17 and 18, you could look great depending on the lab. Healthcare providers, you need to know this. Men, you need to know this. Now, also risks and and symptoms, they're, they're none. I see guys with hematocrits of over 60 and they don't, they otherwise feel fine. Hemoglobins of 19, 20, even over 20. How do you feel, brother? I don't feel anything. I'm unbelievable. But you could have symptoms. Now, what are the symptoms? Potentially, again, they're they're picking up those symptoms from polycythemia vera patients: vision changes, uh, uh, headaches, malaise, and fatigue. Lethargy. Now, it is true that when you have thick blood and you're crowding in the capillary bed, especially in the eye, in the central nervous system, it, it doesn't have to be primary, uh, polycythemia vera. Just having polycythemia from a secondary state, having too much thick blood, can cause these symptoms. Now, this is apart from the data that said there's really no proof, direct ABC proof that you're going to get a blood clot. So, but this is right here, that JAMA study, that's your study, healthcare providers. But is there an association with dizziness? Is there an association? Personally, fingerprint medicine, that's what I do for you guys on the Anabolic Doc App. Hypertension, or men just they get over a certain level and they don't feel good and they just like to be phlebotomized on the testosterone or deal with the hemoglobin, hematocrit, not to mention iron studies. Absolutely.
So let's conclude now with management. So you have to have your H&P. That's why we have the Anabolic Doc App for you to have great access to your history and physical exam and all this information in-depth, just unlimited access. And now healthcare providers, we're going to be working with with an allied healthcare provider affiliation program in 2024. So number one, you need to know your medical conditions. Do you see the genetics? Do you have a history of hypercoagulable state? Do you have, uh, uh, uh, injury? Do you have obesity? Do you have diabetes? Do you have medical issues? Okay? Now, management, the labs, the CBC. I don't want any of my patients to ever live much over 17, 17.5. Some men, very rarely, if they feel perfect, they have no hypercoagulable disease or risk factors or heart disease, guys. I go through this. This is what your healthcare providers need to do. You can't just, oh, you're done, stop testosterone. That is ridiculous. That is ridiculous. So you, I, I like to keep my men equal to or less than 18 grams per deciliter. I don't want them to live up there. I don't want to use the whole bandwidth. Now, hematocrit, 52 to 54%. When my men go over 18 and 54, 52, I have to do something about it, guys. I address the issues. But before I address the other issues, you need to look at those iron studies. That's total iron, iron saturation, and ferritin. If you have hereditary hemochromatosis or genes for it, or even even some type of thalassemia or sickle cell carrying state, African-American guys, you, you guys have to understand these other physiologic pieces. You can't just look at the CBC and the hemoglobin hematocrit and be dumping blood because most guys that do that, you're going to shoot overshoot it and you're going to tank out your iron. You need iron levels. So this physiology of androgens, not just on red blood cells and thickness, but on the iron metabolism, is so intricate. But I do this all day long, and this is real hematology, and it's got to be fingerprint medicine, guys. Man per man, what is your risks? What's going on with you? How high do you want to let your H&H, hemoglobin, hematocrit go up to, and how do you want to maintain your ferritin in your iron levels? You can get all this, all these labs on the Anabolic Doc App with no doctor's prescription right now.
