My Experience On Jatenzo (Oral TRT) Log

[Fortunate]

So, I apologize, I'd have to go back to understand your iron issues better, but can you summarize why you have to supplement? Seems like donating and supplementing are like playing a tug of war?

 

[Systemlord]

Seems like donating and supplementing are like playing a tug of war?

That's exactly what it is. Today my endo blamed the iron problems on TRT, not diabetes, but it's not like I didn't see this coming.

I have been referred to a hematologist because the next phlebotomy could result in iron deficiency anemia and that's the last thing I need right now.

I was fine until my endo scheduled a phlebotomy a month apart from the last one.

 

[JA Battle]

That's exactly what it is. Today my endo blamed the iron problems on TRT, not diabetes, but it's not like I didn't see this coming.

I have been referred to a hematologist because the next phlebotomy could result in iron deficiency anemia and that's the last thing I need right now.

I was fine until my endo scheduled a phlebotomy a month apart from the last one.

What is the reason for needing phlebotomy? Is the hematocrit the issue even while on jatenzo?

 

[tareload]

I have been referred to a hematologist because the next phlebotomy could result in iron deficiency anemia and that's the last thing I need right now.

I'm glad you are heading in this direction. Please go see a qualified hematologist that can help you.

Your HgB/Hct would suggest you are far away from iron deficiency anemia:

Iron Deficiency Anemia - StatPearls - NCBI Bookshelf

Evaluation​

Laboratory evaluation will identify anemia. The hemoglobin indices in iron deficiency will demonstrate a low mean corpuscular hemoglobin and mean corpuscular hemoglobin volume. Hematoscopy shows microcytosis, hypochromia, and anisocytosis, as reflected by a red cell distribution width higher than the reference range. Serum levels of ferritin, iron, and transferrin saturation will be decreased. Serum ferritin is a measure of the total body iron stores. The total iron-binding capacity will be increased. Stool for occult blood may reveal a gastrointestinal source of bleeding. A simple mean corpuscular hemoglobin/RBC index, or Mentzer index, can help differentiate between the two causes of microcytic/hypochromic anemia. These causes are iron deficiency and thalassemia minor. An index greater than 15 suggests iron deficiency, while an index less than 11 suggests thalassemia minor. The definitive test to rule out thalassemia minor is hemoglobin electrophoresis. Other tests like an iron profile are necessary for severe anemia or when anemia does not respond to iron therapy. Low ferritin is a reliable marker of iron deficiency. However, a ferritin level that is within the reference range or elevated is not very useful in patients with inflammatory conditions such as malignancies, infection, and collagen disease. This is because it is an acute-phase reactant. The standard for establishing iron deficiency is a bone marrow aspiration or biopsy followed by iron staining since it is unaffected by inflammation. However, the cost and invasiveness of this test make it less feasible; it is rarely performed for this reason.[8]



My previous questions from other post:

Vitamin D supplementation modestly reduces serum iron.

I started Vitamin D supplementation due to a deficiency on Jan 13th and started having problems I couldn't identify until now. My iron requirements have gone up considerably since starting Vitamin D supplementation and was having symptoms that started at the time I started Vitamin D...

www.excelmale.com

1. Why are you taking iron supplement?
2. Drop the iron supplement and drop the frequent phlebotomy?
3. What was your Hct before TRT?
4. Do you have an iron panel prior to TRT?
5. Were you diagnosed anemic prior to TRT?
6. What does your iron panel+ferritin look like currently?

Lay out this information methodically for the hematologist. Try to organize all of this information coherently. Please get screened for hemochromatosis so you can potentially deconvolute the TRT, iron supplementation, iron status, CBC status, phlebotomies.

Ask the provider what you are trying to fix and do you need to remove items or add items to accomplish this.

 

[Systemlord]

What is the reason for needing phlebotomy? Is the hematocrit the issue even while on jatenzo?

Yes, I hit 57% hematocrit and 19.2 hemoglobin and while my blood pressure is still within normal, my heart is clearly working harder and I can feel it.

