Fainting, High HCT, Low Ferritin — TRT Vet of 15+ Years Needs Help ASAP

[Robertearl18]

Hey guys,
I’ve been on 100mg Test Cyp IM weekly for the past 15 years, started at 25 I'm now 40 with good results overall, but something’s changed recently and I need experienced eyes on this.

For the past month, I’ve had constant lightheadedness, faint feelings, brain fog, and general weakness — especially in the mornings. It’s persistent and exhausting. The only thing that gives temporary relief is 0.5–1mg Xanax, which tells me it might be calming something neurologic or adrenal, but it’s not a real solution.

• Total T: 634
• SHBG: 24.3
• Free T (calc): 162.7
• Estradiol: 65 pg/mL

• 4/3/25 – RBC: 6.11 / HGB: 18.8 / HCT: 55.9
• 4/10/25 – RBC: 5.71 / HGB: 17.8 / HCT: 52.4
• 4/28/25 – RBC: 5.80 / HGB: 18.0 / HCT: 53.7

• Iron: 132 (50–180)
• TIBC: 390 (250–425)
• Saturation: 34%
• Ferritin: 23 (Ref: 38–380) ←
  
  Very concerned about this

• Omeprazole 40mg daily for 10+ years (likely impacting iron absorption)
• Diagnosed mild sleep apnea (on CPAP since Jan 2024)
• Went to ER twice recently with near-syncope; both times told it’s just low potassium and dehydration (which I’m now addressing)
• Current PCP says: my symptoms are from elevated HCT/HGB and is pushing me to donate a unit of blood
• She also wants to cut my Test to every 2 weeks and start an AI, which I know from this forum is not best practice

---

• Have any of you had symptoms like mine (faintness, dizziness, visual pressure) with elevated HCT or low ferritin?
• Would you donate blood with ferritin at 23?
• Should I be concerned about Estradiol at 65, or just leave it alone?
• Is there any chance this is more ferritin-related than HCT-related?
• Could long-term omeprazole be contributing to the problem?
• What labs or fixes would you suggest next?

I really value this community’s knowledge. I’m looking for clarity and a solid path forward from people who’ve walked this road. Appreciate any and all input.

 

[Guided_by_Voices]

I would not jump to the conclusion that your issues are hormonal. For example, your symptoms are very similar to someone I know who had Lyme disease. It could also be something in your environment like mold, but those are just two examples of what could be caused by many things. Do you have access to a good integrative doc who can do testing for infections and who has experience with your types of issues? Personally, I would donate blood since from what I know, Ferritin is a very poor marker of Iron status (TIBC is better) and you could see if it made a difference, but I doubt if that's your issue.

 

[Seagal]

Imho you should compare the current lab report with previous ones in order to identify significant changes. Compare the hematocrit and estrogen values. PCP's reaction is typical... Question is what would be next on the list of possible causes. Your ferritin is further off range than the hct.
I wonder why you have xanax available and would take it ... Think about it, and compare your estrogen and hct values.

 

[Robertearl18]

I would not jump to the conclusion that your issues are hormonal. For example, your symptoms are very similar to someone I know who had Lyme disease. It could also be something in your environment like mold, but those are just two examples of what could be caused by many things. Do you have access to a good integrative doc who can do testing for infections and who has experience with your types of issues? Personally, I would donate blood since from what I know, Ferritin is a very poor marker of Iron status (TIBC is better) and you could see if it made a difference, but I doubt if that's your issue.

Thank you for that reply, I'm literally desperate at this point. I have not been in contact with any Ticks and don't have some of the other symptoms so don't think it's that. House has no mold and just had whole hvac system and ducting replaced last year. I'm fixing to sign up with a vip/concierge doctor at my cost of $2500 to get more personalized care and maybe he can spend the time to investigate. I'm pretty sure I will donate blood at least one to see how i feel afterwords. I also think possibly anxiety is now possibly a leading cause as I can feel faint super bad and 30 min after a xanax it goes away. I'm going to investigate that further as well. I do appreciate your input as the public sometimes knows more than your pcp.

 

[Robertearl18]

Imho you should compare the current lab report with previous ones in order to identify significant changes. Compare the hematocrit and estrogen values. PCP's reaction is typical... Question is what would be next on the list of possible causes. Your ferritin is further off range than the hct.
I wonder why you have xanax available and would take it ... Think about it, and compare your estrogen and hct values.

First time checking estrogen levels in the 15 years I've been on TRT, my doctor only tested my "total T" I now know that's been incorrect. My hema/hemo levels have always been between 50-55 so nothing new there but she said she wants me to donate as it's at a dangerous level now. Never had my Ferritin checked either so this is the first time with that so don't know a baseline. First time checking estrogen as she never checked that either. I know I know, Why didn't I do it myself...Well I did..I paid out of pocket to get all of this tested and now know levels. My Xanax is for anxiety for the past 10 years. I'm starting to think all of my blood levels etc are my "normal" granted a little high but i've been high forever but possibly I'm having issues caused 100% by anxiety? All of the symptoms align with anxiety but i'd hate to think that I am having anxiety every day but the xanax is the only thing that fixes it. Any insight there? I've just been hyper fixated on the stuff i've read about when you donate blood your ferritin will drop which mine is low already that i don't want to deplete it completely. Do you suggest I donate blood and see what it does for me? I'm also going to contact my psychiatrist and see what she thinks.

