16 replies to this topic

[John250]

I can’t figure out what in the world is going on with my iron related bloodwork. I am on testosterone replacement therapy and in the past I was referred to do several phlebotomies to lower my hemoglobin. This ended up tanking my ferritin levels. It’s been almost a year since I’ve done a phlebotomy so I could get my iron levels and ferritin increased.


The following Labs were taken 4/29/18

Total iron 71 range 50-180

TIBC 382 range 250-425

% saturation 19 range 15-60

Ferritin 29range 29-345

Transferrin 265 range 188-341

RBC 5.9 range 4.2-5.8

Hemoglobin 17.1 range 13-17

Hematocrit 50.5 range 38-50

RDW 13 range 11-15

MCV 87 range 80-100

Platelets 192 range 140-400

B12 serum 1941 range 200-1100

Folate serum 9.6 range >5.4

Methylmalonic Acid 3.6 range 1.6-29.7

MMA Normalized 1.6 range 0.4-2.5

Homocysteine 4.6 range 0-15

Liver normal

Jak mutations normal

EPO 14.2 range 2.6-18.5

I recently got a b12 unsat binding test to see if I need to supplement with B12 and the results confuse me. They are very low yet I have high B12 serum and normal MMA.

Vitamin B12 Blood Test, Unsaturated Binding Capacity:

Result 481 range 725-2045

Mutations are:

MTHFR GT risk allele G (A1298C)
MTHFR AG risk allele A (C677T)
MTRR GG risk allele G (A66G)
MTRR CT risk allele T (C524T)
MAOB C risk allele T +/+*(male)
COMT AG risk allele A (V158M)
COMT CT risk allele T (H62H)
GSTP1 GG risk allele G (lle105Val)
APOE CC risk allele C (Arg176Cys)

Edited by John250, 08 October 2018 - 09:08 PM.

[John250]

Oops I should probably note that I just read the test could be skewed if supplementing with b12. At the time I was using 1mg adenosylcobalamin and 1mg hydroxocobalamin. Last dose was maybe 36hrs prior to blood test.

[Krocius]

Looks like an iron deficiency for me but you still have enough iron to make hemoglobin. There is possibility that you develop iron deficiency anemia later if iron levels will continue to drop. I guess you have high levels of hemoglobin due to high physical activities (increased muscle mass).

Edited by Krocius, 10 October 2018 - 03:39 PM.

[John250]

Looks like an iron deficiency for me but you still have enough iron to make hemoglobin. There is possibility that you develop iron deficiency anemia later if iron levels will continue to drop. I guess you have high levels of hemoglobin due to high physical activities (increased muscle mass).

The high Hemoglobin is from my testosterone replacement therapy. After reading that secondary erythrocythemia induced by hormone replacement therapy does not have the side effects of true erythrocythemia I am not concerned about this as much so I’m more focused on my iron/ferritin.

Edited by John250, 10 October 2018 - 04:05 PM.

[jack black]

the results totally make sense. you have secondary polycythemia (erythrocythemia) due to testosterone and that depletes your ferritin, but you get enough iron from diet, hence normal serum iron. checking for a JAK2 mutation was an expensive blunder. what's your test number?

[John250]

the results totally make sense. you have secondary polycythemia (erythrocythemia) due to testosterone and that depletes your ferritin, but you get enough iron from diet, hence normal serum iron. checking for a JAK2 mutation was an expensive blunder. what's your test number?

Where have you seen the testosterone depletes ferritin?

Below are my Jak mutations. My hematologist said even though some are flagged they don’t indicate Primary polycemia especially since my Epo is normal

rs10758669(red flagged) linked to the following genes: JAK2, RCL1. The major allele (A) is observed in 68% of the general population. The minor allele © is observed in 32%. Your genotype is CC, which is observed in 12% of all individuals reported.

rs10974944(red flagged) is linked to the following genes: INSL6, JAK2. The major allele © is observed in 75% of the general population. The minor allele (G) is observed in 25%. Your genotype is GG, which is observed in 7% of all individuals reported.

rs12340895(red flagged) is linked to the gene JAK2. The major allele © is observed in 75% of the general population. The minor allele (G) is observed in 25%. Your genotype is GG, which is observed in 7% of all individuals reported.

rs3780374 (red flagged) is linked to the gene JAK2. The major allele (G) is observed in 76% of the general population. The minor allele (A) is observed in 24%. Your genotype is AA, which is observed in 7% of all individuals reported.

rs7849191 (red flagged) is linked to the gene JAK2. The major allele (T) is observed in 52% of the general population. The minor allele © is observed in 48%. Your genotype is CC, which is observed in 28% of all individuals reported.

rs9969783(yellow flagged) is linked to the following genes: JAK2, RCL1. The major allele (A) is observed in 64% of the general population. The minor allele © is observed in 36%. Your genotype is AC, which is observed in 39% of all individuals reported. What the science suggests: Your genotype (AC) is potentially associated with:
0.2949 unit decrease for Dementia ®
0.2949 unit decrease for Alzheimer'S Disease Neuropathologic Change ®

rs2274471 (green flagged) is linked to the gene JAK2. The major allele (A) is observed in 83% of the general population. The minor allele (G) is observed in 17%. Your genotype is AA, which is observed in 68% of all individuals reported. What the science suggests:
Your genotype (AA) is potentially associated with: Crohn'S Disease ®

[jack black]

Where have you seen the testosterone depletes ferritin?
 

