Adrenal, Thyroid, RBC Chaos after Blood Donation (with Labs)

I hope this is the right spot? Even if it is, I probably have too dadgum many moving pieces for anyone to make sense of it, but at least I have labs.

Trying to figure out how to get things back to a more normal state. Guys who donate blood, you know how you feel in the hours right after you do double reds for HCT management? I’ve felt like that for a good week now, and no sign of recovering.

The background:
41, on TRT for ~3 years. I’ve dabbled with bigger doses, played with peptides, done one anavar cycle, but all more than 2 years ago.

I probably didn’t need it, in hindsight, most of my symptoms were likely down to my thyroid issues - which I’ll get to.

Also have familial hyperlipidemia, which…may well be exacerbated by the thyroid, who knows.

Maybe 3 months ago my sleep went wonky in such a way that, in hindsight, seems my adrenals may have been in the toilet? I’d crash at night immediately, wake up at like 4AM poorly rested, clenching my whole body, can’t get back to sleep until 8ish. Eyes were sensitive to light at night off and on.

My life stress is through the roof, I fully expect my adrenals to be putting in work. That’s getting worked out, will be back to normal in a few months, but beyond the thyroid and life stress, my neurochemistry is otherwise very boring and ordinary.

Blood pressure has been…hard to manage, I’m inconsistent yet not totally absent in the gym, but I eat…really healthy.

At any rate:
I’d been running 150mg/week of Test, split into 5 doses (0.15ml Enanthate every weekday from a 200mg/ml vial, prescribed), HCG 500IU/wk split into 2 doses.
Libido went to hell, upped Test to 200mg/week based on no bloods or anything else, 0.25mg Adex with each jab. A colossal “meh”, no real improvement, and my energy generally was fairly lackluster. My suspicion is my thyroid probably finally started running out of juice here, and I would have resolved all symptoms getting on thyroid meds (with a doctor obviously). But I didn’t. I assumed testosterone was the solution to everything.

Time to donate blood came around, out of curiosity I went and got my bloods just to see where I sat. I also got a full thyroid panel because my “pep” was still…down, and I was curious if it was worse than the first time I ever tested it. I knew thyroid meds were going to happen sooner or later, but I honestly didn’t feel bad enough to justify it, so I thought. Either way, good to know since it runs in the family, mom is on synthroid + armour, and has been since the 60s (she’s a twig, and healthy as a horse).

Got the lab draw, donated before I got the results, but isntead of doing double reds I did something different (I’m a rare type, I want the blood people to have what they need!). This first set of tests from Quest was very limited, I specifically wanted to see these few things (no CBC, no CMP, I wanted to see my Test, and if my PRL was high - it wasn’t, so I omitted).

5/22/2023 - Quest:

HCT: 53.3% (HIGH)
TSH: 5.33 (range: 0.40-4.50mIU/L) (HIGH)
T4 Free: 1.3 (range: 0.8-1.8 ng/dL)
T3 Free: 4.0 (range: 2.3-4.2 pg/mL)
Reverse T3: 29 (range: 8-25 ng/dL) (HIGH)
Estradiol (Ultrasensitive LC/MS): 24 (<= 29 pg/mL)
TT: 1571
FT: 315.6

5/25/2023: donated plasma, platelets, RBC

This was a mistake. First came what felt like a full on adrenal crash. Literally bumps in the road evoked a brief feeling of terror. Then on top of that came what my mother used to get when she didn’t take her thyroid meds - the “weepy for no reason” feels. And then finally the symptoms you get either when your HCT/RBC are too high, OR, you’re anemic - hitting a wall, fatigue, feel like a swollen tick, tightness everywhere. I’ve never felt this bad in my life. I figured it was just dehydration form donating plasma, but it’s persisted.

