What Would A Doctor Typically Do With HIGH RBC And Low Iron & Ferritin

[Stpfan]

I've been on TRT for about 3 years now. I've been taking 140mg of Test Cyp (weekly) for a very long time. I was donating blood rather consistently during those 3 years. Oddly enough during my last blood donation around October 2021 I haven't recovered. Both Iron and Ferritin sit exactly at 2 points from critically low. But are in the Low Normal range. While I was injecting 140mg of Test Cyp (weekly) from November 2021 to February 2022... you'd figure the Hematocrit and Hemoglobin would be astronomically high? For some reason the opposite was occurring.. The blood work in February 2022 showed 46% and 16.7. Rather normal. In fact, it was the lowest ever while being on TRT. Testosterone levels were around 1200 and High Free Testosterone. What exactly was going on?? I asked the same question.

My Hematologist couldn't believe the lab reports. He quickly said you have to be bleeding internally somewhere. He said do you have bloody stools? I said no. Even though the labs were very odd... he said... well I'll leave everything up to your Endocrinologist. See me in 6 months. I said really? Wow. Like, that's all you're going to do?

As the months have gone by... I never figured out why my RBC was normal without donating?? Like... it was very low. Some people have told me... it's because your Iron is low. That's why you aren't gaining RBC's like you normally would. Again... I don't know what to believe?

I had my August 2022 lab tests... and my Hematocrit and Hemoglobin are HIGH again... this time with Low Iron and Low Ferritin. I automatically reduced my injection amount to 90mg a week. My Testosterone Level is around 720. To be honest with you... I'm slower in my decision making. Not quick witted with ideas... just a fraction of a second off with a lot of things. I don't like this feeling. It's not normal for me.

So, what is my next step? I can't donate blood because I simply won't be well enough to recover from the donation with low iron. I can't really go any lower with my Test Cyp injections. I'm already barely functioning My body simply won't gain iron anymore. My Endocrinologist keeps telling me to DONATE!!! I said I can't donate... I don't even feel well right now... but you want me to donate???

Has anyone ever been in this situation? Is there any other way to maintain Testosterone levels while having low iron... without increasing Hematocrit and Hemoglobin levels?

 

[FunkOdyssey]

In your shoes, I would do the following:

1. Reduce testosterone dosage (you've done this already)
2. Increase injection frequency
3. Try naringin supplement assuming no contraindicated drug interactions
4. Increase consumption of iron-rich foods and/or take iron supplements

 

[Systemlord]

If I remember correctly there's a type of iron that goes directly to building up your ferritin.

 

[Stpfan]

I appreciate the posts fellas. Yes, I've tried to do frequent injections... small dosages everyday. I feel like sh##. I tried every day for a few weeks. I tried every other day for a few weeks. Doesn't change the way I feel. Every 3rd day seems to be the best choice. But again... I just feel "mentally" awful at times. Just comes out of nowhere. Anxiety. Lethargy. Loss of confidence.

I'm really upset at my Endocrinologist. I already made an appointment for a new Endo... But I can't see him for about 3 months from now. I'll see my current Endo 1 more time in about 2-3 weeks from now... but if he doesn't listen... I'm done.

My PCP is absolutely worthless... every condition I have... she says it's from your TRT and have your Endo look into it. Every problem I have that I explain to my Endo he says... have your PCP take care of it. I relay this back to my PCP and tell her... my Endo said it's ok for you to handle it... she says... I don't want to get involved. It's an absolute merry go round of sh##.

Here's what I do know from being on TRT for 3 years....

1. Systemlord... I think you said this in quite a few threads before... watch your blood donations... sometimes the iron and ferritin levels just don't come back. After numerous lab testing... and donating about 9 pints of blood in about 558 days... after my last donation in October 2021... my levels were never restored. I finally feel a little bit better... not dizzy anymore... levels are still near low normal... it took about 8 months after the last donation... to feel somewhat normal. Why all of a sudden my body doesn't want to restore anything??? I have no idea. My PCP did prescribe Iron Pills back in March 2022... but I didn't take any... I'm nervous. I've heard a lot of negatives.

2. After donating all this blood... I have severe itching all over my body. Scalp... to toes... there's like a heat sensation that comes over my body... and I have to start itching everywhere. As fast as it comes... it goes away. I blame it on nutrients lost from all the blood donations. Trying to figure out what vitamins and or minerals to take... to reverse these issues?

3. Even though I'm on T4 25mcg for the last 3 years for my thyroid... the first 2 months being on T4... was absolutely amazing. I felt like a "new me"... plenty of energy. After those first 2 months... ever since... I would say a form of lethargy. I think about telling my Endo to get me off this stuff. I don't think it's working anymore. TSH score being on 25mcg is about 2.20-2.45. Endo says it's perfect. Before the 25mcg T4 it was around 4.40-4.75.

