TRT, Low Ferritin, Possible Iron Deficiency Anemia

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JKc94

New Member
Been on TRT for 5 years. (Age 48 years). Never had hemoglobin or hematocrit get outside of range, but would occasionally get close to upper limit at times. Started donating blood on an occasional basis (2-3 times per year) with no issues. Starting in January 2016, I thought I would be a good guy and start donating blood more frequently. Previously, a donation always made me feel good (physically) and I liked that I was doing something to help others. In 2016, I donated one pint of whole blood almost exactly every 56 days. I did have donation period that was 23 days between two separate donations. Not sure why I did that, except there was a local blood drive. I knew better, but did the donation anyway.

Sometime during the year 2016, I started feeling lethargic at times, occasionally weak, but not overly so. I dismissed the symptoms and kept going forward. My last blood donation in 2016 was 11/13/16. On January 12, 2017, blood work showed:

ferritin level < 10ng/ml (30-40ng/ml)
serum iron 28ug/dl (59-158ug/dl)
Rbc 5.2 (4.1-5.6)
Hgb 13.9 (12.5-17.0)
Hct 42% (36-50%)
Mcv, Mch, Mchc all in limits but right at the lowest point on scale
Rdw 16.6% (11.7-15)
Testosterone serum 606, Free 15.06

As a follow up, labs were repeated on 3/20/17:
ferritin 6ng/ml (20-380ng/ml)
serum iron 29mcg/dl (50-180mcg/dl)
Rbc 5.36 (4.2-5.8)
Hgb 14.4 g/dl (13.2-17.1)
Hct 44.3% (38.5-50.0)
Mcv 82.6 fl (80-100 fl)
Mch 26.9 pg (27.0-33)
mchc 32.5 g/dl (32-36)
Rdw 20.3% (11.0-15.0)

Then, donated 1 pint whole blood on 5/1/17 and then again on 6/26/17. (Before asking, why the donations, I don't know. The doctor mentioned the low iron only, but only said we would check it again next time. I mentioned giving blood, and doctor said it was likely from that.)

Sometime around July 2017, I started feeling very tired at times. I would often take naps during the day and sometimes couldn't get a good night's rest. Started having frequent headaches, and occasionally would become lightheaded but never fainted. Started having some occasional chest discomfort (not pain, but bothersome) and would also, at times, have some peripheral neuropathy in arms---just enough to be noticeable and annoying. I would be short of breath at times, too, especially excercising.

In August 2017, went to doctor to have an EKG to make sure issues weren't heart related. CBC was drawn and showed: Rbc 5.44 (4.10-5.80), Hgb 13.9 (12.5-17.1 g/dl), Hct 43.4 (36-50%), Mcv 79.8 (80.0-100 fl), Mch 25.6 (27-34 pg), Mchc 32.1 (32-36 g/dl), Rdw 16.8 (11-15%). The iron serum was 34 ug/dl (59-158), Ferritin < 10 ng/ml (30-400)

EKG was fine; echocardiogram was fine.

Had CBC redone on 11/27/17; Rbc 5.95 (4.20-5.80), Hgb 14.8 (13.2-17.1 g/dl), Hct 47.3 (38.5-50%), Mcv 79.5 (80-100 fl), Mch 24.9 (27-33 pg), Mchc 31.3 (32-36 g/dl), Rdw 18.3 (11-15%)

12/20/17 donated one pint whole blood.

CBC 1/11/18, Rbc 5.45, Hgb 14.8, Hct 45.6, Mcv 83.7, Mch, 27.2, 32.5, Rdw 17.0 (scale limits same as 11/27/17)

Around 1/11/18, started having tingling in left foot and occasional tingling in face. It was very light, but concerning. Felt cold a lot and sometimes fingers and hands would feel cool or like they might come numb, although they wouldn't. Doctor ordered a lot of other blood tests, but they were all fine. The doctor was uncertain what was going on and made a referral to neurologist. Before seeing the neuro, I visited another doctor who redrew iron panel, which showed on 2/7/18: D-TIBC 500 (250-450 ug/dl), TSAT 32 (15-50%), Iron Serum 158 (59-158 ug/dl), Ferritin 17 (30-400 ng/ml). I should point out that prior to the iron panel bloodwork, I had started taking an iron pill on a daily basis. I had developed restless leg syndrome issues and read that it could be from low iron. I had been taking the iron pill 2-3 weeks before the iron panel was drawn.

