HealthRX.com · Printable lab tracker
Testosterone cypionate hematocrit tracking sheet
Use this sheet when hematocrit stays high while on testosterone cypionate or another testosterone product. Record each result, treatment change and symptom, then bring it to your prescriber or pharmacist to discuss next steps.
Current treatment details
Fill in before your visit. Keep a copy at home.
Testosterone product nameCopy the name from your pharmacy label
Formulation typeInjection, gel, patch or pellet
Date treatment started
Prescriber name and phone
Pharmacy name and phone
Most recent hematocrit result and dateCopy from your lab report
Hematocrit level your provider named as a limitWrite the exact figure and who gave it
Hematocrit and symptom tracking log
Record each lab draw and any symptoms between visits. Bring this log to every appointment.
| Date | Hematocrit result | Treatment change | Symptoms noticed | Provider comment |
|---|---|---|---|---|
Bring and confirm before the visit
- Bring your most recent lab report with the hematocrit line marked.
- Bring every testosterone product you use and any other medicines you take.
- Write the dates of your last few injections, gel applications or patch changes.
- Confirm whether your lab reports hemoglobin as well as hematocrit.
- Check with your pharmacist which testosterone formulation you currently fill.
- Ask your insurer whether repeat lab draws are covered under your plan.
- Note any warning signs about blood clots you were told to watch for.
Questions for your prescriber
- Is my current hematocrit above the level that would prompt a change in therapy?
- Would you adjust my testosterone dose, stop therapy or switch the formulation?
- Is phlebotomy an option for me, and how would it be scheduled?
- Should I have a screen for a gene mutation linked to polycythemia vera?
- Are there other causes of my high hematocrit you would like to rule out first?
- Which symptoms should prompt me to call you before my next lab?
- Would a gel or patch be a reasonable alternative to my current injection?
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.