@DrMariano 3171 wrote:

Testosterone stimulates red blood cell production. This will then take what iron is absorbed and stored in Ferritin and turns it into hemoglobin for red blood cell production. This can then lead to excessive hemoglobin and hematocrit when testosterone replacement leads to high testosterone levels.

Low ferritin levels may limit red blood cell production stimulated by iron. But when ferritin is raised, it allows the iron to be used in red blood cell production.

I have seen opinions that Hgb~16 is an ideal number.

What difference in health does it make if that Hgb is achieved with lower Ferritin (40-50)levels,
rather than the usually recommended Ferritin~150?

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@DrMariano 3174 wrote:

It doesn’t matter if Hemoglobin is maintained via Ferritin at low or high levels.

The body will take iron (from ferritin) from tissues in order to maintain blood iron levels. Blood iron has primary priority given the importance of oxygen transport.

Ferritin represents iron that is available to cells outside of blood, for metabolic activities, including the generation of ATP – i.e. energy – from carbohydrates, proteins, and fats.

The problem of low ferritin levels is that less iron is available to cells in the body outside of the blood. This impairs numerous metabolic functions.

For example, iron is necessary to produce all of the cytochrome enzymes in the body. This includes the enzymes involved in ATP production, enzymes involved in steroid hormone synthesis (including aromatase, 11 beta hydroxylase that produces cortisol), and the P450 enzymes that get rid of various hormones and medications in the liver, the enzymes that produce Vitamin D, etc. Iron is also a cofactor in many enzyme reactions. For example, Tyrosine hydroxylase needs iron as a cofactor in converting tyrosine to L-dopa – which is later converted to dopamine. No iron, no dopamine production.

Numerous metabolic processes ground to a halt without adequate tissue iron availability (represented by Ferritin). This is why i use the analogy that iron is like oil in a car engine. And the car engine doesn’t run without engine oil.

I take that good hemoglobin and low ferritin continue to be less than desirable.

Is there a way to address low ferritin in this situation?

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@DrMariano 3194 wrote:

In addition to high testosterone signaling, other conditions may drive excessive red blood cell production, resulting in high hemoglobin and hematocrit. Such conditions, such as respiratory illness which may drive erythropoietin production up or hemochromocytosis, need to be assessed for and treated if necessary. In these conditions, essentially, iron is being shifted from cells of the body to the blood, leaving the rest of the body at a deficit of iron.

When testosterone replacement to supraphysiologic levels is driving production of red blood cells to excessive levels, to the point ferritin cannot be raised adequately to supply the body with adequate iron for metabolism, I would consider reducing testosterone replacement to achieve more physiologic levels. This would allow iron supplementation to supply the body rather than the blood with iron, restoring ferritin levels.

Although Vitamin A (Retinol) in excessive amounts can lead to anemia, Vitamin A (Retinol), itself, helps release iron from the storage form, Ferritin. Thus, in the presence of strong signals to produce red blood cells (such as high testosterone levels), then the simultaneous presence of Vitamin A makes it easier to shift iron from Ferritin to hemoglobin, helping testosterone produce excessive red blood cells. Vitamin A, however, is necessary to free iron from Ferritin for cells also. Without adequate vitamin A, iron becomes trapped in the ferritin form. Thus, an optimal level of Vitamin A needs to be determined for the individual.

respiratory ilness– not applicable

high testosterone replacement— not applicable. I do supplement with test and stay at current BAT level steady and for long time, years, without affecting Hgb & Hct

I supplement with vit A (and other vitamins, minerals, lipids, micronutrients), per testing (Spectracell)
So I assume that I am dosing them just right.
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I suspect that my current Hct/Hgb spike is related to my Green Laser Prostate surgery or anestesia during that surgery.
Any ideas what that may be???

While supplementing with testosterone and maintaining same T levels as now, I had much heavier surgery (liposarcoma in left thigh), 5 years ago, but it did not affected my Hgb/Hct (see table in post #1).