TRT, Low Ferritin, Possible Iron Deficiency Anemia

Blackhawk

Member
Are you saying because I donated so frequently that I run the risk of higher hemoglobin and hematocrit while supplementing with iron or that just by being on TRT and taking iron I need to watch for elevated levels. In other words, did the extensive donations cause issues for me on the recovery of ferritin side of things?

Donating blood (phlebotomy) does not promote higher hgb and hct, it is done to treat (reduce) high hbg and hct by removing red blood cells from the blood volume. It also decreases ferritin, and many guys who donate blood to bring down HGB/HCT end up depleted of ferritin. Yes, TRT can cause erythrocytosis. Read around the forum, It is a very common problem. There are many threads addressing these issues.

No question in my mind, yes, the extensive donations depleted your ferritin. That's the whole point.
 

Saul

Member
Are you saying because I donated so frequently that I run the risk of higher hemoglobin and hematocrit while supplementing with iron or that just by being on TRT and taking iron I need to watch for elevated levels. In other words, did the extensive donations cause issues for me on the recovery of ferritin side of things?

I agree with blackhawk. IMO, the donations depleted your ferritin. My ferritin was over 450 and it is now less than 50. Took 1.5 years of donations monthly and then every two months. For you it will be a balancing challenge to maintain ferritin levels high enough to have suitable iron stores while also maintaining hematocrit low enough to be in a proper range. Donations decrease ferritin and hematocrit. As said, a common issue faced by TRT members. Some people seem to supplement with iron or eat high iron food and/or lower TRT dose to find a balance. Iron from meat (heme) is more easily absorbed by the body. Acidic food and alcohol increase iron absorption and dairy/calcium reduce absorption.
 

JKc94

New Member
IMO, definitely low iron. My hematologist does not wants me to drop below ~ 50. I am probably a bit below that (finally) and have stopped donating. Don't go overboard with the supplements. Increasing or decreasing ferritin is a slow process. Stop donating but watch your htc.

Really more accurately erythrocytosis rather than polycythemia vera which also involves elevated platelets. Erythrocytosis secondary to TRT is indicated by elevated hemoglobin and hematocrit. All those values you posted are fine, but with donating so often, it is possible that without further donations they will rise to undesirable levels. It is a valid concern, but if you are symptomatic from single digit low ferritin, it seems currently the more important problem to fix.

Donating blood (phlebotomy) does not promote higher hgb and hct, it is done to treat (reduce) high hbg and hct by removing red blood cells from the blood volume. It also decreases ferritin, and many guys who donate blood to bring down HGB/HCT end up depleted of ferritin. Yes, TRT can cause erythrocytosis. Read around the forum, It is a very common problem. There are many threads addressing these issues.

No question in my mind, yes, the extensive donations depleted your ferritin. That's the whole point.

Understood. I am in agreement. Just wanted to make sure I was clear on what you said. Truthfully, the hematologist got me a little concerned when he mentioned polycythemia. I can see now all I need to do is focus on getting ferritin up and watch hgb & hct. Thanks.
 

JKc94

New Member
IMO, definitely low iron. My hematologist does not wants me to drop below ~ 50. I am probably a bit below that (finally) and have stopped donating. Don't go overboard with the supplements. Increasing or decreasing ferritin is a slow process. Stop donating but watch your htc.

Really more accurately erythrocytosis rather than polycythemia vera which also involves elevated platelets. Erythrocytosis secondary to TRT is indicated by elevated hemoglobin and hematocrit. All those values you posted are fine, but with donating so often, it is possible that without further donations they will rise to undesirable levels. It is a valid concern, but if you are symptomatic from single digit low ferritin, it seems currently the more important problem to fix.

Donating blood (phlebotomy) does not promote higher hgb and hct, it is done to treat (reduce) high hbg and hct by removing red blood cells from the blood volume. It also decreases ferritin, and many guys who donate blood to bring down HGB/HCT end up depleted of ferritin. Yes, TRT can cause erythrocytosis. Read around the forum, It is a very common problem. There are many threads addressing these issues.

