First, their body acclimatizes. Over time, climbers will gradually ascend to higher altitudes to give their bodies time to adjust to lower oxygen levels. The body increases red blood cell production, enhancing oxygen transport to tissues which allows climbers to tolerate higher altitudes. Also, Certain populations, such as the Sherpa people from the Himalayas, have genetic adaptations that allow them to function well at high altitudes. They are more efficient in their oxygen use and have an increased lung capacity.
Climbers often undergo rigorous physical training to improve their cardiovascular and respiratory systems before embarking on these climbs to prepare their bodies. This training inevitably improves their ability to utilize oxygen more efficiently, even in low-oxygen environments.
Climbing without additional oxygen requires a higher level of mental toughness and the ability to endure harsh conditions and some measure of pain, which is a critical part of the process. Experience is essential in these conditions. Experienced climbers understand the importance of pacing. They develop strategies to conserve energy, maintain a slower pace, and use proper breathing techniques, all of which help them manage without extra oxygen. Even then, not all can make it without supplemental oxygen but these factors enable some individuals to ascend extreme altitudes without needing supplemental oxygen.