Cycle Recommendation / Hematocrit

[Nick_Vaz]

No. I’m one of the main reasons for the extra blood test was to check hct levels. To be honest I was surprised it had fallen. I was expecting to need to try and arrange phlebotomy.

Full disclosure the 2 tests were done in different labs.

I think a combination of reducing test dose significantly and adding a grapefruit per day (plus the use ancillaries like bo meds, statin, fish oils etc) moved my haematocrit by c.3pp

I mean even despite the different labs making changes like that it definitely make sense to have better looking bloodwork

 

[nathenking]

Do you think NPP or any of the popular orals have their place 2-3 cycles down the road?

I would say yes on your fourth cycle. I never used orals the first few years and I grew like a weed without them.

 

[BigDadd7]

No. I’m one of the main reasons for the extra blood test was to check hct levels. To be honest I was surprised it had fallen. I was expecting to need to try and arrange phlebotomy.

Full disclosure the 2 tests were done in different labs.

I think a combination of reducing test dose significantly and adding a grapefruit per day (plus the use ancillaries like bo meds, statin, fish oils etc) moved my haematocrit by c.3pp

Grapefruit and statin meds are usually a no go together.

 

[Manualtrt]

Grapefruit and statin meds are usually a no go together.

I agree that’s the usual position. My understanding is that pitavastatin is different.

Here is what ChatGPT has to say…

grapefruit is generally considered safe to take with pitavastatin.

Why this is different from other statin

• Grapefruit interferes with the CYP3A4 enzyme in the gut.
• Many statins (like simvastatin, lovastatin, and atorvastatin) rely heavily on CYP3A4, so grapefruit can dangerously raise their levels.
• Pitavastatin is not significantly metabolized by CYP3A4. It’s mainly processed by other pathways (glucuronidation), so grapefruit has little to no effect on its blood levels.

 

[Manualtrt]

Worth saying that my ldl went from 78 to 54 over that period. I was taking 4mg pita, Ezetimbe and bempodic as well as BP meds

 

[RockyP]

Every time blood viscosity comes up I think it's important to realize that while it is VERY important to keep an eye on your HCT, it is only one variable, in fact, the only measurable variable, that we can track to get a sense on viscosity. However, there are many other factors that we cannot account for / measure. That being said, if you search this topic with @readalot handle you'll find a link to some very interesting data about the slope of the curve in blood viscosity that happens around (IIRC) 53-54 HCT. That is, viscosity tends to rise drastically above this level (again, all else being equal, not taking into account other factors such as genetic pliability of your vasculature, other issues that may predispose you to clotting, etc.).

So, in no way shape or form should you hand-wave high HCT. I would venture to guess that the vast majority of people who suffer heart attacks and strokes did not have HCT levels in the range that PED users walk around at. But because we can measure it, we should use that data as intelligently as possible, though splitting hairs about 48 vs 51 vs 52 I don't think is helpful. Meds like tadalafil are critical for PED users not just for BP (minimal impact) but moreso for the positive impact they have on the endothelial lining. Also, nattokinase is a winner in this area. I also like fish oil / Vascepa for the anti-inflammatory and modest blood thinning impacts.

Control your lipids and BP as aggressively as you can. Find meds / supplements that minimize oxidative stress, and manage your HCT. None of this guarantees anything but it's your best chance at harm reduction based upon what we currently know.

 

[Nick_Vaz]

Every time blood viscosity comes up I think it's important to realize that while it is VERY important to keep an eye on your HCT, it is only one variable, in fact, the only measurable variable, that we can track to get a sense on viscosity. However, there are many other factors that we cannot account for / measure. That being said, if you search this topic with @readalot handle you'll find a link to some very interesting data about the slope of the curve in blood viscosity that happens around (IIRC) 53-54 HCT. That is, viscosity tends to rise drastically above this level (again, all else being equal, not taking into account other factors such as genetic pliability of your vasculature, other issues that may predispose you to clotting, etc.).

