Hello everyone! I have low testosterone levels and elevated ferritin. What now?:)

[Johnny]

Hello everyone,

I was recommended to join this forum by PMgamer18 which I know from another forum.

I will now share my history as quickly as possible, even though I have a problem with being short in words. Please bear with me:)

I am a man of 25 years of age from Norway. I have been healthy and active for most of my life without any diseases except for slight asthma when I was a youth, but I believe I don`t have it any longer.

During the period of my life when I was 17-19 or so, I had way too much going on in my life at the same time. Having a strong and energetic body, I simply continued pushing myself day after day, week after week. Caffeine and willforce seemed to help me along. I did heavy weights, focused a lot on nutrition, had a job with rough physical labour (carpentry), other projects, school, friends, etc. Basically, I slept way too little over a long period of time and never took any time off. My body never had time to recover from either work or weights, much less the stress.

Eventually, I had a breakdown of sorts. A severe anxiety attack. Many others followed in the time to come. Thus I had to completely quit with heavy weights and all my other stuff and simply recover and sleep. I also got depressed for various reasons, but I believe that a weakened body made me far more susceptible. Eventually, I recovered without any drugs from my doctor, but I took a lot of effort and time.

The reason I`m mentioning this period of my life is in case it might be relevant for my situation today. Could I have done any damage to my body back then that didn`t heal?

I`ve heard of adrenal fatigue, but western medicine seem to think that the condition is only speculative.

Today I can honestly say that my mental health is excellent. I have confidence in most situations, I`m a happy person, I like myself and I enjoy life.

A few years ago I restarted with weights once a week very carefully. Mostly I did long walks for exercise.

One year ago when I became a full-time student I got back to working out 3-4 times a week. This time however, I had learned to listen to my body and I felt recovered. I also ate very well and slept 8-9 hours of sleep every night.

In March 2009, I decided to take a test of my hormones with my family doctor. For curiosity`s sake and being into fitness, I had wanted to take such a test for a long time.

What made me finally take the test was that I was feeling very fatigued, had low/none libido and was tired during this period. It should be mentioned that I had been on a light diet (calorie deficit) for 4 weeks leading up to this, but nothing extreme. Honestly.

When the tests came back, everything was within the referance range and I did not know what to make out of it. My doctor told me everything was completely normal. I have contact with a reliable (at least I perceive him to be) source online, that told me my levels were way below average and that I should try to get TRT.

Had it not been for this comment, I think I would have gone on with my life, but this got me really worried.

I talked to my doctor and he once again said that everything was completely fine.

I got a phone appointment by an andrologist in the private sector and he also said that I was completely fine and that I simply should start seeing more girls:)

Thus, I decided that there was nothing left to do and that my online source probably was not as reliable as I thought.

I started eating much more food and healthy fats in order to promote optimal hormone production, but I did not notice much improvement.

Then I noticed that my ferritin levels were elevated: 337. This seemed rather high. I called my doctor, but he simply laughed it away. I should take a new test in 6 months he said.

The days went by and I felt extreme tiredness and fatigue many days. I was now a student, but I was exhausted simply sitting at my desk and I had to take breaks just lying in my bed.

I decided I could not wait longer for a test so I scheduled a new one. Ferritin was now 405. This was late May.

My doctor laughed it away and said that I was completely fine. He disregarded any suspicions about hemochromatosis and did not allow me to take the gene test.

I went to see a doctor in the private sector and even this guy I had to persuade into taking the gene test.

I got the results back yesterday with a note that everything was fine and that I did not have HH, but that I did have elevated ferritin levels. They are higher since May, but it seems like he does not intend to do anything about it.

Here are the recent most relevant results regarding iron:

PS-IRON-FASTING (I guess this is serum iron) – 19,1 (9,0 – 34,0 umol/l)
PS-FERRITIN – 429 – (20 – 250 ug/l)
S-TIBC – 58 (49 – 83 umol/l)
S-Transferrinsaturation – 33%
PS-VITAMIN B12 – 721 (115 – 600 pmol/l)

As you can see, everything iron related seems to be normal, except ferritin. Vitamin B12 is also elevated.

I am going to call my doctor and ask him about the ferritin levels, but I would love to get a second opinion here first.

Since I`m already using a doctor in the private sector which is really small here in Norway, I don`t really have many other doctors left to see after this one. That`s why I want to be prepared.

