[Please note that full labs are at the end of this lengthy introduction]
First of all, thanks to everyone here for the tremendous amount of information regarding HRT. The stickies
were of invaluable help to get me on the right path.
I do have an issue that I would like to get some comments on regarding low ferritin levels with high
hematocrit levels.
I have been on HRT for almost a year now and started with compounded cream. After switching last fall from
compounded creams to 100 mg/week of Test Cyp my hematocrit shot up and my ferritin levels (always on the low
side) dropped significantly.
The cream at 30mg/day was not increasing my T levels. The compounding pharmacy was claiming an absorption
rate of 50% but I sure was not seeing results and they decided I was a non-absorber. I started Test Cyp
injections of 100mg/week divided into two 50mg SubQ injections along with 0.25mg of Anastrozole EOD in
September 2013. I use a 0.5 inch 30 gauge insulin syringe.
The lab tests immediately prior to switching from the 30mg/day of compounded cream to the 100mg/week Test Cyp
were Total T 325 ng/dl, Free T 6.1 pg/ml, Iron Serum 103 ug/dl, RBC 5.43, Hematocrit 45.7% and Ferritin 81
ng/ml.
My blood test in December 2013 (three months after starting the Test Cyp injections) showed Total T (1361
ng/dl), Free T (34.3 pg/ml), Hematocrit (51.4%), Iron Serum (171 ug/dl) & RBC (6.09) all high out of range.
Ferritin was low out of range at 23 ng/ml.
The doctor lowered my Test Cyp to 80mg/week (twice a week SubQ at 40mg each) and sent me to donate blood.
Subsequent blood tests since donating blood (shown below) show that ferritin is still low out of range and
hematocrit is creeping back up.
I do not want to stop HRT with the Test Cyp as I am feeling better than I have for twenty years or more. The
cream was just not working for me. I feel very good on the current protocol with my Free and Total
Testosterone in the upper third of the range and E2 at 20.
It appears that I am on a path to donating blood every month or so in order to keep my hematocrit levels
within range. The Test Cyp seems to be driving my iron levels up in my blood.
However, how do I keep donating blood and still maintain my ferritin levels at an acceptable level? My
ferritin levels are now low out of range and how do I build my iron stores while donating blood?
It may be difficult to balance the two competing constraints as donating one pint of blood dropped my
ferritin from 23 ng/ml (30-400) to 14 ng/ml.
I am meeting with my doctor next week to discuss, but one way forward that comes to mind is to start iron
supplementation to see if I can get my ferritin levels stabilized within range while monitoring hemoglobin
with a home tester and going in for a phlebotomy every time its above 17 or so.
The only way other than a blood donation to decrease hematocrit that I found was a suggestion to eat a
grapefruit a day. I am not sure how credible that is but I have started to eat a whole grapefruit daily.
Looking back over the last five years of labs, my ferritin has always been in the 50 to 90 ng/ml range. All of
the other iron markers have been in the mid ranges. I do eat red meat and eggs daily. My total cholesterol
has always been in the 130 to 150 mg/dl range all of my life no matter what I eat. The first thing my current
doctor told me was to get my cholesterol levels up.
I had a colonoscopy three years ago with nothing found. Fecal blood test was negative. Doctor thinks that I
may have a leaky gut and placed me on a Paleo diet with no dairy or wheat.
Body temperatures consistently get close to 98.6 Fahrenheit in the afternoon.
Background:
After years of feeling tired and my doctor saying my testosterone levels were in range (as low as 2.83
ng/ml [range of 2.80-8.0] at age 44), I finally found an experienced hormonal doctor in December 2012.
After spending 30 minutes reviewing my last ten years of lab results, the new doctor offered to start me on
HRT immediately. The doctor said that my cholesterol was too low and was concerned about a high Free T3 test
from November 2009 (5.08 pg/mL range 1.5-4.1).
She told me to eat a Paleo type diet with no dairy. I eat eggs/bacon 6 days a week and meat daily. My
cholesterol has ranged between 130 to 160 no matter what I eat. My blood pressure is almost always 118 over 68.
She was also concerned about potential adrenal fatigue, referred me to Wilsons book and added a cortisol
test to the labs.
I do wish that I had read this site prior to starting HRT and skipped the cream trials.