 

 by producing more red cells.

[John250]

by producing more red cells.

I would have thought this would increase iron and ferritin not decrease it.

[jack black]

I would have thought this would increase iron and ferritin not decrease it.

 

why would you think that?

when you produce RBCs you use up iron stores, as measured by ferritin.

this why people with polycythemia vera (the one with JAK2 mutation) end up with iron deficiency; that is a good thing, as it's a self-treatment.

[John250]

why would you think that?
when you produce RBCs you use up iron stores, as measured by ferritin.
this why people with polycythemia vera (the one with JAK2 mutation) end up with iron deficiency; that is a good thing, as it's a self-treatment.

Interesting I did not know that. Thanks

[John250]

So it’s been about a year since I’ve done a phlebotomy and I just got an iron panel done. I used 100mg iron bisglycinate for about 45days and then took about a month off before bloods.

My previous results were

Total iron 71 range 50-180

TIBC 382 range 250-425

% saturation 19 range 15-60

Ferritin 29 range 29-345

Transferrin 265 range 188-341


New results are

Total iron 64 range 50-180

TIBC 394 range 250-425

% saturation 16 range 15-60

Ferritin 42 range 29-345

Transferrin 308 range 188-341


So my ferritin improved which is good but my iron is actually a little lower. I assume ferritin is more important.

Edited by John250, 21 October 2018 - 04:40 PM.

[Puppalupacus]

It takes a long time to recover from anemia, and I don't feel bisglycinate is the best form for the job.  Try a heme iron supplement, but be warned they are not cheap.  I am on TRT, as well, and also have had issues with polycythemia... to the point I learned to self-phlebotomize and cut out the middle-man.  I dug myself into the anemia hole, and it took months on higher doses of heme iron to get out.  My B12 was also very high, beyond the top end of the reference range.  I never could find an explanation for that, but I can say that any form of B12 supplementation (hydroxo, cyano, methyl, adenosyl) make me feel awful.  Nowadays, I only self-phlebotomize when I start feeling symptoms and have lab-verified high hematocrit.

[Krocius]

Your iron deficiency worsened a bit. Transferrin saturation below 20% is considered as iron deficiency. Actually TIBC and TS are more important than ferritin. I’m in the same situation I have normal ferritin but low TS and high TIBC. I don’t know why my ferritin is normal (inflammation?) despite having low TS. Maybe optimal ferritin for male should be over 100. I don’t know is it OK or bad to have iron deficiency but there is study about improvement of psychiatric illnesses after iron supplementation.

Edited by Krocius, 21 October 2018 - 08:34 PM.

[John250]

It takes a long time to recover from anemia, and I don't feel bisglycinate is the best form for the job. Try a heme iron supplement, but be warned they are not cheap. I am on TRT, as well, and also have had issues with polycythemia... to the point I learned to self-phlebotomize and cut out the middle-man. I dug myself into the anemia hole, and it took months on higher doses of heme iron to get out. My B12 was also very high, beyond the top end of the reference range. I never could find an explanation for that, but I can say that any form of B12 supplementation (hydroxo, cyano, methyl, adenosyl) make me feel awful. Nowadays, I only self-phlebotomize when I start feeling symptoms and have lab-verified high hematocrit.

When I take B12 I don’t feel anything and if I’m taking it or not taking it may be 12 levels are always hard when I take B12 I don’t feel anything and if I’m taking it or not taking it may be 12 levels are always high. This last test they were 1389 range 200-1100 but again I have energy drinks and I’m sure some of my supplements also have B 12. What heme iron supplement do you recommend? Price is not a factor. Thank you

[Puppalupacus]

I use ProFerrin ES.  I took three a day for a few months and finally got out of the hole.  My blood chemistry was just awful.. all of those metrics like variability in RBC size and such.  I just take one a day for maintenance now, and when I do phlebotomies, I ramp up for a few weeks.

[jack black]

It takes a long time to recover from anemia, and I don't feel bisglycinate is the best form for the job.  Try a heme iron supplement, but be warned they are not cheap.  I am on TRT, as well, and also have had issues with polycythemia... to the point I learned to self-phlebotomize and cut out the middle-man.  I dug myself into the anemia hole, and it took months on higher doses of heme iron to get out.  My B12 was also very high, beyond the top end of the reference range.  I never could find an explanation for that, but I can say that any form of B12 supplementation (hydroxo, cyano, methyl, adenosyl) make me feel awful.  Nowadays, I only self-phlebotomize when I start feeling symptoms and have lab-verified high hematocrit.

 

i don't understand the logic behind phlebotomy and iron supplementation at the same time. if one has polycythemia (what whatever reasons), iron deficiency is beneficial, as it slows blood production, preventing need for phlebotomies in the first place. What am I missing?

[John250]

i don't understand the logic behind phlebotomy and iron supplementation at the same time. if one has polycythemia (what whatever reasons), iron deficiency is beneficial, as it slows blood production, preventing need for phlebotomies in the first place. What am I missing?

Because polycythemia is different than testosterone induced secondary erythrocythemia

I use ProFerrin ES. I took three a day for a few months and finally got out of the hole. My blood chemistry was just awful.. all of those metrics like variability in RBC size and such. I just take one a day for maintenance now, and when I do phlebotomies, I ramp up for a few weeks.

Thank you. I found some on eBay that were dented but brand new for about 30% off.