How can I raise my Ferritin while lowering Crit and Hemoglobin?

specter · Mar 26, 2023

Lumpi said:
Nebivolol lowers my erythrozyts, hematocrit, hemoglobin depending on the dose without touching ferritin.

Dose ?

bg65 · Mar 26, 2023

strongsafety41 said:
I’m looking at his slightly low ferritin levels because of what it could lead to if he doesn’t address it. Let’s say he chooses to donate to lower his RBC and HCT (bad advice as it is temporary and will further deplete his ferritin stores leading to anemia).
Low ferritin can have some serious sides (SOB, high HR, high BP, arrhythmias, weakness etc.. ) and can lead to anemia. Especially if you’re donating frequently. Blood loss is a common cause of low ferritin, in my case blood donations.
I was in OP’s shoes and saw several docs trying to figure out what was wrong with me. Got on my friend ole google which led me to testing ferritin with private labs md. Ferritin came back at 25 and all of a sudden my docs were all marching to a different beat.

You're placing ferritin before iron and the symptoms that you described are symptoms of anemia, not low ferritin. You could have normal iron levels (and corresponding normal ferritin levels) but if you were b12 or folate deficient leading to anemia then you would have the same symptoms you described. There are not symptoms directly related to low ferritin. Low ferritin does not lead to anemia (it only reflects low iron, it is not the cause). Low iron will eventually lead to anemia and low iron will usually be reflected by a low ferritin level.
Iron deficiency leads to low ferritin. Low ferritin does not lead to iron deficiency. Ferritin is not a protein that the body monitors or has in any sort of feed-back loop trying to keep it within normal limits.
Free iron is toxic to cells as it serves as a catalyst for the formation of free radicals and ferritin stabilizes and stores the iron safely so it is no longer in its free and reactive state. Ferritin is produced in response to the amount of iron in the body. It is not produced by the body with any intent to just have a normal ferritin value. If your iron is low then ferritin will be low, if iron is high then the body will produce more ferritin to store the iron safely and ferritin will be high. The key here is that the body doesn't have some sort of monitoring system to make sure ferritin is normal range. It just should be in the normal range if iron is in the normal range. I think you're placing ferritin in the driver's seat when it is actually iron levels that push ferritin levels higher or lower.
Blood loss will lead to low ferritin because the body will ramp up RBC production cutting into the iron stores, then ferritin drops because w less iron there is less ferritin needed.

Back to his original question/problem. He may very well have a slight amount of iron deficiency but we're trying to interpret lab values of someone w polycythemia and AAS use. There is no cause for concern whatsoever with his labs besides the elevated hct. He should drop the EQ and get labs in a month or 2. If hct is normal then we can take a look at his ferritin levels

strongsafety41 · Mar 26, 2023

bg65 said:
You're placing ferritin before iron and the symptoms that you described are symptoms of anemia, not low ferritin. You could have normal iron levels (and corresponding normal ferritin levels) but if you were b12 or folate deficient leading to anemia then you would have the same symptoms you described. There are not symptoms directly related to low ferritin. Low ferritin does not lead to anemia (it only reflects low iron, it is not the cause). Low iron will eventually lead to anemia and low iron will usually be reflected by a low ferritin level.
Iron deficiency leads to low ferritin. Low ferritin does not lead to iron deficiency. Ferritin is not a protein that the body monitors or has in any sort of feed-back loop trying to keep it within normal limits.
Free iron is toxic to cells as it serves as a catalyst for the formation of free radicals and ferritin stabilizes and stores the iron safely so it is no longer in its free and reactive state. Ferritin is produced in response to the amount of iron in the body. It is not produced by the body with any intent to just have a normal ferritin value. If your iron is low then ferritin will be low, if iron is high then the body will produce more ferritin to store the iron safely and ferritin will be high. The key here is that the body doesn't have some sort of monitoring system to make sure ferritin is normal range. It just should be in the normal range if iron is in the normal range. I think you're placing ferritin in the driver's seat when it is actually iron levels that push ferritin levels higher or lower.
Blood loss will lead to low ferritin because the body will ramp up RBC production cutting into the iron stores, then ferritin drops because w less iron there is less ferritin needed.

