Ferritin Levels beyond low...

Hey guys,

I've been on TRT for about three years now and all of a sudden my ferritin is very low. I've noticed that in the last six months, my energy level is also very low. I also give blood every two months. I'm curious to know why all of a sudden my ferritin is so low. I do 120mg of Test Cyp. every week (Everyday injections of 20mg).

I have partial lab results back so I don't know what my Test levels are at, but I'm concerned about my ferritin and my cholesterol (which has always been high and I'm not in bad shape). And I didn't fast before the blood test if that makes a difference in levels.

Should I be on some iron supplement and how much should I take for it being so low?
Any recommendations on brand of supplement?
And should I stop giving blood?

I would appreciate any help!

wig surf said:

I'm curious to know why all of a sudden my ferritin is so low.

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wig surf said:

I also give blood every two months.

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^^^ That's why your ferritin is low, iron is blood, you're bleeding out iron/blood every two months!

There are all sorts of metabolic abnormalities with low iron/ferritin.

wig surf said:

And should I stop giving blood?

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You need to find another solution. No one knows at what level of hematocrit is dangerous. The guidelines say the cutoff is 54%, labs ranges are as follows, 49, 50, 51 and 52%.

If your lab ranges are 50%, and you're at 51%, go to another lab company with a 52% cutoff and now you're in range.

With a secondary erythrocytosis there is an increase in blood volume which enlarges the vascular bed, decreases peripheral resistance and increases cardiac output. Therefore, in a secondary erythrocytosis optimal oxygen transport with increased blood volume occurs at a higher hematocrit value than with a normal blood volume. A moderate increase in hematocrit may be beneficial despite the increased viscosity.

There are over 80 million people that live higher than 2,500 meters and they develop a secondary erythrocytosis. Men in parts of Bolivia for instance have a normal range of HCT from 45-61%. These men are not at an increased risk of thrombotic events nor do they have to undergo phlebotomies to manage their hematocrit.

Now for my next question, doctors often mismanage hematocrit for levels slightly over the ranges which is completely unnecessary, unless you're symptomatic as a result of higher hematocrit.

At what level of hematocrit did you or your doctor start blood donations?

For those with unmanageable secondary erythrocytosis or high hematocrit on TRT, the newer oral testosterone undecanoate, Jatenzo, Orlando, Kyzatrex are recommended because in the clinical trials, there were no cases of secondary erythrocytosis due to the PK profiles and shorter half lives of these newer oral testosterone undecanoate.

Systemlord said:

^^^ That's why your ferritin is low, iron is blood, you're bleeding out iron/blood every two months!

There are all sorts of metabolic abnormalities with low iron/ferritin.


You need to find another solution. No one knows at what level of hematocrit is dangerous. The guidelines say the cutoff is 54%, labs ranges are as follows, 49, 50, 51 and 52%.

If your lab ranges are 50%, and you're at 51%, go to another lab company with a 52% cutoff and now you're in range.

With a secondary erythrocytosis there is an increase in blood volume which enlarges the vascular bed, decreases peripheral resistance and increases cardiac output. Therefore, in a secondary erythrocytosis optimal oxygen transport with increased blood volume occurs at a higher hematocrit value than with a normal blood volume. A moderate increase in hematocrit may be beneficial despite the increased viscosity.

There are over 80 million people that live higher than 2,500 meters and they develop a secondary erythrocytosis. Men in parts of Bolivia for instance have a normal range of HCT from 45-61%. These men are not at an increased risk of thrombotic events nor do they have to undergo phlebotomies to manage their hematocrit.

Now for my next question, doctors often mismanage hematocrit for levels slightly over the ranges which is completely unnecessary, unless you're symptomatic as a result of higher hematocrit.

At what level of hematocrit did you or your doctor start blood donations?

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I don't know what my hematocrit was when I started donating blood. I just canceled my blood donations, so I'll start there until my next blood workup in six months. Thank you!!

