Warning for Men on TRT: Low Ferritin is Bad

Fortunate said:

So, I went down a massive ferritin wormhole today and ended up here. I have been thumbing through the discussion only to learn we don't have a lot of definitive guidance here!

I have been battling fatigue for about a year. Have been working on systematically eliminating various medications I thought could be causing it (beta blockers, migraine prevention meds, etc). TRT numbers are perfectly in range. I did a bunch of labs, including some iron studies. My TRT doc didn't say much, because everything was "normal", including HGB and HCT. But, I just looked back at them and my ferritin of 30 (very low end of "normal") caught my eye, thus leading me to the wormhole.

I literally have many of the classic symptoms of iron deficiency without anemia (fatigue, poor mood, restless leg - rarely, some pain, etc) and I really wonder if my ferritin is the issue.

So far, it seems like there is some consensus on a few things. I'd love for others to help me summarize what we know, what we think we know and what we don't know.

Off the top of my head:

• There are a few theories on why testosterone treatment lowers ferritin, but the connection is pretty clear and well recognized
• Quitting TRT will raise your ferritin
• Lowering your dose might raise your ferritin
• There is debate about whether the form of TRT matters (ie injecting vs. cream)
  • Why would the form of TRT matter? Is the mechanism for dropping ferritin related to your levels, regardless of how you get there? Or, are sustained high levels more important than absolute numbers?
    • @Systemlord feels strongly that Jatenzo won't drop your ferritin. Why is that? Periodic drops in levels versus sustained high levels? If this is true, shouldn't cream be ferritin friendly? Seems like some here have low ferritin on cream, too. I never checked ferritin while on Natesto, but I would venture to guess it was normal. That said, I think Natesto left my testosterone levels a bit low, which also leads to fatigue
• It's really hard to balance raising ferritin without raising Hct
• Taking vitamin C may or may not help raise ferritin
• What seems pretty consistent is that guys who check ferritin and notice it's low tend to feel shitty. Seems like some guys drop TRT doses, or entirely drop TRT, ferritin goes up and they actually feel better than when on TRT
  • if I'm wrong, please chime in

I am trying to crystalize what we think we know about this issue. Please feel free to correct, add or subtract anything to this list.

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Only gonna chime in on the whole raising ferritin while having to worry about hct/ hgb levels thing. The reason people struggle with that whole thing, is because they thing they have to worry about hct and hgb, when they don’t. Yes, hgb and hct will most likely go up, if ur consuming/ supplementing with more iron, to get ferritin levels up. Guys see this as a problem, when it’s just a normal process of the body, not a problem. Yes, if hct gets above say 55%, I would probably start actively trying to lower it, but most likely guys will be fine even with a 55-57% hct level. Just to err on the side of caution, however, I would recommend that guys start looking into lowering it a bit, if they do see their hct level get to around 55%, to above. But the first thing guys think of, in regards to lowering it, is to donate blood. When the first thing they should be doing is trying to figure out how to be better hydrated. A guy can lower their hct level multiple points, simply by being better hydrated. Being better hydrated can also lower hgb levels, as well as their RBC level.

My point is, that anytime guys get stuck in the loop of raising iron/ ferritin levels, then donating blood because their hct went up, thus lowering their ferritin/ iron levels, they’re simply doing it wrong. The way to do it is, increase ferritin/ iron levels, if that’s the goal, and don’t worry/ fear certain HCT levels as much/ decrease HCT levels via improving hydration status, over donating blood. It’s literally that simple

I believe anyone concerned about ferritin and iron levels should know their genetic composition regarding HFe gene. The variants or combination of, may lead one down the wrong path. For now, I've stopped TRT since I discovered being compound heterozygous for C282Y/H63D. Ferritin levels went down to 12 while iron sat rose above 300 at one point. Now I'm at 51 and 202 since stopping. Be mindful of your makeup!

Gman86 said:

My point is, that anytime guys get stuck in the loop of raising iron/ ferritin levels,

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Your HCT should not have gone up more than one point on my protocol in a typical 7 day run. How much did yours go up?

DorianGray said:

I believe anyone concerned about ferritin and iron levels should know their genetic composition regarding HFe gene. The variants or combination of, may lead one down the wrong path. For now, I've stopped TRT since I discovered being compound heterozygous for C282Y/H63D. Ferritin levels went down to 12 while iron sat rose above 300 at one point. Now I'm at 51 and 202 since stopping. Be mindful of your makeup!