Back to his original question/problem. He may very well have a slight amount of iron deficiency but we're trying to interpret lab values of someone w polycythemia and AAS use. There is no cause for concern whatsoever with his labs besides the elevated hct. He should drop the EQ and get labs in a month or 2. If hct is normal then we can take a look at his ferritin levels

Your opening sentence has me at a loss for words. Nevermind what my hematologist, cardiologist and Internal medicine docs agree on, even a google search presents this evidence…
I’m tapping out of this conversation, lol, you can’t be serious.

OP, good luck and I hope you get your issue figured out.

bg65 · Mar 26, 2023

strongsafety41 said:
Your opening sentence has me at a loss for words. Nevermind what my hematologist, cardiologist and Internal medicine docs agree on, even a google search presents this evidence…
I’m tapping out of this conversation, lol, you can’t be serious.

OP, good luck and I hope you get your issue figured out.

Please dont infer any demeaning tone or anything, that shit gets lost via this form of communication and i mean to be totally respectful toward you, just a good back and forth...

What is it that you think ferritin does? Can you answer that question? It does not transport oxygen in the blood. Please explain how a low level of ferritin causes any of the symtpoms you described? I can explain the physiology of how anemia causes those symptoms as they are rooted in decreased oxygen transport to tissues throughout the body. How would low ferritin cause tachycardia? Or shortness of breath? It ONLY stores iron, it does not transport anything but iron.
Dude, don't blindly just believe people, including me, but try to make sense of it yourself. Are you the one that posted you had to check your ferritin on your own because your docs hadn't thought to check it? If so, find better doctors. The symptoms that you are attributing to ferritin are 100% due to anemia and decreased oxygen transport throughout the body. And ferritin has nothing to do with oxygen transport.
And yes, a simple google search shows this, you're just reading it wrong. In the context of what you're reading on google with regard to "symptoms of low ferritin" they are citing symptoms that are present if the ferritin is representing iron deficiency anemia.
Again, think abt it man, how would ferritin cause those symptoms? It only serves to store iron. It does not transport anything else in the body.
All good man, i don't mean to be contentious, just hopeful for people to understand.
Just read about what ferritin does in the body and from there try to propose the physiologic mechanism where low ferritin would cause any of those symptoms you listed. Or ask any of those docs you mentioned to explain it. They're just giving you a lazy answer if they say low ferritin causes those symptoms.
And i am absolutely not a physician basher but like any job there are lousy docs and lazy docs that dont take the time to actually explain stuff to their patients.
Don't just say, "well my doctor said" understand the role of ferritin in the body and try to explain how low ferritin, as an isolated finding, would cause those symptoms. The symptoms are caused by the anemia.

bg65 · Mar 26, 2023

strongsafety41 said:
Your opening sentence has me at a loss for words. Nevermind what my hematologist, cardiologist and Internal medicine docs agree on, even a google search presents this evidence…
I’m tapping out of this conversation, lol, you can’t be serious.

OP, good luck and I hope you get your issue figured out.

Man, i thought that opening sentence was great haha

bg65 · Mar 26, 2023

I found this, pretty decent article. I was trying to find something that really gets into the mechanisms and processes at play

Iron Deficiency Anemia - Hematology and Oncology - Merck Manuals Professional Edition

Iron Deficiency Anemia - Etiology, pathophysiology, symptoms, signs, diagnosis & prognosis from the Merck Manuals - Medical Professional Version.

www.merckmanuals.com

mike036 · Mar 26, 2023

bg65 said:
Please dont infer any demeaning tone or anything, that shit gets lost via this form of communication and i mean to be totally respectful toward you, just a good back and forth...

