Low ferritin but high iron levels??

[JetSpyder]

I've been on TRT for 10 years now with many ups and downs. Over the past year I've been reducing my dose to as low as possible to curb anxiety, heart palpitations and libido/sexual dysfunction issues. Trying to get on the "less is better" train. I'm currently taking 77 mg weekly test cyp with injections EOD. Doesn't seem to matter because my estradiol always comes back elevated.

I read a lot on the forums, but a lot of this shit just confuses the hell out of me. I'm one of the unlucky who cannot use HcG. I've tried MULTIPLE times and all it does is fuck me up and make me feel like absolute shit. So 2 things I'm trying to get a handle on:

I see all the talk about hematocrit levels and 54% being the number when I should start to care. However, recently when I really feel heart issues and anxiety and I get my blood work, my hematocrit is around 50 - 53%. But at the same time my estradiol levels are always elevated as well so I'm not sure what is causing my issues. When I talk to my endo (who knows NOTHING about TRT) he tells me that my hematocrit levels wouldn't cause these problems and to go donate blood. I do donate blood but not very often. On average 2-3 times per year.

1. How does anyone else get a handle on lowering their estrogen levels while being on such a low dose and not taking HcG? They aren't super high on the ultra-sensitive test but they always come back elevated. Also my DHT has been high for the past 2 tests.

2. I've been reading about ferritin levels recently, so I had them add it to my labs. My ferritin levels came back super low but my iron levels and saturation came back really high. TIBC is within range. This is the first time they've ever been checked in 10 years so I have nothing to compare them with. I thought if my ferritin came back low that my iron levels would also?? Does this mean I'm iron deficient?

Appreciate any thoughts or advice since I can't get any logical advice from my Endo or any of them where I live. I posted some of my labs. At my appt my endo said everything looks fine, just don't donate blood for a little while.

Thanks

 

[Systemlord]

I see all the talk about hematocrit levels and 54% being the number when I should start to care. However, recently when I really feel heart issues and anxiety and I get my blood work, my hematocrit is around 50 - 53%.

My hematocrit is 55% on Jatenzo, I'm one of the small percentage of men that get erythrocytosis on the newer oral testosterone. I have found that the higher hematocrit and hemoglobin aren't the cause of my ED, low libido and palpitations, it's the iron levels causing these symptoms.

Your iron is high, that's it! I recently discovered I had been using large doses of iron to treat hypotension, symptoms very similar to iron deficiency which I experienced more than once in my lifetime.

Whenever I'd lower my iron dosage, I unknowingly was experiencing hypotension that I mistook for iron deficiency. You see excess iron increases blood pressure, and for someone experiencing low blood pressure, the iron treats the hypotension and for years I always suspected I was using iron to treat an unknown medical condition and recently stopped my beta-blocker and hypotension cured.

So my ferritin and iron are on lower end of the ranges and my hematocrit and hemoglobin are unchanged, still elevated yet the symptoms (irritability, heart palpitations, libido/sexual dysfunction) are starting to go away.

High iron essentially means high transferrin, so your body because of very low iron previously is shuttling iron around as fast as it can to make up for lost time. This will keep the ferritin low while iron (transferrin) is rising.

You should check for iron overload or hemochromatosis and check for the C282Y genes. If you have it, you have your reason for needing TRT because hemochromatosis causes low-T.

 

[Seagal]

I've been on TRT for 10 years now with many ups and downs. Over the past year I've been reducing my dose to as low as possible to curb anxiety, heart palpitations and libido/sexual dysfunction issues. Trying to get on the "less is better" train. I'm currently taking 77 mg weekly test cyp with injections EOD. Doesn't seem to matter because my estradiol always comes back elevated.

I read a lot on the forums, but a lot of this shit just confuses the hell out of me. I'm one of the unlucky who cannot use HcG. I've tried MULTIPLE times and all it does is fuck me up and make me feel like absolute shit. So 2 things I'm trying to get a handle on:

I see all the talk about hematocrit levels and 54% being the number when I should start to care. However, recently when I really feel heart issues and anxiety and I get my blood work, my hematocrit is around 50 - 53%. But at the same time my estradiol levels are always elevated as well so I'm not sure what is causing my issues. When I talk to my endo (who knows NOTHING about TRT) he tells me that my hematocrit levels wouldn't cause these problems and to go donate blood. I do donate blood but not very often. On average 2-3 times per year.

1. How does anyone else get a handle on lowering their estrogen levels while being on such a low dose and not taking HcG? They aren't super high on the ultra-sensitive test but they always come back elevated. Also my DHT has been high for the past 2 tests.

