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

[FDV70]

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 work, ran it by him, and tried it on myself. It worked (I was able on my first try to raise ferritin 10 points in 3 days, but I've learned more since then). I have shared it with other guys on TRT who have seen the same success. Now I'd like to share it with you.

How to raise ferritin, the short version
Three 60mg doses a day of Ferrous bisglycinate chelate spaced apart at 9am, 3pm, and 8pm all on the same day, at least 3 days in a row. You MUST NOT be taking vitamins C and D. Your Estradiol should ideally be 20-60pg/mL range. (I'm not saying never take vitamins C and D. Just not during these days.) The times of day absolutely do matter. Your initial dose of iron MUST be 60mg or higher. Subsequent doses may be 60 or higher. Right now I'm telling people do not exceed 300mg in a day.

The key to raising ferritin is understanding how hepcidin works. Saying that it "blocks absorption" as you see in a lot of blogs is incredibly misleading. It binds to and degrades ferroportin, trapping iron in cells and blocking export of iron into serum. A large portion of that trapped iron will become ferritin. Vitamins C and D both crush hepcidin (which obviously increases the amount of iron in your blood, but guys with high hemoglobin want to avoid that).

My ferritin drops 5 points with a donation of whole and 10 points with a double red donation. Most recently, my ferritin was at 26. I donated 455ml of RBCs, followed my post-donation protocol for 4 days, and my ferritin was at 28. My intention is to develop my protocol further with more days and use of Adenine. The point for now is that you can put ferritin back to where it was pre-donation.

I have this written up in lengthier form because it's a LOT, and I wanted to explain everything about it to doubters and put sources to it. I have the long explanation here on my own, non-commercial site:

Fixing High Hemoglobin or Hematocrit and Low Ferritin While on TRT

 

[M.J]

i am currently taking vitamin c liposomal only. It’s been few days, not sure where do I stand as of now.

 

[FDV70]

i am currently taking vitamin c liposomal only. It’s been few days, not sure where do I stand as of now.

What's your ferritin and hemoglobin right now?
Worth a try if you're low ferritin. Works best right after a donation, but can work any time.

 

[MedicineMan]

So based on your research and experience, are you saying that taking 30 mg of your specified iron supplement everyday long term could theoretically lower hematocrit and increase ferritin because daily dosing would increase hepcidin and therefore increase iron storage resulting in lower serum or blood iron levels? Also in regard to dosing,I am talking about taking 15mg twice a day for a total of 30mg a day. You said your hemo wanted you to try it. What is holding you back? It makes a lot of sense to me. Also makes me wonder if frequent donators like myself who have crashed ferritin had lower levels to start with in comparison to trt guys that never need to donate. Thanks for the write up!

 

[MedicineMan]

Also for reference sake I have been on trt for 5 years. Low shbg guy around 20. Sub q daily dosing. Levels around 850. Everything dialed in except the donating merry go round. HCT increases regardless of dose. Without donating HCT creeps up to 54. After donation HCT goes down. Ferritin and iron crash. Eventually without donation, iron returns to mid normal range and ferritin stays low.

 

[Cataceous]

... HCT increases regardless of dose. ...

How low have you tried? It looks as though you could cut your dose by up to 40% and still have adequate free testosterone. I'd be surprised if you still had HCT issues at that level. If you don't want to go that low then switch to a propionate blend, which would allow you to lower the dose while preserving higher peak testosterone levels. This is closer to how things work naturally.

 

[FDV70]

So based on your research and experience, are you saying that taking 30 mg of your specified iron supplement everyday long term could theoretically lower hematocrit and increase ferritin because daily dosing would increase hepcidin and therefore increase iron storage resulting in lower serum or blood iron levels? Also in regard to dosing,I am talking about taking 15mg twice a day for a total of 30mg a day. You said your hemo wanted you to try it. What is holding you back? It makes a lot of sense to me. Also makes me wonder if frequent donators like myself who have crashed ferritin had lower levels to start with in comparison to trt guys that never need to donate. Thanks for the write up!