I use iodized salt on everything and crave salt constantly. There is no iodine in my multi vitamins, but I do
take 1mg of Iodine daily.
Oral temperatures are consistently near 98.5 Fahrenheit in the afternoon.
After reading some of the threads, I am now concerned about a couple of car accidents. I had one severe
accident back when I was 23 (knocked unconscious). Within 3 months of the accident I started putting on
weight going from 140lbs to 185lbs, mainly around my abdomen. It was like someone threw a switch on my
metabolism, going from eating 4 meals a day to maintain 140lbs to having a hard time keeping my weight under
170lbs. Coincidental? I am able now to maintain a body weight of 160lbs by cutting out all wheat products
and sugar sweetened drinks. I did check my prolactin in my December 2013 labs and it came back 7.8 ng/ml
(4.0-15.2). My doctor was not concerned but Iâ??m thinking about getting an MRI of my pituitary. Immediately
prior to the car accident and weight gain I also spent time in Africa and Southeast Asia.
-age: 54, white male
-height: 5 feet 8 inches
-waist: 39 inches
-weight: 160lbs
-describe body and facial hair: Thick, full head of hair. Fairly hairy body; can easily grow beard
-describe where you carry fat and how changed: Fat carried primarily in abdomen. Pot belly that just wonâ??t go
away.
-health conditions, symptoms [history]: fatigued and feeling somewhat blue for last 8 years. My skin is
very dry and has been for years. This has changed for the better since starting the Test Cyp injections.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever - No hair loss or prostate drugs ever.
Current Daily Supplements: 50mg DHEA, Dr. Wilsonâ??s Super Adrenal Stress Formula multivitamin (no iodine),
Natural Creations Nutriplenish GL multivitamin. (no iodine), D3 oil caps (5,000 iu), ZMA, fish oil (1,200mg),
time released melatonin (3mg), Vitamin C (1,000mg) and Iodine (1mg). I also have a multi-year use history
of triamcinolone acetonide cream (.1%).
I totally wrecked my sleep with 17 years of rotating shiftwork (shiftwork ending 1997) and the melatonin
seems to be very helpful in maintaining good sleep patterns.
-describe diet [some create substantial damage with starvation diets]: Paleo for last year. I eat eggs and
bacon 6 days per week. I have craved salt as far back as I can remember. Gave up bread and wheat in 2012.
-describe training [some ruin their hormones by over training]: bicycle and some weights.
-testes ache, ever, with a fever? - No
-how have morning wood and nocturnal erections changed: Same
Lab prior to starting HRT and all labs after starting injections of Test Cyp are below in reverse
chronological order.