I was on Anavar about 10mg every 24 hours... you feel an amazing mental alertness... and a pep in your step. It totally wrecked my Cholesterol ratio. In August 2022 the ratio was 8.1 (Standard Range 1.8 - 4.9) Before Anavar... my Cholesterol ratio was 3.7 (Standard Range 1.8 - 4.9). And my diet was absolutely the same.

For my entire life... my HDL has always been low... August 2021 37 and August 2022 21 (on Anavar). How do you raise HDL? It's never been normal.

Regardless... just throwing things out there. So people can read... possibly learn from my mistakes. Life isn't fun being on TRT. It's almost like I feel I'm destined to die. I've always been a non-smoker... I drink alcohol like twice a year. No drugs... other than steroids when I was younger.

I remember being low on Testosterone 3 years ago... and yes... that feeling sucked. But as of right now... you're just existing.. don't really have the "mental" alertness and desire as I once did. It's sad.

 

[Systemlord]

TSH score being on 25mcg is about 2.20-2.45. Endo says it's perfect.

You can’t optimize thyroid treatment only testing TSH! You have to test the active fT3 hormone to see how much thyroid hormone is getting into the cells.

The median TSH is <1.5.

A lot of doctors are brain dead when it comes to TRT, so don’t expect them to have answers for you. There are a lot of doctors out there that want nothing to do with TRT.

You’re never gonna feel good unless you get your iron levels up.

Don’t give up!

 

[Nelson Vergel]

Some good info here:

High Hematocrit Caused by TRT: How to Lower and Manage it​

Consistent high hematocrit, low ferritin​

Solution to infamous high HCT low ferritin dilemma​

How much reduction in hematocrit would be expected with a blood donation???​

 

[Stpfan]

Thanks for the posts fellas. Been very depressed lately. Had a phone consultation with my Endocrinologist on Thursday November 17. He says he doesn't want to prescribe me any Test Cyp anymore. My irons levels are low. He said he is concerned.

Wants me to start taking Clomid I believe he said 1 pill a day. He did not tell me the milligrams... I'm supposed to pick up the prescription today.

Can anyone tell me any do's and dont's to this??? Positives and negatives? For some reason.... I feel this isn't going to work.

 

[Stpfan]

My doctor called in the prescription to the pharmacy... he wants me to take Clomid 50mg but break each pill in halves. 90 day supply 45 pills. And it's not covered under my insurance. What a joke right? How is this going to help? My doctor left his office for the day. Will try to follow up with him tomorrow. Its funny... I did blood work in August. He prescribes Test Cyp as normal in September. Then, I have a phone appointment with him 2 days ago... and he says your Hemoglobin is HIGH... we have to get you off of Test Cyp. Does the guy even know what he's doing? He just went through my labs in August and wrote the prescription for Test Cyp in September (as usual). But changes his mind in November... reading the same labs from August? lol

 

[Stpfan]

Spoke to my Endocrinologist earlier today. I said I don't understand why are we changing the TRT protocol on a whim? You claim my Hematocrit and Hemoglobin are HIGH but it's always been high for 3 years. Considering high points... this isn't the highest it's ever been. A few fraction points just above Normal High. I don't understand why you are doing this? He said go and donate blood. I said my last donation my iron levels haven't recovered and you keep telling me this is a PCP issue... but my PCP tells me this is your issue. Why aren't you trying to restore my Iron levels? He said because it isn't my issue.

I said ok. What is the game plan? He said since you don't want to take the Clomid... I'm advising you no Test Cyp for 1 month and see if the Hematocrit and Hemoglobin levels come down on their own.

LOL Is this guy for real? This is some Twilight Zone sh## right here. I seriously don't know how this doctor got his degree. How does any doctor leave their patient "stranded."

 

[gallant]

Normal High may just be your new normal and it might stay there without going dangerously high. I stopped giving blood 6 months ago due to low ferritin and I seem to staying right there at High Normal without creeping higher. I'll keep monitoring but for now no worries.

 

[Systemlord]

I'm advising you no Test Cyp for 1 month and see if the Hematocrit and Hemoglobin levels come down on their own.

LOL Is this guy for real? This is some Twilight Zone sh## right here. I seriously don't know how this doctor got his degree. How does any doctor leave their patient "stranded."

Unfortunately you don’t have to have critical thinking and analytical thought processes to practice medicine.

Your doctor just wants his ass covered, stranded and hypogonadal is preferred to the high hematocrit.

 

[Keepfit1]

I've been on TRT for about 3 years now. I've been taking 140mg of Test Cyp (weekly) for a very long time. I was donating blood rather consistently during those 3 years. Oddly enough during my last blood donation around October 2021 I haven't recovered. Both Iron and Ferritin sit exactly at 2 points from critically low. But are in the Low Normal range. While I was injecting 140mg of Test Cyp (weekly) from November 2021 to February 2022... you'd figure the Hematocrit and Hemoglobin would be astronomically high? For some reason the opposite was occurring.. The blood work in February 2022 showed 46% and 16.7. Rather normal. In fact, it was the lowest ever while being on TRT. Testosterone levels were around 1200 and High Free Testosterone. What exactly was going on?? I asked the same question.

