Can't get it up... Ferritin that is. Blood issues after 5 years. HCG related question. Labs attached.

[Westin]

I have been on TC for over 5 years with varying results, mostly positive until the last year. I have had to do a few blood donations within the last 3 years due to rising HCT. It dropped my ferritin levels to 10, range 30 - 400.

I can't get my ferritin levels up. My Mayo PCP said that if I take iron supplements it will raise HCT and put me back in a position where the levels are too high.

I'm wondering a few things:
1. Could low ferritin result in low libido or the TC not being as effective?

I know anytime a level is off in a post some forum users jump/point directly to a low or high result, even when it may not apply. I know that TC can inhibit hepcidin, which I'm told is needed to build ferritin reserves.

2. I'm considering going off TC for a few months due to some foot fusion surgery coming up in 45 days. I'm concerned about the iron and ferritin levels being a little low.

I have started HCG 500iu X 3 times weekly to try to get some testicular activity started so hopefully going off TC won't be so dramatic of a change. Does HCG inhibit hepcidin or ferritin also? If so than the ferritin probably won't come back up. Can anyone with knowledge pipe up on this please?

Labs attached. I know the free T is a tad low. I was adjusting dosage when these labs were drawn.

 

[Systemlord]

I can't get my ferritin levels up. My Mayo PCP said that if I take iron supplements it will raise HCT and put me back in a position where the levels are too high.

The guidelines for TRT and HCT is <54%, at which point the dosage is reduced and or a donation is recommended periodically.

The lab ranges, depending on the lab company can be 49%, 50%, 51%, and 52%. If you're at 51% and the lab ranges are 50%, go to a different lab company where the cutoff is 52% and now you're in range.

What HCT level is your doctor saying is too high?

I'm wondering a few things:
1. Could low ferritin result in low libido or the TC not being as effective?

Yes, I have personal experience with iron deficiency on TRT. There are all sorts of metabolic abnormalities with iron deficiency.

TRT doesn't feel like it's working at all when my ferritin is low, in fact I need it at a minimum of 80 to feel good consistently.

 

[Westin]

My PCP is not concerned about HCT currently. He was saying due to previous blood donations the levels are low currently, and to avoid iron supplements because it will raise HCT quickly but not ferritin. He doesn't want me back to needing to donate so suggested avoiding supplements.

 

[Systemlord]

For those who have problems with secondary erythrocytosis or high HCT, the newer oral testosterone undecanoate, Jatenzo, Orlando, Kyzatrex are recommended and do not cause secondary erythrocytosis in any of the clinical trials.

I'm surprised your Mayo PCP doctor didn't recommend any of these oral T options.

If you're on TRT, and you can't maintain normal ferritin, it’s because TRT increases EPO which increased erythroferrone, lowering hepcidin and ferroportin lets iron release from hepatocytes and therefore ferritin doesn't rise.

So if this is the case for you, if you don't supplement iron, ferritin will not rise!

A lot of doctors talk like they know what they're talking about when it comes to TRT, but trust me, the majority of them are mostly clueless!

Your Mayo PCP is dropping the ball! Fire him!

I know the free T is a tad low.

Many experts are now saying the bottom 25 percentile is a sign of hypogonadism. The normal ranges have nothing to do with quality of life.

So you're not just a little bit low, you are low.

Does HCG inhibit hepcidin or ferritin also?

Anything that increases testosterone, uses up iron, affects ferritin and increases hematocrit.

 

[Westin]

Systemloard- Thanks for the suggestions.

GoodRX prices monthly: Orlando $43,373, Jatenzo $1,010, Kyzatrex -This is a limited distribution drug and is generally not available at a pharmacy.

Pricing prohibits this option.

 

[Nelson Vergel]

I have had to do a few blood donations within the last 3 years due to rising HCT. It dropped my ferritin levels to 10, range 30 - 400.

How frequently did you donate blood? How high was your hematocrit before donating? Do you have sleep apnea or smoke? What's you TRT dose and frequency?

I can't get my ferritin levels up. My Mayo PCP said that if I take iron supplements it will raise HCT and put me back in a position where the levels are too high.