My main problem now is that I experience low libido, difficulties with getting 100% erections, lack of energy, tired in the morning even after 8-9 hours of sleep (unrefreshing sleep), general fatigue in my body, sometimes I freese easily, etc.

One thing that is worth mentioning is that it seems to go in cycles and I actually usually feel great after working out even though it is tough to get started. Also I seem to feel better late in the day. I remember a particular week (with no change in my daily life) where I simply felt like I was on fire. I wanted to go running, lift weights, and generally just be energetic. I had a hard time being still and trying to study:)

But most of the time and at least recently now, I`m feeling fatigued and tired. It seems to go away in the evening though.

What can I make out of all this? I`m starting to think that maybe it is my psyche that is messing with me, but still I suspect that it might be something physical.

Mostly because I find no correlation with my psyche/mood and the times when I`m actually feeling great. Quite the contrary, I`m often quite happy when I`m in the fatigued state, even though it slows me down.

I swear to God, I tried to make this short, but at least I don`t think I left anything out:p

EDIT: I forgot to mention. I have had a diet where I have eaten red meat 5-7 days a week for the last 5-6 months or so. Still, it is my understanding that with a healthy person this alone cannot raise ferritin levels significantly?

I will post the original test results from March in the post after this one.

Best regards,

Johnny

[Johnny]

Test results from March:

PS-T3-FREE: 3.8 (2.6 – 5.7)
PS-T4-FREE 12 (9 – 24)
PS-TSH 1.22 (0.35 – 4.70)
PS-ANTI-TPO <3 (0 – 15)

PS-FERRITIN 337 (20-250)
PS-CORTISOL 264
PS-OSTRADIOL <0,07 (0.04 – 0.18)
PS-FSH 2 (1 – 12)
PS-LH 2 (2 – 12)
PS-SHBG 36 (13 – 60)
PS-TESTOSTERON 14.9 (10.0 – 40.0)

I also should mention that I think this period when I took the test was my overall low in terms of libido. I have experienced far more drive since this test, but it is still lower than what I think is normal for a healthy 25 year old male. At least that is my subjective experience.

[DrMariano2]

@Johnny 1365 wrote:

Test results from March:

PS-T3-FREE: 3.8 (2.6 – 5.7)
PS-T4-FREE 12 (9 – 24)
PS-TSH 1.22 (0.35 – 4.70)
PS-ANTI-TPO <3 (0 – 15)

PS-FERRITIN 337 (20-250)
PS-CORTISOL 264
PS-OSTRADIOL <0,07 (0.04 – 0.18)
PS-FSH 2 (1 – 12)
PS-LH 2 (2 – 12)
PS-SHBG 36 (13 – 60)
PS-TESTOSTERON 14.9 (10.0 – 40.0)

I also should mention that I think this period when I took the test was my overall low in terms of libido. I have experienced far more drive since this test, but it is still lower than what I think is normal for a healthy 25 year old male. At least that is my subjective experience.

CONVENTIONAL VERSUS SI UNITS
It would be useful to have the units so we can convert the numbers between the measurement systems (e.g. SI vs. Conventional).

IRON OVERLOAD
When high in tissue iron levels – as indicated by elevated ferritin – metabolism may become impaired by the excessive oxidative stress iron poses to cells. Hereditary hemochromatosis may not be present, but iron overload through excessive absorption of iron may be present and can be just as destructive. Excessive iron impairs endocrine system function – including reduction in testosterone production, cortisol production, thyroid hormone production, etc.

Dietary suggestions to reduce iron generally would include the following:

• DIET:
• Reduce consumption of red meat
• Avoid foods high in animal fats
• Limit supplemental vitamin C to 200 mg per dose
• Avoid alcohol
• Avoid sugary foods or beverages (including excess fruit juice)
• Consume plenty of fruits and vegetables including spinach
• Eat nuts, grains, rice, and beans
• Avoid raw shellfish
• Tea or Coffee with meals can reduce iron absorption.

VITAMIN B12
High B12 generally indicates a good supply of animal fat (with fat soluble vitamins) in the diet.

