SHBG finally increased, but the hematocrit increased, ferritin decreased. Thyroid?

[gerardo]

High hematocrit, low ferritin and thyroid.

Does taking 15 mg of ferrous sulfate increase ferritin?

Hello everybody. I will attach my exams below and I would like your opinion. Thank you very much.

In early January of this year I had a phlebotomy due to an increase in hematocrit. I only did this once. My triglycerides and cholesterol are always high and I have to be very attentive to my diet. My thyroid needs to be optimized and when I did that the serum iron and ferritin levels went down but the hematocrit is very high.

Some days I have woken up very weak and the desire is to continue to lie down. 30 days ago I started supplementing 25 mcg T4 + 1 mcg T3. I also take 2 drops of lugol in the morning + 200 mcg of chelated selenium + 30 mg of zinc to try to improve the thyroid. Is it because of this supplementation that my ferritin has decreased since the thyroid consumes a lot of iron? And the problem is the hematocrit that is high 53 and at this level I cannot do a phlebotomy and if supplemented with iron, that hematocrit tends to get higher. I had a covid in October 2020. Will it be a sequel to the covid and my blood oxygen is low and the hematocrit increases because of that? Will I have to stop Trt to try to stabilize all of this?

I have been lowering Trt doses due to hematocrit and side effects that increase my blood pressure. I am currently injecting 15 Mg E3D enanthate + 250 ui Hcg twice a week + 24 Mg Dhea ED. Low shbg. 12.7.

 

[gerardo]

I just received other exams. The TT is 400 and the FT is 13.27. The interesting thing is that my Shbg that was low is now 29.90 and the E2 plummeted to <10. The progesterone that was always undetectable is now 0.10.

 

[JA Battle]

Wow, great example here of how excessive testosterone levels seem to affect other important hormones and their respective balance. Thank you for posting this.

This is something I’ve been aware of for some time and is why I dose my testosterone in the physiological range. I’m not worse off and in most ways I’ve proven to be better off.
When I experimented with 5.5mg of testosterone enanthate daily I had my levels 543ng/dl.

your hematocrit will come down at these lower doses. It may just take a little time. Hematocrit at 53 will not kill you overnight. You will be fine. give it more time.

and if you want to increase iron absorption, take this iron with some vitamin c or orange juice.

 

[gerardo]

Wow, great example here of how excessive testosterone levels seem to affect other important hormones and their respective balance. Thank you for posting this.

This is something I’ve been aware of for some time and is why I dose my testosterone in the physiological range. I’m not worse off and in most ways I’ve proven to be better off.
When I experimented with 5.5mg of testosterone enanthate daily I had my levels 543ng/dl.

your hematocrit will come down at these lower doses. It may just take a little time. Hematocrit at 53 will not kill you overnight. You will be fine. give it more time.

and if you want to increase iron absorption, take this iron with some vitamin c or orange juice.

I am taking 1 gram of vitamin C every day. My iron is low and prolactin has increased. The thyroid needs ferritin to be 75 to 100. So I need to supplement iron, increase estradiol and lower prolactin. Perhaps increasing the dose of T will partially solve it.

 

[JA Battle]

I would say that it will certainly assist with estradiol increase. I would up it to 16 every other day. Your hematocrit will still continue to fall even with 16 every other day.

 

[madman]

High hematocrit, low ferritin and thyroid.

Does taking 15 mg of ferrous sulfate increase ferritin?

Hello everybody. I will attach my exams below and I would like your opinion. Thank you very much.

In early January of this year I had a phlebotomy due to an increase in hematocrit. I only did this once. My triglycerides and cholesterol are always high and I have to be very attentive to my diet. My thyroid needs to be optimized and when I did that the serum iron and ferritin levels went down but the hematocrit is very high.

