Ferritin Declining While on TRT

[infuriatedrain]

Hey everyone - I have a question hopefully someone can help me out with. I have spent a few hours searching online but wasn't able to find much that really matches with my situation and/or what the best course of action is.

My issue is that my Ferritin has drastically reduced since starting TRT while my RBC, HGB, and HCT have slightly increased (I will include my labs in this post). My Free and Total Test numbers are perfect, in my opinion, so I'm content with those. I can include those if it can help with my question.

I started on TRT in August of this year, 2017. My pre-TRT CBC labs on August 16, 2017 were:
RBC 5.2 (4.2-5.8)
Hgb 15.3 (13.2-17.1)
Hct 47% (38-50)
Ferritin 118 (20-345)

We started me off at 150mg Test Cypionate once per week, 500 iU of HCG once per week, and 1mg of anastrazole once per week. I didn't agree with doing it once a week, but that's just how they do it at the clinic. I had to suck it up for 6 weeks until I could get on the "long distance" program and I could do it how I wanted at home.

We checked my progress 6 weeks later on September 9, 2017. My follow up CBC labs were:
RBC 5.36
Hgb 15.9
Hct 47.5%
Ferritin 81

RBC, Hgb, Hct went up sightly while Ferritin decreased a good amount.

At this point, I was able to start injecting myself at home. Since then, I have been injecting myself on a MWF schedule, doing 60mg each injection for 180mg per week. I have been injecting myself with HCG doing 400 iU on a Tues Thursday schedule for 800 iU per week. And I have been doing 0.25mg of anastrazole on the days of my Test injections on MWF for 0.75mg per week.

We just recently checked my labs to see how things were. The CBC labs on October 25, 2017 were:
RBC 5.51
Hgb 16.3
Hct 47.5%
Ferritin 28

Again, RBC and Hgb went up slightly, Hct stayed the same, and Ferritin decreased quite a bit again.

Is this normal? Do a lot of you guys experience this? I've read that TRT can lower Ferritin levels, but I wasn't sure if it was normal for my RBC, Hgb, and Hct levels to be normal while Ferritin is low. I feel that I eat plenty of iron rich foods (I'm basically on a Paleo Diet) so I eat a lot of meat, I take around 5g of Vitamin C a day (I've read Vit C helps with Iron absorption).

I expressed my concerns to my doctor, so he wrote me a script of 325mg Ferrous Sulfate once per day. I'm just concerned that my Hct levels will go over 50%.

Sorry for the book - let me know if I need to include any other details. Thanks in advance!!

Testosterone Replacement Therapy (TRT) Decreases Ferritin

Testosterone replacement can cause a decrease in ferritin in men even without the presence or use of blood donations or therapeutic phlebotomies. A study gave men testosterone enanthate at a dose of 125 mg per week (it also used T enanthate with or without finasteride to see the effect of...

www.excelmale.com

 

[johndoesmith]

Did you donate blood?

Another thing is that ferritin is an acute phase reactant, so by reducing inflammation you can potentially reduce ferritin levels on an assay. TRT is known to reduce inflammation.

 

[infuriatedrain]

Have not donated blood.

 

[johndoesmith]

Have not donated blood.

Wow that was ridiculously fast. I'd go with the inflammation then.

 

[infuriatedrain]

Can you tell me what you mean by that? Are you saying it was that high before because of inflammation?

I will say that, in the past, I had an ANA ran that came back positive, indicating the possibility of me having an autoimmune disorder - if that could somehow be related.

 

[johndoesmith]

Can you tell me what you mean by that? Are you saying it was that high before because of inflammation?

I will say that, in the past, I had an ANA ran that came back positive, indicating the possibility of me having an autoimmune disorder - if that could somehow be related.

That's what I'm thinking.

Definitely get that checked out. The ANA that is you should definitely have that evaluated.

 

[infuriatedrain]

I actually went to a rheumatologist last year about it but, because I'm not having specific symptoms to any one disease, he said there's not much to be done for now.

I'm thinking of seeing a Hematologist about all tbis.

 

[CoastWatcher]

That's what I'm thinking.

Definitely get that checked out. The ANA that is you should definitely have that evaluated.

I'd also have your CRP measured. Welcome to the winding-road that may lead to rheumatologically-focused discussions.

 

[infuriatedrain]

Yeah after reading into this more, I was thinking that would be a good idea, as well.

I'm going to ask to have my Ferritin, Iron, and CRP done. Any other suggestions?

