Low Ferritin Solutions With Frequent Blood Donations

[ManOnMission]

48 year old male. On HCG and Testosterone for TRT. Hematocrit levels were getting too high.

Did 2 blood donations in 30 days (on 5/5 and 5/23).
On 5/30 did blood tests. Went from Hematocrit 58 down to 47.5 and Hemaglobin now 15.9 (which is good). But, Ferritin dropped to 18 (range is 21 to 274). DHEA 48.3 (low: 70-495 range), Glucose Serum (high: 103), Estradiol (High 65)..put on Anastrazole)

Been told to start taking Ferrous Fumarate Iron 29 mg 2 times per day (58 mg per day) plus Vitamin C to get Ferritin levels up. Then give next blood donation on 6/21

Wont this raise my H&H levels too? Does this sound right? (Im guessing the 2 blood donations back to back tanked my ferritin levels). I finally got my H&H levels down and now it sounds like they will be jacked back up. Is this a decision of what is more important, Ferritin or H&H?


Next Labs 7/15

New Program based on last test results:
Iron Supplement 2 x per day (added)
Vitamin C: 500 mg per day (added)
Test Cyp 60 mg 2 x per week (changed for 100 mg per week)
Anastrazole: ½ mg 2 times per week (same day as test cyp)
HCG daily 10ML per day

 

[ERO]

it is likely that the back to back blood donations tanked your ferritin, so I would not necessarily start supplementing ferrous fumarate based upon that. I mean, you most likely created an artificially low level due to the 2 donations so that is not a baseline reading. Baseline would be 4-6 weeks after your last donation.

 

[ManOnMission]

They asked that I go ahead and give ANOTHER blood donation on 6/21. Does this make sense? Isnt that going to tank my Ferritin even more? Perhaps taking the supplement s to offset the blood donation? Next labs are on 7/15

 

[Nelson Vergel]

What ERO said is right.

If your hematocrit is 47 I would not donate so soon.

Warning about frequent blood donations used to decrease hematocrit.
Supplementing iron is tricky. It can increase liver burden, hematocrit, production of oxidants, and make you constipated.

 

[Vince Carter]

Based on what you've posted I can't see another pint donated as being something medically necessary. I too, had a low in the teens Ferritin test, having never had one before, but I had also donated 3x in 6 months of every 59 days whatever Red Cross allows, to treat my high Hematocrit. I've been taking Vitron-C daily in the AM for a few weeks now. I will retest my Ferritin along with my usual stuff and see how that goes. I have not and don't expect to donate any time soon.

 

[ManOnMission]

Nelson, I just checked my dates and they were wrong. They have me donating at Red Cross on 7/6 and retesting on 7/13.
After that, blood donations will be at 56 days or later, depends on test results. Does this sound too soon or what are everyones thoughts?

 

[ManOnMission]

If I dont supplement with iron and I dont donate blood, I would think my hematocrit would go back up, maybe for 49 (guess), but how much would ferritin go up?

 

[Nelson Vergel]

"The impact of limiting whole blood donation frequency to every 3–4 months also needs to be evaluated, since such a change could significantly impact blood supplies."

"This attests to the approximate 230 mg iron loss associated with every donated red cell unit. Nearly as important was the interval since the last red cell donation; donors who attempted to return to donate within approximately 14 weeks of their last donation had significantly higher odds of AIS or IDE than donors returning between 14–18 weeks, and, even more so, than donors returning at least 19–20 weeks after their last donation."


Iron Deficiency in Blood Donors: The REDS-II Donor Iron Status Evaluation (RISE) Study

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3618489/

 

[gallan]

I have to slightly disagree with Nelson as I have been down this road for a few years. I would be much more concerned about high hematocrit than low iron and would continue donating and supplementing iron until you get things balanced out. High hemo is an immediate health concern. Low ferritin can be dealt with in time and your levels were not dangerously low.

 

[Nelson Vergel]

Gallan

What did I say that you disagree with? I never said to ignore high hematocrit.

 

[Nelson Vergel]

Hematocrit may stabilize after long term testosterone replacement

Although this study was done in mice, it may explain why hematocrit may eventually decrease and stabilize in men on TRT. I am one of those men who only went for therapeutic phlebotomy twice. There seems to be an adaptive mechanism that makes red blood cells get change form while hematocrit stabilizes.

