- This topic is empty.
-
Posts
-
A patient came to us and was wanting TRT. His doctor had just issued him testosterone cypionate at 150 mgs a week. Patient was complaining of fatigue and brain fog, lethargy, libido. We ran and adrenal profile results where normal. Before adminstering TRT we ran a complete profile we run on ever patient and it was found to have high ferritin, RBC, hemocrit, with low testosterone. With out checking these parameters the Dr he was seeing was going to adminster him TRT. Patient is now really confused as what direction to go. I suggested that hemochromatosis needs to be ruled out before initiating TRT. He agreed, but his dr is being hesitant about running proper test because he went to “an outside dr” If a dr is jealous of another Dr when their welfare of the patient is at stake is a very dangerous mentality to have. I have an idea that he is upset because we uncovered something that he had missed. More so if that person would have commenced TRT there could have been potential complications I told the patient that we would send down the proper blood work to rule this out. I examined his diet and there was no iron content, excessive vitamin C, ect that could be contributing to this factors. His copper levels where in mid range which was a good sign. I thought about sleep apnea test to rule that out as the indices of high RBC, hemocrit are usually indicators of hypoxia, but since there was ferritin elevation we decided to rule out hemochromatosis.
His adrenals and thyroid do not look to bad, but with ft3 bordering with 3.3 and low total t-3 makes me want to examine thyroid more carefully.
Could the hemochromatosis also affect adrenal, thyroid, testosterone signaling?
Hes renin was extremely low which puzzle me. Could this be from an over stimuation of norephinerine which you mentioned before?What are the psychological implication of hemochromatosis? The patient is exhibiting extreme high anxiety and confusion (constantly bouncing around from one thing to the next) This may be in desperation of the fact that it is starting to impact his daily life and work status.
When checking hemochromatosis should all iron parameters be checked to be sure there was not a mistake on the test or would just running the test not ran such as transferritin, TIBC, and serum iron be enough? The genetic test to verify this seems to have some flaw in it from what I have read and also what you mentioned. Since he has 3 of the 5 major indicators as well as low testosterone which can be linked to this disorder.
If TRT is commenced when there is hemochromatosis involved with low testosterone what are the patients health complications. Also could the Dr be found of negligence because of his action of commencing TRT with out proper evaluations?
Thanks
Hemochromatosis will end up destroying the entire endocrine system – actually causing whole body cell destruction – before it even hits the liver. One will see multiple endocrine abnormalities – hypothyroidism, adrenal problems, diabetes, hypogonadism, etc.
With such wide spread destruction, the brain will become highly stressed as the pathways to generate energy become impaired. Mood problems such as irritability, depression, anxiety occur. Impaired concentration and memory occur. The patient will develop severe lack of energy which can’t be fixed by anything other than addressing hemochromatosis.
Since the rest of the system will not be working well and will only get worse, testosterone replacement may often not work at all or it may cause worsening of mood problems since it will also lower thyroid hormone and suppress adrenal function. Testosterone replacement may work for a while as it usually does. But as the system breaks down from excessive oxidative stress from iron, eventually testosterone replacement will not work.
Norepinephrine increases Renin. Low renin means the factors that increase it, such as low blood pressure, are not present.
Ferritin is the best measure of the iron that isn’t in myoglobin and hemoglobin. But there are other tests to run to determine a diagnosis of hemochromocytosis. When Ferritin is above 300, I would diagnosis it. If it was near 300, I would strongly consider the diagnosis and treatment. Genetic testing may need to be done.
When hemochromocytlsis is not addressed or is missed, the patient often becomes chronically ill and treatment resistant to other modalities of treatment – because one of the primary causes of illness isn’t being addressed.
He may also be hypermetabolizing testosterone or have very low SHBG.
13 days after 200mg test cyp shot
TT=187
cobalt
cobalt drops
Dr Wright
anyman
B12
.
.When he comes in for next visit we are going to be running a FIA 5,000 to look at how out of balance his nutrient levels are at. Testosterone is last thing on the list until he gets this iron issue sorted out. He has low T for many years, but even had high normal RBC, hemocrit before he started TRT previously with gels, but was never properly monitored. Yes I am very familar with Dr Wrights protocols as I have watched several hours of his lectures.
My Ferritin was rather high on the two or three occasions I had it tested. The Dx of hemochromatosis was rejected because of other measures of iron, but I’d like to hear what this board has to say, because my PCP wasn’t alarmed at all after seeing my tests. I didn’t like seeing my Ferritin hover in these normal high values.
My posting about this came after reading Dr. Mariano’s post where he says that he’d make the Dx of Hemochromatosis at 300. Granted, my lab’s reference range and his aren’t the same, but still according to my lab’s reference range, I’m up there nonetheless. I seem to recall that because of normal TRF % saturation and normal serum iron it was ruled out. I’m simply asking whether or not I should pay to get more tests done by another M.D. than my PCP.
FYI, 3 months after the score of 284 on Ferritin in March 2007, it was tested again in June 2007 and it was down to : 229
In ascending order of tests dates :
March 2007 :
Dihydrotestosterone : 2015 ( [male 20-49 yo] 217 – 1650) PMOL/L
DHEA-S : 11.1 ( 4.0 – 16.3) umol/L
SHBG : not in yet–will post when I get it.