2. I've been reading about ferritin levels recently, so I had them add it to my labs. My ferritin levels came back super low but my iron levels and saturation came back really high. TIBC is within range. This is the first time they've ever been checked in 10 years so I have nothing to compare them with. I thought if my ferritin came back low that my iron levels would also?? Does this mean I'm iron deficient?

Appreciate any thoughts or advice since I can't get any logical advice from my Endo or any of them where I live. I posted some of my labs. At my appt my endo said everything looks fine, just don't donate blood for a little while.

Thanks

Your SHBG is low. Your E2 is normal, the free E2 is higher but so is your DHT.
I would stop donating blood for one year and check what impact that has on your ferritin and iron.
However, we don't know anything about your health and the medicines and supplements you possibly take...

 

[t_spacemonkey]

there is definitely a point where e2 will cause mood issues, for me personally, while not sure exactly where, it is much much higher then 60pg/ml. currently I do run 50. your T is on the low side, which I assume is what you expect. I would highly suspect your anxiety is not T related. there is a bit of confusion on the ferritin side, my general doc claimed low ferritin will not cause any issues if rbc/hematocrit are ok. what I would do, with current symptoms. i too have suffered a lot of anxiety, but have it fully under control now.
a) try supplementing 100mg pregnenolone+200-400mg magnesium/day
b) try the how to raise ferritin fast protocol found on this forum
c) consider switching to Tprop ED - for me personally this resolved many anxiety issues. and I am on a high dose up to 30mg/day. on Tcyp anything above 150mg/week i felt like shit, but below 120mg i felt like shit too. your T dose might be too low as well

 

[JetSpyder]

Your SHBG is low. Your E2 is normal, the free E2 is higher but so is your DHT.
I would stop donating blood for one year and check what impact that has on your ferritin and iron.
However, we don't know anything about your health and the medicines and supplements you possibly take...

My SHBG has always been low. Even when I was taking 200mg/wk. Always floats around the 20 mark. Thanks for the advice and I agree about not donating for at least a year. As for my other health. I am pretty healthy and don’t take a lot of supplements. I have some joint issues from sports so I currently take:
Fish Oil - Omega 3s
Glucosamine+Chondroitin
Magnesium (glycinate)
B-12 injections

I eat a pretty clean diet consisting mostly of fish and chicken. On occasion I have red meat but only a few times per month. I don’t smoke and have a few beers a week. Workout and play sports 4-5 days per week and I am in good shape.

How do I get my iron levels back down?

 

[Seagal]

My SHBG has always been low. Even when I was taking 200mg/wk. Always floats around the 20 mark. Thanks for the advice and I agree about not donating for at least a year. As for my other health. I am pretty healthy and don’t take a lot of supplements. I have some joint issues from sports so I currently take:
Fish Oil - Omega 3s
Glucosamine+Chondroitin
Magnesium (glycinate)
B-12 injections

I eat a pretty clean diet consisting mostly of fish and chicken. On occasion I have red meat but only a few times per month. I don’t smoke and have a few beers a week. Workout and play sports 4-5 days per week and I am in good shape.

How do I get my iron levels back down?

Your health and diet sounds very good. I don't know about the iron ferritin dynamics, whether you absorb more iron in order to refill ferritin or if the high iron is a sign of some abnormality. Since your endo looked over your lab results, I would assume it's normal!

Regarding your doubts about elevated E2: my pragmatic suggestion is to just try an AI, low dose, e.g. get 0.1 or 0.05mg compounded anastrozol, and try 0.05mg twice per week etc. Just observe how you feel. And if you can, do a E2 blood test.

 

[JetSpyder]

You should check for iron overload or hemochromatosis and check for the C282Y genes. If you have it, you have your reason for needing TRT because hemochromatosis causes low-T.

I had done the 23andMe about 6 months ago so I just went in and paid to see if I had the C282Y genes. I am negative for both!!
How do I check to see if I have iron overload or hemochromatosis?

 

[JetSpyder]

Regarding your doubts about elevated E2: my pragmatic suggestion is to just try an AI, low dose, e.g. get 0.1 or 0.05mg compounded anastrozol, and try 0.05mg twice per week etc. Just observe how you feel. And if you can, do a E2 blood test.

Yeah, I've mulled this over for a while now. Unfortunately, my endo is a hard no on prescribing me any AI. I recently found a new endo and he won't even see me unless I get off of TRT for 8 weeks so he can diagnose why I have hypogonadism in the first place.