No question in my mind, yes, the extensive donations depleted your ferritin. That's the whole point.

I agree with blackhawk. IMO, the donations depleted your ferritin. My ferritin was over 450 and it is now less than 50. Took 1.5 years of donations monthly and then every two months. For you it will be a balancing challenge to maintain ferritin levels high enough to have suitable iron stores while also maintaining hematocrit low enough to be in a proper range. Donations decrease ferritin and hematocrit. As said, a common issue faced by TRT members. Some people seem to supplement with iron or eat high iron food and/or lower TRT dose to find a balance. Iron from meat (heme) is more easily absorbed by the body. Acidic food and alcohol increase iron absorption and dairy/calcium reduce absorption.

I understand. Thanks for the feedback.
 

JKc94

New Member
I thought I would give an update after meeting with a different hematologist. Basically, doc said to continue taking iron supplements (recommended Slow Fe) and not do any blood donations for the time being. She said it was okay to continue TRT but just need to monitor blood work, as we all know. She did not seems concerned about anything. Drew labs in office and said to return in 4 months for appointment and repeat labs.

At this point, it has been six weeks since last blood donation and about 3 weeks since starting iron supplements:

The lab results came in and show ferritin is up to 38mcg/dl (50-180); iron binding capacity 404mcg/dl (250-425); iron saturation 9% (15.0-60.0). The CBC is normal except Lymph% is 13.2% (25-50), Lymph# 0.88 K/ul (1.0-5.0) and Baso% 4.3% (0-2.0); Base# 0.29 K/ul (0.29).

I looked at past blood work and on Jan 11, 2018, lymphocytes were a little low then, too. However, blood work done in November, August, and March 2017 showed RBCs normal except for the previously reported (in this thread) MCV, MCH issues.

Wondering if anyone has any input on the low lymphocytes. Generally, I know what it means with respect to decreased immune fighting. I have not been sick, but I have been under incredible stress since I started having symptoms at the end of December/first of January, which I believe was related to the low ferritin. I have read that stress can suppress immune system and lower lymphocyte counts. Anyone have any thoughts?
 

Blackhawk

Member
Congrats, seems you are on the right track Re: iron and Ferritin.

Re: the lymphocyte question, your reasoning could be right on or not. A quick look at causes and there are a lot of possibilities. From: http://www.md-health.com/Low-Lymphocytes.html (Unfortunately the general causes are incredibly vague)

What Causes Low Lymphocyte Count?

There are a number of factors that can contribute to a low lymphocyte count. The causes can be classified into general causes, acquired causes, or inherited causes.
General Causes


  • The body fails to produce an adequate number of lymphocytes.
  • The body produces a sufficient number of lymphocytes, but they are destroyed.
  • The lymphocytes become trapped in the spleen or lymph nodes.
Acquired Causes

The acquired causes are related to underlying medical conditions or responses to medical treatments. Some examples of acquired causes are:

  • infectious diseases
  • autoimmune disorders
  • steroid therapy
  • blood cancers and blood diseases
  • radiation/chemotherapy
Inherited Causes

The inherited causes are related to defects in the genes that play a role in lymphocyte development. Some key examples of these diseases are:

  • DiGeorge anomaly
  • Wiskott-Aldrich syndrome
  • Severe combined immunodeficiency syndrome
  • Ataxia-telangiectasia


basophils are related to allergy response and release of histimines. I think that higher levels can be related to provoking itching (pruritis) and higher levels to drops in blood pressure. Severe cases can be involved in anaphylactic reactions.
 

JKc94

New Member
Well darn. I made a mistake in reading the lab reports. My ferritin level is actually only 12. Iron serum is 38. This is after being on iron supplements for about three weeks. Still have a long way to go! (On a good note, the doctor's office said the low lymph% and lymph# is not of concern.)
 

pred43

New Member
Hello, do you have any update on this issue you had back in 2018? I am having similar low ferritn issues after random symptoms that can be caused by low ferritin. TY
 

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