Some days I have woken up very weak and the desire is to continue to lie down. 30 days ago I started supplementing 25 mcg T4 + 1 mcg T3. I also take 2 drops of lugol in the morning + 200 mcg of chelated selenium + 30 mg of zinc to try to improve the thyroid. Is it because of this supplementation that my ferritin has decreased since the thyroid consumes a lot of iron? And the problem is the hematocrit that is high 53 and at this level I cannot do a phlebotomy and if supplemented with iron, that hematocrit tends to get higher. I had a covid in October 2020. Will it be a sequel to the covid and my blood oxygen is low and the hematocrit increases because of that? Will I have to stop Trt to try to stabilize all of this?

I have been lowering Trt doses due to hematocrit and side effects that increase my blood pressure. I am currently injecting 15 Mg E3D enanthate + 250 ui Hcg twice a week + 24 Mg Dhea ED. Low shbg. 12.7.

Unfortunately, the first 2 sets of labs are from Jan.13 and Feb.12 and during the first 2 months of the year, you had changed your protocol (dose T/injection frequency) numerous times let alone tested well before blood levels would have stabilized (4-6 weeks).

Protocol (dose T/injection frequency) would have been kept consistent as it will take 4-6 weeks for blood levels to stabilize let alone we test at the trough.

Regardless as you can see from the labs (Jan.13) that your TT 959 ng/dL is on the high end let alone your FT would be very high due to your low SHBG 12.7 nmol/L.

Lab (Feb.12) had your TT 594 ng/dL and had your FT above-mid-range or close to the top-end (depending on the age range/reference range used).

We have no idea where your FT truly sat as it was not tested using an accurate assay (ED or UF) as unfortunately, you do not have access in your country.


JAN13/2021

FEB12/2021

I have been lowering Trt doses due to hematocrit and side effects that increase my blood pressure. I am currently injecting 15 Mg E3D enanthate + 250 ui Hcg twice a week

What matters as of now is your most recent labs and as you can clearly see that you are only hitting a TT 400 ng/dL.

Have no clue when labs were done but if these are at trough then your TT is fairly low and your SHBG is now higher 29.9 nmol/L which would have your FT low.

In your previous labs from Feb.12, your FT is above-mid-range or close to the top-end (depending on the age range/reference range used) and that was with a much high TT of roughly 600 ng/dL and lower SHBG 12.7 nmol/L.


MAR6/2021

In early January of this year I had a phlebotomy due to an increase in hematocrit. I only did this once. My triglycerides and cholesterol are always high and I have to be very attentive to my diet. My thyroid needs to be optimized and when I did that the serum iron and ferritin levels went down but the hematocrit is very high.

Some days I have woken up very weak and the desire is to continue to lie down. 30 days ago I started supplementing 25 mcg T4 + 1 mcg T3. I also take 2 drops of lugol in the morning + 200 mcg of chelated selenium + 30 mg of zinc to try to improve the thyroid.

Your hematocrit as of now is high as it sits at 53 and your TT levels are fairly low on your current protocol.

Not sure how long you have been on the current protocol?

Also, keep in keep in mind T formulation, the dose of T, genetics (polymorphism of the AR), age all play a role in the impact a trt protocol will have on blood markers (RBCs/hemoglobin/hematocrit).

Other factors such as sleep apnea, smoking can have a negative impact on hematocrit.

For all, we know you may have already had borderline low iron/ferritin even before you did your first blood donation in January, and donating would drop ferritin down further.

Although you have dropped your T dose significantly it would take time for hematocrit to drop and regarding the low ferritin/iron you would need to start supplementing which can take 2-3 months for your levels to build back up.

 

[gerardo]

Unfortunately, the first 2 sets of labs are from Jan.13 and Feb.12 and during the first 2 months of the year, you had changed your protocol (dose T/injection frequency) numerous times let alone tested well before blood levels would have stabilized (4-6 weeks).

Protocol (dose T/injection frequency) would have been kept consistent as it will take 4-6 weeks for blood levels to stabilize let alone we test at the trough.

Regardless as you can see from the labs (Jan.13) that your TT 959 ng/dL is on the high end let alone your FT would be very high due to your low SHBG 12.7 nmol/L.

Lab (Feb.12) had your TT 594 ng/dL and had your FT above-mid-range or close to the top-end (depending on the age range/reference range used).

