Low ferritin doesn't matter as long as hemoglobin and hematocrit are good?

[gallant]

Hello, I have been struggling with low ferritin and high hematocrit. I've searched and read through the subject matter here and elsewhere. Some folks elsewhere are saying that low ferritin is not an issue and should be of no concern as long as other blood markers such as hemoglobin and hematocrit are in range.
Gil T, who seems knowledgeable and is popular on YouTube promotes this. The theory is that Ferritin is just a storage account and it's the other markers that are the only concern for health and well being. I would certainly like this to be true as this would eliminate my worries.
My ferritin level is currently running around 25 with blood donations every 3 months. These people are saying DO NOT take an iron supplement to increase Ferritin as long as hematocrit is in range.

 

[FunkOdyssey]

Low ferritin is absolutely an issue. The term you want to google is "iron deficiency without anemia". A good paper on the topic and a graphic listing the clinical features are below.

Restricting your iron intake and suffering with iron deficiency is not the way you want to manage your hematocrit. Adjustment to your TRT protocol would make alot more sense. Naringin supplements may also help if you don't take drugs that interact with it.

Iron deficiency without anaemia: a diagnosis that matters

 

[Guided_by_Voices]

Low ferritin is absolutely an issue. The term you want to google is "iron deficiency without anemia". A good paper on the topic and a graphic listing the clinical features are below.

Restricting your iron intake and suffering with iron deficiency is not the way you want to manage your hematocrit. Adjustment to your TRT protocol would make alot more sense. Naringin supplements may also help if you don't take drugs that interact with it.

Iron deficiency without anaemia: a diagnosis that matters

View attachment 23695

What's your basis for equating low ferritin to low iron? My understanding is that Total Iron Binding Capacity (TIBC) is a better measure of iron status. That said, there are other threads here that suggest low ferritin may be an issue, but IIRC it is not the best measure of iron status.

 

[Systemlord]

The term you want to google is "iron deficiency without anemia". A good paper on the topic and a graphic listing the clinical features are below.

I was iron deficient with normal hemoglobin and hematocrit in 2019, and the symptoms were severe. I also had iron saturation at 14% 2 years earlier and 12% at the time of the diagnosis (ranges 20-50%).

Gil T, who seems knowledgeable and is popular on YouTube promotes this.

Gil T isn't a doctor, doesn't mean he's not knowledgeable, just saying. YouTube isn't always the best place for accurate information.

 

[FunkOdyssey]

What's your basis for equating low ferritin to low iron? My understanding is that Total Iron Binding Capacity (TIBC) is a better measure of iron status. That said, there are other threads here that suggest low ferritin may be an issue, but IIRC it is not the best measure of iron status.

From the paper I linked above:

Ferritin is an indicator of iron stores and is the most sensitive and specific biomarker for assessing ID. The WHO defines low ferritin as levels <15 μg/L for adults and <12 μg/L for children.6 However, in clinical practice, when ferritin levels dip below 30 μg/L, ID can be ascertained.7 Ferritin is an acute-phase reactant that is increased in serum during chronic inflammation. Cut-off values for ferritin in ID are increased to 100 μg/L in states of chronic inflammation. Transferrin saturation (TSAT) levels below 20% are also diagnostic of ID. In chronic inflammatory conditions when ferritin levels are 100–300 μg/L, TSAT should be used to diagnose ID.6,8 Serum iron levels fluctuate throughout the day and should not be used for diagnosis.9 Fig 1 proposes an algorithm for diagnosing ID based on the current literature.

 

[gallant]

Then we are faced on what to do about it. There is a popular thread here where they say to take 60mgs of Iron Bisglycinate Chelate 3 times a day after blood donation with the key factor being no vitamin c during this time. Others say take vitamin c with it. Is this the general consensus here?
I understand that lowering test dosage applies as well. Seems to be a common problem here with no real consensus from the varying threads I've read. Lots of anecdotes and N=1. I'm getting the same confusion from other resources as well. Perhaps it's a tricky issue.

 

[gallant]

After some more research I've found another variable that seems to come in to play. Some doctors are saying that yes low ferritin matters UNLESS total iron is in range. My total iron is 135 (range 50-180). If total iron is fine there is no need to be concerned about the low ferritin. What could you possibly do anyway? Taking an iron supplement would just drive up your total iron unacceptably. Any thoughts?

