ERYTHROPOIESIS

(“THICK BLOOD”)

DURING AN AAS CYCLE. Haematocrit, iron and ferritin

The use of AAS leads to an increase in haematocrit (HCT) and haemoglobin (HB) ⇒ an increase in red blood cells (RBC) and the red pigment that binds to oxygen and contains iron. This is an undesirable effect!

HCT ⇒ % of blood volume occupied by RBC.

Reference range HCT: 41–51%
HB ⇒ enables RBC to carry oxygen and carbon dioxide in the body.

Reference range HB: 13.5–17 g/dl

HCT and HB levels rise significantly in the first month of AAS use. With continued use of the same substances and doses, they generally return to normal values within about 6 months.

AAS can only raise HCT and HB to a certain limit, usually by 3–6% (a moderate increase).

The higher the HCT level, the higher the blood viscosity ⇒ increased risk of thrombosis, fatigue, shortness of breath.

Higher HCT during AAS use does not improve endurance or aerobic performance – on the contrary, it causes unpleasant shortness of breath even with light cardio.

The reason is that this is not such a rapid and immediate increase as with EPO administration (in cycling, HCT increases by 25–28% immediately after administration). With AAS, the increase is only 3–6% and gradual, whereas with EPO it is immediate.

CONSEQUENCES OF INCREASED HCT AND HB CAUSED BY AAS:

Increased risk of blood clots, heart attack, stroke
Headaches
Blood becomes markedly red (erythraemia)
Reduced endurance capacity
Enlargement of the spleen and liver (excess accumulation of RBC)
Fatigue and weakness
Increased strain on the heart and raised blood pressure

WHY IT IS IMPORTANT TO MONITOR IRON AND FERRITIN DURING AAS USE:

Iron (Fe) is required together with EPO to increase the number of RBC → increased HCT.
If blood Fe levels are too high, it means the body is ready to produce more RBC if EPO is triggered. High Fe is still relatively safe for AAS users.
Excess Fe is stored in the form of ferritin in organs (liver, heart, pancreas) → leading to their damage!
Ferritin therefore shows how much Fe is stored in the body’s reserves, and its levels should never be high during an AAS cycle!

ASPIRIN AND INCREASED Haematocrit and Haemoglobin:

Aspirin cannot reduce HCT and HB levels – this is a myth!
Aspirin only prevents blood clotting ⇒ lowers the risk of thrombosis, but increases the risk of brain haemorrhage.
Therefore, its use makes no sense for reducing HCT/HB.
However, if someone decides to take it during an AAS cycle, they must use it throughout the entire cycle and not stop suddenly, because discontinuation significantly increases the risk of thrombotic events.

HOW TO REDUCE Haematocrit AND Haemoglobin LEVELS?

Reduce the dose of AAS used or discontinue them (which most will not want to do).
Phlebotomy (bloodletting/donation of blood) – donating blood immediately lowers HCT and HB, because the body replaces the lost blood with water.
Use of Telmisartan (a blood pressure medication) → may slightly reduce HCT and HB, as it lowers EPO stimulation in the kidneys.