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Agreed. My ferritin on TRT last year was 124 but I didn't pay attention, yet everyone on TRT/androgens should pay attention if its > 120. Now I'm 6 months off TRT and my ferritin came back 390 and transferrin saturation at 52% so both above range. Glad I came off as was having other symptoms which now I'm sure wasn't even TRT related. Has any damage been done to any of the organs and how was/is your symptoms if I may ask?

Belekas said:

I've chatted with Fred Vorck a bit in his FB "Iron Disorder" group as he seems really good at this as well and also Kyle Van.ous and hope no organs have been damaged while this issue was persistent.

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BTW thanks for the mention! Here's the link for others. We specialize in TRT and all things blood. We have a lot of info on disorders most notably the two major forms of hemochromatosis as well, C282Y and H63D.

FDV70 said:

BTW thanks for the mention! Here's the link for others. We specialize in TRT and all things blood. We have a lot of info on disorders most notably the two major forms of hemochromatosis as well, C282Y and H63D.

https://www.********.com/groups/591473358577668

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Didn't know you was here lol You're welcome. Glad to have such smart men among us.

Belekas said:

Agreed. My ferritin on TRT last year was 124 but I didn't pay attention, yet everyone on TRT/androgens should pay attention if its > 120. Now I'm 6 months off TRT and my ferritin came back 390 and transferrin saturation at 52% so both above range. Glad I came off as was having other symptoms which now I'm sure wasn't even TRT related. Has any damage been done to any of the organs and how was/is your symptoms if I may ask?

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On TRT, I felt off, mildly like being disconnected from self. That has since gone away and I feel more like my one, familiar self again, however, tired lack of energy. I hope to improve that as iron levels normalize and I exercise more.

DorianGray said:

On TRT, I felt off, mildly like being disconnected from self. That has since gone away and I feel more like my one, familiar self again, however, tired lack of energy. I hope to improve that as iron levels normalize and I exercise more.

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Have you done abdomen ultrasound to see if any organ damage have been done due to HH?

Belekas said:

Have you done abdomen ultrasound to see if any organ damage have been done due to HH?

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Hematologist doesn't suspect any. One would have to do more like an MRI or biopsy to definitively diagnose.

DorianGray said:

Hematologist doesn't suspect any. One would have to do more like an MRI or biopsy to definitively diagnose.

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Yeah, i've read they do them all. Happy days then, enjoy the healing.

My ferratin is 6. Anyone know if hCG raises hematocrit as much as TRT?

billsman said:

My ferratin is 6. Anyone know if hCG raises hematocrit as much as TRT?

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Testosterone increases hematocrit not the hCG.

DorianGray said:

I believe anyone concerned about ferritin and iron levels should know their genetic composition regarding HFe gene. The variants or combination of, may lead one down the wrong path. For now, I've stopped TRT since I discovered being compound heterozygous for C282Y/H63D. Ferritin levels went down to 12 while iron sat rose above 300 at one point. Now I'm at 51 and 202 since stopping. Be mindful of your makeup!

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I think you are mixing up your levels your iron saturation was 300%? hmm

i forget which i think its the C282Y is the only really bad one around 1 in 5 people if not more are heterozygous for the h63D and (i could be mixing up which gene is worse), which means some people will have no issue and some people get elevated ferretin (but does not continue to rise lik ethe other gene). ferretin is just a marker and you need to look at other iron markers to know if there is any concern for alot of oxidative damage. as far as 300 ferritin levels thats pretty low and aslong as not getting worse some blood draws can get you to normal range.

at any rate, consult ur DR but they wont be too concerned over 300 ferritin as again a huge swath of america has the mutation you do. and infact they often are more concerned over saturation than ferritin as gives more perspective IIRC. 12% saturation is pretty low for a man. anyway, consult ur dr!

billsman said:

My ferratin is 6. Anyone know if hCG raises hematocrit as much as TRT?

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i know there is iron issues in pregnant ladies and correlated with HCG levels.

but as others said depends on how much your increasing your androgen levels(and likely ratios of other hormones) more than specific compounds.

Everyone who got raw DNA data run it through checkiron.com algorithm. Preferably from AncestryDNA as it tests more HH types compared to 23andMe. The guy who runs it also has a FB group and is very smart and helpful. Its more Haemochromatosis and inflamation related but I'm sure you will find useful data.