That was my heme's conception of what would happen. He knows TRT and his practice deals with a few guys like us. I said 30 is too much doc, it makes me nervous and years of donating I don't want to make myself worse. So he said allright take 25 or 20. His idea is that it should keep hepcidin up, allowing ferritin to rise over time. But my concern is the downward pressure of TRT keeping hepcidin low and my HGB going up.

I have a group of guys doing this and one reported that although his ferritin did fully restore, he did daily iron of IIRC 28mg and he had to donate a month earlier. So that scared me and I stopped my daily. (Me: TRT 20 years, donating around 18, scar tissue in my veins, so I am way more of a chickensh-t on this than most really.) I was just happy to get my ferritin to pre-donation levels.

From my research, it's the initial loading dose of 60+ that elevates hepcidin enough to pull this off reliably. The lower daily dosing I just don't know, because it's once daily not 3x. Unknown territory now, and I depend on guys testing on themselves to get a sense.

"Also makes me wonder if frequent donators like myself who have crashed ferritin had lower levels to start with in comparison to trt guys that never need to donate."

I suspect that's exactly right. I have a suspicion that a biological cutoff for ferritin exists for _anyone_ on TRT, even if they don't need to donate, and ferritin won't stay up (unless they have some disease or something). I would love to see data showing donor and "never had to donate" guys on TRT over a year and their mean, median, and mode ferritin levels.

Over time, the idea that HCT would be lower from daily dosing makes me suspicious. I will say this. Before I decided on the 3x per day, I was doing 2x per day. On June 8th:
RBC-6.34
HGB-16.9
HCT-52.5
I did 60mg iron@9am, and 3pm for a few days, then stopped. Went to get a blood test and came up with:
RBC-6.05
HGB-16
HCT-49
My heme asked me ALL the questions. Could it have been dehydration? I was well hydrated both times (and a drop in RBCs like that would be really dramatic for hydration issues. Could be.) Could be lab error. In any case I got a month reprieve from donating. But this got him all excited and had him encouraging me to go up to 3x per day.
Sadly, I was unable to replicate this, although a drop did make sense, in my case this is all just too imprecise. So that's why I mainly just rely on this for ferritin restoration.

When you read, you saw the information about Rusfertide. Rusfertide (which is a knock-off of human hepcidin) does this exact thing, lowers the RBC's and HGB etc. So when my process seemed to work my heme was sold. It is my hope that some other peptide company will create their own and offer it. If you compare Rusfertide and human hepcidin on pubchem, they are clearly in the same neighborhood, and my point here is that if they tweak it, they could come up with something new that would likely work and could try again. But this is a really long winded way for me to say that I don't think daily iron can really keep H&H down -- I think we're going to have to use actual hepcidin itself, sub-q.

"HCT increases regardless of dose."

Me too. My heme tested my EPO level and it was 20 or 21 I forget. After two decades. Clearly the "new set point" isn't doing me any good.

"Thanks for the write up!"

My pleasure! I hope it catches on as a post donation recovery method. No question it works, now we just have to optimize it. I am going to be ordering bulk Adenine (hepcidin agonist) next time. Maybe that will amplify the effect. If/when you try, report in so I can get a sense of different success rates.

 

[MedicineMan]

I am like you scared to try it. I donated Sunday and feel pretty good right now. I will say I did see a benefit from using Apolactoferrin and IP6. My hct lowered and stayed low over the summer. I then started using Colostrum instead of Apolactoferrin and it rose again. So, after this last donation on Sunday, I am going to stick with Apo and IP6 and see it it stays down. Hopefully just let ferritin gradually come up. I never have had any symptoms from low ferritin except when I donated two months in a row back in February and March of this year. Even then it was not bad. I got a little winded lifting weights and cardio for about two days. I really do feel like it is just chasing a number. I feel no different after donating blood. Sunday, I donated in 6 minutes for what that’s worth lol! In contrast I have a friend on trt always feels immediately better after donating despite lower numbers. So, I think there are obviously a lot of factors involved blood pressure etc.. To the previous poster, I am on 125 mg a week. Started out like a lot of guys at 200mg (bad doctor) IM once a week. She never tested my shbg.I did that myself. Worked my way down to 125mg. Also, as I mentioned low shbg high metabolizer, very sensitive to estrogen. I personally think I am at the sweet spot for low shbg guys. Low shbg plays a major role metabolically, hormonally and in trt. Anyway, I will read up on the Adenine. Thanks guys!