In late February, I had a cervical MRI and Lumbar MRI because of the tingling in the lower extremities and the facial parathesia. Both MRI were normal with exception of mild degenerative disc disease, which is normal for my age (48 years). The doctor referred to neurologist.

My blood pressure had been slightly elevated, which was unusual for me. The doctor suggested I might donate blood to see if that would help. Yes, I know. With all the low issues and CBC issues staring her in the face, she suggested a blood donation. So on 3/2/18, I donated a pint. Within 3 days, the tingling in my legs that I had been having got a lot worse. Muscle twitches were more frequent. Facial tingling was all day. Anxiety went way, way up. And, I became very concerned. I couldn't stay off the internet searching for answers. The anxiety got worse and worse; I couldn't sleep more than 2-3 hours each night; developed tinnitus in both ears and generally felt like I might have multiple sclerosis or ALS. I have never experience anything like this, but I can say the anxiety was real.

By the time I saw the neurologist, I was a nervous wreck. He reviewed by lab work and right away said the ferritin level was extremely low. I had no idea he would immediately hone in on that. He was emphatic my symptoms of Restless leg, parathesia, etc. were coming from that. The muscle twitches he diagnosed as benign fasculatations due to anxiety and possibly related to low ferritin as well. He put me on Integra iron capsules, one each day and sent me for a brain MRI just to be safe. Within a week, the brain MRI came back negative and the neurologist said you don't have MS or ALS. He said, let's get your ferritin up and you'll be fine. He said it could take 3-6 months. And yes, he knew I was on TRT; we discussed it briefly. He referred me to a hematologist as well just for a consult---not due to a new problem.

At this point, I felt a lot better. Anxiety came down and I felt like I was finally on the road to getting me. EXCEPT, when I go see the hematologist, he didn't seem to care much about the low ferritin and really didn't think I needed to be on iron pills. He never looked at my blood donation record or past blood work; he only want to see the most recent (February 2018). He said he is 95% sure I have polycythemia secondary to TRT. He said the swings in Hgb and Hct can cause unusual symptoms. He wants me to wait a month before having new blood work done to give more time since last blood donation and recommended stopping the iron pills. He also wants me to have an abdominal ultrasound to check the liver and spleen. He said he doesn't expect any issues but wants to be sure.

After all this, here is my thoughts and questions:

I think I have iron deficiency anemia due to low ferritin, low iron, increased Rdw, low Mcv, low Mch, etc, which is secondary to excessive blood donations The CBC issues seem to be classic for iron deficiency anemia. I think the only reason my Hgb and Hct have not tanked below normal is the TRT has kept the levels in the normal range. My TRT dose is now 125mg every 14 days.

I am continuing to take the Integra iron, but I have to take it every other day (or sometimes every 3 days) because it creates stomach issues. I'm not trying to discount the hematologist, but I have set up an appointment with a different hematologist because the one I saw was not a good listener. He didn't seem to care about my blood donation record or my symptoms.

I know this is a long post, but I welcome any comments or feedback.
 
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Blackhawk

Member
Krikey, glad you know now that donating probably made you crash!

And BTW, is your 125mg dose once every 14 days? And is it t cypionate? If so, that is a TERRIBLE protocol!!! First, 62.5mg a week is quite low, and second, a bolus once every two weeks is going to give you a temporary boost which then crashes probably below your pre TRT baseline level by the time you take the next dose. Huge roller coaster.
 

Vettester Chris

Super Moderator
Take a look at some slow release elemental iron, you are probably needing 150mg to 200mg day. Divide it up, with meals, avoid coffee when taking, and make sure to take with ample amounts of vitamin C.

This is also having an impact on your thyroid, as T3 won't be productive with getting to the cells. It might take a few months to get back on the right track, but stay with it, and I would stop donating for the time being ...