Result Order: Lab Test, Units, out of range if applicable, range
Labcorp labs taken March 19, 2014 (8 weeks after blood donation)
HRT protocol: 80mg/week Test C divided into two 40mg injections Monday & Wednesday, blood draw was 48 hours
after Test C injection, 0.25mg Anastrozole EOD
Comments: Ferritin still low out of range, one point higher from previous lab; Bun/Creatinine ratio low out
of range; RBC high out of range; Hematocrit and Hemoglobin increasing from prior labs
LDH 180 IU/L 0-225
Alkaline Phosphatase, S 51 IU/L (39-117)
Bilirubin, Total 0.4 mg/dL (0.0-1.2)
A/G Ratio 1.9 (1.1-2.5)
Globulin, Total 2.5 g/dL (1.5-4.5)
Albumin, Serum 4.7 g/dL (3.5-5.5)
Protein, Total, Serum 7.2 g/dL (6.0-8.5)
Phosphorus, Serum 3.1 mg/dL (2.5-4.5)
Calcium, Serum 9.6 mg/dL (8.7-10.2)
Carbon Dioxide, Total 26 mmol/L (19-28)
Chloride, Serum 102 mmol/L (97-108)
Potassium, Serum 4.9 mmol/L (3.5-5.2)
Sodium, Serum 139 mmol/L (134-144)
BUN/Creatinine Ratio 8 Low (9-20)
eGFR If Africn Am 86 mL/min/1.73 (>59)
eGFR If NonAfricn Am 74 mL/min/1.73 (>59)
Creatinine, Serum 1.12 mg/dL (0.76-1.27)
BUN 9 mg/dL (6-24)
Uric Acid, Serum 5.4 mg/dL (3.7-8.6)
Glucose, Serum 86 mg/dL (65-99)
Immature Granulocytes 0 % (0-2)
Baso (Absolute) 0.0 x10E3/uL (0.0-0.2)
Eos (Absolute) 0.3 x10E3/uL (0.0-0.4)
Monocytes (Absolute) 0.5 x10E3/uL (0.1-0.9)
Lymphs (Absolute) 2.1 x10E3/uL (0.7-3.1)
Neutrophils (Absolute) 2.7 x10E3/uL (1.4-7.0)
Basos 1 % (0-3)
Eos 4 % (0-5)
Monocytes 9 % (4-12)
Lymphs 38 % (14-46)
Neutrophils 48 % (40-74)
Platelets 375 x10E3/uL (155-379)
RDW 14.8 % (12.3-15.4)
MCHC 34.4 g/dL (31.5-35.7)
MCH 28.6 pg (26.6-33.0)
MCV 83 fL (79-97)
Hematocrit 50.0 % (37.5-51.0)
Hemoglobin 17.2 g/dL (12.6-17.7)
RBC 6.01 High x10E6/uL (4.14-5.80)
WBC 5.6 x10E3/uL (3.4-10.8)
Estimated CHD Risk < 0.5 times avg. (0.0-1.0)
T. Chol/HDL Ratio 3.1 ratio units 0.0-5.0
LDL Cholesterol Calc 94 mg/dL (0-99)
VLDL Cholesterol Cal 15 mg/dL (5-40)
HDL Cholesterol 51 mg/dL (>39)
Triglycerides 76 mg/dL (0-149)
Cholesterol, Total 160 mg/dL (100-199)
Iron, Serum 69 ug/dL (40-155)
AST (SGOT) 21 IU/L (0-40)
ALT (SGPT) 20 IU/L (0-44)
Prostate Specific Ag, Serum 0.9 ng/mL (0.0-4.0)
Estradiol 20.6 pg/mL (7.6-42.6)
DHEA-Sulfate 212.2 ug/dL (71.6-375.4)
Free Testosterone (Direct) 17.9 pg/mL (7.2-24.0)
Testosterone, Serum 859 ng/dL (348-1197)
Folate (Folic Acid), Serum 17.7 ng/mL (>3.0)
Vitamin B12 629 pg/mL (211-946) 78-61068-0
Iron Saturation 17 % (15-55)
UIBC 333 ug/dL (150-375)
Iron Bind.Cap. (TIBC) 402 ug/dL (250-450) -60068-0
Immature Grans (Abs) 0.0 x10E3/uL (0.0-0.1)
Ferritin, Serum 15 Low ng/mL (30-400)
Reticulocyte Count 1.0 % (0.6-2.6)
Labcorp labs taken February 6, 2014 (3 weeks after blood donation)