My Hematologist couldn't believe the lab reports. He quickly said you have to be bleeding internally somewhere. He said do you have bloody stools? I said no. Even though the labs were very odd... he said... well I'll leave everything up to your Endocrinologist. See me in 6 months. I said really? Wow. Like, that's all you're going to do?

As the months have gone by... I never figured out why my RBC was normal without donating?? Like... it was very low. Some people have told me... it's because your Iron is low. That's why you aren't gaining RBC's like you normally would. Again... I don't know what to believe?

I had my August 2022 lab tests... and my Hematocrit and Hemoglobin are HIGH again... this time with Low Iron and Low Ferritin. I automatically reduced my injection amount to 90mg a week. My Testosterone Level is around 720. To be honest with you... I'm slower in my decision making. Not quick witted with ideas... just a fraction of a second off with a lot of things. I don't like this feeling. It's not normal for me.

So, what is my next step? I can't donate blood because I simply won't be well enough to recover from the donation with low iron. I can't really go any lower with my Test Cyp injections. I'm already barely functioning My body simply won't gain iron anymore. My Endocrinologist keeps telling me to DONATE!!! I said I can't donate... I don't even feel well right now... but you want me to donate???

Has anyone ever been in this situation? Is there any other way to maintain Testosterone levels while having low iron... without increasing Hematocrit and Hemoglobin levels?

Has any of your docs tested you for Polycythaemia Vera(PV)(Primary). I have it and when diag Hct and HGB high but ferritin at 30, I hadnt been donating blood. I note you itch after donating, this can be a symptom of low iron but itching , usually after a shower can also be a symptom of PV. They can do a Jack2 test which is positive in 95% of those with PV but you can be Jack2 positive and not have PV. You probably dont have PV but maybe worth checking with a haem, its bread and butter job for them.

 

[Stpfan]

Has any of your docs tested you for Polycythaemia Vera(PV)(Primary). I have it and when diag Hct and HGB high but ferritin at 30, I hadnt been donating blood. I note you itch after donating, this can be a symptom of low iron but itching , usually after a shower can also be a symptom of PV. They can do a Jack2 test which is positive in 95% of those with PV but you can be Jack2 positive and not have PV. You probably dont have PV but maybe worth checking with a haem, its bread and butter job for them.

I haven't been tested for Polycythaemia Vera (PV). I have been tested for JAK2 (V617F) if that's what you meant for Jack2? And that was tested on 5/5/20 and came back negative.

I'm all out of answers in regards to regaining my energy back. I would go to the Red Cross and donate right now if I felt my body could recover. My body is telling me I wouldn't be able to recover. The itching has increased... tops of my hands (which is very weird)... ankles... upper back... scalp. Doctors have basically told me... the tiredness is simply getting up in age... well... I'm 45... and I never knew 45 was getting up in age.

 

[Systemlord]

Doctors have basically told me... the tiredness is simply getting up in age... well... I'm 45...

This is medical gaslighting and it’s very common.

So all 45 year old men should feel tired? What about Dwayne Johnson at 50, is he tired?

I’m 50 and have the energy of a 25 year old, go to the gym twice a day.

 

[Stpfan]

This is medical gaslighting and it’s very common.

So all 45 year old men should feel tired? What about Dwayne Johnson at 50, is he tired?

I’m 50 and have the energy of a 25 year old, go to the gym twice a day.

I'm happy to hear that you have that energy System! I miss those days. I've been doing my best trying to study if this is a thyroid issue? Like... t3 and reverse t3 etc. I've even been thinking to get off the small t4 medication of 25 mcg a day. Like maybe it's doing other negative things to me? I don't know? I even had a PCP tell me.. "This is all in your head."

Here are the complete facts

1. If I go to the gym... after my workout... the recovery time is literally 3-4 days until I feel somewhat "normal." Which shouldn't happen. It's an odd/sickness feeling that is hard to describe. The tiredness is so overwhelming from a mental standpoint... its night and day with my thought process. So I decide not to workout. I can function a lot better without working out. Which isn't healthy.

2. Been having constant eye itching lately. Or eye irritation. Never had eye issues in my life. Not allergic to anything.

3. The body itching starts up out of nowhere.... and as quickly as it comes... it goes away. This started probably around November 2021. I don't know what's causing it.

Mixing Nandrolone does stimulate my mind more... makes me more energetic. The issue is... hard to sleep at night. Been off of it for about 10 months now. Even the smallest dose around 50mg a week makes my eyeballs feel wired. You never reach a full deep sleep.

I was thinking am I deficient with minerals? Should I be taking a mineral supplement? And when you mind fu## this constantly... it becomes a total nuisance. Because really... we don't know if I'm even looking in the right place or not? That's why I just leave it alone... life will be life.