Solution to infamous high HCT low ferritin dilemma

[sifter]

Feeling great. No symptoms I'm aware of.

Just a heads-up to those guys who have tested very low on their Ferritin-
My functional doc discovered I had low ferritin (11) a number of years ago, and I was having minor gut issues at the time. She was looking for the root cause since the low ferritin in an adult male was unusual. The possible causes she considered included internal bleeding, Celiac disease, others. She zeroed in on Celiac after more diagnosis. I am a skeptic generally, and my fitness level and health caused me to discard this diagnosis ("this is bs.... there is no way I am celiac...") . The antibody test was positive...then the biopsy was positive and it was impossible to refute...
Just saying- malabsorption (from Celiac) will cause low ferritin. Certainly donating blood will whack your Ferritin temporarily, but if it does not recover, you should consider other causes-

 

[Gman86]

Feeling great. No symptoms I'm aware of.

Would be very interested to see ur current ferritin level. When was the last time u had it tested?

 

[lowtdunce]

Would be very interested to see ur current ferritin level. When was the last time u had it tested?

Probably late 2017.

 

[Gman86]

Probably late 2017.

U ever plan on checking it just out of curiosity?

 

[lowtdunce]

Might, but probably not unless I develop some symptom thats warrants looking further. After my first year on TRT I'm so done with stressing over every little number and just happy to be feeling good.. and for a quite a long stretch now.

 

[Gman86]

Might, but probably not unless I develop some symptom thats warrants looking further. After my first year on TRT I'm so done with stressing over every little number and just happy to be feeling good.. and for a quite a long stretch now.

Totally agree. If ur not curious, then I don’t see any reason to check it, if u feel good. Might be good to know where it is while u feel so good, just for future reference, but other than that there’s really no reason to bother.

 

[Buff56]

I experienced an elevated Hb level and my doc prescribed a therapeutic phlebotomy course of weekly donations until my Hb dropped to 15.5. Subsequent blood tests indicated a ferritin level of 12. Thus my trip to receive an endoscopy/colonoscopy for possible internal bleeding which was negative. My hematologist told me to quit the TRT. The middle finger was soon presented. I researched and found several articles and podcasts regarding iron and TRT By James Cambell. Here is the link to one of the articles:

Why You Need to Take Care of Hemoglobin and Hematocrit Levels While on TOT | Jay Campbell

If you use the search function and search ”phlebotomy” more articles were show up.

I have decided to keep my TRT protocol and deal with the high Hb. There are indigenous people in Nepal that have Hb levels in the 20’s and don’t experience any blood-related complications. I also take low level iron supplements.

Enjoy!

 

[Gman86]

I experienced an elevated Hb level and my doc prescribed a therapeutic phlebotomy course of weekly donations until my Hb dropped to 15.5. Subsequent blood tests indicated a ferritin level of 12. Thus my trip to receive an endoscopy/colonoscopy for possible internal bleeding which was negative. My hematologist told me to quit the TRT. The middle finger was soon presented. I researched and found several articles and podcasts regarding iron and TRT By James Cambell. Here is the link to one of the articles:

Why You Need to Take Care of Hemoglobin and Hematocrit Levels While on TOT | Jay Campbell

If you use the search function and search ”phlebotomy” more articles were show up.

I have decided to keep my TRT protocol and deal with the high Hb. There are indigenous people in Nepal that have Hb levels in the 20’s and don’t experience any blood-related complications. I also take low level iron supplements.

Enjoy!

If ur looking to feel better about having slightly higher HGB and HCT levels, while on HRT, checkout Neil Rouzier talking about this topic on YouTube. You’ll sleep much better at night after listening to him. Here’s a quick synopsis of his views.

 

[M.J]

Here is a nice update !!!
I was feeling great HCT at 48, hemoglobin at 17.6 I was concerned about hemoglobin so I went to donate two days ago.
since I donated I couldn’t sleep Very well anymore I went back to iron+lysin+vitamin C.

I am thinking to stay on iron and donate again 3 month from now to get back to around 15 hemoglobin. Not sure what is the risk of high hemoglobin would like to keep it down.

 

[Gman86]

Here is a nice update !!!
I was feeling great HCT at 48, hemoglobin at 17.6 I was concerned about hemoglobin so I went to donate two days ago.
since I donated I couldn’t sleep Very well anymore I went back to iron+lysin+vitamin C.

I am thinking to stay on iron and donate again 3 month from now to get back to around 15 hemoglobin. Not sure what is the risk of high hemoglobin would like to keep it down.

Do u happen to know ur serum iron and ferritin levels?

Usually HCT is ur HGB multiplied times 3. Which for u before u donated would of been 52.8. Much higher than the 48 ur labs had u at. Wonder which is accurate.

If u feel great at a HGB of 17.6, why don’t u just stay around there? As long as ur platelets aren’t high, there’s no risk to having that level of HGB.

 

[M.J]

Do u happen to know ur serum iron and ferritin levels?