What is it that you think ferritin does? Can you answer that question? It does not transport oxygen in the blood. Please explain how a low level of ferritin causes any of the symtpoms you described? I can explain the physiology of how anemia causes those symptoms as they are rooted in decreased oxygen transport to tissues throughout the body. How would low ferritin cause tachycardia? Or shortness of breath? It ONLY stores iron, it does not transport anything but iron.
Dude, don't blindly just believe people, including me, but try to make sense of it yourself. Are you the one that posted you had to check your ferritin on your own because your docs hadn't thought to check it? If so, find better doctors. The symptoms that you are attributing to ferritin are 100% due to anemia and decreased oxygen transport throughout the body. And ferritin has nothing to do with oxygen transport.
And yes, a simple google search shows this, you're just reading it wrong. In the context of what you're reading on google with regard to "symptoms of low ferritin" they are citing symptoms that are present if the ferritin is representing iron deficiency anemia.
Again, think abt it man, how would ferritin cause those symptoms? It only serves to store iron. It does not transport anything else in the body.
All good man, i don't mean to be contentious, just hopeful for people to understand.
Just read about what ferritin does in the body and from there try to propose the physiologic mechanism where low ferritin would cause any of those symptoms you listed. Or ask any of those docs you mentioned to explain it. They're just giving you a lazy answer if they say low ferritin causes those symptoms.
And i am absolutely not a physician basher but like any job there are lousy docs and lazy docs that dont take the time to actually explain stuff to their patients.
Don't just say, "well my doctor said" understand the role of ferritin in the body and try to explain how low ferritin, as an isolated finding, would cause those symptoms. The symptoms are caused by the anemia.

Is it safe to say if one’s ferritin is low they most likely would have iron deficiency anemia ?

bg65 · Mar 26, 2023

mike036 said:
Is it safe to say if one’s ferritin is low they most likely would have iron deficiency anemia ?

From my understanding, IF they are anemic AND ferritin is low that would for sure point toward iron deficiency as the likely etiology of the anemia.
I don't think you could look at just a low ferritin level and determine that they have iron deficiency anemia because ferritin on its own doesn't tell you their hgb/hct. Meaning you wouldn't know for sure they were actually anemic unless you could see that hgb/hct are low.
Classically, iron deficiency anemia should have labs showing low hgb/hct, low ferritin, low iron, high transferrin (TIBC) and the RBCs would be smaller than normal.
Ferritin doesn't always cooperate as expected though since it is an acute phase reactant

And as i beat to death like 6x, the low ferritin is caused by low iron. Low ferritin is not the cause of low iron. You ingest more iron and that is a direct stimulus for the body to make more ferritin, to store the iron

Pheedno · Mar 26, 2023

Cook your food in cast iron. Anecdotal but it seemed to work for me in the past

strongsafety41 · Mar 26, 2023

bg65 said:
From my understanding, IF they are anemic AND ferritin is low that would for sure point toward iron deficiency as the likely etiology of the anemia.
I don't think you could look at just a low ferritin level and determine that they have iron deficiency anemia because ferritin on its own doesn't tell you their hgb/hct. Meaning you wouldn't know for sure they were actually anemic unless you could see that hgb/hct are low.
Classically, iron deficiency anemia should have labs showing low hgb/hct, low ferritin, low iron, high transferrin (TIBC) and the RBCs would be smaller than normal.
Ferritin doesn't always cooperate as expected though since it is an acute phase reactant

And as i beat to death like 6x, the low ferritin is caused by low iron. Low ferritin is not the cause of low iron. You ingest more iron and that is a direct stimulus for the body to make more ferritin, to store the iron

No offense taken brother. Years ago I would’ve really enjoyed this conversation, I’m getting older and this shit doesn’t excite me as much as Sunday basketball … too bad it’s not football season. Lol

I see the disconnect, I don’t recall anyone saying low ferritin is the cause of low iron. Also you’re missing the point of we’re not talking about classic labs of a normal person who’s anemic. I may be wrong but .., you will never find someone on gear with a low RBC’s and Low Hemoglobin.
But you will find them with high HGB, high RBC’s, and low ferritin from blood donations, low mcv, high RDW etc… I challenge you as you’ve challenged me, think outside the box. Don’t just go off of google.

Edit … just realized you were in the camp of donating blood to lower HCT. That temp fix would lower his ferritin level 30-50ng with each pint! What do you think that would do to his ferritin level/iron storage of 38. Definitely would be anemic at that point.