Don't get off your TRT before surgery. You will need it to heal and to cope. Try a protocol like this:

Raising ferritin FAST (a how-to, not a question)

Hi all, I started TRT in 2001 and have been giving blood over the years and have always had issues with recovering my ferritin. Long story short, I got tired of waiting for others to do the research, so I did it myself, created a protocol, hired a hematologist in May 2021 who thought it could...

www.excelmale.com

I'm wondering a few things:
1. Could low ferritin result in low libido or the TC not being as effective?

Low ferritin or iron= Low stamina- low libido etc

I know anytime a level is off in a post some forum users jump/point directly to a low or high result, even when it may not apply. I know that TC can inhibit hepcidin, which I'm told is needed to build ferritin reserves.

2. I'm considering going off TC for a few months due to some foot fusion surgery coming up in 45 days. I'm concerned about the iron and ferritin levels being a little low.

I would not

I have started HCG 500iu X 3 times weekly to try to get some testicular activity started so hopefully going off TC won't be so dramatic of a change. Does HCG inhibit hepcidin or ferritin also? If so than the ferritin probably won't come back up.

hCG has exactly the same effect as testosterone on ferritin/hematocrit

Can anyone with knowledge pipe up on this please?

 

[Westin]

How frequently did you donate blood? How high was your hematocrit before donating? Do you have sleep apnea or smoke? What's you TRT dose and frequency?

>> About a year ago I had HCT of 50.5 and donated. A few months later it was at 50 and I donated again. Now I realize I had the draws when dehydrated and probably did not need the 2nd donation.

My doc is understanding of why I donated and is saying the iron levels are better lower than higher if I'm on TC. He says supplements will put me back to high HCT. I do not expect him/Mayo to have expertise in dialing in. I'm actually surprised he was willing to write the TC script to begin with. I pushed him for over a year.

I do smoke, quitting for the upcoming surgery today.

Current dose 50mg X 2 weekly, and just added 500iu HCG twice a week. Prior to the raise to 50, I was on 40mg twice weekly for 3 months and free T came back low. Before the 40mg, I was on 60mg twice weekly plus 375iu HCG 3 times weekly and felt great but saw the HCT going up and dropped to the 40mg.

Don't get off your TRT before surgery. You will need it to heal and to cope. Try a protocol like this:

Raising ferritin FAST (a how-to, not a question)

Hi all, I started TRT in 2001 and have been giving blood over the years and have always had issues with recovering my ferritin. Long story short, I got tired of waiting for others to do the research, so I did it myself, created a protocol, hired a hematologist in May 2021 who thought it could...

www.excelmale.com

Low ferritin or iron= Low stamina- low libido etc

I would not

hCG has exactly the same effect as testosterone on ferritin/hematocrit

I would prefer to stay on the TRT and just get the iron and ferritin up a little if I could.

I very much appreciate the responses. This has really been stressing me out.

 

[Nelson Vergel]

I would stay as is and would not donate until my hematocrit is 53 and never more frequently than every 2.5 months. I would also make sure I have no sleep apnea.

Your ferritin will probably stabilize around 50 to 100. TRT decreases ferritin even without blood donations.

 

[Westin]

I would stay as is and would not donate until my hematocrit is 53 and never more frequently than every 2.5 months. I would also make sure I have no sleep apnea.

Your ferritin will probably stabilize around 50 to 100. TRT decreases ferritin even without blood donations.

I will stay as is.

Any additional thoughts regarding that “Raising ferritin fast” protocol noted above? Has this been successful with anyone else here in the forum currently?

I do not have sleep apnea, I tested 2 years ago.

 

[Systemlord]

>> About a year ago I had HCT of 50.5 and donated.

That's not high HCT my friend. Your PCP has caused all of your problems and it's all for nothing!

There are people living at high altitude with HCT at 52% and no one is telling them to control their HCT.

 

[Westin]

He didn't tell me to donate. I did it because I thought if he saw me over the range limit, I doubt he'd renew my script. I jumped the gun. And I wasn't fully hydrated at the previous blood draw I now realize.