Agree with Blackhawk, that protocol is dismal at best! Peak activity is around 3 days, half-life is around 7 days, making active life 14 days. Good chance you're seeing your serum levels do a 700-800ng/dl +/- deviation over the course of two (2) weeks ?!?! Hormone management is about balance and stability. I would suggest looking into another regimen that will help you sustain balance.
 

JKc94

New Member
I missed typed. The dosage is actually 125mg every 10 days. (Cypionate) Probably still a little low in your view. I agree the protocol needs to be revisited. Years ago, I started with 400mg every 3 weeks; that didn't work well either. My last test level was around 400-500 serum a couple of months ago, but I wasn't keeping up with the injection schedule as closely either. All these other symptoms have had me concerned.
 

JKc94

New Member
Take a look at some slow release elemental iron, you are probably needing 150mg to 200mg day. Divide it up, with meals, avoid coffee when taking, and make sure to take with ample amounts of vitamin C.

This is also having an impact on your thyroid, as T3 won't be productive with getting to the cells. It might take a few months to get back on the right track, but stay with it, and I would stop donating for the time being ...

Agree with Blackhawk, that protocol is dismal at best! Peak activity is around 3 days, half-life is around 7 days, making active life 14 days. Good chance you're seeing your serum levels do a 700-800ng/dl +/- deviation over the course of two (2) weeks ?!?! Hormone management is about balance and stability. I would suggest looking into another regimen that will help you sustain balance.

It is actually 125mg every 10 days (mistyped). Likely still too low, but with all I have had going on lately, I haven't been as motivated to keep up with schedule. Since the hematologist mentioned the possibility of polycthemia secondary to TRT, I also haven't wanted to take supplemental iron and cause my Hgb and Hct to get high. I know my ferritin has got to come up.

My last Thyroid panel on 11/27/17 was: T3 uptake 33 (22-35%), T4 total 6.9 (4.5-12 mcg/dl), Free T4 2.3 (1.4-3.8), TSH 1.35 (0.40-4.50 mIU/L)

Regarding the slow release elemental iron, you are suggesting that over the Integra iron prescribed by the neurologist? I think Integra is 125mg elemental iron with Vitamin C. I just want to be sure I understand your recommendation. Interestingly, I have thought that slow release (like Slow-FE) might be better tolerated anyway.

Thanks for the reply.
 

Vettester Chris

Super Moderator
The Integra iron might be fine, but I think you need to up it. My wife didn't have any real luck with that, but slow release worked better and was better tolerated as you indicated ...

On those thyroid labs ... Ughhh ... Toss that T3 Uptake right out the window. Is doesn't tell anyone anything, and doesn't measure anything with T3. Essentially, it's an outdated method to measure Free T4 via binding proteins. Take your Total T4 and multiply it by the T3 Uptake. Now, look at your FT4 serum result and look at the calculator ... You need Free T3, Reverse T3, antibodies (TPO & TgAb), and obviously FT4 & TSH are good to have in the mix.
 

madman

Super Moderator
Been on TRT for 5 years. (Age 48 years). Never had hemoglobin or hematocrit get outside of range, but would occasionally get close to upper limit at times. Started donating blood on an occasional basis (2-3 times per year) with no issues. Starting in January 2016, I thought I would be a good guy and start donating blood more frequently. Previously, a donation always made me feel good (physically) and I liked that I was doing something to help others. In 2016, I donated one pint of whole blood almost exactly every 56 days. I did have donation period that was 23 days between two separate donations. Not sure why I did that, except there was a local blood drive. I knew better, but did the donation anyway.

