Thanks everyone and being very new to TRT I learned a lot from you guys.
Taked to Dr Saya and I am so greatful that he got me in quickly. I am overseas and had to stay up like past midnight to talk to him but it was worth it.
He put me on 4 weeks of 200 iu HCG per day to jump start my system, since my prolactin is high he wants to somehow see if it is the pituitary that is an issue but at the same time he thinks that it is not the culprit. But my prolactin values goes down with estrogen.
The biggest reason for taking me off the TestCYp is that I am low on Ferratin and my value is 20 normal being 30-200. And I mentioned to him that there are so many men that are doing TRT and at the same time doing phlebotomy even when their Ferratin is too low, somewhere in my range. According to dr Saya they are doing more harm than a benefit to the body becujase very low Ferratin is bad.
I missed one week of TestCYp and HCG injection and I feel like crap. My prostate was so happy on higher Ts and my PSA went down to 1.5 from a 3.
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AI generated thread summary (Curated by Nelson Vergel- admin)
Taked to Dr Saya and I am so greatful that he got me in quickly. I am overseas and had to stay up like past midnight to talk to him but it was worth it.
He put me on 4 weeks of 200 iu HCG per day to jump start my system, since my prolactin is high he wants to somehow see if it is the pituitary that is an issue but at the same time he thinks that it is not the culprit. But my prolactin values goes down with estrogen.
The biggest reason for taking me off the TestCYp is that I am low on Ferratin and my value is 20 normal being 30-200. And I mentioned to him that there are so many men that are doing TRT and at the same time doing phlebotomy even when their Ferratin is too low, somewhere in my range. According to dr Saya they are doing more harm than a benefit to the body becujase very low Ferratin is bad.
I missed one week of TestCYp and HCG injection and I feel like crap. My prostate was so happy on higher Ts and my PSA went down to 1.5 from a 3.
_____________________________________
AI generated thread summary (Curated by Nelson Vergel- admin)
Briefing Document: Ferritin Levels and Testosterone Replacement Therapy (TRT)
This briefing document summarizes key information regarding ferritin levels, iron metabolism, and their interaction with Testosterone Replacement Therapy (TRT), drawing insights from the "Warning for Men on TRT: Low Ferritin is Bad" forum on ExcelMale.com.Executive Summary:
Ferritin is a crucial protein for iron storage and transport in the body. While a common concern for men on TRT is high hematocrit (HCT) and red blood cell (RBC) count, leading to therapeutic phlebotomy (blood donation), this forum highlights a critical, often overlooked issue: low ferritin levels in men on TRT are detrimental and can have significant health implications. TRT itself can decrease ferritin, and frequent blood donations, while intended to lower HCT, can exacerbate already low ferritin, creating a challenging "catch-22" situation for many patients.Main Themes and Key Facts:
- What is Ferritin and its Normal Values?
- Ferritin is a protein in the bloodstream that stores iron and helps transport it throughout the body where needed.
- Normal ferritin values differ for men and women:
- Men: 24 - 500 ng/ml of blood (some sources in the forum state 20-500 ng/ml).
- Women: 24 - 200 ng/ml of blood (some sources in the forum state 20-200 ng/ml).
- Crucial Note: "There is some evidence that ferritin values under 50 ng/mL are enough to cause fatigue and other symptoms (restless leg syndrome and even fibromyalgia) in men and women." (Nelson Vergel, Post #16).
- The Dangers of Low Ferritin:
- Fatigue: Iron is essential for red blood cell production, which transports oxygen. Low ferritin leads to iron deficiency, causing fatigue as "Virtually all cells, tissues, and organs in the human body require oxygen to survive, so if you don't have enough red blood cells to carry it, you will feel fatigued." (Nelson Vergel, Post #16). This fatigue can severely impact daily life, productivity, and physical activity.
- Impact on Thyroid Function: "Low ferritin can also affect thyroid function." (Nelson Vergel, Post #3).
- Other Symptoms: Users report symptoms like itching, leg aches/pains, and migraines associated with low ferritin. (ipi, Post #11; BuzzSaw, Post #14).
