Warning for Men on TRT: Low Ferritin is Bad

[Nelson Vergel]

Intravenous iron for the treatment of fatigue in nonanemic, premenopausal women with low serum ferritin concentration

Abstract. This is the first study to investigate the efficacy of intravenous iron in treating fatigue in nonanemic patients with low serum ferritin concent

ashpublications.org

This randomized, double-blinded, placebo-controlled study investigated for the first time the efficacy and safety of intravenous iron therapy in the treatment of fatigue in premenopausal nonanemic (hemoglobin ≥ 120 g/L) women with low serum ferritin concentration ( ≤ 50 ng/mL). A significant effect of iron (compared with placebo) on fatigue was observed exclusively in patients with substantially depleted iron stores, as indicated by a serum ferritin concentration ≤ 15 ng/mL at baseline. More than 80% of these patients reported improved fatigue 6 and 12 weeks after treatment initiation, as well as decreases in the severity of fatigue to less than half of the initial value at study completion. These are the first results providing evidence that intravenous supplementation of iron can improve fatigue symptoms in iron-deficient, nonanemic premenopausal women.

In the present study, serum ferritin concentration ≤ 15 ng/mL or transferrin saturation ≤ 20% (with serum ferritin concentration ≤ 50 ng/mL) were predictive for a significant benefit from intravenous iron therapy. Of these criteria, serum ferritin concentration ≤ 15 ng/mL is probably more suitable for use in general practice. However, the size of the study population does not allow definitive determination of a cutoff serum ferritin concentration below which patients benefit from iron therapy.

A total dose of 800 mg of intravenous iron administered over 2 weeks resulted in a marked increase in serum ferritin concentration (98 ng/mL), which indicated sufficient replenishment of body iron stores. Iron administration, however, did not influence hemoglobin concentration, which was in the normal range at baseline and remained constant during the observation period in both iron-treated and placebo-treated patients. Therefore, the fatigue-reducing effects of iron therapy reflect the nonhematological functions of iron. Iron is an essential component of a large number of human metabolic enzymes, including ribonucleotide reductase, NADH dehydrogenase, succinate dehydrogenase, and cytochrome c reductase/oxidase. These enzymes catalyze essential biochemical reactions such as the formation of deoxyribonucleotides and aerobic oxidation of carbohydrates and fatty acids in the mitochondrial citric acid cycle and the respiratory chain.

 

[Wolverine]

How do u feel having low iron levels compared to the high levels u have now?

Aside from ferritin levels, which is storage iron, your serum iron level is important. That raised also. Serum iron is the actual iron level in your blood. Better energy and strength. However, because of my higher hct from the higher iron levels and higher T levels from TRT, I have had some EQ issues, shortness of breath, elevated resting heart rate etc. I'm in the process of lower my T dosage and increasing frequency, and drinking lots of water to hopefully bring my hct levels down without having to donate blood. I'm also taking fish oil and daily aspirin to thin out my blood.

I have noticed via doing labs over the years that the lower my T level is the higher my serum iron is. My theory is that your body seeks homeostasis. The higher your T level the higher your red blood cells and hct. Your body senses this and since it cannot control the exogenous T, it lowers the serum iron (and keeps it in storage) to try to keep the red blood cells and HCT in check. Just a theory but my labs have seemed to indicate this.

 

[Nelson Vergel]

@Wolverine you are a wise man. After all these years, I learned what you mentioned just last week. I thought I knew all things TRT but iron homeostasis is a new subject matter for me. The more I dig into it, the more I realize this subject has not been discussed enough.
My fatigue is starting to lift and my hip pain is almost gone after months. I started iron and vitamin C just a week ago. I am glad I decided to check my ferritin even though I don’t ever need to do phlebotomies.
I am now obsessed with researching about hepcidin and testosterone. I am finding some good stuff and will be writing an article soon.

 

[Nelson Vergel]

High serum iron with low ferritin on TRT patients

I have posted this elsewhere but given Nelson created this forum to ask questions for specialists and I couldn’t find an answer elsewhere here we go. Myself like many other people on TRT have to donate blood in order to control hematocrit. A lot of times this might lead to low ferritin levels...

www.excelmale.com

@HealthMan has also been looking into this.

 

[fifty]

@Wolverine you are a wise man. After all these years, I learned what you mentioned just last week. I thought I knew all things TRT but iron homeostasis is a new subject matter for me. The more I dig into it, the more I realize this subject has not been discussed enough.
My fatigue is starting to lift and my hip pain is almost gone after months. I started iron and vitamin C just a week ago. I am glad I decided to check my ferritin even though I don’t ever need to do phlebotomies.
I am now obsessed with researching about hepcidin and testosterone. I am finding some good stuff and will be writing an article soon.

What iron tests do I care about? Just ferritin?

 

[Nelson Vergel]

What iron tests do I care about? Just ferritin?

I just created this panel below. I ran ferritin as part of this panel two weeks ago and it came back at 19. I will run this panel tomorrow to go deeper. I will post results.

History: TRT for over 34 years. Stable hematocrit of 49-51 for years with no blood donations. Fatigue in the past 6 months. Joint aches in the past 3 months. No inflammatory marker increases. Low ferritin detected. Supplementing with iron glycinate plus Vit C for the past week. Some symptom improvement but still no complete resolution.

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

Anemia Panel- 18 Tests

 

[VideoNo345]

Glad to see this thread come up. I ran into the same issues with extreme fatigue, headaches, and muscle weakness over the past few months. My regular doctor thought it was an electrolyte imbalance and didn't check my blood work, so I ended up paying out of pocket for one. I had low ferritin and iron and high binding capacity. My RBC was slightly elevated but my hematocrit was OK.