HPA AXIS DYSREGULATION
The term “Adrenal Fatigue” is inaccurate since many factors may contributes to low adrenal cortex output. For example, excessive immune system pro-inflammatory signaling can shut down adrenal cortex activity. Excessive pro-inflammatory cytokine signals may have numerous causes including excessive stress signaling, low thyroid hormone, infections, etc. A history of asthma is a clue that at one point in time, a person may have had excessive pro-inflammatory cytokine signaling and excessive immune system activity.

CORTISOL
Often, a morning cortisol near 10 ug/dL means a person may have significant impairment in energy production, though can still perform usual daily activities. When it goes below 5 ug/dL, I would suspect posttraumatic stress disorder or similar extreme stresses as a factor in the illness.

THYROID HORMONE
It is very important to have a Total T4 to help determine the total output of the thyroid gland. The free levels actually do not directly tell this since the factors influencing thyroid binding proteins complicate the assessment.

Thyroid, iron, cortisol, testosterone, B12 are just some of the factors involved in determining energy and mood. There are many other factors to consider – with nutrition being a large component.

[Johnny]

DrMariano,

Thank you very much for your reply.

I am sorry, but I don`t know what the unit of measurement is for my bloodwork as it is not listed on my test results, only the numbers. Is there perhaps a standard unit in Norway?

I tried finding it, but with no luck. I will do some more research on this.

Regarding my diet, I mostly eat fruits, nuts, vegetables, red meat, chicken, fish, coffee, etc. Pretty healthy. I have however avoided red meat since the last test. Alcohol is limited to once a week maximum, but that has been just recently. I have been nearly sober for the whole last year.

How would you recommend me to proceed?

Should I ask my doctor for phlebotomy? New tests? Should I just go on with my life and forget about this?

Thank you in advance,

Johnny

[pmgamer18]

Hi John good to see you hear call the Dr. or the lab that did the tests and get the units this helps big time. Dr. M thanks for the help this one has most of us stumped.

[DrMariano2]

BLOOD DONATION
Another option to reduce iron, if one isn’t taking medications and does not have an infectious disease, is to donate blood. A unit of blood removes 250 mg of iron. Given the need for blood donations, this would be also a charitable donation.

[Johnny]

@DrMariano 1386 wrote:

BLOOD DONATION
Another option to reduce iron, if one isn’t taking medications and does not have an infectious disease, is to donate blood. A unit of blood removes 250 mg of iron. Given the need for blood donations, this would be also a charitable donation.

DrMariano,

Do you think reducing iron is the way to go for me? Based on my blood tests, do I have iron overload?

I have registered for blood donation, but since I have had a new sexual partner the last 6 months, I believe I have to wait for another 6 months to donate.

I`m considering asking my doctor if he will start phlebotomy on me.

Kind regards,

John

[Johnny]

I have now added unit of measurement based on my own research on norwegian lab test sites.

PS-T3-FREE: 3.8 pmol/l (2.6 – 5.7)
PS-T4-FREE 12 pmol/l (9 – 24)
PS-TSH 1.22 mU/l (0.35 – 4.70)
PS-ANTI-TPO <3 (0 – 15)

PS-FERRITIN 337 uh/l (20-250)
PS-CORTISOL 264 nmol/l
PS-OSTRADIOL <0,07 nmol/ (0.04 – 0.18)
PS-FSH 2 ie/l (1 – 12)
PS-LH 2 ie/l (2 – 12)
PS-SHBG 36 nmol/L (13 – 60)
PS-TESTOSTERON 14.9 nmol/l (10.0 – 40.0)

[DrMariano2]

@Johnny 1387 wrote:

DrMariano,

Do you think reducing iron is the way to go for me? Based on my blood tests, do I have iron overload?

I have registered for blood donation, but since I have had a new sexual partner the last 6 months, I believe I have to wait for another 6 months to donate.

I`m considering asking my doctor if he will start phlebotomy on me.

Kind regards,

John

I can’t give you advice since you are not a patient. This site is primarily an education forum.

—

Generally, what can confirm iron overload are:

• Ferritin is > 300 ng/mL in men or > 200 ng/mL in women.
• Transferrin iron saturation percentage (TSat%) > 45%
• Serum Iron is high.