We have no idea where your FT truly sat as it was not tested using an accurate assay (ED or UF) as unfortunately, you do not have access in your country.


JAN13/2021
View attachment 13213


FEB12/2021
View attachment 13214




I have been lowering Trt doses due to hematocrit and side effects that increase my blood pressure. I am currently injecting 15 Mg E3D enanthate + 250 ui Hcg twice a week

What matters as of now is your most recent labs and as you can clearly see that you are only hitting a TT 400 ng/dL.

Have no clue when labs were done but if these are at trough then your TT is fairly low and although your SHBG is low 12.7 nmol/L your FT would be far from ideal.

In your previous labs from Feb.12, your FT is above-mid-range or close to the top-end (depending on the age range/reference range used) and that was with a much high TT of roughly 600 ng/dL.


MAR6/2021
View attachment 13215
View attachment 13217


In early January of this year I had a phlebotomy due to an increase in hematocrit. I only did this once. My triglycerides and cholesterol are always high and I have to be very attentive to my diet. My thyroid needs to be optimized and when I did that the serum iron and ferritin levels went down but the hematocrit is very high.

Some days I have woken up very weak and the desire is to continue to lie down. 30 days ago I started supplementing 25 mcg T4 + 1 mcg T3. I also take 2 drops of lugol in the morning + 200 mcg of chelated selenium + 30 mg of zinc to try to improve the thyroid.

Your hematocrit as of now is high as it sits at 53 and your TT levels are fairly low on your current protocol.

Not sure how long you have been on the current protocol?

Also, keep in keep in mind T formulation, the dose of T, genetics (polymorphism of the AR), age all play a role in the impact a trt protocol will have on blood markers (RBCs/hemoglobin/hematocrit).

Other factors such as sleep apnea, smoking can have a negative impact on hematocrit.

For all, we know you may have already had borderline low iron/ferritin even before you did your first blood donation in January, and donating would drop ferritin down further.

Although you have dropped your T dose significantly it would take time for hematocrit to drop and regarding the low ferritin/iron you would need to start supplementing which can take 2-3 months for your levels to build back up.

As you can see in the attached photo of ferritin it was at 146 and then dropped to 79 after phlebotomy.

About the protocol, there is no way to continue in one that causes side effects to the point of going to the hospital. I believe that anyone will change a protocol if it is not doing you good. I'm on this protocol for 25 days with a very low dose of testosterone.

The hematocrit was good and now the testosterone dose has even increased by lowering it.

About the testosterone test I wrote the current value and in the attached photo shbg also has it.

What I notice and it's important is that with the low dose of testosterone + Hcg, thyroid supplementation increased my Shbg, increased prolactin, decreased estradiol and increased hematocrit, decreased ferritin (I only had a phlebotomy in my life). That is the question. Please note that below the posted exams you can see the previous exam results.

Any suggestion? Do you think I should supplement ferrous sulfate?

Thank @madman

 

[madman]

As you can see in the attached photo of ferritin it was at 146 and then dropped to 79 after phlebotomy.

About the protocol, there is no way to continue in one that causes side effects to the point of going to the hospital. I believe that anyone will change a protocol if it is not doing you good. I'm on this protocol for 25 days with a very low dose of testosterone.

The hematocrit was good and now the testosterone dose has even increased by lowering it.

About the testosterone test I wrote the current value and in the attached photo shbg also has it.

What I notice and it's important is that with the low dose of testosterone + Hcg, thyroid supplementation increased my Shbg, increased prolactin, decreased estradiol and increased hematocrit, decreased ferritin (I only had a phlebotomy in my life). That is the question. Please note that below the posted exams you can see the previous exam results.

Any suggestion? Do you think I should supplement ferrous sulfate?

Thank @madman

Again if you have only been on your current protocol for 25 days then your most recent bloodwork was done too soon as you would need to wait 4-6 weeks for blood levels to stabilize.

If your hematocrit was high when you donated in early January it would take time to drop and if it has increased over the past few months then you need to look into this deeper.

Regarding the low ferritin, you may not be getting enough iron through dietary sources let alone may have absorption issues.