I managed to get ahold of a prescription for Armour from a doc that was willing to write it as a one-off. That actually had an immediate benefit in terms of stress/adrenal sort of feelings. I had no idea my neck was so swollen, until it wasn’t. Suddenly I have a jawline, water weight is dropping off like crazy.
I’ve probably lived with a crappy thyroid all my life - we actually have T4 => T3 conversion issues, but as of yet I show no Hashi’s antibodies

I got with one of the popular telemedicine, “mens health” providers to get help with my thyroid, and they asked for additional labs. This is what stood out to me (everything else is in range and/or boring - the DHEA-S I’ve never tested before but I guess it’s useful for adrenalinformation?).

6/6/2023 - LabCorp:

HCT: 47.7%
Hemoglobin: 15.3 g/dL (range: 13.0-17.7)
RBC: 6.0 (range: 4.14 - 5.8 x10E6/u) (HIGH)
MCH: 25.5 (range: 26.6 - 33 pg) (LOW)
RDW: 16.9 (range: 11.6 - 15.4 %) (HIGH)
DHEA-S: 263 (range: 102.6 - 416.3 ug/dL)
Lipids: absolute crap

That’s the background info. What’s scary to me is the anemia-like fatigue, and the fact that my RBC is still so high right after donating blood. I’m guessing I effed up donating blood the way that I did, and I should have stuck with double RBC.

How do I get this back to normal? I’ve ordered a lab panel that includes all of the interesting iron tests, I’m about to head out for that blood draw. I know that thyroid “conversion issues” often get exacerbated by inadequate iron.
Those MCH and RDW numbers, from what I read online, suggest mild anemia, and my symptoms jibe with that, BUT, my RBC numbers are high.

So I’m not entirely sure how to get this back in balance.

  • Do a RBC donation?
  • Drink lots of water, try not to die, wait, and then do a donation?
  • Why did the plasma donation crush me so hard?
  • Am I not taking in enough iron and therefore I can make RBC, but they’re all disfigured abominations?

I’m hoping the iron labs come back and show my iron/ferritin/TIBC/etc are all normal range. If so, I would think donating RBC would be not only ok, but advisable. But if it’s genuinely low, how on earth can I bring it back up without my RBC going into the danger zone?

I’m going back to 150mg/week of Test, I had no HCT issues then and I barely had to touch an AI. If I can ever get all of this to go to a nice healthy state, I do absolutely intend to try one or two “cycles” after a while, but that’s…not in the immediate future. I want to see what 150 + thyroid meds can do for my physique, general health, but especially cardiovascular health.

But before that I need to be able to climb a flight of stairs without getting gassed - which…I was lifting and walking no problem before the blood donation. Right now I feel like I used to feel in the immediate hours after doing a double RBC donation, only, I feel like that almost all day. Yall know the feeling.

No suggestions are stupid suggestions. I may not take them, but I do appreciate the brain dump. I even appreciate the “you’re an idiot for doing X” commentary, it’s educational if nothing else.

I used to get phlebotomies every month for over a year, I felt like sh** for a week right after the phlebotomies, and it would take about 2 more weeks to recover. In the first week, my diabetes was suddenly worse.

The loss of iron was clearly to blame, which brings me to my next point, a low iron state causes all sorts of metabolic abnormalities.

In the end a hematologist put a stop to the phlebotomies, and at the time my HCT was 55% and blood pressure 110/64.

My RDW was high and MCH low at the time of my iron deficiency. Donating blood when iron deficient would be incredibly stupid.

What is this obsession with donating blood?

I’d been doing double reds every 16 weeks both as an ancillary to TRT, and, because I’m A- and they need it.

My worry at the moment is the high RBC, and the blood pressure. Especially with the reds being so high right after donating.

Usually I’d be back lifting a week or so after a double red donation, but this last plasma etc donation hit me like a ton of bricks, never been like that before. I came home, laid in bed, felt like I was out of breath just rolling over.

I don’t plan on anything until the iron/anemia labs come back, mind you. But having joint compound for blood scares me a bit, and with symptoms that mirror both anemia AND excess RBC/HCT, I’m stumped for a path forward

EDIT: I should add this is the first time that my MCH or RDW have been out of range

Your body is losing iron, so your body in response is cranking up the RBC. If you’re having side effects on TRT, you either need blood pressure medicine and or a dosage reduction or more frequent smaller injections.