 

[Saul]

I don't have any answers. Sorry. You are in a pickle though. If you give blood to drop the HCT your ferritin is going to crash even further. But if you don't, your HCT is going to be high. Your ferritin are your iron stores in your body (organs) and the up side is that even though very low, your RBC count is good and your other blood iron levels are in range. It is like your body is not absorbing or storing the iron your are consuming. Your Dr is not too concerned because you are only 1 pt off the low level range.

My only input is to drastically cut back on the T injections. As far as I can tell you are at 180 mg per week, which IMO is very high and your T levels are over the limit. Your peaks are even higher. Why such a large dose when you are having issues with ferritin, HCT and T levels?

 

[infuriatedrain]

Sorry I forgot to mention that I am now doing daily injections at 26mg per day. Apparently I require quite a bit less when doing daily injections.

When I was doing the MWF schedule, my HCT never went over 48%

 

[Vince Carter]

My ferritin is subterranean and won't move but I donate blood, too. I'm currently using Ferrets high potency iron @ I think 106mg twice per day, with 1g of Vitamin C. Previously with Vitron-C @ 62mg wasnt' doing anything for me.

 

[infuriatedrain]

I was trying to edit my last post and it got deleted for some reason....

So just following up on this as I just got another set of labs done last week.

Ferritin - 19 (20-345)
Total Iron - 64 (50-180)
Iron Binding Capacity - 352 (250-425)
Iron Saturation % - 18% (15-60)

Rbc - 5.89 (4.2-5.8)
Hgb - 16.9
HCT - 50.4%

Total test - 1262 ng/dL
Free test - 300.4 pg/mL

Now this is with me having been on 325 mg ferrous sulfate for a month. I am at a complete loss as to what to do. My docs aren't much help other than telling me to continue with the ferrous sulfate. Couldn't this risk my HCT going higher? I'm already planning on decreasing my testosterone injections since my HCT is creeping up.

It is also important to note that I have switched from doing MWF injections to daily injections where I administer 26mg per day as well as injections 120 iU of HCG per day. I have been doing this for 5 weeks now.

Any and all advice would be greatly appreciated. Thanks!

 

[Nelson Vergel]

Hey everyone - I have a question hopefully someone can help me out with. I have spent a few hours searching online but wasn't able to find much that really matches with my situation and/or what the best course of action is.

My issue is that my Ferritin has drastically reduced since starting TRT while my RBC, HGB, and HCT have slightly increased (I will include my labs in this post). My Free and Total Test numbers are perfect, in my opinion, so I'm content with those. I can include those if it can help with my question.

I started on TRT in August of this year, 2017. My pre-TRT CBC labs on August 16, 2017 were:
RBC 5.2 (4.2-5.8)
Hgb 15.3 (13.2-17.1)
Hct 47% (38-50)
Ferritin 118 (20-345)

We started me off at 150mg Test Cypionate once per week, 500 iU of HCG once per week, and 1mg of anastrazole once per week. I didn't agree with doing it once a week, but that's just how they do it at the clinic. I had to suck it up for 6 weeks until I could get on the "long distance" program and I could do it how I wanted at home.

We checked my progress 6 weeks later on September 9, 2017. My follow up CBC labs were:
RBC 5.36
Hgb 15.9
Hct 47.5%
Ferritin 81

RBC, Hgb, Hct went up sightly while Ferritin decreased a good amount.

At this point, I was able to start injecting myself at home. Since then, I have been injecting myself on a MWF schedule, doing 60mg each injection for 180mg per week. I have been injecting myself with HCG doing 400 iU on a Tues Thursday schedule for 800 iU per week. And I have been doing 0.25mg of anastrazole on the days of my Test injections on MWF for 0.75mg per week.

We just recently checked my labs to see how things were. The CBC labs on October 25, 2017 were:
RBC 5.51
Hgb 16.3
Hct 47.5%
Ferritin 28

Again, RBC and Hgb went up slightly, Hct stayed the same, and Ferritin decreased quite a bit again.

Is this normal? Do a lot of you guys experience this? I've read that TRT can lower Ferritin levels, but I wasn't sure if it was normal for my RBC, Hgb, and Hct levels to be normal while Ferritin is low. I feel that I eat plenty of iron rich foods (I'm basically on a Paleo Diet) so I eat a lot of meat, I take around 5g of Vitamin C a day (I've read Vit C helps with Iron absorption).

I expressed my concerns to my doctor, so he wrote me a script of 325mg Ferrous Sulfate once per day. I'm just concerned that my Hct levels will go over 50%.