Total Testosterone : 14.8 (8.4 – 28.7) nmol/L
Bioavalable Testosterone : 10.6 ( 2.0 – 14.0) nmol/L
Estradiol-17B : 122 (42 – 151) pmol/L
Cortisol (8 hours) : 623 (160 – 700) nmol/L
Time of draw : 8:30 AMCortisol ( 16 hours) : 330 (50 – 500) nmol/L
time of draw 3:30 PMPSA : 1.1 (0.0 – 1.4) ug/L
TSH : 2.06 Euthyr. 0.27 – 5.0 mUI/L
hypothyr. >5.00
hyperthyr. <0.01FSH : 3 (2 – 12) U/L
LH : 5 (2 – 9) U/L
Prolactin : 7.2 (4.0 – 15.2) ug/L
Ferritin : 284 (50 – 250) ug/L
Folic acid : 35.8 Normal : (11.9 – 46.7) nmol/L
B12 : 542 Normal : (96 – 568) pmol/L
RBC folate : 1136 (> 634) nmol/L
Homocysteine : 7.6 (3.7 – 13.9) umol/L
==========================================================================Cholesterol : 4.4 (2.0 – 5.2) mmol/L
Triglycerides : 1.3 (0.5 – 2.0) mmol/L
Cholesterol-HDL : 1.36 (1.00 – 2.60) mmol/L
Cholesterold-LDL : 2.4 ( 2.0 – 3.4) mmol/L
Cholesterol Total/HDL : 3.2 no ref. range provided for this one.
==========================================================================
UrinalysisAspect : slightly cloudy
Color : yellow
Volume : 12 mL
Density : 1.025 (1.014 – 1.028)
pH : 5.0 (4.8 – 7.5)
Proteins : Negative Negative g/L
Glucose : Negative Negative mmol/L
Cetonic bodies : Negative Negative mmol/L
Blood : Negative (0 – 5) x10-6 Erc
Leucocytes : Negative Negative x10-6 Lkc
Nitrites : Negative Negative
Urobilinogen : negative Negative umol/L
Bilirubin : Negative Negative umol/L
==========================================================================
HematologyLeucocytes : 5.1 x10-9/L (4.0 – 12.0)
Erythrocytes : 5.30 x10-12/L (4.40 – 6.00)
Hemoglobin: 160 g/L (140 – 180)
Hematocrit: 0.461 (0.0420 – 0.520)
CGMH: 347 g/L (320 – 365)
VGM : 87 fL (80 – 100)
TGMH: 30.1 pg (27.0 – 34.0)
IDE: 12.0 (10.5 – 16.0)
Platelets: 227.0 x10-9/L (120.0 – 400.0)
VPM: 7.3 fL (7.0 – 10.4)automated analysis of leucocyte formula :
Relative value Absolute value
Neutrophils : 0.517 2.6 (1.4 – 6.5)
Lymphocytes : 0.340 1.7 (1.2 – 3.4)
Monocytes : 0.101 0.5 (0.1 – 0.8)
Eosinophils: 0.036 0.2 (0.0 – 0.7)
Basophils : 0.006 0.0 (0.0 – 0.2)
==========================================================================
BiochemistryGlucose 5.0 (4.2 – 6.1) mmol/L
Serum creatinine 70 (62 – 106) umol/L
Sodium 140 (137 – 145) mmol/L
Potassium (plasma) 3.3 (3.4 – 4.8) mmol/L
Chloride 102 (98 – 109) mmol/L
AST 18 (0 – 37) U/L
ALT 19 (0 – 41) U/L
Alkaline Phosphatase 54 (52 – 132) U/L
Total Bilirubin 32 (3 – 22) umol/L
Direct Bilirubin 4 (0 – 7) umol/L
Calcium 2.43 ( 2.15 – 2.65) mmol/L
Uric acid 394 (255 – 430) umol/L
Total protein 79 (63 – 83) g/L
Albumin 51 (35 – 60) g/L
Magnesium 0.97 (0.65 – 1.05) mmol/L
Serum iron 23.4 (9.5 – 29.9) umol/L
Transferrin 2.8 (2.0 – 3.4) g/L
TIBC 64 (47 – 78) umol/L
TRF saturation % 0.37 (0.20 – 0.50)
==========================================================April 2008 :
Fibrinogen (non-anticoagulted) : 2.4 (2.0 – 3.8) g/L
Cortisol (8 AM) : 622 (160 – 700) nmol/L
Hb1AC : 0.050 (0.047 – 0.060) Interpretation : ideal glycemic control.