@wig surf Do you have labs before starting TRT? Iron saturation? You may have genetic factors with HFe gene that is contributing also. TRT can push up lipids, iron and lower ferritin.

wig surf said:

Hey guys,

I've been on TRT for about three years now and all of a sudden my ferritin is very low.

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Not sure why nobody directed you to what people normally use.

FDV70 said:

Not sure why nobody directed you to what people normally use.

Fixing High Hemoglobin or Hematocrit and Low Ferritin While on TRT

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Hey, man. I have been trying to reply in the other thread, but my browser is acting weird and I can't seem to reply. Yes, I have seen your protocol. I have to read it again (there is a lot there), but it appears the actual protocol is straight forward.

Maybe it's on your page (I have to read it again), but what can you tell me about symptom resolution that may occur with your protocol? It appears that it works to correct lab values, but can you give any anecdotes about guys who have noticed low ferritin symptoms resolve after your protocol? And, how long can you expect the corrected labs values and/or the subjective improvement to last?

Sorry to OP for hijacking and sorry to @FDV70 if this is answered on your website. I will review closer.

Fortunate said:

Hey, man. I have been trying to reply in the other thread, but my browser is acting weird and I can't seem to reply. Yes, I have seen your protocol. I have to read it again (there is a lot there), but it appears the actual protocol is straight forward.

Maybe it's on your page (I have to read it again), but what can you tell me about symptom resolution that may occur with your protocol? It appears that it works to correct lab values, but can you give any anecdotes about guys who have noticed low ferritin symptoms resolve after your protocol? And, how long can you expect the corrected labs values and/or the subjective improvement to last?

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The explanation is one I always left off of my page actually because I just wanted how to raise without anyone getting bogged down. Like for example, restless leg is a known issue with low ferritin. But it can come from other things too. So my page was always "here's a how-to if you wanna." It also tends to avoid the Morley Robbins crowd who try to debate. I do not agree with Robbins, and if I put symptoms or numbers on things I run the risk of getting "actually the issue is copper." (Wouldn't you know, I started to get that anyway, so I now have a blurb addressing that.)

The major symptoms I would see would be easy exhaustion. Like "I need a nap at 3pm" even when well slept. Also for some guys, a sense of warped reality. Hard to explain, but like you question your own interpretations of events, like the world you experience isn't quite real. Maybe just 'warped reality' is the best way to put it. This is like single digits of ferritin.

The exhaustion is one that kept appearing everywhere in men with low ferritin, and here's the thing -- we are all on TRT as well as tons of supplements. We are literally the very men who typically do not have ANY nutrition deficiencies. Vits D and B12? Got them covered. Sleep apnea? Treated. And we're the ones who do peptides for this, that, and every other thing, because once you start injecting T, you tend to start optimizing everything else. And being on TRT, well that addresses a ton of issues. So why are so many long term users dragging so often? Well, I noted one remedy was consuming iron. And it works, except H&H go right up. But the iron part was pretty apparently effective. I was just the first guy to dive into "what if we use OUR OWN recycled RBC iron?" In order to do that I had to figure out how to force the drainplugs closed and keep iron out of hemoglobin. A ton of reading later, here we are.

There are two types of ferritin, heavy chain and light chain. The liver and spleen together hold about 85% of the body's ferritin. But the other organs have ferritin as well, of both types, including brain, lungs, even genitals. It stands to reason that when you deplete circulating serum ferritin and prevent new ferritin from building (low hepcidin), you will feel this depletion systemically.

Once ferritin is raised, the issue becomes how to maintain. My elevated ferritin lasts about one month. I just run my protocol again. I have a few guys who take 5mg of iron every day. I can't really say what the right answer is on that one. In fact, I don't even have a good explanation for why ferritin stay up even two weeks. From what I see on paper, it makes sense that it would drop within days, but it doesn't.