 

[Cataceous]

... To the previous poster, I am on 125 mg a week. Started out like a lot of guys at 200mg (bad doctor) IM once a week. She never tested my shbg.I did that myself. Worked my way down to 125mg. Also, as I mentioned low shbg high metabolizer, very sensitive to estrogen. I personally think I am at the sweet spot for low shbg guys. Low shbg plays a major role metabolically, hormonally and in trt. Anyway, I will read up on the Adenine. Thanks guys!

Are you aware that this dose still approaches double the amount of testosterone that the average young man makes naturally? If you haven't tried more physiological levels then how do you know that the extra testosterone is worth the hassle with hematocrit? I've taken from 100 mg per week down to 38 mg cypionate-equivalent and feel best overall at the lower levels. I do notice reduced athleticism at the lower doses.

 

[FDV70]

I will say I did see a benefit from using Apolactoferrin and IP6. My hct lowered and stayed low over the summer. I then started using Colostrum instead of Apolactoferrin and it rose again. Hopefully just let ferritin gradually come up.

Keep in mind that taking any amount of iron without an initial loading dose to raise hepcidin will keep ferritin low. Just taking iron daily will do very little if anything to raise ferritin. And vitamins C and D reduce hepcidin and channel all the iron into hemoglobin, not ferritin.

 

[MedicineMan]

Yes I am aware of that. Dosage adjustments and frequency of injections made no difference. I should have said settled at 125mg dose instead of working way down to it. I also based dose on my levels of free testosterone. My free levels are at the high end of normal. This is the most important number for me. Anything lower and free drops off substantially. Also, did not feel good on other doses. The main thing is my lipid profile, mood, body composition all improved when I adjusted the dose. Not sure that on 38mg a week I could justify the cost, needle sticks, labs etc.. I understand the young man argument but I don’t think it is that simple. For example, if I used the same amount a young man makes naturally as dosage marker I would get no where near his natural levels. I also have secondary hypogonadism. So I had lower levels even in my early 20s. I also looked at my pre trt hct levels compared with now and I am still within range of the average increase in levels. The challenge is that we have to base all of our information and hypothesis on men who are not on trt. We need studies that focus on trt guys. It is my guess that for example in regard to hct we may or may not learn that in trt guys there is a new set point for hct and lower ferritin may not be as important without symptoms in our subset because of higher iron serum values. For myself, I just try to base it on how I feel and look at other combined factors such as lipids, body composition, blood pressure, platelets etc.. In my case, everything improved except for a number on a scale that has not been studied in men on trt therapy. I am guilty just like everyone else of getting on the blood donating bandwagon out of a abundance of caution but it seems like something does not add up. It may be an outdated way to address hct in trt guys or more factors need to be taken into consideration. Vicious cycle. I totally agree with your too high of dose point but it probably took me 3 and a half years to dial dosage, hormones, supplements and everything else in.

 

[MedicineMan]

Thanks FD, good information. I am going to avoid the iron. Have had 2 hard workouts since donating Sunday and I feel good. Going to go with the Apo and IP6 and hopefully get away from the donations. This combo did not bottom me out just lower limit of normal earlier in the summer. What messed me up was switching back to Colostrum. It raised my iron very quickly. The reason for use was because I have not had a cold or anything else in a couple of years while using it. When I was using Apolactoferrin my hct was good but I accredited it to my trt dosage and switched back to Colostrum for immunity. Wrong choice. Just whiffed on the fact that colostrum is lactoferrin and will help raise iron and ferritin but is a great immune booster. I will let you know how it turns out.

 

[Cataceous]

Yes I am aware of that. Dosage adjustments and frequency of injections made no difference. I should have said settled at 125mg dose instead of working way down to it. I also based dose on my levels of free testosterone. My free levels are at the high end of normal. This is the most important number for me. Anything lower and free drops off substantially. Also, did not feel good on other doses. ...

So going from a massive dose (200 mg/wk) down to a large dose (125 mg/wk) makes no difference? But that doesn't say anything about physiological dosing.