HRT protocol: Test C decreased on Jan 6th from 100mg total per week to 80mg/week Test C divided into two
40mg injections Monday & Wednesday, blood draw was 48 hours after Test C injection, 0.25mg Anastrozole EOD
Comments: Bun/Creatinine ratio low out of range; Ferritin low out of range; LDL cholesterol high out of
range; Hematocrit, Hemoglobin & RBC decreased from prior labs
LDH 173 IU/L (0-225)
Alkaline Phosphatase, S 55 IU/L (39-117)
Bilirubin, Total 0.6 mg/dL (0.0-1.2)
A/G Ratio 1.9 (1.1-2.5)
Globulin, Total 2.4 g/dL (1.5-4.5)
Albumin, Serum 4.5 g/dL (3.5-5.5)
Protein, Total, Serum 6.9 g/dL (6.0-8.5)
Phosphorus, Serum 3.2 mg/dL (2.5-4.5)
Calcium, Serum 9.2 mg/dL (8.7-10.2)
Carbon Dioxide, Total 24 mmol/L (19-28)
Chloride, Serum 100 mmol/L (97-108)
Potassium, Serum 4.6 mmol/L (3.5-5.2)
Sodium, Serum 140 mmol/L (134-144)
BUN/Creatinine Ratio 5 Low (9-20)
eGFR If Africn Am 88 mL/min/1.73 (>59)
eGFR If NonAfricn Am 76 mL/min/1.73 (>59)
Creatinine, Serum 1.10 mg/dL (0.76-1.27)
BUN 6 mg/dL (6-24)
Uric Acid, Serum 5.8 mg/dL (3.7-8.6)
Glucose, Serum 81 mg/dL (65-99)
Estimated CHD Risk < 0.5 times avg. (0.0-1.0)
T. Chol/HDL Ratio 3.1 ratio units (0.0-5.0)
LDL Cholesterol Calc 101 High mg/dL (0-99)
VLDL Cholesterol Cal 14 mg/dL (5-40)
HDL Cholesterol 56 mg/dL (>39)
Triglycerides 71 mg/dL (0-149)
Cholesterol, Total 171 mg/dL (100-199)
Iron, Serum 94 ug/dL (40-155)
ALT (SGPT) 24 IU/L (0-44)
AST (SGOT) 25 IU/L (0-40)
Immature Granulocytes 0 % (0-2)
Baso (Absolute) 0.0 x10E3/uL (0.0-0.2)
Eos (Absolute) 0.2 x10E3/uL (0.0-0.4)
Monocytes (Absolute) 0.5 x10E3/uL (0.1-0.9)
Lymphs (Absolute) 2.2 x10E3/uL (0.7-3.1)
Neutrophils (Absolute) 3.3 x10E3/uL (1.4-7.0)
Basos 0 % (0-3)
Eos 3 % (0-5)
Monocytes 8 % (4-12)
Lymphs 36 % (14-46)
Neutrophils 53 % (40-74)
Platelets 333 x10E3/uL (155-379)
RDW 14.0 % (12.3-15.4)
MCHC 34.1 g/dL (31.5-35.7)
MCH 28.6 pg (26.6-33.0)
MCV 84 fL (79-97)
Hematocrit 47.8 % (37.5-51.0)
Hemoglobin 16.3 g/dL (12.6-17.7)
RBC 5.70 x10E6/uL (4.14-5.80)
WBC 6.3 x10E3/uL (3.4-10.8)
Reticulocyte Count 0.9 % (0.6-2.6)
Ferritin, Serum 14 Low ng/mL (30-400)
Folate (Folic Acid), Serum 18.5 ng/mL (>3.0)
Vitamin B12 659 pg/mL (211-946)
Iron Saturation 24 % (15-55)
UIBC 301 ug/dL (150-375)
Iron Bind.Cap. (TIBC) 395 ug/dL (250-450)
Immature Grans (Abs) 0.0 x10E3/uL (0.0-0.1)
Labcorp labs taken December 11, 2013 (3 months after switch from 30mg/day of compounded cream to 100mg/week
of Test Cyp)
HRT protocol: 100mg/week Test C divided into two 50mg injections Monday & Wednesday, blood draw 48 hours
after Test C injection, 0.25mg Anastrozole EOD
Comments: Total T, Free T, Hematocrit, Iron Serum & RBC all high out of range. Ferritin low out of range.
Doctor decreased Test C to 80mg per week total and sent me to blood donation.