So, in no way shape or form should you hand-wave high HCT. I would venture to guess that the vast majority of people who suffer heart attacks and strokes did not have HCT levels in the range that PED users walk around at. But because we can measure it, we should use that data as intelligently as possible, though splitting hairs about 48 vs 51 vs 52 I don't think is helpful. Meds like tadalafil are critical for PED users not just for BP (minimal impact) but moreso for the positive impact they have on the endothelial lining. Also, nattokinase is a winner in this area. I also like fish oil / Vascepa for the anti-inflammatory and modest blood thinning impacts.

Control your lipids and BP as aggressively as you can. Find meds / supplements that minimize oxidative stress, and manage your HCT. None of this guarantees anything but it's your best chance at harm reduction based upon what we currently know.

What is your take on the supplement side? lifestyle wise I think the non negotiables are daily cardio(fasted preferentially), hydration 1-1.5 gal + electrolyes, and a good diet (perhaps not abusing fatty red meat consumtion). for the CBC and lipids what kind of supplements would you guys consider a must.

 

[Sicsemptyran]

I sound like a broken record but if you're already caring about lipids and hematocrit, you 100% should give bempedoic acid a look. It is shown in clinical trials to universally lower hematocrit, may slightly improve insulin sensitivity, and lowers ApoB without any of the tendon/muscle issues of any statins. Any tendon issues shown in the clinical trials were in individuals on concurrent max dose statin therapy.

For many, it is not enough ApoB/LDL lowering on its own (though with ezetimibe it oftentimes can be!), but the hematocrit lowering is a lovely ancillary benefit.

I've run all sorts of doses and eat plenty of iron, have never had to donate a single time and my hematocrit is deadlocked at 47-48% no matter what.

Edit: I have a whole thread mostly about this topic

 

[Nick_Vaz]

I sound like a broken record but if you're already caring about lipids and hematocrit, you 100% should give bempedoic acid a look. It is shown in clinical trials to universally lower hematocrit, may slightly improve insulin sensitivity, and lowers ApoB without any of the tendon/muscle issues of any statins. Any tendon issues shown in the clinical trials were in individuals on concurrent max dose statin therapy.

For many, it is not enough ApoB/LDL lowering on its own (though with ezetimibe it oftentimes can be!), but the hematocrit lowering is a lovely ancillary benefit.

I've run all sorts of doses and eat plenty of iron, have never had to donate a single time and my hematocrit is deadlocked at 47-48% no matter what.

Edit: I have a whole thread mostly about this topic

Thats amazing ive never heard of that before ill have to do more looking into it. Do you run that just on its own or in combo with other stuff I know you mentioned ezetimbe

 

[RockyP]

What is your take on the supplement side? lifestyle wise I think the non negotiables are daily cardio(fasted preferentially), hydration 1-1.5 gal + electrolyes, and a good diet (perhaps not abusing fatty red meat consumtion). for the CBC and lipids what kind of supplements would you guys consider a must.

My regimen is:
Pitavastatin 4 mg
Nattokinase 4000 FU
Vascepa 4 g
Ezetimibe 10 mg
Tadalafil 5 mg
Reta 5 mg weekly

Lots of other ancillaries but these are most applicable to cardiac stuff. The above are a must for me. I’m an old fart and I have genetically low HDL at baseline so PeDs make that worse and I need to bury my LDL.

I have nexletol (bemp acid) on hand and will likely add it soon after I get my most recent bloodwork back.

I do 30 mins fasted LISS 5-6 days per week (that will eventually go up to 45-60 mins the lower the bf gets) and get at least 10,000 steps. 2+ gallons of water daily. And I use my CPAP religiously. None of this is targeted at lowering HCT but it’s my lifestyle / cardiac risk mitigation approach. My diet is very clean. Only “cheat” is sushi once to twice per week. Only fish on rice. None of the fancy rolls with all the fatty shit on them. I eat 6 oz of red meat (angus steak) approx 4-5x per week.