 

[FunkOdyssey]

After some more research I've found another variable that seems to come in to play. Some doctors are saying that yes low ferritin matters UNLESS total iron is in range. My total iron is 135 (range 50-180). If total iron is fine there is no need to be concerned about the low ferritin. What could you possibly do anyway? Taking an iron supplement would just drive up your total iron unacceptably. Any thoughts?

Papers I've seen say serum iron fluctuates throughout the day and isn't reliable for diagnosis. If you're skeptical of the low ferritin, check your transferrin saturation (TSAT). If that is also low, you definitely have iron deficiency regardless of what your serum iron is doing.

 

[gallant]

Papers I've seen say serum iron fluctuates throughout the day and isn't reliable for diagnosis. If you're skeptical of the low ferritin, check your transferrin saturation (TSAT). If that is also low, you definitely have iron deficiency regardless of what your serum iron is doing.

Thank you. TSAT is 26 (range 20-48). Looks like my iron pills will be going to the rear of the cupboard for now. Nelson has a recommended iron panel that has been extremely helpful in this regard that tests these different values. Will test again in a month.

Blood Donation Panel

Blood Donation Panel This panel is designed to determine if: 1- Your blood donation or therapeutic phlebotomy was effective in lowering your high hematocrit without negatively affecting ferritin or iron. 2- It is safe to do another blood donation or the

www.discountedlabs.com

 

[TorontoTRT]

First of all, do not take iron and vitamin c at the same time. It turns vitamin c into a pro oxidant. I’m not sure your 25 ferritin is of any concern. Most lab ranges consider 20 as the lower end. My ferritin before trt was like 125. For the last 4 years my ferritin fluctuates between 20-25. I donate twice a year. Only time to be concerned I guess is if your ferritin drops in the single digits. Testosterone works in such a way that it resets your normal values. These numbers are your new normal. Notice how no one is walking around with henaticrits over 60% on trt? Very very few. Same with ferritin on trt. Very very few with ferritin in the single digits. And those that do, are usually blood donation abusers.

 

[M.J]

My experience, low ferritin is a major issue,
When my ferritin is low when I sleep I wake in the middle of it and cant go back to sleep,
Recently I donated thinking my ferritin is fine now ,,,,,,,and again this waking up In The middle of night thing came back (less sever though cuz my ferritin. It very very low)
I checked my ferritin, Attached below I didnt think it can go that low from one donation.
From 59 (It should be even more cuz it was taking last feb) to 21 !!!!
Just one donation took my ferritin that low.
I am sure many with sleeping issue here are because of low ferritin nothing else.

The reason behind my donation is not high hematocrit cuz it was fine at 49.
The reason was high hemoglobin.

Bottom line here is you lose a lot of ferritin with donations, I think it’s a lot to a level you can’t keep up donating more than once a year.

@Nelson I think this loses in ferritin may interest you, I read somewhere you where asking about it (could be an old thread though)

 

[FunkOdyssey]

My experience, low ferritin is a major issue,
When my ferritin is low when I sleep I wake in the middle of it and cant go back to sleep,
Recently I donated thinking my ferritin is fine now ,,,,,,,and again this waking up In The middle of night thing came back (less sever though cuz my ferritin. It very very low)
I checked my ferritin, Attached below I didnt think it can go that low from one donation.
From 59 (It should be even more cuz it was taking last feb) to 21 !!!!
Just one donation took my ferritin that low.
I am sure many with sleeping issue here are because of low ferritin nothing else.

The balance of evidence I've seen definitely points to low ferritin being a major issue. You will see it stated in papers over and over again that values of 30 or below are associated with symptoms, and doctors with greater experience treating IDA often say that number can be higher than 30 depending on the individual (much like the Testosterone threshold for hypogonadal symptoms varies).

From personal experience, I can tell you my wife with a ferritin value of 30 was experiencing several IDA symptoms that have improved with iron supplementation.

To me, claims that there's nothing to worry about with low ferritin are another manifestation of broader efforts to dismiss side effects of TRT/TOT. I notice the same people saying high hematocrit is of no concern.