Mufasa123 · Mar 26, 2023

bg65 said:
From my understanding, IF they are anemic AND ferritin is low that would for sure point toward iron deficiency as the likely etiology of the anemia.
I don't think you could look at just a low ferritin level and determine that they have iron deficiency anemia because ferritin on its own doesn't tell you their hgb/hct. Meaning you wouldn't know for sure they were actually anemic unless you could see that hgb/hct are low.
Classically, iron deficiency anemia should have labs showing low hgb/hct, low ferritin, low iron, high transferrin (TIBC) and the RBCs would be smaller than normal.
Ferritin doesn't always cooperate as expected though since it is an acute phase reactant

And as i beat to death like 6x, the low ferritin is caused by low iron. Low ferritin is not the cause of low iron. You ingest more iron and that is a direct stimulus for the body to make more ferritin, to store the iron

You are the only other person I've seen that asks this question. People sweat ferritin like mad, never being able to state why, and it's likely low from jacking up rbc/crit. Low ferritin with low rbc/crit is an issue but get the crit normalized and it will all work out fine as long as you don't have major underlying issues (rare).

Been dealing with all this stuff myself for many years. As long as you don't have some major anemia or blood disorder, donate until you get in range or where you are fine (ie your range), hydrate well, be fine.

bg65 · Mar 26, 2023

strongsafety41 said:
No offense taken brother. Years ago I would’ve really enjoyed this conversation, I’m getting older and this shit doesn’t excite me as much as Sunday basketball … too bad it’s not football season. Lol

I see the disconnect, I don’t recall anyone saying low ferritin is the cause of low iron. Also you’re missing the point of we’re not talking about classic labs of a normal person who’s anemic. I may be wrong but .., you will never find someone on gear with a low RBC’s and Low Hemoglobin.
But you will find them with high HGB, high RBC’s, and low ferritin from blood donations, low mcv, high RDW etc… I challenge you as you’ve challenged me, think outside the box. Don’t just go off of google.

Edit … just realized you were in the camp of donating blood to lower HCT. That temp fix would lower his ferritin level 30-50ng with each pint! What do you think that would do to his ferritin level/iron storage of 38. Definitely would be anemic at that point.

oh yeah, this isn't a "normal" situation given the presence of AAS. One of our common issues, applying "regular people" studies to people that aren't regular (us).

Regarding your last point, that's the part where i think you and i are most divided... Lowering his ferritin will not make him anemic. Ferritin itself has no bearing on erythropoiesis. Ferritin does not stimulate or inhibit or have any affect on erythropoiesis. His hgb/hct will only drop as much as they remove via phlebotomy. Its not like his RBCs would continue to disappear after the blood draw is over So what if he gets a blood draw to normalize his hgb/hct and the ferritin is low? . If he ingests iron that will directly stimulate the production of more ferritin. We're having a "chicken or the egg" debate here haha

To follow with what you said, in the blood draw scenario, his ferritin likely would drop more (as you guys have found objectively) because there is still an environment in the body stimulating supraphysiologic erythropoiesis and this is exhausting iron stores. Phlebotomy can remove the excess RBCs but the drugs are still on board. So it makes sense that someone who does develop polycythemia from AAS and manages this via regular phlebotomy would develop a low ferritin. Their body is jacked up making RBCs in over time and this uses up iron.
My question remains though, what is specifically the concern if ferritin is low? Take more iron, it will come up, polycythemia comes back, blood gets drawn again. Its what some guys have to do.
If someone was legitimately iron deficient then they likely wouldn't be able to develop polycythemia and the RBCs should be microcytic.

I think mufasa summed it up nicely

nothuman · Mar 26, 2023

TommyJ said:
Do you remember how long it took to get yours to a “good”level with this method?

Also, did the iron give you any side effects?

Is there a brand you recommend?

Thank you!

Not very long. Benefits of being male instead of female. I used Solgar.

strongsafety41 · Mar 27, 2023

bg65 said:
oh yeah, this isn't a "normal" situation given the presence of AAS. One of our common issues, applying "regular people" studies to people that aren't regular (us).