Once ferritin levels become too low it will take 2-3 months and in many cases longer to bring levels back up to a healthy range.

 

[gerardo]

Again if you have only been on your current protocol for 25 days then your most recent bloodwork was done too soon as you would need to wait 4-6 weeks for blood levels to stabilize.

If your hematocrit was high when you donated in early January it would take time to drop and if it has increased over the past few months then you need to look into this deeper.

Regarding the low ferritin, you may not be getting enough iron through dietary sources let alone may have absorption issues.

Once ferritin levels become too low it will take 2-3 months and in many cases longer to bring levels back up to a healthy range.

With the hematocrit of 53, is it safe to take just 18 mg of ferrous sulfate a day? It is the first time that my prolactin increases. Can Hcg cause this? And to my surprise it was the shbg increase. I believe that thyroid supplementation should increase shbg.

 

[gerardo]

Unfortunately, the first 2 sets of labs are from Jan.13 and Feb.12 and during the first 2 months of the year, you had changed your protocol (dose T/injection frequency) numerous times let alone tested well before blood levels would have stabilized (4-6 weeks).

Protocol (dose T/injection frequency) would have been kept consistent as it will take 4-6 weeks for blood levels to stabilize let alone we test at the trough.

Regardless as you can see from the labs (Jan.13) that your TT 959 ng/dL is on the high end let alone your FT would be very high due to your low SHBG 12.7 nmol/L.

Lab (Feb.12) had your TT 594 ng/dL and had your FT above-mid-range or close to the top-end (depending on the age range/reference range used).

We have no idea where your FT truly sat as it was not tested using an accurate assay (ED or UF) as unfortunately, you do not have access in your country.


JAN13/2021
View attachment 13213


FEB12/2021
View attachment 13214




I have been lowering Trt doses due to hematocrit and side effects that increase my blood pressure. I am currently injecting 15 Mg E3D enanthate + 250 ui Hcg twice a week

What matters as of now is your most recent labs and as you can clearly see that you are only hitting a TT 400 ng/dL.

Have no clue when labs were done but if these are at trough then your TT is fairly low and your SHBG is now higher 29.9 nmol/L which would have your FT low.

In your previous labs from Feb.12, your FT is above-mid-range or close to the top-end (depending on the age range/reference range used) and that was with a much high TT of roughly 600 ng/dL and lower SHBG 12.7 nmol/L.


MAR6/2021
View attachment 13215
View attachment 13217




Some days I have woken up very weak and the desire is to continue to lie down. 30 days ago I started supplementing 25 mcg T4 + 1 mcg T3. I also take 2 drops of lugol in the morning + 200 mcg of chelated selenium + 30 mg of zinc to try to improve the thyroid.

What I see is that T4 + T3 supplementation has increased SHBG. Now I stopped for a while and the SHBG is 18. I went back to taking 12.5 mcg of T4 + 5mcg of T3.

 

[Systemlord]

serum iron and ferritin levels went down but the hematocrit is very high.

When your body starts producing more hematocrit and red blood cells, iron is used up for that process.

 

[gerardo]

When your body starts producing more hematocrit and red blood cells, iron is used up for that process.

yes

 

[madman]

Mechanisms Underlying the Metabolic Actions of T in the Human - Excel Male Health Forum

Background. The role of testosterone in improving sexual symptoms in men with hypogonadism is well known. However, recent studies indicate that testosterone plays an important role in several metabolic functions in males. Methods. Multiple Pubmed searches were conducted with the use of terms...

