TRT, Therapeutic Phlebotomy, Low Ferritin, and Iron Replacement

[DMc79]

I'm 59 years old and have been on TRT since 6/12. In the fall of 2012 excessively high testosterone levels forced us to lower the injection amount from 1.0ml to 0.7ml and decrease the injection interval from 14 days to 10 days. That lowered mid-cycle testosterone to 650-675 ng/dL, where it has stayed ever since. In early 2013 my GP noticed that my hematocrit/hemoglobin level was excessive and prescribed therapeutic phlebotomy. Over the next twelve months I donated almost two gallons of blood. Although this procedure did draw down my hematocrit to a normal level, it also severely lowered my ferritin. Over the past year I have donated another gallon of blood (one unit every eight weeks), to bring my total to slightly over three gallons. My GP just ran a complete blood panel and now he wants to address the low ferritin issue. My ferritin was first measured on 9-17-14 at 5.6ng/mL. Last week it was 5.3ng/mL. Both are very low. He wants me to take a iron supplement. My current hematocrit level is 48, crowding the high side of normal.

My question is this: Won't the addition of iron via supplements stimulate RBC production, and elevate my hematocrit levels? It seems that with TRT you solve one problem and that it causes another problem that has to be dealt with.

As a side note, my GP asked me this week if I thought the TRT injections were "worth it". He said there were other ways to deal with my ED issues (pills) and that a lot of guys give up on TRT because of side effects like the ones I'm experiencing. I was taken aback by his suggestion, and explained that TRT also helped me concentrate better, restored my sex drive, and initially it also gave me more energy. I said I didn't see how pills were going to offer all of that.

 

[ERO]

My 2 cents is that you are not on a good TRT protocol, at all.

A single injection every 10 days is putting you on a roller coaster, whereas going on smaller amounts injected twice a week is far superior. Does your Doc check your E2 levels as well? If not, it is really time to change doctors, IMHO.

Additionally, if you stop TRT your T levels are going to drop to next to nothing unless you do a re-start and depending upon whether you are primary or secondary, that may not work to restore your levels.

 

[croaker24]

It's a vicious cycle --- donating blood too often can tank the ferritin - then if you take iron supplements, that does seem to shoot the hematocrit up very fast. That happened to me. So for now, I will donate blood less frequently and stop taking iron supplements (which had been prescribed by my PCP) and hopefully allow my ferritin to build back up. Note I am on the protocol as identified by ERO - I inject twice a week.

You said your overall T was too high? How high was it?

 

[Vince]

I am also going to give my 2 cents worth, inject very three and a half days, keep your testosterone levels even, no need for all those spikes. Then i wonder can you raise your iron by eating the proper foods?

 

[DMc79]

What are "E2 levels" ?

Do you think I should see an Endocrinologist, rather than a different GP?

If I'm injecting 0.7ml every ten days, does it make sense to inject one-half of that every five days?

I thought the idea of stopping the TRT was loopy, thanks for the guidance.

 

[DMc79]

My T was over 1500 three months after I started injecting. I thought about sex constantly, had spontaneous erections at age 56, and had severe mood swings. Lowering the dosage helped solve those issues.

Do you have hematocrit tested, to determine when you should donate again? How high do you let it go, before donating? At 48, mine is on the upper end of normal, and I'm worried that if I donate less frequently it will get too high again. At one point it was 63.6, way too high.

 

[Nelson Vergel]

I would inject smaller doses more frequently to prevent high peaks in DHT (DHT has been linked to increased hematocrit). I would also not donate blood more frequently than every 3 months. I would normalize your ferritin since low iron and ferritin can make you tired and slow down your thyroid.



Someone posted this about a blood pressure med that may decrease or stabilize hematocrit


Can Losartan decrease high hematocrit caused by testosterone replacement?



Starting Testosterone with Low Iron and Ferritin

 

[DMc79]

I have been taking Losartan for high BP for many years now, prior to starting TRT, but I appreciate the info. I wonder how high my hematocrit would be if I wasn't taking it.

Do you agree that an iron supplement is needed, in order to normalize my low ferritin? I have a diet that is low fat, but I do eat a lot of poultry, and some pork, fish, and red meat too. I also eat beans and I have iron fortified cereal nearly every day. I will try your idea of citrus juice to help with the absorption.

 

[Concerned wife]

Croaker 24, how is your ferritin now?

 

[Vince]

Croaker 24, how is your ferritin now?

Croaker as not logged in since 09-25-2015, hopefully he will again soon.

 

[Concerned wife]

Thanks, Vince. Yes, I was hopeful he might get an alert to activity and check this thread again.

 

[croaker24]

Croaker 24, how is your ferritin now?

I've not measure my ferritin in a while - I'll ask Defy to do so at my next blood test. I've been eating more fish, adding eggs on weekends, and some sea veggies now and then. I understand it's a slow process so frequent measurement is not something I think is warranted.

Right now our focus is been on getting my T numbers under control - at 100 mg a week of cypionate after 1 year of injections, my total T had shot up to over 1200 (measured the day before my next injection), my estradiol was at 49, my free T went from being low to being top of the range. So I'm going down to 80 mg/week (2x subq) as per Defy.

 

[CoastWatcher]

I've not measure my ferritin in a while - I'll ask Defy to do so at my next blood test. I've been eating more fish, adding eggs on weekends, and some sea veggies now and then. I understand it's a slow process so frequent measurement is not something I think is warranted.

Right now our focus is been on getting my T numbers under control - at 100 mg a week of cypionate after 1 year of injections, my total T had shot up to over 1200 (measured the day before my next injection), my estradiol was at 49, my free T went from being low to being top of the range. So I'm going down to 80 mg/week (2x subq) as per Defy.

With your estradiol at 49, were you/are you dealing with any of the classic E2 issues? Or, in light of the total testosterone value, are you feeling no ill effects?

 

[croaker24]

None of the classic issues just yet, the noticeable issues were my morning erections were not as strong/weaker, and I was also starting to feel the higher T - tense, impatient, wired up in the mornings.

I may be one of those slower metabolizers. The trough was consistently increasing, when I started a year ago, to 700, 800, 900, etc.

I do feel better going down to 80 mg.

 

[Concerned wife]

Thanks, Croaker.

 

[Nelson Vergel]

For vegetarians

6 Iron-Rich Food Combos—No Meat Required