You need to understand what’s at play here, you’re fighting a battle you can’t win. The TRT is jacking up your RBC, which forces a blood donation, which then increases RBC.

I don’t see how you can win here.

If you continues upon this course, these markers will remain out of range for the foreseeable future.

Interesting. So RBC elevation right after donation is an expected thing?
I really do have way too many moving pieces here. Interesting to me is that RBC goes up after donation, I didn’t realize that.

I wonder if it’s possible my thyroid condition and the TRT both, on their own, have atypical requirements for iron intake. Putting the BP issue aside for the time being, I wonder if I didn’t crash both my serum thyroid hormones, and my already-unknowingly-low iron, when I did this plasma donation. And now with higher iron requirements stemming from both my crap thyroid and the exogenous Test, I’m finally seeing signs of anemia on blood work?

In the days after a donation, red blood cells are replaced at an astounding rate. The last donation likely f***** you over! After I started TRT, my ferritin levels went 128->24 requiring me to supplement 175 mg iron daily.

That’s 7 capsules, 25 mg each! If so miss one capsule, it’s fatigue and sleepiness all day long.

That’s so wild, but informational gold.
3 years of doing this, donating double reds every 16w, never low hemoglobin or anything else suggesting an iron issue…but I never tested iron itself.

I’ve always bounced back after double reds like it was nothing, so I might not be crazy, maybe there really is something extra taxing about adding plasma to the mix, and the demands of both a crummy thyroid AND running test too high were just too high an iron demand.

This is great information for me to chew on even if it sounds like I’m thinking out loud gibberish. That knowledge about RBC changes everything.

I’ll post back when I get my labs, just had the draw for ferritin, folate, B12, another CBC, Total Iron, and Total Iron Binding Capacity.

Feels a lot better at least knowing this is probably down to iron

You don’t want to test iron, not only is it inaccurate, it can change drastically after eating.

Ferritin is more informative. I expect your ferritin, iron saturation to be below normal.

Iron supplements will raise HCT and RBC, so reducing your T dosage is a must unless you want higher RBC.

Yeah half the time I’m using iron and ferritin synonymously, half the time I’m not, probably not helpful.

Did find that thyroid site that’s oft referenced here and the list of iron related tests to run - there were four they mentioned It’s just been information overload, thought I had everything dialed in, felt like it was dialed in, then bam.

See what the labs say but dialing in iron and thyroid, plus lowering Test back to 150 I should be in good shape - and then no messing around with higher doses of Test or any other AAS until I have a good year of happiness.

Lads, I believe this qualifies as crashed ferritin.

Ferritin: 6ng/mL (38-380)
% Saturation: 17 (20-48)
Iron, Total: 73 (50-180)
Iron Binding Capacity: 424 mcg/dL (calc) (250-425)
B12: 1053 ph/mL (200-1100)
Folate: 10.1ng/mL

The CBC is as bad as the one above.
Guess we’ll see how long crashed ferritin takes to recover, have iron supplements en route for delivery today.

I don’t doubt my thyroid and a bunch of other stuff is bad, but not nearly as bad as my ferritin. Good Lord.

This is everything that was expected. Blood donations aren’t for you. You should supplement 175-250 mg elemental iron split three times daily.

120mg in me as we speak, and I’m about to head to get an IV infusion.

I guess one big takeaway for me is I should have had ferritin as part of my lab work the whole time. The “crash” seems so sudden, but maybe if ferritin was part of my list I’d have seen it inching downward.

And yeah, maybe if I rack up 6 months straight of high-normal ferritin levels (which I’ll be including in my panels from now on) I’ll go back to donating, not before. Forget the TRT aspect, I hate the idea that I’m a rare blood type and I can’t give blood.