www.excelmale.com

Hematocrit

The stimulatory effect of testosterone on hematocrit has been known for a long time (59). Hypogonadal states are characterized by a mild normocytic normochromic anemia which reverses following testosterone treatment (2). The mechanism underlying this effect has been thought to be due to an increase in erythropoietin synthesis in the kidney. However, more recently, it has been shown that hepcidin concentration is suppressed by testosterone (60, 61). Hepcidin suppresses the expression of ferroportin, the membrane protein responsible for the absorption of iron by the enterocyte, and the release of iron stored in the monocytes and macrophages of the reticuloendothelial system (62). Thus ferroportin has a cardinal role in increasing the bio-availability of iron. Recent investigations have also revealed that with the suppression of hepcidin, testosterone therapy increases the expression of ferroportin along with that of transferrin receptor and plasma transferrin concentrations (63). Plasma iron and ferritin concentrations fall. These findings are consistent with the release of iron from the stores with an increase in ferroportin and the transport of iron to erythropoietic cells through transferrin and the uptake of iron by erythropoietic tissues through the transferrin receptor. These effects, in addition to the stimulatory effect of testosterone on erythropoietin production, enhance hemoglobin production following testosterone therapy.




Erythrocytosis: Erythrocytosis is a known adverse effect of testosterone administration. A randomized placebo-controlled trial of transdermal testosterone therapy for one year in elderly men found a 2% incidence of polycythemia (2). The effect is dose-dependent and is seen more commonly in those with supra-normal levels of testosterone. Hematocrit above 55% increases blood viscosity and could exacerbate vascular disease in the coronary, cerebrovascular, or peripheral vascular circulation. Periodic hematological assessment is therefore indicated (1). In those with other causes of secondary polycythemia (such as smoking or sleep apnoea), dose adjustment and/or periodic phlebotomy may be necessary to keep the hematocrit below 55%.

 

[gerardo]

Mechanisms Underlying the Metabolic Actions of T in the Human - Excel Male Health Forum

Background. The role of testosterone in improving sexual symptoms in men with hypogonadism is well known. However, recent studies indicate that testosterone plays an important role in several metabolic functions in males. Methods. Multiple Pubmed searches were conducted with the use of terms...

www.excelmale.com

Hematocrit

The stimulatory effect of testosterone on hematocrit has been known for a long time (59). Hypogonadal states are characterized by a mild normocytic normochromic anemia which reverses following testosterone treatment (2). The mechanism underlying this effect has been thought to be due to an increase in erythropoietin synthesis in the kidney. However, more recently, it has been shown that hepcidin concentration is suppressed by testosterone (60, 61). Hepcidin suppresses the expression of ferroportin, the membrane protein responsible for the absorption of iron by the enterocyte, and the release of iron stored in the monocytes and macrophages of the reticuloendothelial system (62). Thus ferroportin has a cardinal role in increasing the bio-availability of iron. Recent investigations have also revealed that with the suppression of hepcidin, testosterone therapy increases the expression of ferroportin along with that of transferrin receptor and plasma transferrin concentrations (63). Plasma iron and ferritin concentrations fall. These findings are consistent with the release of iron from the stores with an increase in ferroportin and the transport of iron to erythropoietic cells through transferrin and the uptake of iron by erythropoietic tissues through the transferrin receptor. These effects, in addition to the stimulatory effect of testosterone on erythropoietin production, enhance hemoglobin production following testosterone therapy.




Erythrocytosis: Erythrocytosis is a known adverse effect of testosterone administration. A randomized placebo-controlled trial of transdermal testosterone therapy for one year in elderly men found a 2% incidence of polycythemia (2). The effect is dose-dependent and is seen more commonly in those with supra-normal levels of testosterone. Hematocrit above 55% increases blood viscosity and could exacerbate vascular disease in the coronary, cerebrovascular, or peripheral vascular circulation. Periodic hematological assessment is therefore indicated (1). In those with other causes of secondary polycythemia (such as smoking or sleep apnoea), dose adjustment and/or periodic phlebotomy may be necessary to keep the hematocrit below 55%.

Madman. In your opinion what is the best TRT protocol, more frequently or less frequently, that causes less suppression of hepcidin?

 

[gerardo]

Updating this topic. On May 1st, I started the new TRT protocol. See here: Hematocrit and TRT. How to have balance.

The shbg decreased again. It reached 30, dropped to 21, 18 .. and now 11.4. I think T4 supplementation increases SHBG. I'm only 12.5. I will return to 25 mcg T4 + 10 mcg T3. T3 decreased from 3.39 to 3.18. What do you think?