Ferritin Declining While on TRT

infuriatedrain said:

Have not donated blood.

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infuriatedrain said:

Can you tell me what you mean by that? Are you saying it was that high before because of inflammation?

I will say that, in the past, I had an ANA ran that came back positive, indicating the possibility of me having an autoimmune disorder - if that could somehow be related.

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johndoesmith said:

That's what I'm thinking.

Definitely get that checked out. The ANA that is you should definitely have that evaluated.

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infuriatedrain said:

Hey everyone - I have a question hopefully someone can help me out with. I have spent a few hours searching online but wasn't able to find much that really matches with my situation and/or what the best course of action is.

My issue is that my Ferritin has drastically reduced since starting TRT while my RBC, HGB, and HCT have slightly increased (I will include my labs in this post). My Free and Total Test numbers are perfect, in my opinion, so I'm content with those. I can include those if it can help with my question.

I started on TRT in August of this year, 2017. My pre-TRT CBC labs on August 16, 2017 were:
RBC 5.2 (4.2-5.8)
Hgb 15.3 (13.2-17.1)
Hct 47% (38-50)
Ferritin 118 (20-345)

We started me off at 150mg Test Cypionate once per week, 500 iU of HCG once per week, and 1mg of anastrazole once per week. I didn't agree with doing it once a week, but that's just how they do it at the clinic. I had to suck it up for 6 weeks until I could get on the "long distance" program and I could do it how I wanted at home.

We checked my progress 6 weeks later on September 9, 2017. My follow up CBC labs were:
RBC 5.36
Hgb 15.9
Hct 47.5%
Ferritin 81

RBC, Hgb, Hct went up sightly while Ferritin decreased a good amount.

At this point, I was able to start injecting myself at home. Since then, I have been injecting myself on a MWF schedule, doing 60mg each injection for 180mg per week. I have been injecting myself with HCG doing 400 iU on a Tues Thursday schedule for 800 iU per week. And I have been doing 0.25mg of anastrazole on the days of my Test injections on MWF for 0.75mg per week.

We just recently checked my labs to see how things were. The CBC labs on October 25, 2017 were:
RBC 5.51
Hgb 16.3
Hct 47.5%
Ferritin 28

Again, RBC and Hgb went up slightly, Hct stayed the same, and Ferritin decreased quite a bit again.

Is this normal? Do a lot of you guys experience this? I've read that TRT can lower Ferritin levels, but I wasn't sure if it was normal for my RBC, Hgb, and Hct levels to be normal while Ferritin is low. I feel that I eat plenty of iron rich foods (I'm basically on a Paleo Diet) so I eat a lot of meat, I take around 5g of Vitamin C a day (I've read Vit C helps with Iron absorption).

I expressed my concerns to my doctor, so he wrote me a script of 325mg Ferrous Sulfate once per day. I'm just concerned that my Hct levels will go over 50%.

Sorry for the book - let me know if I need to include any other details. Thanks in advance!!

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• Mean corpuscular volume (MCV)
• Mean corpuscular hemoglobin (MCH)
• Mean corpuscular hemoglobin concentration (MCHC)
• Red cell distribution width (RDW)

infuriatedrain said:

Sorry I forgot to mention that I am now doing daily injections at 26mg per day. Apparently I require quite a bit less when doing daily injections.

When I was doing the MWF schedule, my HCT never went over 48%

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1. As one of the posters mentioned, ferritin is also an acute phase reactant, so if testosterone is decreasing inflammation then the ferritin may decline irrespective of body iron stores. (I don't fully believe the data regarding this, though).
2. Testosterone has been shown to decrease hepcidin, resulting in increased ferroportin expression. While this functions to increase iron absorption from the diet, it also results in release of iron from ferroportin expressing cells… namely hepatocytes and macrophages. Ferritin is a marker of tissue iron levels, so the decrease ferritin may just be demonstrating a reduction in liver iron concentrations. If the subject is increasing muscle bulk, the excess serum iron may be used by muscle to make myoglobin. Otherwise, it may be increasing serum iron levels or getting deposited in other, non-ferroportin tissues (similar to hemochromatosis). His lack of anemia would suggest that he has adequate iron stores for erythropoiesis.

Nelson Vergel said:

I contacted a PhD hematologist from Baylor and this is what he said:

"Hi Nelson-
Thanks for the question. I read through the thread. I will preface what I say by the following, though: the iron-testosterone link is hypothetical and until demonstrated other causes of anemia should be evaluated. That being said, here are some thoughts.

1. As one of the posters mentioned, ferritin is also an acute phase reactant, so if testosterone is decreasing inflammation then the ferritin may decline irrespective of body iron stores. (I don’t fully believe the data regarding this, though).
2. Testosterone has been shown to decrease hepcidin, resulting in increased ferroportin expression. While this functions to increase iron absorption from the diet, it also results in release of iron from ferroportin expressing cells… namely hepatocytes and macrophages. Ferritin is a marker of tissue iron levels, so the decrease ferritin may just be demonstrating a reduction in liver iron concentrations. If the subject is increasing muscle bulk, the excess serum iron may be used by muscle to make myoglobin. Otherwise, it may be increasing serum iron levels or getting deposited in other, non-ferroportin tissues (similar to hemochromatosis). His lack of anemia would suggest that he has adequate iron stores for erythropoiesis.

Again, this is all hypothetical at this point. While it makes sense to me, it shouldn’t be used to guide treatment."

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