Next, when you look at the management, guys, you have to understand the symptoms. Do you feel crummy? Are you feeling terrible? Do you have headaches or blurry vision? Even some guys, it's rare, some guys are very sensitive, and it's very rare, but they have, "Doc, I don't feel great if my hemoglobin goes over 17.7 or 17.2 or 17.3." Okay, you've checked off all the boxes. Well, then don't. Well, that's why it's like, come on, dude, lower the testosterone. That's why Deca is great for the shoulders, but not great for red blood cells because it's androgen-induced erythrocytosis. It's going to thicken up the blood. And if you have genes for it, if you have sleep apnea, maybe you're eating tons of iron-rich foods, which I do love. I love meats. But you're going to the moon. Line up. Are you at risk for a for a rare embolic, a blindness clot in the eye, or a stroke, or a, of course, a blood clot? It's, it's just gambling, guys. I think it's very, very rare. And I just explained all the direct, indirect data because they're using polycythemia vera and they're focusing it, apple versus orange, on androgen-induced erythrocytosis. It's wrong. It's not scientific. But we don't have anything else. So a lot of doctors are unfortunately stopping testosterone even when when a guy hits 17, maybe a little over 17, and hematocrit goes over 50, 51. That doctor, healthcare provider, really look, watch this video, look at the data, look at the JAMA, and understand the risks and the, the ABCD's and the A1C, the blood pressure, the cholesterol, the cardiac, all my app. So really look at this before you just stop a man. Then what are they going to? The man's going to feel terrible, and then you're going to go back on it when he goes back down. It's a seesaw. What's the underlying issue? I'm explaining it to you. It's either, it's, it's not going to be primary. How rare is polycythemia vera? And if you have it, is it going to happen in a 35-year-old man? Unlikely. I want doctors to pay attention. Blurry vision. Some men have blurry vision, and then you have this malaise and fatigue. Malaise and fatigue is the most difficult symptom for an internal medicine doctor to work up. And I know you primary care doctors and healthcare providers, I know you agree with that. I have malaise and fatigue. Is it from red blood cells? I mean, could it worsen it? But are you at risk? There's so many, very, you can't just cookie-cut this. This is not McDonald's medicine.
Next, number three, I'm going to say it again. What's your medical history? When you're managing the thickness of the blood, do you have diabetes, obesity, sleep apnea? Do you have deposition disease, hereditary hemochromatosis? Get the iron studies. Blood pressure. Do you have heart disease? Do you have a history of blood clotting disorder? Have you had a blood clot? And then screening for these. Do you have cancer? Are you screening for cancer? It's called rectal, skin cancer. So that's the ABCD's on the Anabolic Doc App that are that are right there for you to demystify to understand and to guide you with your healthcare providers. If you had a family history of blood clots, or you have some cancer, or you have heart disease, or, or, or stroke history, you have to keep the the H&H, the hemoglobin, hematocrit, and the thickness of the blood. You have to keep that potentially because that's those moons that are there for for the red blood cells to increase, not to mention hypertension, and then you're going to have another event, another stroke, another heart attack, or blood clot. You see, this stuff is all integrated, guys. You can't tease this stuff out. That's why polycythemia, the word, and erythrocytosis, really mean the same thing. But is it independent? Is it primary? Or is it secondary? We're talking secondary now. What's the goal? I told you, I want everyone to live under 18 grams per deciliter. Look at Europe. If you're in Europe, do the calculation conversion. That's that's a he, that's hemoglobin equal to. I don't even want you 18. I want my patients under 18. And I sometimes do have to phlebotomize. I want hematocrits under 54, technically 52. Even some guys, you find a sweet spot, personal medicine, see your doctor. How do you feel now? The iron studies. This is where if you're not looking at the iron studies, you're not looking at the full picture when you're looking at the thickness of the blood because you have to factor in the iron metabolism. That's going to look at that. That's where you look at the ferritin. Imagine your ferritin is very low, which it can be because you're using it all, you're not even dumping blood, but you're using it. It's a store. Or do you have, um, it's controversial. Do, do you have an inflammatory condition? You better recheck it because if you have inflammatory condition or cancer, or even, even a vaccine can cause this transiently, and it may go down. You really need to understand your own history. That's why looking at these labs on the app and with your doctor every four to six months, or at least every six months or a year, it's mandatory.