Your HgB/Hct would suggest you are far away from iron deficiency anemia:

Had I not started taking more iron 3 weeks ago, that wouldn't now be the case, blood testing at 1 and the 2nd weeks after my last phlebotomy, hematocrit and hemoglobin was nosing diving quickly and the symptoms were mounting.

I started taking more iron knowing my ferritin must be low from all the phlebotomies, and I was right as later testing shows.

 

[tareload]

hematocrit and hemoglobin was nosing diving quickly and the symptoms were mounting.

values?

 

[Systemlord]

values?

One week after the phlebotomy hematocrit was 50.8, 2 weeks after 48% and feeling worse fast. Then I start taking more iron and at week 4 hematocrit is 52%.

I'm bruising easily, feet swell, feel cold and iron fixes the problem. The further I get away from iron dosing later in the day, the symptoms start piling up.

My body wants a lot of iron. Life was good with a ferritin at 99.

 

[tareload]

One week after the phlebotomy hematocrit was 50.8, 2 weeks after 48% and feeling worse fast. Then I start taking more iron and at week 4 hematocrit is 52%.

I'm bruising easily, feet swell, feel cold and iron fixes the problem. The further I get away from iron dosing later in the day, the symptoms start piling up.

My body wants a lot of iron. Life was good with a ferritin at 99.

Please find someone you trust and get some direction on your medical care. Not much more that can be done on this forum but your Hct above is no where even in the remote region near anemia.

You'd have to do the work and drop the iron and see where your Hct would stabilize on TRT vs no TRT. I don't see any evidence of anemia pre TRT but that's why you would go through your case history with a trusted board-certified physician.

Best wishes and I'm sorry I've been hard on your sometimes. I trust you mean well.

 

[Systemlord]

Best wishes and I'm sorry I've been hard on your sometimes. I trust you mean well.

Thanks, I appreciate it.

 

[Fortunate]

One week after the phlebotomy hematocrit was 50.8, 2 weeks after 48% and feeling worse fast. Then I start taking more iron and at week 4 hematocrit is 52%.

I'm bruising easily, feet swell, feel cold and iron fixes the problem. The further I get away from iron dosing later in the day, the symptoms start piling up.

My body wants a lot of iron. Life was good with a ferritin at 99.

Easy bruising could be related to a platelet deficiency or dysfunction. Have you had this looked at? Feel swelling, cold feet don't seem typical for anemia.

I agree with @readalot - I think it would help to see a hematologist to sort through this with you.

 

[Fortunate]

Interesting study on Jatenzo. I don't think it's been posted here yet.

@Systemlord, maybe you have answered this, but in general, how is your E2?

 

[Systemlord]

I agree with @readalot - I think it would help to see a hematologist to sort through this with you.

I wasn't given an ounce of concern by a hematologist yesterday.

 

[tareload]

I wasn't given an ounce of concern by a hematologist yesterday.

Can you elaborate? He wasn't concerned about any ill health effects during your consult or didn't give you an ounce of concern?

 

[Systemlord]

Can you elaborate?

He did say that low normal ferritin, iron can present with symptoms, but was more concerned about IV infusion exacerbating my HCT.

My counter to that was more frequent phlebotomies if needed, but a low iron state is not a condition I want to live with.

He even said if my ferritin dropped below 30 he would still do nothing. He recommended stopping the TRT, the only treatment keeping my diabetes in check.

That's like telling a type 1 diabetic to stop injecting insulin.

May I remind you 8 months ago my diabetes was out of control and was at risk for heart attack and strokes.

So androgen deprivation therapy is what he recommended.

 

[tareload]

He recommended stopping the TRT, the only treatment keeping my diabetes in check

Thanks for the summary. Why did he recommend you stop TRT?

Why do you need TRT to control your diabetes? This is type 2?
What is your waist to height ratio?

 

[Systemlord]

Why did he recommend you stop TRT?

Because of the iron and HCT issue.