 

[JetSpyder]

there is definitely a point where e2 will cause mood issues, for me personally, while not sure exactly where, it is much much higher then 60pg/ml. currently I do run 50. your T is on the low side, which I assume is what you expect. I would highly suspect your anxiety is not T related. there is a bit of confusion on the ferritin side, my general doc claimed low ferritin will not cause any issues if rbc/hematocrit are ok. what I would do, with current symptoms. i too have suffered a lot of anxiety, but have it fully under control now.
a) try supplementing 100mg pregnenolone+200-400mg magnesium/day
b) try the how to raise ferritin fast protocol found on this forum
c) consider switching to Tprop ED - for me personally this resolved many anxiety issues. and I am on a high dose up to 30mg/day. on Tcyp anything above 150mg/week i felt like shit, but below 120mg i felt like shit too. your T dose might be too low as well

Thank you for the insights. Yeah I've basically just kept lowering my dose over the past 2 years to try and curb my anxiety and heart palps. I've never really had any serious anxiety until the past couple years. And the biggest problem is the head fog. Just can't seem to focus or concentrate on anything and I get super irritable.

a) and supplement with pregnenolone with the magnesium I currently take.

b) I just came across this last night and I'm planning on giving it a try this week.

c) I do think I might try switching to Prop and give it a shot. Though because of my work schedule its already difficult for EOD. What dosage would you recommend starting out with if I continue EOD? I am def much more tired these days. Could be in part to either my high iron levels or my low total T levels. 77 mg is pretty low. I get a little nervous thinking about increasing my dosage and bringing any more of the anxiety and sexual problems back to a worse level.

 

[t_spacemonkey]

Thank you for the insights. Yeah I've basically just kept lowering my dose over the past 2 years to try and curb my anxiety and heart palps. I've never really had any serious anxiety until the past couple years. And the biggest problem is the head fog. Just can't seem to focus or concentrate on anything and I get super irritable.

a) and supplement with pregnenolone with the magnesium I currently take.

b) I just came across this last night and I'm planning on giving it a try this week.

c) I do think I might try switching to Prop and give it a shot. Though because of my work schedule its already difficult for EOD. What dosage would you recommend starting out with if I continue EOD? I am def much more tired these days. Could be in part to either my high iron levels or my low total T levels. 77 mg is pretty low. I get a little nervous thinking about increasing my dosage and bringing any more of the anxiety and sexual problems back to a worse level.

here is how I personally would approach, first of all, if you not supplementing pregnenolone (not clear from your response), start with this before doing anything other changes for a week or so
if you decide on Tprop I would start with exactly the same dose you do EOD. EOD with Tprop might not work since it half life is 19h but i've seen some protocols recommending that. I would try exactly same dose as your current Tcyp, so 11mg/daily. most Tprop solution come in 100mg/1ml, so you would inject 0.11cc each day, upon waking ideally.
the good thing about Tprop is that you will notice dose changes very quick, due to 1/2 life. i notice them within 1-2days max. then you can increase your dose by 0.01cc and run it for 4-7 days or so if you want to go the super slow route. or do any variation/speed you feel comfortable with.
my shbg is ultra low as well. i am at 8! currently. i think guys with super low shbg and anxiety do better on Tprop and shorter esters with daily injections.

 

[Systemlord]

I recently found a new endo and he won't even see me unless I get off of TRT for 8 weeks so he can diagnose why I have hypogonadism in the first place.

This endo is anti-TRT, nothing good will come from this. Since when do they look for the reasons why someone has cancer? Is it diet, environmental etc. They don’t give a sh**.

They just give them you the appropriate treatment. Besides, the majority of men with secondary hypogonadism do not know why they have testosterone.

The only man that have an official diagnosis are those with testicle failure, type 2 diabetes and or testicular cancer.

That leaves more than 80% of men without an official diagnosis or known cause for low-T.

 

[JetSpyder]

This endo is anti-TRT, nothing good will come from this. Since when do they look for the reasons why someone has cancer? Is it diet, environmental etc. They don’t give a sh**.

They just give them you the appropriate treatment. Besides, the majority of men with secondary hypogonadism do not know why they have testosterone.

Amen brother. I was shocked when I went in. Waited 3 months to see him and for him to tell me that. I got iritated and basically told him to fuck off. Just frustrating trying to find any TRT doctors with any knowledge but hey... thats why this forum is great. Luckily my endo is cool about most of my requests and fills my scripts for me. Blood work costs $10 and my Test cost me $90 for a bottle.

 

[JetSpyder]

first of all, if you not supplementing pregnenolone (not clear from your response), start with this before doing anything other changes for a week or so

Got to love amazon. I was not supplementing preg but 2 hours ago I ordered a bottle and it just arrived.

I am going to try the switch over to prop and give it a shot. I have a couple weeks left of cyp that I am going to finish off before I start.