Some signs and symptoms:

• chronic fatigue
• arthritic pain in joints
• loss of libido (sex drive) or impotence
• amenorrhea (premature cessation of menstrual cycle)
• changes in skin color such as jaundice
• bronze or gray-olive colored skin
• a tan without being in the sun
• redness in the palms of the hands
• abdominal pain
• weight loss
• shortness of breath
• chest pain
• heart arrhythmia
• depression
• elevated blood sugar
• hypothyroidism
• enlargement of spleen
• elevated liver enzymes (ALT/AST)

If a person was doing well and the full lab signs were not present or ferritin was not extremely high (e.g. > 600), then it may be best to monitor the situation regularly via lab tests, take prudent dietary measures (e.g. avoid iron containing supplements, avoid smoking or second-hand smoke) though not the full iron avoiding diet (e.g. red meat and animal fat are OK), and not otherwise worry excessively. Excessive worrying may only exacerbate one’s problems.

This manner of medical management is called “Treat the patient, not the lab test.”

If a person significantly ill, then measures to remove it as a factor may be considered to remove iron as a factor contributing to health problems.

[Johnny]

[*]chronic fatigue
[*]arthritic pain in joints
[*]loss of libido (sex drive) or impotence
[*]shortness of breath

Check on all of these.

I understand that you can`t give me direct advice, but I was hoping you could suggest to me what I could ask of the doctor to consider, etc.

The reason being that the doctor definitely will not contact me or do anything about my situation, unless I call him. And if I do, I need to be assertive and know what to ask for.

Regarding worrying, I definitely do not spend time worrying, but it has been on my mind for sure.

Oh, and by the way, do you have any comments regarding my testosterone levels? Any reason to worry about those or are they within a reasonable range?

Thanks in advance,

John

[DrMariano2]

@Johnny 1396 wrote:

[*]chronic fatigue[*]arthritic pain in joints[*]loss of libido (sex drive) or impotence[*]shortness of breath
Check on all of these.

It is useful – since I am in the U.S. – to convert values from SI to Conventional Values for the sake of conversation.

CORTISOL 264 nmol/L = 9.57 ug/dL

In a healthy, resting, minimally-stressed person, the AM Cortisol is around 17 to 20 ug/dL.

When there is hypothalamic-pituitary-adrenal axis dysregulation from either one or more causes (e.g. mental illness, environmental stress, infection, hormonal deficiencies, metabolic-nutritional problems, etc.), adrenal cortex production of signals drops.

Since Cortisol is one of the signals for energy production, a reduction in cortisol signaling can contribute to fatigue.

Since Cortisol is one of the anti-inflammatory signals, a reduction in cortisol signaling can allow inflammatory conditions to occur or worsen. Inflammatory conditions include migraine, asthma, arthritis, irritable bowel syndrome, fibromyalgia, etc.

Since Cortisol is one of the primary control signals for stress/norepinephrine signaling, a reduction in cortisol signaling allows stress/norepinephrine signaling to increase. This can lead to destabilization of mood – at the extremes, can lead to rage or panic attacks.

Dopamine signaling can be reduced to allow norepinephrine to further increase. The reduction in dopamine signaling can lead to a loss of libido.

The increase in norepinephrine/stress signaling, may lead to an increase in pro-inflammatory cytokine signaling from the immune system. This can lead to further loss of energy (e.g. via a reduction in thyroid hormone signaling, reduction in cortisol signaling, behavioral changes including a loss of drive and motivation and interest in activities – including a loss of libido).

Additional labs which would be helpful are: DHEA-s, Progesterone, Pregnenolone, Aldosterone, ACTH, fasting glucose, fasting insulin. These would provide additional information on adrenal function. A plasma fractionated catecholamine test can help determine norepinephrine signaling.

TESTOSTERONE 14.9 nmol/L = 429 ng/dL
ESTRADIOL <0,07 pmol/L = < 0.07 pg/mL

Testosterone in a 20-25 y.o. male adult is generally around 600-650 ng/dL.

I would generally not do testosterone replacement therapy until the level is close to 300 ng/dL. Addressing the other causes of lowered testosterone production (such as low Vitamin A, low Magnesium, Low Zinc, excessive iron, low iron, insulin resistance, high insulin, low thyroid hormone, etc. etc.) would be a better tactic.

A variety of conditions may reduce testosterone production. Stress/norepinephrine signaling can reduce testosterone production. A reduction in dopamine signaling can reduce testosterone. Etc.

Low estradiol production – both from the adrenals and from testicular production – can lower libido. Estradiol is necessary for sex drive. Estradiol signals the production of testosterone receptors. With Estradiol, the body can become “deaf” to testosterone.