Regarding your last point, that's the part where i think you and i are most divided... Lowering his ferritin will not make him anemic. Ferritin itself has no bearing on erythropoiesis. Ferritin does not stimulate or inhibit or have any affect on erythropoiesis. His hgb/hct will only drop as much as they remove via phlebotomy. Its not like his RBCs would continue to disappear after the blood draw is over So what if he gets a blood draw to normalize his hgb/hct and the ferritin is low? . If he ingests iron that will directly stimulate the production of more ferritin. We're having a "chicken or the egg" debate here haha

To follow with what you said, in the blood draw scenario, his ferritin likely would drop more (as you guys have found objectively) because there is still an environment in the body stimulating supraphysiologic erythropoiesis and this is exhausting iron stores. Phlebotomy can remove the excess RBCs but the drugs are still on board. So it makes sense that someone who does develop polycythemia from AAS and manages this via regular phlebotomy would develop a low ferritin. Their body is jacked up making RBCs in over time and this uses up iron.
My question remains though, what is specifically the concern if ferritin is low? Take more iron, it will come up, polycythemia comes back, blood gets drawn again. Its what some guys have to do.
If someone was legitimately iron deficient then they likely wouldn't be able to develop polycythemia and the RBCs should be microcytic.

I think mufasa summed it up nicely

Your last paragraph says it all. It’s a delicate balance. IMO continuing to donate (blood loss) without supplementing iron will lead to anemia. If you’d like a quick reference check out the Red Cross website. It’s the reason they suggest regular donors to supplement with iron. In the example low ferritin is just an indicator of what’s to come if you continue the blood loss (donations) anemia.

I’m not against donating, just donate when your labs says you’re healthy enough. Donating with low ferritin isn’t the answer IMO. Dropping the additional compounds should get levels to normalize. Get it well within range through iron supplementation then donate.

I don’t think we’re too far apart. Lol… We can agree to disagree on this one.

RandomMachine · Mar 27, 2023

I seem to be a person who consistently has low iron/ferritin due to androgens. Trying to supplement to bring it up now.

Without supplements my iron and ferritin are at the bottom or slightly below the bottom of the range. I've never had low hemoglobin or RBC during that time.

Not really sure what the cause is at this point.

Lumpi · Mar 27, 2023

specter said:
Dose ?

That's up to you. Even 2.5 to 5mg can have a good impact. With more gear you need more nebivolol to counter it's hematology side effects.

bg65 · Mar 27, 2023

RandomMachine said:
I seem to be a person who consistently has low iron/ferritin due to androgens. Trying to supplement to bring it up now.

Without supplements my iron and ferritin are at the bottom or slightly below the bottom of the range. I've never had low hemoglobin or RBC during that time.

Not really sure what the cause is at this point.

you might want to look into it a bit. From what I've read its generally recommended to rule out GI blood loss first. Not sure if that's something that can be ordered online like privatemdlabs, etc... your doc could order it for you, checking for occult blood. I have a family h/o of colon CA so I've already had a colonoscopy at age 42. Thankfully it was clean but its being seen in younger people these days so new guidelines recommend routine colonoscopy for anyone at age 45 (used to be age 50)
It could also just be that your body doesn't absorb iron well, i think there's lots of potential causes but guys cant just explain it away like women can with their menses

RandomMachine · Mar 27, 2023

bg65 said:
you might want to look into it a bit. From what I've read its generally recommended to rule out GI blood loss first. Not sure if that's something that can be ordered online like privatemdlabs, etc... your doc could order it for you, checking for occult blood. I have a family h/o of colon CA so I've already had a colonoscopy at age 42. Thankfully it was clean but its being seen in younger people these days so new guidelines recommend routine colonoscopy for anyone at age 45 (used to be age 50)
It could also just be that your body doesn't absorb iron well, i think there's lots of potential causes but guys cant just explain it away like women can with their menses

Yeah I've got a family history of colon cancer as well. Did a colonoscopy last year at 36.

I've done a ton of private blood work trying to figure it out.

I actually just made a GI appointment because the only thing I can come up with is poor ability to absorb iron.

Know things like h. pylori and celiac can potentially cause absorption issues. Just throwing darts right now and hoping to hit something.