One question though. You suggest starting with the same dosage as I'm currently on (.11 ML/22 mg EOD) but then you said something about .11 ML daily. You think I should jump to 22 mg daily? Seems like a pretty big jump. But I don't have any experience with prop.

Is this similar to cyp in that I should give 6-8 weeks of a protocol before getting bloodwork?

And BTW... Thank you for your responses and thoughts. Its much appreciated.

 

[t_spacemonkey]

Got to love amazon. I was not supplementing preg but 2 hours ago I ordered a bottle and it just arrived.

I am going to try the switch over to prop and give it a shot. I have a couple weeks left of cyp that I am going to finish off before I start.

One question though. You suggest starting with the same dosage as I'm currently on (.11 ML/22 mg EOD) but then you said something about .11 ML daily. You think I should jump to 22 mg daily? Seems like a pretty big jump. But I don't have any experience with prop.

Is this similar to cyp in that I should give 6-8 weeks of a protocol before getting bloodwork?

And BTW... Thank you for your responses and thoughts. Its much appreciated.

no, 0.11cc is 11mg Tprop as most will be 100mg/1ml (even ugl ones i've seen)
once the cyp clears your system, Tprop will take ~4 days to reach a steady state, but remember there will be variations in time of day when blood is taken. i personally reach the max 4h post injection

 

[Belekas]

I had done the 23andMe about 6 months ago so I just went in and paid to see if I had the C282Y genes. I am negative for both!!
How do I check to see if I have iron overload or hemochromatosis?

Upload your raw dna file to checkiron.com and join same name FB group. This is the most advanced up-to-date algo to check for HH and inflamations around it. The main guy behind this great project is a smart physician/PHD and really helpful if you ask and share your results. Just one thing to know that 23andMe checks for just a few HH types when AncestryDNA checks a lot more so if you want to be sure you need to do AncestryDNA test and go from there. Still try with your 23andMe data and see what result you get.

Good luck!

 

[DorianGray]

I had done the 23andMe about 6 months ago so I just went in and paid to see if I had the C282Y genes. I am negative for both!!
How do I check to see if I have iron overload or hemochromatosis?

Did you check for H63D gene variant? The main problematic ones for hemochromatosis are C282Y and H63D.

 

[BJE]

I’m not saying this is your problem but I have heterozygous hemochromatosis. Because of this and because of high hematocrit from TRT I have donated a lot of blood. The result of this is that I have driven my ferritin level very low. I’ve decreased the amount of blood I donate in order to raise my ferritin level. I don’t give blood unless my hematocrit tests high. However, because of my hemochromatosis my iron level and percent saturation are always high. I could give blood one week and the next week my blood iron level will test high. Although high hematocrit is a concern, high iron is not a problem so long as ferritin is not high. The damaging part of high iron is when the excess iron gets stored in your organs causing damage to them. Ferritin is a measure of stored iron. If your ferritin level is low you are not storing an excess of iron.

 

[JetSpyder]

I’m not saying this is your problem but I have heterozygous hemochromatosis. Because of this and because of high hematocrit from TRT I have donated a lot of blood. The result of this is that I have driven my ferritin level very low. I’ve decreased the amount of blood I donate in order to raise my ferritin level. I don’t give blood unless my hematocrit tests high. However, because of my hemochromatosis my iron level and percent saturation are always high. I could give blood one week and the next week my blood iron level will test high. Although high hematocrit is a concern, high iron is not a problem so long as ferritin is not high. The damaging part of high iron is when the excess iron gets stored in your organs causing damage to them. Ferritin is a measure of stored iron. If your ferritin level is low you are not storing an excess of iron.

Thank you. This is all pretty me to me. None of my previous Dr have tested my ferritin or iron levels before. Only my hemoglobin and hematocrit. Have you tried to up your ferritin levels to see how you feel? I feel like I'm just going in circles.

 

[BJE]

My ferritin level has been low for years. As low as 7 to 10. It was tested a couple weeks ago and has increased to 27.6 with the low end of the range being 28 so almost in the normal range. I asked my doctor once why I could feel okay when it was so low and the answer is basically that although my stored iron level is low my blood iron level is always high.

 

[Systemlord]

My ferritin settles on the lower end while on TRT, ferritin above 50 gives me palpitations from the excess iron, given that the hemoglobin and hematocrit are very elevated, 19 and 55%.

I believe that high hemoglobin and hematocrit together with lower end ferritin versus higher ferritin and high hemoglobin and hematocrit are two different ball games.

I was able to stop my blood pressure medicine with these very high hemoglobin and hematocrit values because the beta-blocker was causing hypotension, even at half the dose.

That's my bodies way of balancing things. It didn't help matters for the fact I was supplementing iron for 4 years.