Free T is important, but there's no evidence that being above your own healthy natural set point is a good thing overall. About half the healthy population must have free T below the mean of that population. If members of this lower half later develop hypogonadism and go on TRT then they should initially target levels that are the best approximation of their own natural levels. They should not succumb to the more-is-better mentality. I'd further argue that if we don't know our optimal level a priori then it's safest to initially target the average of the healthy young population.

... I understand the young man argument but I don’t think it is that simple. For example, if I used the same amount a young man makes naturally as dosage marker I would get no where near his natural levels...

From a statistical and technical viewpoint the opposite is true. The underlying metabolic clearance rate tends to lessen as we get older. This increases testosterone levels at the same dose. I'm not arguing that you personally would do well at 40 mg TC/week, but your numbers do suggest that 75 mg would still put your free T in the healthy normal range. Furthermore, using 75 mg equivalent in an ester blend would allow daily peak free and total testosterone to be considerably higher than otherwise, possibly without the negative HCT consequences.

... The challenge is that we have to base all of our information and hypothesis on men who are not on trt. We need studies that focus on trt guys. ... I totally agree with your too high of dose point but it probably took me 3 and a half years to dial dosage, hormones, supplements and everything else in.

I'm sympathetic to the fact that you don't want to tamper with an otherwise successful protocol. But in my opinion trying to carve out exceptions for guys on TRT is wrong. What's our goal with TRT? Do we want to imitate healthy 30-year-olds or do we want to be old guys with excessive testosterone who must donate blood, take AIs, etc.?

 

[MedicineMan]

I respectfully disagree. I have been on the low end at 100mg and even at current dose at different times. Also, I am not an old guy. Again, I have secondary hypo. Obviously, we have different goals. Nothing wrong with that. I am glad your dose meets your goals. I am not trying to imitate anybody or any age. I am trying to optimize how I feel. That has always been my goal.Thanks for input. I really just wanted ask about FD’s protocol. Good luck!

 

[Cataceous]

I respectfully disagree. I have been on the low end at 100mg and even at current dose at different times. Also, I am not an old guy. Again, I have secondary hypo. Obviously, we have different goals. Nothing wrong with that. I am glad your dose meets your goals. I am not trying to imitate anybody or any age. I am trying to optimize how I feel. That has always been my goal.Thanks for input. I really just wanted ask about FD’s protocol. Good luck!

I'm certainly not intending to pick on you personally, and I wish you luck as well. I do hope to encourage others to consider trying lower doses when they're experiencing side effects. Thanks to @FDV70 for all the research and for highlighting the dose issue in your summary: "If you are on TRT, you have multiple options for controlling erythrocytosis and the resulting high hemoglobin and hematocrit:
- modified dosing to be daily, or daily with a lower overall dose. ..."

 

[FDV70]

@Cataceous I read your blend thread. I was actually wondering if a mix would let me take less and have the same effect (I mean with prop) before I even ran across your thread. I had no idea people actually do it. I am 50 and my TT is at 550 and I admin 30mg EOD of Cyp. And I still have to donate 4x/yr. What are your levels of TT and FT and how much do you take of your blend in mg's of Test (in the aggregate if that makes sense)? I just don't see a way out of donating. Even f'ing pellets had my hemoglobin elevated when I gave them a try at my uro's insistence.

 

[Cataceous]

@Cataceous I read your blend thread. I was actually wondering if a mix would let me take less and have the same effect (I mean with prop) before I even ran across your thread. I had no idea people actually do it. I am 50 and my TT is at 550 and I admin 30mg EOD of Cyp. And I still have to donate 4x/yr. What are your levels of TT and FT and how much do you take of your blend in mg's of Test (in the aggregate if that makes sense)? I just don't see a way out of donating. Even f'ing pellets had my hemoglobin elevated when I gave them a try at my uro's insistence.

My average Tru-T free testosterone is predicted pretty accurately as 0.627 * (weekly testosterone intake). For example, when I was taking 18 mg T enanthate EOD my Tru-T free was about 28 ng/dL—my SHBG is usually around 30 nMol/L. Total testosterone then was around 800 ng/dL.