Sometime during the year 2016, I started feeling lethargic at times, occasionally weak, but not overly so. I dismissed the symptoms and kept going forward. My last blood donation in 2016 was 11/13/16. On January 12, 2017, blood work showed:

ferritin level < 10ng/ml (30-40ng/ml)
serum iron 28ug/dl (59-158ug/dl)
Rbc 5.2 (4.1-5.6)
Hgb 13.9 (12.5-17.0)
Hct 42% (36-50%)
Mcv, Mch, Mchc all in limits but right at the lowest point on scale
Rdw 16.6% (11.7-15)
Testosterone serum 606, Free 15.06

As a follow up, labs were repeated on 3/20/17:
ferritin 6ng/ml (20-380ng/ml)
serum iron 29mcg/dl (50-180mcg/dl)
Rbc 5.36 (4.2-5.8)
Hgb 14.4 g/dl (13.2-17.1)
Hct 44.3% (38.5-50.0)
Mcv 82.6 fl (80-100 fl)
Mch 26.9 pg (27.0-33)
mchc 32.5 g/dl (32-36)
Rdw 20.3% (11.0-15.0)

Then, donated 1 pint whole blood on 5/1/17 and then again on 6/26/17. (Before asking, why the donations, I don't know. The doctor mentioned the low iron only, but only said we would check it again next time. I mentioned giving blood, and doctor said it was likely from that.)

Sometime around July 2017, I started feeling very tired at times. I would often take naps during the day and sometimes couldn't get a good night's rest. Started having frequent headaches, and occasionally would become lightheaded but never fainted. Started having some occasional chest discomfort (not pain, but bothersome) and would also, at times, have some peripheral neuropathy in arms---just enough to be noticeable and annoying. I would be short of breath at times, too, especially excercising.

In August 2017, went to doctor to have an EKG to make sure issues weren't heart related. CBC was drawn and showed: Rbc 5.44 (4.10-5.80), Hgb 13.9 (12.5-17.1 g/dl), Hct 43.4 (36-50%), Mcv 79.8 (80.0-100 fl), Mch 25.6 (27-34 pg), Mchc 32.1 (32-36 g/dl), Rdw 16.8 (11-15%). The iron serum was 34 ug/dl (59-158), Ferritin < 10 ng/ml (30-400)

EKG was fine; echocardiogram was fine.

Had CBC redone on 11/27/17; Rbc 5.95 (4.20-5.80), Hgb 14.8 (13.2-17.1 g/dl), Hct 47.3 (38.5-50%), Mcv 79.5 (80-100 fl), Mch 24.9 (27-33 pg), Mchc 31.3 (32-36 g/dl), Rdw 18.3 (11-15%)

12/20/17 donated one pint whole blood.

CBC 1/11/18, Rbc 5.45, Hgb 14.8, Hct 45.6, Mcv 83.7, Mch, 27.2, 32.5, Rdw 17.0 (scale limits same as 11/27/17)

Around 1/11/18, started having tingling in left foot and occasional tingling in face. It was very light, but concerning. Felt cold a lot and sometimes fingers and hands would feel cool or like they might come numb, although they wouldn't. Doctor ordered a lot of other blood tests, but they were all fine. The doctor was uncertain what was going on and made a referral to neurologist. Before seeing the neuro, I visited another doctor who redrew iron panel, which showed on 2/7/18: D-TIBC 500 (250-450 ug/dl), TSAT 32 (15-50%), Iron Serum 158 (59-158 ug/dl), Ferritin 17 (30-400 ng/ml). I should point out that prior to the iron panel bloodwork, I had started taking an iron pill on a daily basis. I had developed restless leg syndrome issues and read that it could be from low iron. I had been taking the iron pill 2-3 weeks before the iron panel was drawn.

In late February, I had a cervical MRI and Lumbar MRI because of the tingling in the lower extremities and the facial parathesia. Both MRI were normal with exception of mild degenerative disc disease, which is normal for my age (48 years). The doctor referred to neurologist.

My blood pressure had been slightly elevated, which was unusual for me. The doctor suggested I might donate blood to see if that would help. Yes, I know. With all the low issues and CBC issues staring her in the face, she suggested a blood donation. So on 3/2/18, I donated a pint. Within 3 days, the tingling in my legs that I had been having got a lot worse. Muscle twitches were more frequent. Facial tingling was all day. Anxiety went way, way up. And, I became very concerned. I couldn't stay off the internet searching for answers. The anxiety got worse and worse; I couldn't sleep more than 2-3 hours each night; developed tinnitus in both ears and generally felt like I might have multiple sclerosis or ALS. I have never experience anything like this, but I can say the anxiety was real.