Usually HCT is ur HGB multiplied times 3. Which for u before u donated would of been 52.8. Much higher than the 48 ur labs had u at. Wonder which is accurate.

If u feel great at a HGB of 17.6, why don’t u just stay around there? As long as ur platelets aren’t high, there’s no risk to having that level of HGB.

I am sure hct is correct 48.
I was concerned about high hemoglobin that’s all. I am taking another lab measurements in two days to see my trough. Will do ferreting and complete blood again.

 

[Buff56]

If ur looking to feel better about having slightly higher HGB and HCT levels, while on HRT, checkout Neil Rouzier talking about this topic on YouTube. You’ll sleep much better at night after listening to him. Here’s a quick synopsis of his views.

Neal Rouzier is a game changer. His presentation at an anti-aging conference was the most influential in my decision to bypass phlebotomy. I emailed the organization that hosted the lecture for access to the slides of his presentation and they gave me his personal email address. I emailed him a brief background and asked for a copy of his presentation and his response was very condescending. Basically he told me, actually, here is his response:

Joe: You are tired because you are iron deficient due to the phlebotomies. The only way to fix that is to take iron or stop the phlebotomies. You cannot convince your PMD or hematologist and don't try to do so. You will have to change doctors and stop the phlebotomies. Or stop the testosterone. Good luck. Neal

Now...does that sound like a response from a doctor that is pro-TRT? His income comes mainly from teaching doctors the nuances of TRT. Needless to say he did not send me a copy of the presentation.

 

[Gman86]

Neal Rouzier is a game changer. His presentation at an anti-aging conference was the most influential in my decision to bypass phlebotomy. I emailed the organization that hosted the lecture for access to the slides of his presentation and they gave me his personal email address. I emailed him a brief background and asked for a copy of his presentation and his response was very condescending. Basically he told me, actually, here is his response:

Joe: You are tired because you are iron deficient due to the phlebotomies. The only way to fix that is to take iron or stop the phlebotomies. You cannot convince your PMD or hematologist and don't try to do so. You will have to change doctors and stop the phlebotomies. Or stop the testosterone. Good luck. Neal

Now...does that sound like a response from a doctor that is pro-TRT? His income comes mainly from teaching doctors the nuances of TRT. Needless to say he did not send me a copy of the presentation.

I wouldn’t take it personal. That’s just his personality. He’s definitely pro TRT. He’s just very direct. U either not worry about E2 or ur an idiot. U either not worry about high HCT or ur an idiot. There’s no wiggle room with him. Idk how to put it. But u can just tell from listening to him talk that u either listen to what he says or ur an idiot lol. There’s no inbetween with him. I wouldn’t expect anything less from him than what he wrote in that email lol.

 

[SkyWarn]

I dropped my T dose to 14mg EOD and my HCT stays around 51 and HGB 18
almost 2 years since last donation.
I am perplexed why HGB is 18 with a HCT of 51 honestly.

 

[Gman86]

I dropped my T dose to 14mg EOD and my HCT stays around 51 and HGB 18
almost 2 years since last donation.
I am perplexed why HGB is 18 with a HCT of 51 honestly.

Ya usually the multiplying HGB by 3 trick to get HCT is pretty accurate, but guess that’s not always the case.

Have u had ur ferritin and serum iron levels checked recently? How u feeling overall?

 

[SkyWarn]

Ya usually the multiplying HGB by 3 trick to get HCT is pretty accurate, but guess that’s not always the case.

Have u had ur ferritin and serum iron levels checked recently? How u feeling overall?

Yes my Ferritin is in the 20s. Still low. When I was donating every 3 months it dropped to 0. I feel fine.

 

[Dr Justin Saya MD]

I dropped my T dose to 14mg EOD and my HCT stays around 51 and HGB 18
almost 2 years since last donation.
I am perplexed why HGB is 18 with a HCT of 51 honestly.

I would suspect this apparent discrepancy could be reconciled with the explanation that your MCV (mean corpuscular volume = “average size of RBCs”) is likely on the lower/smaller side...I would guess low to mid 80s. This smaller size means the RBCs essentially “take up less space” in the blood...the hematocrit is a measure of the solid fraction of blood (vs liquid fraction).

 

[SkyWarn]

I would suspect this apparent discrepancy could be reconciled with the explanation that your MCV (mean corpuscular volume = “average size of RBCs”) is likely on the lower/smaller side...I would guess low to mid 80s. This smaller size means the RBCs essentially “take up less space” in the blood...the hematocrit is a measure of the solid fraction of blood (vs liquid fraction).

You got me thinking so I went and looked it up:
MCV 90.3. Range 80.0-100.0 fL

 

[Dr Justin Saya MD]

You got me thinking so I went and looked it up:
MCV 90.3. Range 80.0-100.0 fL

I would have suspected lower, as in most cases this explains the discrepancy. Nonetheless, not high. I would expect you’ll run 80-90 range on MCV consistently.

 

[Gman86]

@Dr Justin Saya MD Just curious, for urself, or anyone else, what is ur preferred ferritin range, if u have one.