 

[M.J]

The balance of evidence I've seen definitely points to low ferritin being a major issue. You will see it stated in papers over and over again that values of 30 or below are associated with symptoms, and doctors with greater experience treating IDA often say that number can be higher than 30 depending on the individual (much like the Testosterone threshold for hypogonadal symptoms varies).

From personal experience, I can tell you my wife with a ferritin value of 30 was experiencing several IDA symptoms that have improved with iron supplementation.

To me, claims that there's nothing to worry about with low ferritin are another manifestation of broader efforts to dismiss side effects of TRT/TOT. I notice the same people saying high hematocrit is of no concern.

Not only sleeping issues, when it was around 10 I had bp problems.
I am stopping blood donations now that my hematocrit under control. I just hope hemoglobin don’t go up again. I have no idea why it did go up the first place. Maybe I was supplementing something that increased it.

 

[ajax31]

Can iron deficiency cause low aromatase levels? They fed mice a low iron diet (LFD) and then looked at various markers. The expression of CYP19A1 mRNA dropped significantly. CYP19A1 is part of the cytochrome P450 family and is responsible for making the aromatase enzyme.

Iron deficiency induces female infertile in order to failure of follicular development in mice - PMC

Iron is important for many cellular functions, including ATP synthesis and cell proliferation. Insufficient of iron in the diet causes iron deficiency anemia (IDA), which often occurs in people living in the world. Since 50% of women with IDA show ...

www.ncbi.nlm.nih.gov

 

[RN2PA0611]

My experience, low ferritin is a major issue,
When my ferritin is low when I sleep I wake in the middle of it and cant go back to sleep,
Recently I donated thinking my ferritin is fine now ,,,,,,,and again this waking up In The middle of night thing came back (less sever though cuz my ferritin. It very very low)
I checked my ferritin, Attached below I didnt think it can go that low from one donation.
From 59 (It should be even more cuz it was taking last feb) to 21 !!!!
Just one donation took my ferritin that low.
I am sure many with sleeping issue here are because of low ferritin nothing else.

The reason behind my donation is not high hematocrit cuz it was fine at 49.
The reason was high hemoglobin.

Bottom line here is you lose a lot of ferritin with donations, I think it’s a lot to a level you can’t keep up donating more than once a year.

@Nelson I think this loses in ferritin may interest you, I read somewhere you where asking about it (could be an old thread though)
View attachment 23772

Any other symptoms besides the poor sleep?

 

[M.J]

Any other symptoms besides the poor sleep?

You wake up around two hours from sleeping.
And if very low, it affects your blood pressure as I remember. Very dangerous.

 

[RN2PA0611]

You wake up around two hours from sleeping.
And if very low, it affects your blood pressure as I remember. Very dangerous.

Definitely had the insomnia thing happen. It's horrible. I find that if my T level is lower I'm just exhausted but can sleep the entire night. Wake up feeling exhausted tho.

 

[M.J]

Definitely had the insomnia thing happen. It's horrible. I find that if my T level is lower I'm just exhausted but can sleep the entire night. Wake up feeling exhausted tho.

Did you donate ? Are you on trt ?

 

[RN2PA0611]

Did you donate ? Are you on trt ?

Yes, too much and for no reason. TRT company urged me to donate. I donated every 8-10 weeks for the good part of 2 years. Yes, currently on/off TRT. Feel good for a bit then have to stop. I think I may have some malabsorption going on as well with my GI tract. Waiting on a referral for that. I didn't have issues with any anabolic steroids when in my 30s. So frustrating.

 

[M.J]

Yes, too much and for no reason. TRT company urged me to donate. I donated every 8-10 weeks for the good part of 2 years. Yes, currently on/off TRT. Feel good for a bit then have to stop. I think I may have some malabsorption going on as well with my GI tract. Waiting on a referral for that. I didn't have issues with any anabolic steroids when in my 30s. So frustrating.

Measure your ferritin, donating every 8 weeks is for sure not good at all.
Based on my experience once a year maybe twice max !!!

If ferritin is low you need to get it back up to have a good sleep. I am sure also can cause other serious health issues.