7 day follow up for anyone who happens upon the thread; I found a standalone no-name ER that did iron infusions for 40 bucks of copay (I have great insurance). Showed them the labs I already had, they did TWO bags of iron. Bad as this was crashed, this has NOT been an immediate recovery.

The iron is likely to blame for my high rT3. The more reading I’ve done seems it can absolutely crush your cortisol homeostasis. I’m also reading that a)I likely need to up my Armour dosing, b)upping any T3 containing medication, like Armour, is a BAD idea while your iron is in the toilet, and your cortisol is out of balance.

So I’m going to need to be patient, stay the course with the iron supplementation, and get all of my main markers into a good range. When those test close to optimal, I’ll go up to 60mg Armour, hopefully in time to get new bloods before the endo meeting scheduled on July 10th.

Summarily: I’ve learned low iron can crush your thyroid, a crummy thyroid can crush iron, and treating a crummy thyroid can crush iron, the three exacerbating each other in a perfect cycle of ferrous hell. I’m going to do the “anemia” panel I did above again in another week and see how things look, plus the thyroid panel.

As I said, for other dudes who make the mistake I made - this is NOT a quick recovery, even with two bags of iron administered intravenously. I’ve spent most of this past week scared, today was the first day I felt like there was a non-zero chance I’ll feel normal and good again at some point, instead of a guy who won’t make it to 45. I’m not even thinking about diet other than getting adequate iron, I’m not even walking for cardio, I’m getting my ferritin sane again then starting over.

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Also had a crazy low iron saturation…so what I’ve learnt in regards to Iron supplementation:

  1. Avoid tea/coffee/wine/fruit/vegetables/cereals 2 hrs before and after taking iron dose. The above items when broken down bind to iron and carry it out of the body. So your (x) dose can be reduced by a % depending what you ingest. May not need the -/+ 2 hours, but I do it to try ensure max absorption. Low Iron fucking sucks!
  2. Take 1,000-2,000 Vitamin C with the Iron as it boosts absorption.

Within 2 months of taking 52mg *2 a day, my ferratin saturation dose (which systemlord flagged for me as well!) went from the toilet to mid range.

Yeah I slam vitamin C, and, take ACV capsules with my iron - the ER doc gave me a prescription for high dose iron tablets. The OTC iron I was taking was 60mg+ of elemental iron, taken 3x daily with something acidic - and I read that too about coffee and tea, up to 70% of what you consume is wasted.

What spins me out, I knew crashed ferritin was a thing, but I never gave blood as a therapeutic phlebotomy - I waited my 16 weeks after a double red donation like the rest of the population, did it again, waited 16 weeks, repeated for a few years - so I never suspected crashed ferritin. It was when I saw the MCH, RDW, googled why they’d be out of range…anemia, wtf? I was worried I had a marrow problem, so I did the anemia panel. But my hemoglobin is normal, shouldn’t the blood donation center have caught that? But no, they only test hemoglobin.

So yeah - I’ll be focused squarely on ferritin and saturation, getting the former to 110ish and the latter to roughly 38%, values I found elsewhere specifically for hypothyroid people.

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Why are you still taking testosterone if you don’t need it given all these issues?

We don’t know if I need it.
When I started all of this I was at 570TT and feeling what at the time I ascribed to low T. Benefit of hindsight it may have been hypothyroidism misidentified.

What I do know is at 150/wk my numbers on paper looked perfect, including no issues with HCT (I only donated for philanthropic reasons). So the only variables I think it makes sense to change for now, is to stop giving blood, get my ferritin in order, keep my “good on paper” status with the test, get the thyroid dialed in and go from there.

It’s possible once that’s done that an HPTA restart puts me in an ok spot on the testosterone side of it, but trying to do that now and change a million things at once sounds like a recipe for panic and failure. I won’t know what’s working and what isn’t, I’ll panic and jump to conclusions and change a million things that possibly dont need to be changed. It’s on mind, though.

Brutal this is from donating blood. No good deed goes unpunished.

Sounds like you’re heading towards resolving. Good luck!