LH production can stimulate aromatase enzyme production to convert testosterone to estradiol.

Low adrenal production of DHEA can lead to a reduction in estradiol production from DHEA.

IRON – 19,1 (9,0 – 34,0 umol/l)
FERRITIN – 429 – (20 – 250 ug/l)
TIBC – 58 (49 – 83 umol/l)
TRANSFERRIN SATURATION % = 33%

A high ferritin but normal values for serum Iron and Transferrin Saturation % in an otherwise healthy person may mean iron values may need to be monitored over time to see if they shift to an iron overload state. A person may need to watch iron intake and diet to help avoid excessive iron absorption (e.g. avoiding excessive vitamin C, cigarette smoke, iron in supplements – otherwise may continue a health intake of red meat with fat).

VITAMIN B12 = 721 pmol/L = 976 pg/mL

When Vitamin B12 is less than 550-600 pg/mL, demyelination of the nervous system may occur. This leads to fatigue, depression, impaired memory and concentration. If if falls too low for too long, irreversible damage occurs to the point of developing dementia.

Generally, B12 is nontoxic. Thus high levels are not much of a concern.

A good B12 level in the absence of supplements, generally indicates a person has good animal fat intake in their diet since B12 is a fat soluble vitamin that is primarily from animal fat. Other fat soluble vitamins which would be useful to measure to monitor nutritional status include Vitamin A (retinol) and Vitamin D 25-Hydroxy. Vitamin E and Vitamin K1 can also be measured.

T3-FREE: 3.8 (2.6 – 5.7)
T4-FREE 12 (9 – 24)
TSH 1.22 (0.35 – 4.70)
ANTI-TPO <3 (0 – 15)

As a rule of thumb, I like to see thyroid levels in an adult which are in these ranges:

• Free T3 = 330 – 340 pg/dL
• Free T4 = 1.2 – 1.76 ng/dL
• Total T3 = 130 – 205 pg/dL
• Total T4 = 8.0 – 12.0 ug/dL

When the Total T4 > 8.0, I would generally not consider treating a person with thyroid hormone initially (though there is headroom to improve the level to near or at 12.0 if this would be useful in treatment). I would try to determine what other factors (e.g. HPA Axis dysregulation, metabolic-nutritional problems, etc.) are contributing to hypothyroid symptoms and signs when there is sufficient T4 to active to T3, then treat the problems I can identify.

[Johnny]

Dr Mariano,

I`m am humbled and sincerely thankful for your thorough answer.

It is obvious to me that your understanding of the body and the interplay of the various hormones are light years ahead of the doctors I`ve visited this far.

I wish I could have visited you as a patient, but I`m afraid I can`t afford traveling outside the country right now.

I fear that no matter what tests I take here in Norway, I will not received a qualified answer.

To illustrate the quality of advice from my family doc: “Your ferritin levels are completely normal. It`s simple statistics. Some people are naturally higher on the scale.”

Or, “LH are completely where you want it to be. It is basically a ladies hormone, so you would not want any more of that. There is nothing wrong with you”

Would asking for phlebotomy be a shot in the dark? Are there any downside to such a treatment?

If not, it definitely would not hurt trying that first.

Kind regards,

Johnny

[DrMariano2]

If one’s blood is acceptable, and one is considering a therapeutic phlebotomy, then one can also consider helping others through blood donation as an option.

[Johnny]

@DrMariano 1440 wrote:

If one’s blood is acceptable, and one is considering a therapeutic phlebotomy, then one can also consider helping others through blood donation as an option.

I have registered as a blood donor, but I will be able to donate only every 4th month.

Since I had a new sexpartner the last 6 months, I will need to wait 6 months after that in order to donate. That`s the policy here in Norway.

[hardasnails1973]

One may also use molybednum, milk thistle, and NAC to help chelate iron from the system
Many knuckle head bodybuilders years ago were complaining about fatigue for no reason, but when I examined their nutritional supplements they where taking huge amounts of milk thistle (2-3 times the normal amounts). I also learned from this experience as well that herbs must be used with caution. Many people with high ferritin just are not metabolizing or mobilizing it properly. Molybednum helps to the utilization of ferritin. Could hemochromatosis cause low testosterone due to causing a cellular deficiency of zinc? This is only speculation.

[Author]

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