The measurements get a lot noisier once propionate is in the picture. I accumulated the following data when using only propionate daily:

I dismiss the 6 mg reading as an outlier, leading me to use a figure of 50% as the daily variation about the mean in my serum testosterone. With this number I can estimate the variation about the mean with any blend as 50% * percent_T_from_TP_in_blend. Thus if half of my testosterone is coming from TP and half from a longer ester then variability in serum testosterone about the mean is predicted to be 25%. This is what I targeted with my blend. Daily doses ranged from 2.8 mg TP/3.7 mg TE (5 mg T) down to 2.1 mg TP/2.8 mg TE (3.8 mg T). Subjectively the best was 2.4 mg TP/3.2 mg TE (4.3 mg T).

Regarding your situation: It's useful to get a sense of your dose-response characteristic. In theory the dose proportionally drives free T. What is your SHBG like? Lower levels lead to less total testosterone. Is that TT of 550 ng/dL at trough? I personally see little serum variation with EOD use of longer esters, but anecdotally—and uncommonly—it seems like some guys see a fair bit of variation. Are you a large guy? This is another factor that influences the response to dose.

As discussed in the other thread, it's hypothesized that daily peak testosterone has beneficial effects that are independent of average and trough levels. If so, and if hematocrit happens to be relatively decoupled from daily peak testosterone then it may be possible to lower hematocrit by lowering average and trough testosterone while preserving peak values and their attendant benefits.

I'll add one anecdote: I'm conducting a test at the moment with a considerably lower dose of only propionate, 4.5 mg daily. While peak testosterone is predicted to be over 700 ng/dL, trough testosterone is likely in the 200s. The interesting thing is that since the transition period there have been no obvious subjective problems with having such low troughs. There could still be less obvious problems that will be uncovered with lab work.

 

[MedicineMan]

No worries! I did not take it that way. You have made some good points in your posts. After sleeping on it, I have decided to cut my dose by 25mg. I went back and looked at some things and realized that when I tried lower doses other things were out of whack such as high dht conversion and hgh estrogen spikes from hcg. Not the case now.I will see how it goes..

 

[Cataceous]

@Cataceous I read your blend thread. I was actually wondering if a mix would let me take less and have the same effect (I mean with prop) before I even ran across your thread. I had no idea people actually do it. ...

Some additional details on using an ester blend to reduce the dose of testosterone: If the desire is to preserve peak serum testosterone while restricting the daily variation in levels to something physiological then the variation about the mean should be limited to +/- 25% or so. This is about the highest natural variation I've seen in the literature. You can also look at this as having daily trough testosterone be 60% of the peak value. If we model the variation as linear then we can readily see that going from relatively constant testosterone levels—as in daily cypionate injections—to this maximum physiological variation reduces the average serum level by 20%, which is also the amount of the dose reduction.

I've been using total testosterone and free testosterone somewhat interchangeably in all this, but strictly speaking the calculations should be based only on free testosterone.

If you abandon the requirement that serum testosterone variation remain physiological then in theory by using only propionate you can reduce the overall testosterone dose by a third, assuming your absorption rate is typical. Larger reductions in total testosterone dose are conceivable if testosterone nasal gel, e.g. Natesto, is incorporated in the protocol.

Ideally each person should measure the serum testosterone variation he sees with propionate so that an ester blend can be tailored appropriately. This is effectively measuring the half-life of propionate. As it happens, that figure of 50% I measured corresponds pretty well with the nominal stated half-life of 0.8 days. However, it's quite possible for any individual to absorb the ester faster or slower.

 

[xqfq]

Due to unfortunate diet and a substantial increase in my testosterone dose over the past ~month, I think I may have tanked my already-low ferritin. My diet is effectively vegan and my ferritin, which I haven't measured in ~2 years, was 32. I have only donated blood once and it was 2+ years ago.

I began noticing uncharacteristic lethargy a few weeks ago. Normally I would get lab work done, but I am budget constrained at the moment and prices for lab work appear to have increased in the past two years.

I have been following your protocol for 4 days now and I feel much better. It is like I am a new person. It could be placebo, and I will not have the before-and-after labs to say either way, but I wanted to share my experience regardless.

I plan to continue the protocol through today and then stop (so ~5 days total).