And now the ferritin levels that I like to see. This is controversial. You'll see those ferritin go up to up to 3 to 400 nanograms per milliliter. I don't like that because listen to this. I've de, I've seen patients where they have very excessive levels of ferritin, even as high as 1700, even over over 800, over 400 chronically with without elevated levels of blood thickness with hemoglobin, hematocrit. I send them to hematology doctors. Then they, they do gene studies, hereditary hemochromatosis. They look at JAK2 to make sure that they don't have the primary polycythemia vera. Guys, it's complicated. Hematology guys, they do it all. And then they, for a few number of patients, they start phlebotomizing. He can't get off because he's going to feel terrible. They want to see him stop testosterone. But I tend to push them back and say, he's not going to stop testosterone because he's on it for 10 years now, thank God, nothing's happened. There's a few particular young men, less than 40, so he doesn't have polycythemia vera, that they rule that out. But what are you going to do? So the goal for for the ferritin for these doctors is less than 50. So I'm thinking, do you go less than 200? I, that's my goal for any man because if you're, if you're a European ancestry guy like me and a lot of you guys, and not to mention other genes in the world, you, you, if you have a predilection for for building up too much iron, forget the red blood cells itself, you're going to be at risk for deposition disease. You could look at that. And then you have to make this decision for yourself. But I've already done the work for you. I try to keep those ferritin under 200. I don't even, I like them like 120, 150 for for me. But you don't want to tank your ferritin because then you feel terrible. And if you tank ferritin and iron and everything's low, you, you need iron for cofactors and you just to feel well, not not just making red blood cells because your body is going to scavenge that and make red blood cells first, but you won't have enough extra for the other factors, not to mention the, the CNS. Fastest. What else? You want to microdose testosterone? Lose weight? Look at sleep apnea. I love green tea, curcumin. I love telmisartan for for all these things have been proven in in secondary studies, endpoints to slow down erythrocytosis. And then in the end, guys, yes, you could use some aspirin if you worry that things are too high, your doctor agrees. But there's side effects of aspirin, intracerebral bleed, bleeding in the head, rare, rare as you get older, the increase goes up, and the GI tract bleeds. So just using aspirin for this because it looks like polycythemia vera, I'm not going with that anymore. I'm not doing it because there's no data for it.
So phlebotomy, guys, in the end of the day, phlebotomy of phlebotomy. That's what I do for all my patients one-on-one. And that's what the Anabolic Doc App is here to help with you guys to manage all this together. That's why I'm in there. You could ask me questions in there. You're going to have healthcare providers in there, and you're going to have videos like this in there, just in full depth. But I want this to get out to the world. So also the last piece is, um, flying. So there are risks of blood clots while flying. It's not really completely known. I think it's because of a multifactorial combination where you're, you're not moving, and the cabin pressures and the oxygenation state is is tweaked low. So when you're sitting there and you're under, it's the pressures are different in the cabins and the oxygen, it can stimulate a hypercoagulable state, guys. It's so complex. You just see it. And if you're obese, number one risk of getting a blood clot on a plane is obesity. You could fact-track that. And if you, so you hydrate yourself, stay hydrated, be careful with the androgens, know your underlying health issues, ABCD's, know this video with your doctor, wear stockings, hydrate, and move your legs, get up and move. It doesn't happen on short flights less than three hours. It happens on on long haul flights, four to six hours, and people that are sitting there, they're under that compartment of the, the, the pressure in the cabin. And, uh, again, then there's genetics. And rarely, rarely, because I have patients that we need to give anticoagulation meds to because they have a history of at least one or more blood clots. They may or may not have genes, as I talked about the Factor V and the Prothrombin gene. But they're on androgens. We watch the red blood cells and platelets. But platelets don't get affected from from androgens. If your doctor is saying that they're wrong, your platelets are elevated or or low, you need to get that looked into by a hematology doctor. Hope you guys like this video. I wanted to pack it all in there for you with real science. Now it's your turn to leave comments and everything you guys have experienced about this yourself for other men in the world to learn. Thank you so much.
This is what you get with the Anabolic Doc App. Number one, a digital history and physical exam where I bring you through digitally all the important medical issues that you need to understand one by one. Number two, weekly Zoom meetings with me. They're group meetings where men come from all over the world to ask questions, and I answer the questions. Everyone listens and learns.