FDV70 said:

Considering it's been in use for several years in various FB groups and some reps at Matrix and Defy use it, I would consider my existing protocol to be definitive actually.

Did you not get good results on it?

Edit to add in case someone still hasn't heard of it

Fixing High Hemoglobin or Hematocrit and Low Ferritin While on TRT

vorck.com

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Hey, you and I had a conversation about this in another thread. I tried to find it, but can't quite locate it, so I figured I'd follow up here.

In the other thread, I had questions about whether or not your protocol relieves symptoms? You commented that, yes, many guys have gotten good symptom relief with your protocol. I tried the protocol and couldn't finish due to GI distress. I'd be willing to try it again, but would like to know what the bigger picture looks like.

Assuming one gets through the protocol, ferritin levels rise and symptoms improve, how long can this typically last, assuming you continue the underlying reason for reduced ferritin (in this case, TRT)? I assume there is no science on this, so I am just looking for anecdotes.

Thanks.

Fortunate said:

Assuming one gets through the protocol, ferritin levels rise and symptoms improve, how long can this typically last, assuming you continue the underlying reason for reduced ferritin (in this case, TRT)? I assume there is no science on this, so I am just looking for anecdotes.

Thanks.

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The worst case I have seen is someone dropping their ferritin within 2 weeks. The best was a few months. Almost nobody does second follow up testing after their protocol run. They usually do a ferritin test a few days afterward and then let it ride. I want to say when I did it a few times when I first created the protocol I kept my ferritin a few months, maybe 2 or 3. Mine dropped by 2 or 3 points per month on its own, no bloodletting. That was a TT of ~700ng/dL (160mg in 2 shots/wk FWIW). I need more Test now (60mg EOD) and am a bit higher (TT ~800ng/dL) and have not tested the effect of my higher TRT dose.

This is one of those things where no news is good news, guys tell me they want to run it a second time a week later, I say go for it, but I never heard back. I presume it works because people who write me are pretty vocal about failures and want to figure out why it didn't work, and I don't hear much about second run failures.

FDV70 said:

The worst case I have seen is someone dropping their ferritin within 2 weeks. The best was a few months. Almost nobody does second follow up testing after their protocol run. They usually do a ferritin test a few days afterward and then let it ride. I want to say when I did it a few times when I first created the protocol I kept my ferritin a few months, maybe 2 or 3. Mine dropped by 2 or 3 points per month on its own, no bloodletting. That was a TT of ~700ng/dL (160mg in 2 shots/wk FWIW). I need more Test now (60mg EOD) and am a bit higher (TT ~800ng/dL) and have not tested the effect of my higher TRT dose.

This is one of those things where no news is good news, guys tell me they want to run it a second time a week later, I say go for it, but I never heard back. I presume it works because people who write me are pretty vocal about failures and want to figure out why it didn't work, and I don't hear much about second run failures.

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I keep replying and for some reason, it won't post. My apologies if this is a repeat.

Great stuff. I have more to share but want to wait until I have more information.

Meanwhile, any advice on avoiding the GI distress? Does black, liquid sludge come to mind...?

Fortunate said:

I keep replying and for some reason, it won't post. My apologies if this is a repeat.

Great stuff. I have more to share but want to wait until I have more information.

Meanwhile, any advice on avoiding the GI distress? Does black, liquid sludge come to mind...?

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Our objective is merely to "trick" or trigger the body's natural iron overdose mechanism into releasing a massive amount of hepcidin for 7 days. In order to accomplish this, we overwhelm the intestines with iron.

Unfortunately, we need it all to sit there, triggering hepcidin release, not absorbing. Gut cells shed after about 3 days, absolutely loaded with unabsorbed iron (this is a good thing).

The only options are a probiotic or use of fiber pills (do NOT overdo it) to make life easier, but no matter what, that iron unfortunately has to pass the hard way.

FDV70 said:

Our objective is merely to "trick" or trigger the body's natural iron overdose mechanism into releasing a massive amount of hepcidin for 7 days. In order to accomplish this, we overwhelm the intestines with iron.

Unfortunately, we need it all to sit there, triggering hepcidin release, not absorbing. Gut cells shed after about 3 days, absolutely loaded with unabsorbed iron (this is a good thing).

The only options are a probiotic or use of fiber pills (do NOT overdo it) to make life easier, but no matter what, that iron unfortunately has to pass the hard way.

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Very well said.