 

[Systemlord]

He didn't tell me to donate. I did it because I thought if he saw me over the range limit, I doubt he'd renew my script. I jumped the gun. And I wasn't fully hydrated at the previous blood draw I now realize.

Your mistake is you're trying to be your own doctor without any knowledge of what constitutes normal or in this case optimal hematocrit.

If you want the facts, with a secondary erythrocytosis there is an increase in blood volume which enlarges the vascular bed, decreases peripheral resistance and increases cardiac output. Therefore, in a secondary erythrocytosis optimal oxygen transport with increased blood volume occurs at a higher hematocrit value than with a normal blood volume. A moderate increase in hematocrit may be beneficial despite the increased viscosity.

There are over 80 million people that live higher than 2,500 meters and they develop a secondary erythrocytosis. Men in parts of Bolivia for instance have a normal range of HCT from 45-61%. These men are not at an increased risk of thrombotic events nor do they have to undergo phlebotomies to manage their hematocrit.

 

[Big_Alan]

Any additional thoughts regarding that “Raising ferritin fast” protocol noted above? Has this been successful with anyone else here in the forum currently?

I tried it, it didn't work for me..I did it for 10 days and got rise of 2 (from like 7 to 9), and raised my RBCs and HCT. I read and prepped for a week, rereading the protocol and articles 20 times to make sure I followed every known factor. I must have taken a supplement that caused the iron to absorb systemically....I do take a number kf supplements that weren't addressed in the protocol and a dozen meds.

I'm not knocking it, but I recommend trying it for a few days and getting and iron panel before you go too long on it.

 

[madman]

Systemloard- Thanks for the suggestions.

GoodRX prices monthly: Orlando $43,373, Jatenzo $1,010, Kyzatrex -This is a limited distribution drug and is generally not available at a pharmacy.

Pricing prohibits this option.

The insurance hurdle can easily be overcome as one can skip the hassle and pay out-of-pocket for any of the oral TU (Jatenzo, Tlando and Kyzatrex) formulations.

If you are one who struggles with negative symptoms due to elevated hematocrit or are concerned about running high-end levels 52-54% let alone getting caught up on trying to manage it and fall prey into the donating too frequently merry go round fan club which can easily crash your iron/ferritin then oral TU would be your best bet.

Otherwise you better plan on lowering your overall weekly T dose/manipulating your injection frequency and bringing down your trough FT level which for most would be high/very high/absurdly high!

The majority of men struggling with elevated hematocrit is due to running too high a trough FT let alone steady state!




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[madman]

I have been on TC for over 5 years with varying results, mostly positive until the last year. I have had to do a few blood donations within the last 3 years due to rising HCT. It dropped my ferritin levels to 10, range 30 - 400.

I can't get my ferritin levels up. My Mayo PCP said that if I take iron supplements it will raise HCT and put me back in a position where the levels are too high.

I'm wondering a few things:
1. Could low ferritin result in low libido or the TC not being as effective?

I know anytime a level is off in a post some forum users jump/point directly to a low or high result, even when it may not apply. I know that TC can inhibit hepcidin, which I'm told is needed to build ferritin reserves.

2. I'm considering going off TC for a few months due to some foot fusion surgery coming up in 45 days. I'm concerned about the iron and ferritin levels being a little low.

I have started HCG 500iu X 3 times weekly to try to get some testicular activity started so hopefully going off TC won't be so dramatic of a change. Does HCG inhibit hepcidin or ferritin also? If so than the ferritin probably won't come back up. Can anyone with knowledge pipe up on this please?

Labs attached. I know the free T is a tad low. I was adjusting dosage when these labs were drawn.

As has been stated numerous times on the forum the cut-off for hematocrit is 54%.

Most doctors in the know would recommend donating or reducing your weekly T-dose and bringing down your trough FT once you hit 54%.

Some will be more cautious and take measures once hematocrit hits 52%.

If you have no underlying cardiovascular/health issues are not experiencing any negative symptoms from a slightly elevated hematocrit then I would not be too concerned.

Downfall here is if you are donating way too frequently to try and manage elevated hematocrit it is pretty much a given you will end up crashing your iron/ferritin which can open up another can of worms.

Your ferritin is horribly low and needs to be addressed!

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