LDH 172 IU/L (0-225)
Alkaline Phosphatase, S 58 IU/L (39-117)
Bilirubin, Total 0.6 mg/dL (0.0-1.2)
A/G Ratio 1.5 (1.1-2.5)
Globulin, Total 2.8 g/dL (1.5-4.5)
Albumin, Serum 4.3 g/dL (3.5-5.5)
Protein, Total, Serum 7.1 g/dL (6.0-8.5)
Phosphorus, Serum 3.6 mg/dL (2.5-4.5)
Calcium, Serum 9.5 mg/dL (8.7-10.2)
Carbon Dioxide, Total 25 mmol/L (19-28)
Chloride, Serum 101 mmol/L (97-108)
Potassium, Serum 4.7 mmol/L (3.5-5.2)
Sodium, Serum 138 mmol/L (134-144)
BUN/Creatinine Ratio 9 (9-20)
eGFR If Africn Am 88 mL/min/1.73 (>59)
eGFR If NonAfricn Am 76 mL/min/1.73 (>59)
Creatinine, Serum 1.10 mg/dL (0.76-1.27)
BUN 10 mg/dL (6-24)
Uric Acid, Serum 6.5 mg/dL (3.7-8.6)
Glucose, Serum 74 mg/dL (65-99)
Immature Granulocytes 0 % (0-2)
Baso (Absolute) 0.0 x10E3/uL (0.0-0.2)
Eos (Absolute) 0.3 x10E3/uL (0.0-0.4)
Monocytes (Absolute) 0.5 x10E3/uL (0.1-0.9)
Lymphs (Absolute) 2.1 x10E3/uL (0.7-3.1)
Neutrophils (Absolute) 3.6 x10E3/uL (1.4-7.0)
Basos 1 % (0-3)
Eos 4 % (0-5)
Monocytes 8 % (4-12)
Lymphs 32 % (14-46)
Neutrophils 55 % (40-74)
Platelets 367 x10E3/uL (155-379)
RDW 13.5 % (12.3-15.4)
MCHC 34.0 g/dL (31.5-35.7)
MCH 28.7 pg (26.6-33.0)
MCV 84 fL (79-97)
Hematocrit 51.4 High % (37.5-51.0)
Hemoglobin 17.5 g/dL (12.6-17.7)
RBC 6.09 High x10E6/uL (4.14-5.80)
WBC 6.6 x10E3/uL (3.4-10.8)
Estimated CHD Risk 0.5 times avg. (0.0-1.0)
T. Chol/HDL Ratio 3.4 ratio units (0.0-5.0)
LDL Cholesterol Calc 97 mg/dL (0-99)
VLDL Cholesterol Cal 18 mg/dL (5-40)
HDL Cholesterol 47 mg/dL (>39)
Triglycerides 90 mg/dL (0-149)
Cholesterol, Total 162 mg/dL (100-199)
Iron, Serum 171 High ug/dL (40-155)
ALT (SGPT) 25 IU/L (0-44)
AST (SGOT) 27 IU/L (0-40)
Triiodothyronine, Free, Serum 4.1 pg/mL (2.0-4.4)
Ferritin, Serum 23 Low ng/mL (30-400)
Prostate Specific Ag, Serum 0.9 ng/mL (0.0-4.0)
Estradiol 28.9 pg/mL (7.6-42.6)
Prolactin 7.8 ng/mL (4.0-15.2)
TSH 1.830 uIU/mL (0.450-4.500)
DHEA-Sulfate 243.9 ug/dL (71.6-375.4)
Hemoglobin A1c 5.3 % (4.8-5.6)
Dihydrotestosterone 77 ng/dL (30 â?? 85)
Pregnenolone, MS 14 ng/dL (<151)
Free Testosterone (Direct) 34.3 High pg/mL (7.2-24.0)
Testosterone, Serum 1361 High ng/dL (348-1197)
Immature Grans (Abs) 0.0 x10E3/uL (0.0-0.1)
Quest labs (blood) and Diagnos-Tech (saliva) taken January 1, 2013 (most immediate labs prior to beginning
HRT in February 2013)
HRT protocol: None
Comments: After these results my Doctor started me on 20mg/day compounded Test cream, multi-vitamin, vitamin
C, vitamin D, b12 and 50mg/day of DHEA
Total Testosterone 357 ng/dl (250-1100)
Free Testosterone 53 pg/ml (35-155)
FSH 4.8 mIU/ml (1.6-8.0)
LH 1.9 mIU/ml (1.5-9.3)
Estradiol 20 pg/ml (<39)
Vitamin D, 25-OH, Total 57 ng/ml (30-100)
Vitamin B12 622 pg/ml (200-1100)
DHEA-S 100 mcg/dl (25-240)
Thyroglobulin Antibodies <20 IU/ml (<20)
Thyroid Peroxidase Antibodies 10 IU/ml (<35)
Free T3 3.5 pg/ml (2.3-4.2)
Free T4 1.2 ng/ml (0.8-1.8)
Ferritin 65 ng/ml (20-380)
Cortisol 8am 24 nM (13-24)
Cortisol Noon 3 nM (3.0-8.0)
Cortisol 10pm 2 nM (1.0-4.0)
Cortisol Load 38 nM (22-46)
Milk Ab. SigA negative
Soy Ab. SigA negative
Egg Ab. SigA negative
Gliadin Ab. SigA 7-negative U/ml (>15)
Total Salivary SigA 6-depressed mg/dl (25-60)