FDV70 said:

The explanation is one I always left off of my page actually because I just wanted how to raise without anyone getting bogged down. Like for example, restless leg is a known issue with low ferritin. But it can come from other things too. So my page was always "here's a how-to if you wanna." It also tends to avoid the Morley Robbins crowd who try to debate. I do not agree with Robbins, and if I put symptoms or numbers on things I run the risk of getting "actually the issue is copper." (Wouldn't you know, I started to get that anyway, so I now have a blurb addressing that.)

The major symptoms I would see would be easy exhaustion. Like "I need a nap at 3pm" even when well slept. Also for some guys, a sense of warped reality. Hard to explain, but like you question your own interpretations of events, like the world you experience isn't quite real. Maybe just 'warped reality' is the best way to put it. This is like single digits of ferritin.

The exhaustion is one that kept appearing everywhere in men with low ferritin, and here's the thing -- we are all on TRT as well as tons of supplements. We are literally the very men who typically do not have ANY nutrition deficiencies. Vits D and B12? Got them covered. Sleep apnea? Treated. And we're the ones who do peptides for this, that, and every other thing, because once you start injecting T, you tend to start optimizing everything else. And being on TRT, well that addresses a ton of issues. So why are so many long term users dragging so often? Well, I noted one remedy was consuming iron. And it works, except H&H go right up. But the iron part was pretty apparently effective. I was just the first guy to dive into "what if we use OUR OWN recycled RBC iron?" In order to do that I had to figure out how to force the drainplugs closed and keep iron out of hemoglobin. A ton of reading later, here we are.

There are two types of ferritin, heavy chain and light chain. The liver and spleen together hold about 85% of the body's ferritin. But the other organs have ferritin as well, of both types, including brain, lungs, even genitals. It stands to reason that when you deplete circulating serum ferritin and prevent new ferritin from building (low hepcidin), you will feel this depletion systemically.

Once ferritin is raised, the issue becomes how to maintain. My elevated ferritin lasts about one month. I just run my protocol again. I have a few guys who take 5mg of iron every day. I can't really say what the right answer is on that one. In fact, I don't even have a good explanation for why ferritin stay up even two weeks. From what I see on paper, it makes sense that it would drop within days, but it doesn't.

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This is really good information. At the end of the day, we are all here to address unwanted symptoms, and it sounds like your protocol does that.

By the way, your efforts are admirable. You put a lot of energy into learning the nuances of iron metabolism and could have kept that information for your own benefit. Instead, you decided to share it with all of us, so we can all benefit from your efforts.

I noticed on your page that you specifically call out Natesto and cream as TRT options that are not likely to impact ferritin levels. Have you found this observation to be consistent? I have used primarily Natesto, cream and Xyosted. Unfortunately, I never checked ferritin levels while on Natesto or cream. While I have felt a tad under treated on Natesto, I did not usually experience the daily, recurrent fatigue that I have had on Xyosted.

In the past year, I have used mostly cream or Xyosted for long stretches. Labs pulled on both show that cream gets my T levels a lot higher than Xyosted. Despite this, my Hgb was always in normal range on cream, but elevated on Xyosted. The only ferritin level I have was taken while on Xyosted (level was around 30). I got it to investigate chronic fatigue. However, I also experienced fatigue while on cream about a year ago. Caveat: I also had just started an SSRI, which I strongly suspect may have caused some of the fatigue. That's the part I am currently trying to answer.

I find it interesting that, despite lower T levels, injections raise my Hgb/Hct more than cream. I know I am not the only one to observe this. I think most feel that it is the periodicity to the cream that allows your body to maintain a more normal homeostasis. Even though injections don't push levels nearly as high as cream for me, just having some testosterone "down time" allows the body to function closer to its natural state, I suppose.

What I am trying to determine: If I go back to cream and let my iron metabolism reset itself, while my ferritin normalize, thereby addressing my chronic, daily fatigue? I don't know, but that is what I plan to try to answer by switching back to cream for a while. I decided to go this route and re-check labs in a month or so. I will try to report back here.

Short version of the question: In your observational experience, is cream significantly less likely to impact ferritin like injections?