High serum iron with low ferritin on TRT patients


I have posted this elsewhere but given Nelson created this forum to ask questions for specialists and I couldn’t find an answer elsewhere here we go.
Myself like many other people on TRT have to donate blood in order to control hematocrit. A lot of times this might lead to low ferritin levels accompanied or not by low serum iron levels. However in my case my serum iron levels are high (above lab range) with low to low normal ferritin and slightly above range % saturation. Looks like other TRT users have this same condition that initially looks puzzling given you would expect serum iron levels to be normal or low in frequent blood donors given you are losing iron every time you donate.
I have spoken to a friend of mine that owns a TRT clinic abroad and he mentioned to me that he sees a lot of people with this some condition at his clinic.
I have done some research and found this and a couple of other papers online:

“The striking biochemical characteristic of superdonors is greatly decreased serum hepcidin, consistent with their need to absorb maximal amounts of dietary iron to replace that lost from blood donation.”


TRT patients controlling hematocrit levels through blood donations fall into the superdonors category. Low hepcidin raises serum iron levels and can cause high iron saturation. Looks like this is the answer.
I guess the strategy is to supplement with iron in order to restore ferritin levels and increase hepcidin levels that will then decrease iron absorption and normalize serum iron and iron saturation (at the same time trying to minimize blood donation while keeping HCT under control at safe levels) It might look counterproductive to supplement iron while having high serum iron but this looks to be the approach according to some papers i read.

Worth mentioning that before starting TRT i had a complete iron panel done and all parameters were normal.

Any comments from the experts? Does this explanation for high serum iron with low ferritin make sense? Is this condition (high serum iron) of any concern?

Nelson Vergel

Founder, ExcelMale.com
I apologize for not ever seeing this old post before.

I checked the links and they do not work, so I added the paper here (attached)

"Approximately 14 million units of whole blood are collected annually by blood centers throughout the United States. As a result, approximately 3.5 tons of iron is removed from whole-blood donors each year. This loss of iron is evident in the decrease in the iron stores as mea- sured by serum ferritin that is associated with whole blood donation.12 Garry and coworkers2 demonstrated that serum ferritin concentration decreases steadily through five blood donations and then stabilizes at a mean concentration of approximately 20 ng per mL. During the course of these donations, it appears that daily iron absorption gradually increases to the point that the donor’s iron needs are met without further depletion of stores. However, there is individual variation in the ability to absorb dietary iron, and many frequent donors are deferred for low Hct. Superdonors are a self-selected population able to repeatedly donate whole blood without being deferred for low Hct despite having depleted iron stores, indicating that they have higher than expected absorption of dietary iron."

hematpcrit ferritin iron in frequent donors.jpg