Sorry for the book - let me know if I need to include any other details. Thanks in advance!!

This is strange. Can you post your entire CBC so that I can see your red blood cell values:

• Mean corpuscular volume (MCV)
• Mean corpuscular hemoglobin (MCH)
• Mean corpuscular hemoglobin concentration (MCHC)
• Red cell distribution width (RDW)

 

[infuriatedrain]

Nelson-

 

[Saul]

Sorry I forgot to mention that I am now doing daily injections at 26mg per day. Apparently I require quite a bit less when doing daily injections.

When I was doing the MWF schedule, my HCT never went over 48%

Still over 180 per week. Why so high if your having issues?

 

[infuriatedrain]

I will be decreasing to 20 per day in light of these new labs. I never had issues before.

 

[Nelson Vergel]

I contacted a PhD hematologist from Baylor and this is what he said:

"Hi Nelson-
Thanks for the question. I read through the thread. I will preface what I say by the following, though: the iron-testosterone link is hypothetical and until demonstrated other causes of anemia should be evaluated. That being said, here are some thoughts.

1. As one of the posters mentioned, ferritin is also an acute phase reactant, so if testosterone is decreasing inflammation then the ferritin may decline irrespective of body iron stores. (I don't fully believe the data regarding this, though).
2. Testosterone has been shown to decrease hepcidin, resulting in increased ferroportin expression. While this functions to increase iron absorption from the diet, it also results in release of iron from ferroportin expressing cells… namely hepatocytes and macrophages. Ferritin is a marker of tissue iron levels, so the decrease ferritin may just be demonstrating a reduction in liver iron concentrations. If the subject is increasing muscle bulk, the excess serum iron may be used by muscle to make myoglobin. Otherwise, it may be increasing serum iron levels or getting deposited in other, non-ferroportin tissues (similar to hemochromatosis). His lack of anemia would suggest that he has adequate iron stores for erythropoiesis.

Again, this is all hypothetical at this point. While it makes sense to me, it shouldn't be used to guide treatment."

 

[Saul]

That is interesting. Great Input.

I am/was at the opposite end of the spectrum. I have HH and had high ferritin levels and my iron saturation was 92%. I was donating often and tracking ferritin levels closely. I am also on TRT. I was told by my Dr. (hematologist) that my ferritin level would drop 50 per blood donation. My reading suggested about a 30 point drop per blood donation. My ferritin has dropped much faster once I upped my TRT dose from 100 mg every two weeks to about 85 mg per week. It would drop about 100 pts per the last couple blood donations. My last ferritin test has me back in range, well below 100. Perhaps the my TRT increased the ferritin drop beyond what would be expected for my blood donations. Just another data point. In any event, it has worked well for me since I am now in range.

 

[infuriatedrain]

Nelson,

I GREATLY appreciate you looking into this matter for me. This has shed more insight on the matter far more than the last 3 doctors I have been to have.

Were it not for me having persistent fatigue and headaches, I wouldn't even worry about it. However, I just don't feel nearly as well as I think I should at this point so it certainly concerns me a bit (unfortunately I'm a hypochondriac by nature).

I will say that I have packed on quite a bit of muscle over the last several months so perhaps that is a large cause, as he stated.

That being said... the big question now is: I wonder if I should continue supplementing with the 325mg Ferrous Sulfate or discontinue....

I contacted a PhD hematologist from Baylor and this is what he said:

"Hi Nelson-
Thanks for the question. I read through the thread. I will preface what I say by the following, though: the iron-testosterone link is hypothetical and until demonstrated other causes of anemia should be evaluated. That being said, here are some thoughts.

1. As one of the posters mentioned, ferritin is also an acute phase reactant, so if testosterone is decreasing inflammation then the ferritin may decline irrespective of body iron stores. (I don’t fully believe the data regarding this, though).
2. Testosterone has been shown to decrease hepcidin, resulting in increased ferroportin expression. While this functions to increase iron absorption from the diet, it also results in release of iron from ferroportin expressing cells… namely hepatocytes and macrophages. Ferritin is a marker of tissue iron levels, so the decrease ferritin may just be demonstrating a reduction in liver iron concentrations. If the subject is increasing muscle bulk, the excess serum iron may be used by muscle to make myoglobin. Otherwise, it may be increasing serum iron levels or getting deposited in other, non-ferroportin tissues (similar to hemochromatosis). His lack of anemia would suggest that he has adequate iron stores for erythropoiesis.

Again, this is all hypothetical at this point. While it makes sense to me, it shouldn’t be used to guide treatment."