 

[Systemlord]

Current PCP says: my symptoms are from elevated HCT/HGB and is pushing me to donate a unit of blood

Your low ferritin may not be a bad thing. Your body may be trying to regulate the hemoglobin, hematocrit and red blood cells caused by the TRT by lowering the ferritin and may not be an issue.

You could always change the delivery method to one that doesn't affect hematocrit and hemoglobin as much, like the newer oral testosterone Jatenzo and Kyzatrex.

Usually iron deficiency presents with lower hemoglobin. Your MCHC, MCV and MCH would provide more insight into your iron status.

Thread 'My Experience On Jatenzo (Oral TRT) Log'

Jun 16, 2021

I wanted to start a thread detailing my personal experience with Jatenzo (oral TRT) which is remarkable in how quickly it has shown results when compared with injections. The first week on Jatenzo was very pleasant unlike my experience after dosing changes on injections, all with minimal swings and I felt things stabilize on day 7 which is where things felt consistent.

The first few days on Jatenzo my glucose levels were the lowest, then over the next two and a half weeks I would see glucose levels fluctuate wildly and at the end of week three a return to those same lower fasting and...

• Systemlord
• jatenzo oral testosterone
• Replies: 374
• Forum: Testosterone Basics & Questions

• 

Diagnosed mild sleep apnea (on CPAP since Jan 2024)

This could be partially responsible for your elevated HCT. On 4/3/25 either you were dehydrated or your sleep apnea was out of control due to your hematocrit to hemoglobin ratio being significantly higher.

Omeprazole 40mg daily for 10+ years (likely impacting iron absorption)

Proton-pump inhibitor are well known to cause deficiencies via malabsorption and lead to cognitive decline, increased dementia risk, cause or worsen autoimmune disease and gastric cancer.

Is there any chance this is more ferritin-related than HCT-related?

The higher the testosterone, the more iron is utilized in the creation of more hemoglobin, hematocrit and red blood cells. Your low ferritin, if increased would see your hemoglobin, hematocrit and red blood cells increase further.

 

[Seagal]

First time checking estrogen levels in the 15 years I've been on TRT, my doctor only tested my "total T" I now know that's been incorrect. My hema/hemo levels have always been between 50-55 so nothing new there but she said she wants me to donate as it's at a dangerous level now. Never had my Ferritin checked either so this is the first time with that so don't know a baseline. First time checking estrogen as she never checked that either. I know I know, Why didn't I do it myself...Well I did..I paid out of pocket to get all of this tested and now know levels. My Xanax is for anxiety for the past 10 years. I'm starting to think all of my blood levels etc are my "normal" granted a little high but i've been high forever but possibly I'm having issues caused 100% by anxiety? All of the symptoms align with anxiety but i'd hate to think that I am having anxiety every day but the xanax is the only thing that fixes it. Any insight there? I've just been hyper fixated on the stuff i've read about when you donate blood your ferritin will drop which mine is low already that i don't want to deplete it completely. Do you suggest I donate blood and see what it does for me? I'm also going to contact my psychiatrist and see what she thinks.

You could donate blood to calm your mind. I would also take an iron supplement as well as the psych meds if they help with the symptoms, and also talk to the psychiatrist.
Edit: I'm not sure about the iron supplement after reading @Guided_by_Voices post.
Edit2: Reading up on TIBC, saturation. I think it wouldn't harm to supplement with iron if it goes into storage (ferritin).

Also check vitamin D and B9 (depression, anxiety)

 

[Robertearl18]

Your low ferritin may not be a bad thing. Your body may be trying to regulate the hemoglobin, hematocrit and red blood cells caused by the TRT by lowering the ferritin and may not be an issue.

You could always change the delivery method to one that doesn't affect hematocrit and hemoglobin as much, like the newer oral testosterone Jatenzo and Kyzatrex.

Usually iron deficiency presents with lower hemoglobin. Your MCHC, MCV and MCH would provide more insight into your iron status.

Thread 'My Experience On Jatenzo (Oral TRT) Log'

Jun 16, 2021

I wanted to start a thread detailing my personal experience with Jatenzo (oral TRT) which is remarkable in how quickly it has shown results when compared with injections. The first week on Jatenzo was very pleasant unlike my experience after dosing changes on injections, all with minimal swings and I felt things stabilize on day 7 which is where things felt consistent.

The first few days on Jatenzo my glucose levels were the lowest, then over the next two and a half weeks I would see glucose levels fluctuate wildly and at the end of week three a return to those same lower fasting and...

• Systemlord
• jatenzo oral testosterone
• Replies: 374
• Forum: Testosterone Basics & Questions

• 

This could be partially responsible for your elevated HCT. On 4/3/25 either you were dehydrated or your sleep apnea was out of control due to your hematocrit to hemoglobin ratio being significantly higher.

Proton-pump inhibitor are well known to cause deficiencies via malabsorption and lead to cognitive decline, increased dementia risk, cause or worsen autoimmune disease and gastric cancer.

The higher the testosterone, the more iron is utilized in the creation of more hemoglobin, hematocrit and red blood cells. Your low ferritin, if increased would see your hemoglobin, hematocrit and red blood cells increase further.

Thanks for all the insight...So giving my symptoms do you suggest I donate blood?

 

[Guided_by_Voices]

Thanks for all the insight...So giving my symptoms do you suggest I donate blood?

Yes. Little to no downside, and significant upside even if it is just to rule something out.

Also, even though omeprazole doesn't appear to be anti-cholinergic (which would be a big clue if it was) figuring out the underlying problem and stopping it at least for a while seems prudent. The docs who are forward thinking who I've listened to consistently say that reducing stomach acid is not a good thing.