- Doing More Harm Than Good: Dr. Saya, a physician mentioned in the forum, states that men on TRT performing phlebotomy with very low ferritin levels (e.g., around 20 ng/ml) are "doing more harm than a benefit to the body because very low Ferratin is bad." (ipi, Post #1).
- TRT's Impact on Ferritin Levels:
- 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." (Nelson Vergel, Post #3 & #16).
- Study Findings: A study cited by Nelson Vergel showed that "Ferritin was reduced at an average of 32% within 3 months of treatment initiation without altering iron, transferrin, or transferrin saturation" in men given testosterone enanthate. (Nelson Vergel, Post #16).
- Mechanism: "Yes testosterone will lower feritin due to its inhibition of hepcidin. It also uses up lots of your ferritin stores to produced rapid increase in red blood cells." (TorontoTRT, Post #20).
- The "Catch-22" with High Hematocrit and Low Ferritin:
- Many men on TRT experience elevated hematocrit (HCT) and red blood cell (RBC) counts, prompting therapeutic phlebotomy to reduce cardiovascular risk.
- However, frequent blood donations can further deplete ferritin stores, leading to a situation where a patient has both high HCT/RBC and dangerously low ferritin.
- "I'm in the same boat as you, low ferritin and high HCT/RBC. I'm currently experiencing most of the symptoms of low ferritin, but don't want to take iron as it'll worsen HCT (conversely, I can't donate to lower HCT as ferritin is quite low!)." (BuzzSaw, Post #14).
- Dr. Saya's advice to a patient with low ferritin (20 ng/ml) and high HCT (53%) was to "not take iron supplements as it may boost my Ferratin more increasing HB and HCT... STOP TestCYp till my iron is up NATURALLY and HCT is down naturally too." (ipi, Post #9 & #11).
- Strategies for Managing Low Ferritin on TRT:
- Dietary Iron: Increase intake of iron-rich foods, both heme (animal sources) and non-heme (plant sources).
- Heme iron: Chicken liver, oysters, clams, beef liver, beef, turkey leg, tuna, eggs, shrimp, leg of lamb.
- Non-heme iron: Raisin bran (enriched), instant oatmeal, beans (kidney, lima, Navy), lentils, molasses, spinach, whole wheat bread, peanut butter, brown rice. (Nelson Vergel, Post #3).
- Note on Spinach and Eggs: Some sources suggest spinach inhibits iron uptake, and eggs inhibit iron absorption. (Kirk, Post #6; Xerxes, Post #8).
- Iron Absorption Enhancers:Vitamin C: "To help aid in the absorption of iron, I'd suggest using 500mg of Vitamin C with heme foods..." (Kirk, Post #6). "Appears that vit c alone may raise ferritin without increasing HCT and RBC like iron supplements do." (Wolverine, Post #19).
- Alpha GPC: "...and 300mg of Alpha GPC with non-heme foods." (Kirk, Post #6).
- Caution with Iron Supplementation: Directly taking iron supplements is cautioned by Dr. Saya due to the potential to "boost my Ferratin more increasing HB and HCT." (ipi, Post #9). This highlights the complex balance needed.
- Discontinuing TRT (Temporary): In severe cases, a doctor may advise temporarily stopping TRT to allow ferritin to naturally rise and HCT to decrease. (ipi, Post #9 & #11).
- Monitoring: Regular ferritin testing is crucial, especially for men on TRT, given its propensity to lower levels.
Conclusion:
The forum strongly emphasizes that low ferritin is a significant and often overlooked issue for men on TRT. While managing high hematocrit is important, clinicians and patients must be equally vigilant about maintaining adequate ferritin levels. Ignoring low ferritin can lead to severe fatigue and other health complications. A nuanced approach is required, balancing the need to control HCT with the critical importance of sufficient iron stores, potentially involving dietary adjustments, careful supplementation, and strategic TRT protocol modifications. Open communication with a knowledgeable doctor is paramount to navigating this complex interaction.
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