I’m in a similar position: on TRT with high-normal hgb (16.4), high-normal hct (50), and low ferritin (25). I’m not willing to donate blood because I don’t want to further lower my ferritin. That said, from my perspective the only real downside of these numbers is that I’m not able to take an SGLT2i because I don’t want to raise my hct any further.
Also I think there may be (off-label) pharmaceutical solutions to this issue in the future. For instance, Rusfertide, a hepcidin mimetic for treating polycythemia vera, significantly improved hct control in a phase III trial: https://www.sciencedirect.com/science/article/pii/S2531137925007242
Wow. My ferritin is 20 - I thought I was the lowest on this site! Even Dr. Greger thinks anything below 12-15 is really too low, and he’s a pretty extreme iron skeptic. You have some odd nephrologists. I don’t have any overt side effects, although my mild intermittent RLS may be related, and the rest of my bloodwork seems unaffected, but I’ve been mulling over the best way to raise it at least to 30-50 or so, perhaps starting with some lactoferrin supplements.
FWIW, if you have gout - my uric acid serum levels were knocked pretty low - 3.0 mg/dL - by empagliflozin 25mg/day, below reference range (3.8 - 8.4). Are you on an SGLT2i? Generally those drugs are considered reno protective, unless your GFR is very low (though there have been encouraging results even in dialysis patients). If you’re not on one, and it’s not contraindicated in your case, I’d seriously consider something like empagliflozin for multiple benefits.
I did take one of the flozin drugs, but it resulted in dehydration, even with increased water consumption. I’m happy with the febuxostat, which lowered my uric acid level from 7 to 4.
Yes, I have some odd nephrologists. I’d switch locations, but I don’t drive, and the hospital is only a few blocks away.
My conclusion is that the TRT (and exercise) is driving up use of iron in blood cells which causes my Hemocrit to get high and my ferritin to get low. Donating whole blood to get Hemocrit down works but keeps driving ferritin down. So I’ve had to almost stop blood donation for anything but Hemocrit management and start taking iron supplements to keep from dropping ferritin too low. I’m also now using a lower TRT dose (200 —> 160 per week) and 3x/week injection frequency to keep the side effects (Hemocrit, estrogen, DHT) to a minimum.
Hormone replacement is very complicated. I wouldn’t recommend doing it without a good doctor’s help. An online TRT clinic would not have worked out well for me.
I think it is less complicated if you first start on HCG so your own body starts making it as opposed to exogenous substances/sources which tend to screw up a whole lot of other markers/factors. Just saying,
[Benefits : hCG can lead to a 49.9% increase in testosterone levels, improved libido, energy levels, and ED symptoms. It also helps maintain testicular testosterone, which is important for sperm synthesis and prevents testicular atrophy. ]
Oh sure. Try it. See if it works for you. I see TRT as a tool of last resort. But when you need it get it. My total testosterone was between 180-300 (free was close to zero) for 4 years despite trying everything I could. Perhaps I waited too long but by the time I decided I was being stupid about refusing augmentation I was ready for a solution now rather than a “step in the right direction” (a 50% improvement wasn’t going to do it).
I am very happy with the results I’ve obtained from TRT. My earlier comments were only to warn that it is the most complicated medical intervention I have ever initiated. And I have to give myself an injection 3 times per week. But now I am back to my younger self: recover from hard exercise, sleep, daily sex, etc.
Well, my free T is a bit low at 76 but my total seems ok at 550 (though I’d prefer 700-850), so I’m giving the hCG a try hoping to up them both by about 30-40%. Will measure in couple months to see if it has done anything, but damn that TRT thing is tempting. Every dude I ever discuss it with says same as you, that their youthful years are back. The only thing that bugs me about it is the fact that I’d have to probably do it for life, plus I damn hate IM needling (don’t mind subq, but I think Testosterone can only be administered IM).
Really? I wasn’t aware. @Joseph_Lavelle are you hearing @austin242 about subq as being the best method for TRT? What do you (and others in here) do and say?
p.s. oh i just realized that subq is probably impossible because T is oil based and as such is too thick for 30–31-gauge needles?
I have heard that subcutaneous fat injections are less painful but you must do more injections. Daily in the morning would be best to mimic natural. I am satisfied so far with quad injections 3x/week. I use a very small needle; it is mostly painless. Mostly. Pain helps with the placebo effect. So I got that going for me.
Cost is another factor. I spend $30 per month without insurance. Very low cost.
Subq is usually done more frequently because it’s harder to get a steady release (less blood flow than IM). Plus a bigger dose can lead to lumps. If pain is the only issue, use a smaller gauge IM (and push in the needle very slowly is 85% effective for eliminating pain in my experience). If a more steady chemical availability is the goal, then daily is the best. There is a service available that sells a subq system (like a pen) for daily injections. ($$$). I find it hard enough to measure out ⅓ of 100ml. 1/7 of 100ml is slicing a thin piece of cheese. Maybe a more dilute product would be easier to manage for daily injections.
Don’t think that’s true re subq requiring more frequent dosing to maintain steady levels. If anything the opposite is true: Subq absorption is slower and smoother which can actually produce more stable levels, not less. In any case this isn’t the place to argue this point so happy to let it be