Why do you need TRT to control your diabetes? This is type 2?
What is your waist to height ratio?

A year ago my A1C was 12%, fasting glucose 360 and T injections, T creams and type 2 medicine wasn't working.

Most of the type 2 diabetes medicines caused a potassium deficiency within 24 hours and I'm allergic to insulin.

My cardiologist and endocrinologist had a very serious discussion with me about where things were going.

I went on Jatenzo and it started working right away, my fasting glucose and A1C starting dropping quickly and A1C is now 6.4% and falling.

I notice a masaive difference in my glucose numbers within the first week!

So Jatenzo has singlehandedly allowed me to not only get my glucose numbers down, but also possibly give a chance to reverse my diabetes.

I'm continuing to lose weight, which was 237 and is now 215 and falling 1-2 pounds per week. I'm almost a 34" waist. I'm 6 ft tall.

 

[tareload]

Because of the iron and HCT issue.


A year ago my A1C was 12%, fasting glucose 360 and T injections, T creams and type 2 medicine wasn't working.

Most of the type 2 diabetes medicines caused a potassium deficiency within 24 hours and I'm allergic to insulin.

My cardiologist and endocrinologist had a very serious discussion with me about where things were going.

I went on Jatenzo and it started working right away, my fasting glucose and A1C starting dropping quickly and A1C is now 6.4% and falling.

I notice a masaive difference in my glucose numbers within the first week!

So Jatenzo has singlehandedly allowed me to not only get my glucose numbers down, but also possibly give a chance to reverse my diabetes.

I'm continuing to lose weight, which was 237 and is now 215 and falling 1-2 pounds per week. I'm almost a 34" waist. I'm 6 ft tall.

Thanks for the information.

Have you had your fasting insulin tested? What's your fasting glucose currently?

The numbers you provide above put your current waist to height at ~0.47 and your 237 lb and 215 lb numbers still put you at under 15% BF using a multitude of empirical BF estimators (assuming 16" neck).

What's the highest value your waist circumference reached (for instance when your fasting glucose was 360)?

 

[Systemlord]

What's your fasting glucose currently?

96-130.

What's the highest value your waist circumference reached (for instance when your fasting glucose was 360)?

My waist was size 36".

 

[tareload]

96-130.


My waist was size 36".

I'm having a hard time with the height, weight, and waist circumference you shared at your heaviest. These values point to a bf level (under 15%) that seems really low and typical for a veteran muscular gym-rat not someone with the issues you experience (T2D, nafld, etc)...

For example, your words below don't give me the picture of someone 6 ft, 236 lb with a 36 inch waist:

TRT Protocol Established. Thoughts?

I’m 70 lbs overweight (6ft/238 lbs, normally skinny 160-170 lbs), put me in a wetsuit and I look like a seal! Together with your overall poor metabolism/liver metabolism, the AI was the right call. It’s the job of the liver to rid the body of excess estrogen, the liver is also needed to...

forums.t-nation.com

The posts I read on TNation seemed to peg you above 30% easy when you were heavier. This is my first time really trying to dig into your case.

What am I missing here?

Unreal really was spot on...

TRT Shuts Down Ability to Urinate

Dude… the answer here clearly isn’t trt. You’ve tried again and again with the outcome only being a worsening of health ailment You’ve been very overweight for a very long period of time and health consequences associated with the systemic proinflammatory state, endocrine abnormalities etc...

forums.t-nation.com

Taking TRT away from t2diabetic ain't remotely the same as taking insulin away from t1 diabetic.

He recommended stopping the TRT, the only treatment keeping my diabetes in check.

That's like telling a type 1 diabetic to stop injecting insulin.

 

[tareload]

I joined 24-Hour Fitness today and lifted weights today

Excellent work. Combining cardio with resistance training with proper eating plan will help you with your T2D. Long term increase in lbm and dropping SC and visceral fat is huge. I'm pulling for you.

Please stop drinking fruit juice. Costco makes a nice chewable sugar free vit C product or just have a grapefruit as your special treat every few days.