T Nation

Rapidly Declining Ferritin on TRT

Hey everyone - I have a question hopefully someone can help me out with. I have spent a few hours searching online but wasn’t able to find much that really matches with my situation and/or what the best course of action is.

My issue is that my Ferritin has drastically reduced since starting TRT while my RBC, HGB, and HCT have slightly increased (I will include my labs in this post). My Free and Total Test numbers are perfect, in my opinion, so I’m content with those. I can include those if it can help with my question.

I started on TRT in August of this year, 2017. My pre-TRT CBC labs on August 16, 2017 were:
RBC 5.2 (4.2-5.8)
Hgb 15.3 (13.2-17.1)
Hct 47% (38-50)
Ferritin 118 (20-345)

We started me off at 150mg Test Cypionate once per week, 500 iU of HCG once per week, and 1mg of anastrazole once per week. I didn’t agree with doing it once a week, but that’s just how they do it at the clinic. I had to suck it up for 6 weeks until I could get on the “long distance” program and I could do it how I wanted at home.

We checked my progress 6 weeks later on September 9, 2017. My follow up CBC labs were:
RBC 5.36
Hgb 15.9
Hct 47.5%
Ferritin 81

RBC, Hgb, Hct went up sightly while Ferritin decreased a good amount.

At this point, I was able to start injecting myself at home. Since then, I have been injecting myself on a MWF schedule, doing 60mg each injection for 180mg per week. I have been injecting myself with HCG doing 400 iU on a Tues Thursday schedule for 800 iU per week. And I have been doing 0.25mg of anastrazole on the days of my Test injections on MWF for 0.75mg per week.

We just recently checked my labs to see how things were. The CBC labs on October 25, 2017 were:
RBC 5.51
Hgb 16.3
Hct 47.5%
Ferritin 28

Again, RBC and Hgb went up slightly, Hct stayed the same, and Ferritin decreased quite a bit again. At this point, my doctor had me start supplementing with 325mg Ferrous Sulfate and I made sure I was getting at least 5g of Vitamin C per day to maximize absorption.

Finally, we checked my labs again on December 5, 2017 and I requested that we include checking my Iron/Sat, and binding capacity levels. Labs were:
RBC 5.89
Hgb 16.9
Hct 50.4%
Ferritin 19
Total Iron 64 (46-224)
Iron Binding Capacity 352 (250-425)
% Saturation 18% (15-60%)

My H&H has gone up and I am attributing it to incorporating the Iron supplement.

Is this normal? Do a lot of you guys experience this? I’ve read that TRT can lower Ferritin levels, but I wasn’t sure if it was normal for my RBC, Hgb, and Hct levels to be normal while Ferritin is low. I feel that I eat plenty of iron rich foods (I’m basically on a Paleo Diet) so I eat a lot of meat and veggies.

It is also important to note that I have NEVER donated blood. At this point, I feel like shit and I don’t know if it’s related to my Ferritin levels or not. I am just constantly exhausted. I am at a loss as to what to do. None of the doctors I have asked seem to have an answer and I feel like as soon as I fix one thing, something else goes wrong and I’m constantly chasing fixing something.

Sorry for the book - let me know if I need to include any other details. Thanks in advance!!

I’d get a stool test to check for H. Pylori. Your doc may request a blood draw for antibodies to H. Pylori, but the stool is more accurate because it tells you if the infection is active; the blood test will show antibodies even if you had it in the past, but got rid of it with antibiotics.

This was the cause of my Low Ferritin. And yes, it made me feel very tired all the time.

I just messaged my doctor and asked about putting in am order for me. Thank you for your input. I never even considered that.

Yeah. I am so grateful for my doctor that knew about H. Pylori. I initially brushed him off because I never imagined I could have that because I always eat a clean diet. It may have been from a contaminated food or supplement.

I would discontinue the iron supplement because I believe it will cause more damage your body and have only a negligible increase in Ferritin. It won’t help you anyways while you have the active infection or whatever is the root cause of the depleted Ferritin.

You will need an IV iron infusion known as Ferumoxytol to replete the Ferritin levels. In my case, it took 2 IV treatments to bring me back from the 20s up to about 100.