Anti-TPO : 11 (Negative : <45) kU/L
(dubious : 45-65)
(positive : >65)TSH : 2.46 (euthyr :0.27 – 5.00) mUI/L
(hypothyr. : > 5.00)
(hyperthyr.: < 0.01) FT4 : 18.9 (12.0 – 22.0) pmol/L
LH : 4 (follicular phase : 2 – 13) U/L
(mid-cycle phase : 14 – 96)
(luteal phase : 1 – 11)
(men : 2 – 9)Ferritin : 236 (50 – 250) ug/L
SHBG : 25.3 (11.0 – 63.0) nmol/L
H. pylori : Negative
Progesterone : 4.3 men <4 nmol/L
DHEA-S : 12.3 (7.2 – 12.5) umol/L
IFG-1 (Somatomedin) : 23.4 (14.0 – 37.09) nmol/L
Insulin : 64 (30 – 90) pmol/L
Growth Hormone : < 0.1 (0.0 - 9.9) pmol/L Vitamin D (25 OH) : 38 (30 – 125) Total T3 (aka T3 and FT3 according to http://www.labtestonline.com) : 1.9 (0.9 – 2.8) nmol/L
Estradiol-17 B : 114 men : 42 – 151 pmol/L
Testosterone : 18.1 (8.4 – 28.7) nmol/L
Homocysteine : 9.5 (3.7 – 13.9) umol/L
**an Homocysteine value >15 umol/L is a risk factor for cardiovascular diseases according to The American society of human genetics and The American college of medical genetics. Am. J. Hum. Genet. 63: 1541 – 1543, 1998
===========================================================================================================================
Chemistry
Glucose (overnight fast) : 5.3 (4.2 – 6.1) mmol/L
serum creatine : 77 (62 – 106) umol/L
Sodium : 140 (136 – 145) mmol/L
Potassium (plasma) : 3.7 (3.4 – 4.8) mmol/L
Choride : 99 (98 – 109) mmol/L
AST : 18 (0 – 37) U/L
ALT : 20 (0 – 41) U/L
Gamma GT : 14 (10 – 66) U/L
Total Bilirubin : 30 (3 – 22) umol/L
Direct Bilirubin : 4 (0 – 7) umol/L
Uric Acid : 425 (255 – 460) umol/LC-reactive Protein (ultra sensitive essay) : 0.9 (0.0 – 5.0) mg/L
Cholesterol : 4.8 (2.0 – 5.2) mmol/L
Tryglycerides : 0.9 (0.5 – 2.0) mmol/L
HDL cholesterol : 1.58 (1.00 – 2.60) mmol/L
LDL cholesterol : 2.8 (2.0 – 3.4) mmol/L
Total/HDL cholesterol : 3.0
============================================================================================================================Hematology
Leucocytes : 4.8 X10 (9)/L (4.0 – 12.0)
Erythrocytes : 5.32 X10 (12)/L (4.40 – 6.00)
Hemoglobin : 161 G/L (140 – 180)
Hematocrit : 0.469 ( 0.420 – 0.520)
CGMH : 343 G/L (320 – 365)
VGM : 88 f/L (80- 100)
TGMH : 30.3 pg (27.0 – 34.0)
IDE : 12.1 (10.5 – 16.0)
Platelets : 245.0 X10(9)/L (120.0 – 400.0)
VPM : 7.5 fL (7.0 – 10.4)Automated leucocyte count
Relative value Absolute value
Neutrophils 0.524 2.5 (1.4 – 6.5)
Lymphocytes 0.312 1.5 (1.2 -3.4)
Monocytes 0.081 0.4 (0.1 -0.8)
Eosinophils 0.079 0.4 (0.0 -0.7)
Basophils 0.004 0.0 (0.0 -0.2Furthermore, I took high dse of vitamin C (~3000 mg/day) for most of last winter. Given that vitamin C increases iron absorption, and that I regularly have meat (mostly chicken though, and some beef but only occasionally, beef being a much richer source of iron IIRC)
Does having high dose vitamin C automatically means my ferritin will be higher ? Worded differently, can having high dose vit. C bring on more problems then it solves if one’s ferritin’s already borderline high ?
I’d tend to say it’s not wise to use high dose of vit. C under these conditions, but I may be mistaken.
Juat wanted to add that, while the reason my first ferritin reading was elevated (284) was possibly because my body was fighting off some infection or other, I still find my baseline levels to be rather high.
Having said that, I know there are risk to therapeutic phlebotomy–off the top of my head I can’t recall what this was, but I recall that my source was reliable and that therapeutic phlebotomy isn’t something you decide on on an impulse.
@wondering 404 wrote:
Vitamin D looks low.
And it is.
I’m wanting to find out more on the high normal Ferritin levels–given the downstream adverse outcomes of hemochromatosis, I just want to know what should be done about this. I’m not saying there’s much cause for concern as things stand.
What I’m concerned about to an extent is : what if one is close to fall within the critereria of hemochromatosis Dx, but his/her treating physician decides not to make the Dx ? What are the potential consequence of a near diagnosis on the health of the patient.
Here is a good site about hemochromatosis: http://www.hemochromatosis.org/
One can download the charts they have for reference.
Note that there are two primary treatments for hemochromatosis:
1. Removing Blood (e.g. therapeutic phlebotomy or regular blood donations. 1 unit of blood = 250 mg of iron).
2. Diet changes to avoid excessive iron intake (e.g. avoiding red meat, sugars. Limiting Vitamin C. Eating more nuts, vegetables. Drinking tea or coffee. etc. etc.).
- You must be logged in to reply to this topic.