I dropped my test from 210mg/week to 160mg/week and I'm now taking Proferrin 2x a day along with vitamin c and am feeling much better. Hope I don't run into elevated hematocrit issues from the iron supplements.

 

[Wolverine]

@Wolverine you are a wise man. After all these years, I learned what you mentioned just last week. I thought I knew all things TRT but iron homeostasis is a new subject matter for me. The more I dig into it, the more I realize this subject has not been discussed enough.
My fatigue is starting to lift and my hip pain is almost gone after months. I started iron and vitamin C just a week ago. I am glad I decided to check my ferritin even though I don’t ever need to do phlebotomies.
I am now obsessed with researching about hepcidin and testosterone. I am finding some good stuff and will be writing an article soon.

Thanks Nelson for bringing light to this issue. Ferritin and serum iron are so important to overall well-being. TRT definitely affects these levels, either through the donation issue via high HCT or through increased HGB and HCT and the body's response to the same. Another issue that can cause low serum iron levels is chronic infection. Since most infections feed off iron, the body will keep serum iron levels low in an effort to fight the infection. If ferritin levels are good and yet serum iron levels are low, chronic infection may be another issue to look at. I look forward to your article.

 

[Wolverine]

Glad to see this thread come up. I ran into the same issues with extreme fatigue, headaches, and muscle weakness over the past few months. My regular doctor thought it was an electrolyte imbalance and didn't check my blood work, so I ended up paying out of pocket for one. I had low ferritin and iron and high binding capacity. My RBC was slightly elevated but my hematocrit was OK.

I dropped my test from 210mg/week to 160mg/week and I'm now taking Proferrin 2x a day along with vitamin c and am feeling much better. Hope I don't run into elevated hematocrit issues from the iron supplements.

210mg/week and even 160/week are hefty doses for TRT, although everyone is different and maybe you have high SHBG and thus a normal free T level at those doses. I'm down to 90mg/week in three equally divided doses 56 hours apart. My SHBG is in the 15-20 range normally.

 

[BuzzSaw]

Yeah, iron is interesting. You also want to look into how the body stops iron entering your body if you have certain diseases, or viruses, as iron can worsen disease/virus as they utilize iron (so become worse).

 

[Gman86]

Thanks Nelson for bringing light to this issue. Ferritin and serum iron are so important to overall well-being. TRT definitely affects these levels, either through the donation issue via high HCT or through increased HGB and HCT and the body's response to the same. Another issue that can cause low serum iron levels is chronic infection. Since most infections feed off iron, the body will keep serum iron levels low in an effort to fight the infection. If ferritin levels are good and yet serum iron levels are low, chronic infection may be another issue to look at. I look forward to your article.

Isn’t serum iron levels just a representation of what u’ve eating recently? Does it really tell u that much about ur overall iron status? Can’t u just avoid iron rich foods and make it low, or eat a bunch of iron rich foods and make it high?

 

[Wolverine]

Isn’t serum iron levels just a representation of what u’ve eating recently? Does it really tell u that much about ur overall iron status? Can’t u just avoid iron rich foods and make it low, or eat a bunch of iron rich foods and make it high?

Serum iron is the amount of iron (normally bound to transferrin) actually in your blood (mostly in HGB) that is utilized by the body. Ferritin is the iron storage that is released when needed. The body, seeking homeostasis regarding HGB and HCT, or fending off a virus or other disease that needs iron to survive, will regulate the amount of serum iron via hepcidin.

 

[VideoNo345]

210mg/week and even 160/week are hefty doses for TRT, although everyone is different and maybe you have high SHBG and thus a normal free T level at those doses. I'm down to 90mg/week in three equally divided doses 56 hours apart. My SHBG is in the 15-20 range normally.

Yes, I'm experimenting with lowering my overall dosage but increasing frequency of injections. My clinic had me on much too high of a dosage at 210mg/wk, plus 100mg/wk of nandrolone for awhile.

 

[DorianGray]

Glad I found this thread. My labs last week showed my Ferritin=9ng/mL. HCT=48.8. I was wondering why I had such fatigue, I've never, ever experienced before.

 

[Gman86]

Glad I found this thread. My labs last week showed my Ferritin=9ng/mL. HCT=48.8. I was wondering why I had such fatigue, I've never, ever experienced before.

How did it get so low? Donating too much?

 

[DorianGray]

How did it get so low? Donating too much?

I have no idea. But I need to address it I think. I've been only on TRT cream and HCG since May 16. I posted info and labs in another thread.

 

[Nelson Vergel]

 

[Nocalves]

Thanks Nelson for bringing light to this issue. Ferritin and serum iron are so important to overall well-being. TRT definitely affects these levels, either through the donation issue via high HCT or through increased HGB and HCT and the body's response to the same. Another issue that can cause low serum iron levels is chronic infection. Since most infections feed off iron, the body will keep serum iron levels low in an effort to fight the infection. If ferritin levels are good and yet serum iron levels are low, chronic infection may be another issue to look at. I look forward to your article.

I donate blood every 3 months because of high RBC and HGB. Now I find my ferritin is 52 ug/l but my iron is above range 36 umol/l and HGB and HTC is little bit above too.

Now I am confused... Am I iron deficient??

 

[Charliebizz]

I've been off and on trt a few times over the years. Off trt my ferritin runs about 150. Been on trt this run about a year it has dropped to 51. Would vitamin c be enough to boost the levels up to a more optimal level ?

 

[Vince]

How (I think) I was able to control my Hematocrit and High Iron

This is my experience after studying and dealing with high hematocrit due to TRT. It worked for me maybe it might work for others. Me like many users here had the problem of high hematocrit and the need for frequent blood donations and dealing with low ferritin. I tried everything and nothing...

www.excelmale.com