Guo W, Bachman E, Vogel J, Li M, Peng L, et al. The Effects of Short-Term and Long-Term Testosterone Supplementation on Blood Viscosity and Erythrocyte Deformability in Healthy Adult Mice. Endocrinology.http://press.endocrine.org/doi/abs/10.1210/en.2014-1784


Testosterone treatment induces erythrocytosis that could potentially affect blood viscosity and cardiovascular risk. We thus investigated the effects of testosterone administration on blood viscosity and erythrocyte deformability using mouse models.


Blood viscosity, erythrocyte deformability, and hematocrits were measured in normal male and female mice, as well as in females and castrated males after short-term (2-weeks) and long-term (5-7 months) testosterone intervention (50 mg/kg, weekly).


Castrated males for long-term intervention were studied in parallel with the normal males to assess the effect of long-term testosterone deprivation. An additional short-term intervention study was conducted in females with a lower testosterone dose (5 mg/kg).


Our results indicate no rheological difference among normal males, females, and castrated males at steady-state.


Short-term high dose testosterone increased hematocrit and whole blood viscosity in both females and castrated males. This effect diminished after long-term treatment, in association with increased erythrocyte deformability in the testosterone-treated mice, suggesting the presence of adaptive mechanism.


Considering that cardiovascular events in human trials are seen early after intervention, rheological changes as potential mediator of vascular events warrant further investigation.

 

[Nelson Vergel]

Taking iron to justify frequent therapeutic phlebotomies for hematocrit under 53 only lengthens the potential stabilization of hematocrit that happens in most men after 10-18 months of TRT.

 

[gallan]

Gallan

What did I say that you disagree with? I never said to ignore high hematocrit.

It appeared to me you were hyping the dangers of frequent donation even with folks with high hematocrit when phlebotomies are really the only way to bring it down. Low ferritin is a relatively minor issue can than be corrected.

 

[gallan]

Taking iron to justify frequent therapeutic phlebotomies for hematocrit under 53 only lengthens the potential stabilization of hematocrit that happens in most men after 10-18 months of TRT.

Not in my case. Perhaps I'm an outlier.

 

[Nelson Vergel]

http://biomedgerontology.oxfordjournals.org/content/early/2013/10/24/gerona.glt154.full



The eligibility criteria for the trial have been described (13). Briefly, ambulatory, community-dwelling men, aged 65 years and older, with mobility limitation, total testosterone 100&#8211;350ng/dL, or free testosterone <50 pg/mL, who had no contraindication to testosterone administration, were randomized to placebo or 10g testosterone gel daily for 6 months.

These graphs show how hematocrit increases but then stabilises and then goes down when study was stopped (TRT was stopped) at month 6.

Testosterone Induces Erythrocytosis via Increased Erythropoietin and Suppressed Hepcidin: Evidence for a New Erythropoietin/Hemoglobin Set Point

 

[Nelson Vergel]

I have never said that someone with hematocrit over 53 should not get a phlebotomy. In fact, I have become the main activist on the internet on the subject.

What I am saying is that taking iron supplements for a long time can also be counterproductive for hematocrit stabilization since it is fueling its increase.

The only case scenario where I think it is justified to take iron and donate every month to 6 weeks is when someone has made the mistake to allow hematocrit to go way above 53. Even in those patients, once hematocrit is brought down under 50, I would not take iron for more than a month to help regenerate iron stores.

Most men I have met have not given blood more than 4-5 times in their TRT life. The body adapts by first changing red blood cell shape and volume: "increased erythrocyte deformability"

 

[gallan]

Agreed and the only way to know is testing. I am the exception and have to donate frequently and take iron to keep things in balance after over 5 years on TRT.

Edit: I test ferritin and hemo every 2 months

 

[ManOnMission]

So do you guys believe its OK for me to take 58 mg of iron per day, give blood on 7/6, then retest on 7/15 and then re-evaluate? Ive been on TRT for 3 years now and have not stabilized... Been giving blood pretty much every 52 days. My last Endo doc thought it was better to keep lowering my Testosterone amount and not doing blood donations and I kept feeling worse. I dont think that Endo knew anything. New doc is well versed and experienced in these areas. I just thought it was odd to take iron that will raise Hematocrit and then to do another blood draw so soon.

 

[ERO]

My 2-cents is that if you stop supplementing iron you would not need to donate so frequently - and that is better than reducing your Test in the hopes that alone makes you need to donate less often

 

[ManOnMission]

How quickly does Ferritin levels come up on their own?