By the time I saw the neurologist, I was a nervous wreck. He reviewed by lab work and right away said the ferritin level was extremely low. I had no idea he would immediately hone in on that. He was emphatic my symptoms of Restless leg, parathesia, etc. were coming from that. The muscle twitches he diagnosed as benign fasculatations due to anxiety and possibly related to low ferritin as well. He put me on Integra iron capsules, one each day and sent me for a brain MRI just to be safe. Within a week, the brain MRI came back negative and the neurologist said you don't have MS or ALS. He said, let's get your ferritin up and you'll be fine. He said it could take 3-6 months. And yes, he knew I was on TRT; we discussed it briefly. He referred me to a hematologist as well just for a consult---not due to a new problem.

At this point, I felt a lot better. Anxiety came down and I felt like I was finally on the road to getting me. EXCEPT, when I go see the hematologist, he didn't seem to care much about the low ferritin and really didn't think I needed to be on iron pills. He never looked at my blood donation record or past blood work; he only want to see the most recent (February 2018). He said he is 95% sure I have polycythemia secondary to TRT. He said the swings in Hgb and Hct can cause unusual symptoms. He wants me to wait a month before having new blood work done to give more time since last blood donation and recommended stopping the iron pills. He also wants me to have an abdominal ultrasound to check the liver and spleen. He said he doesn't expect any issues but wants to be sure.

After all this, here is my thoughts and questions:

I think I have iron deficiency anemia due to low ferritin, low iron, increased Rdw, low Mcv, low Mch, etc, which is secondary to excessive blood donations The CBC issues seem to be classic for iron deficiency anemia. I think the only reason my Hgb and Hct have not tanked below normal is the TRT has kept the levels in the normal range. My TRT dose is now 125mg every 14 days.

I am continuing to take the Integra iron, but I have to take it every other day (or sometimes every 3 days) because it creates stomach issues. I'm not trying to discount the hematologist, but I have set up an appointment with a different hematologist because the one I saw was not a good listener. He didn't seem to care about my blood donation record or my symptoms.

I know this is a long post, but I welcome any comments or feedback.

Most that donate 2-3 times/year should not run into low ferritin/iron issues unless they have an iron deficient diet/absorption issues (due to many factors).

Frequent blood donations every 56 days will definitely cause issues regarding low iron/ferritin and if ones diet is lacking iron than supplementing is a must.

If you do not eat red meat/liver frequently than make sure to supplement.

You may have to avoid donations for a while until you can get your ferritin stores back up.

Iron bisglycinate is a form which tends not to cause stomach issues.
 

JKc94

New Member
The Integra iron might be fine, but I think you need to up it. My wife didn't have any real luck with that, but slow release worked better and was better tolerated as you indicated ...

On those thyroid labs ... Ughhh ... Toss that T3 Uptake right out the window. Is doesn't tell anyone anything, and doesn't measure anything with T3. Essentially, it's an outdated method to measure Free T4 via binding proteins. Take your Total T4 and multiply it by the T3 Uptake. Now, look at your FT4 serum result and look at the calculator ... You need Free T3, Reverse T3, antibodies (TPO & TgAb), and obviously FT4 & TSH are good to have in the mix.

Thanks for the reply. It sounds like we are in agreement that the hematologist may be missing the mark somewhat by not wanting me to take iron supplements. The labs clearly show iron deficiency. I think the neurologist is more spot on in his assessment. He was definitely a keep it simple guy. The hematologist on the other hand went off on a tangent with the polycythemia secondary to TRT. I'm not even sure how he came to that conclusion. Regardless, I will keep with the iron supplementation and see how the symptoms respond. Currently, muscle twitches with leg and facial tingling are the most bothersome.
 
Last edited:

madman

Super Moderator
Thanks for the reply. It sounds like we are in agreement that the hematologist may be missing the mark somewhat by not wanting me to take iron supplements. The labs clearly show iron deficiency. I think the neurologist is more spot on in his assessment. He was definitely a keep it simple guy. The hematologist on the other hand went off on a tangent with the polycythemia secondary to TRT. I'm not even sure how he came to that conclusion. Regardless, I will keep with the iron supplementation and see how the symptoms respond. Currently, muscle twitches with leg and facial tingling are the most bothersome.


Seeing as your ferritin is already very low it may be difficult to get it back up with supplementation alone.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5155066/
 

JKc94

New Member
Seeing as your ferritin is already very low it may be difficult to get it back up with supplementation alone.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5155066/

My hope, when I made the appointment with the hematologist, was that he would recommend IV iron. I took the Integra iron on an empty stomach for the first week and it was quite harsh with indigestion. I have GERD already. I’ve been tolerating it better with food, but I know that impacts absorption.

For the time being, I’m stuck with oral iron. But, I am considering a consult with a different hematologist. A new doc may tell me the same thing—-who knows.
 

madman

Super Moderator
My hope, when I made the appointment with the hematologist, was that he would recommend IV iron. I took the Integra iron on an empty stomach for the first week and it was quite harsh with indigestion. I have GERD already. I've been tolerating it better with food, but I know that impacts absorption.

For the time being, I'm stuck with oral iron. But, I am considering a consult with a different hematologist. A new doc may tell me the same thing—-who knows.


Heme iron polypeptide supplement better absorption, minimal chance of negative gastrointestinal issues..expensive though.

https://www.proferrin.com/
 
YOu mention GERD...how much gut issues do you have with gas/bloating/reflux/indigestion? Any of those can affect absorption of nutrients, like Iron. The only way I got my Ferritin up was with Ferrets 325mg once per day, I added 2g of Vitamin C and some added Lysine probably 1g or more. My Ferritin responded that way where it had not with previously supplement strategies.

If you have any of those gut issues I can recommend something.

https://www.amazon.com/Pharmics-Fer...F8&qid=1523213776&sr=1-2&keywords=ferrets+325
 

JKc94

New Member
YOu mention GERD...how much gut issues do you have with gas/bloating/reflux/indigestion? Any of those can affect absorption of nutrients, like Iron. The only way I got my Ferritin up was with Ferrets 325mg once per day, I added 2g of Vitamin C and some added Lysine probably 1g or more. My Ferritin responded that way where it had not with previously supplement strategies.

If you have any of those gut issues I can recommend something.

https://www.amazon.com/Pharmics-Fer...F8&qid=1523213776&sr=1-2&keywords=ferrets+325

Thanks for the recommendation. Is it similar to Slow Fe? I have seen it in local pharmacies, but I'm not sure if its composition. I believe the Integra that I was prescribed is 125mg elemental iron with Vitamin C and Lysine. As has been mentioned here though, that may not be enough iron for me. My primary issue with the integra is substernal indigestion; it's quite a bit. I do get bad, especially if I over indulge. Gas and bloating at times, too.
 

Blackhawk

Member
I'll check it out. Should I be concerned at all about this, "polycythemia secondary to TRT" concern of the hematologist or focus primarily on getting ferritin levels back up?

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.
 
Thanks for the recommendation. Is it similar to Slow Fe? I have seen it in local pharmacies, but I'm not sure if its composition. I believe the Integra that I was prescribed is 125mg elemental iron with Vitamin C and Lysine. As has been mentioned here though, that may not be enough iron for me. My primary issue with the integra is substernal indigestion; it's quite a bit. I do get bad, especially if I over indulge. Gas and bloating at times, too.

OK think about this with reflux.heartburn/GERD....its low stomach acid, contrary to the logic of heartburn being too much acid, it's really LOW acid problem. With this the food wont digest and refluxes upward with the complimentary gas and bloating. I use a supplement called Betaine-HCL which has really helped me with stomach acid. But as I said thru these gut issues you can have malabsorption of nutrients and minerals like Iron. The Ferrets and added Lysine were the only combo that worked for me.
 

Saul

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.
 

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.

Thanks for the info. I think I need a new hematologist.
 

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.

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?
 
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