Finally getting a Phlebotomy

[lovbyts]

For the past several years my hemoglobin & Hematocrit have been slowly getting higher and sometimes peaking past where they should be. Well the last year its been mostly above where it should be and I have been asking my doctor the last few years for an RX to get a Phlebotomy but she has always denied it.My doctor is great in most things but this one she just doesn't want to do for some reason.Thankfully she decided to send me to a Oncologist.. Guess what he wants me to do. Besides drinking more water and exercising more he wants me to do a Phlebotomy. lolI cant donate blood because I had Hep B in 1991 so this is my only option. Thank god someone finally understands. Yeah I had to sit and listen to him explain how it all works and how TRT can cause the red blood cells to increase but Im not stopping TRT. lol

[almostgone]

For the past several years my hemoglobin & Hematocrit have been slowly getting higher and sometimes peaking past where they should be. Well the last year its been mostly above where it should be and I have been asking my doctor the last few years for an RX to get a Phlebotomy but she has always denied it.My doctor is great in most things but this one she just doesn't want to do for some reason.Thankfully she decided to send me to a Oncologist.. Guess what he wants me to do. Besides drinking more water and exercising more he wants me to do a Phlebotomy. lolI cant donate blood because I had Hep B in 1991 so this is my only option. Thank god someone finally understands. Yeah I had to sit and listen to him explain how it all works and how TRT can cause the red blood cells to increase but Im not stopping TRT. lol

Welcome to the club. Make sure (an oncologist/hematologist definitely should) to stay on top of your iron panel, TIBC, ferritin, serum iron, and transferrin.

I think older guys are affected more by the phlebotomies, and can get depleted quicker.

There's several of us older guys that are playing that game now. Like you said whatever it takes to keep my current T dosage!

[lovbyts]

Any tips for a quicker recovery so us older guys who might be affected more by the phlebotomies, and can get depleted quicker?

[lovbyts]

Welcome to the club. Make sure (an oncologist definitely should) to stay on top of your iron panel, TIBC, ferritin, serum iron, and transferrin.I think older guys are affected more by the phlebotomies, and can get depleted quicker.There's several of us older guys that are playing that game now. Like you said whatever it takes to keep my current T dosage!

Any tips for a quicker recovery so us older guys who might be affected more by the phlebotomies, and can get depleted quicker?

[almostgone]

Any tips for a quicker recovery so us older guys who might be affected more by the phlebotomies, and can get depleted quicker?

Monitor your iron and ferritin periodically/ a week or two post phlebotomy and pull a complete iron panel...make sure ferritin is checked as well. If you see it drifting towards the bottom of the range grab some elemental iron. I like Vitron-C
(available on Amazon) . Eat iron rich foods as well.

After taking elemental iron 2-3 times per week for a month, my ferritin and iron saturation went from being in the basement to almost the low end of the normal range.

It usually takes a few phlebotomies and then the cumulative effect kicks in. When/ if it happens, you'll likely be very fatigued as well.

Iron can lock your guts down, so I wouldn't preemptively jump on it without lab work.

[lovbyts]

Monitor your iron and ferritin periodically/ a week or two post phlebotomy and pull a complete iron panel...make sure ferritin is checked as well. If you see it drifting towards the bottom of the range grab some elemental iron. I like Vitron-C (available on Amazon) . Eat iron rich foods as well.After taking elemental iron 2-3 times per week for a month, my ferritin and iron saturation went from being in the basement to almost the low end of the normal range.It usually takes a few phlebotomies and then the cumulative effect kicks in. When/ if it happens, you'll likely be very fatigued as well. Iron can lock your guts down, so I wouldn't preemptively jump on it without lab work.

Thank you for the great advice. I will follow up with my results.

[lovbyts]

Little update, had my Phlebotomy done last week. Only took 3 ml but I guess thats normal. My Ferritin levels were good, right in the middle at 141 ng/ml and also in April it was about the same, 148 ng/ml.

[almostgone]

Little update, had my Phlebotomy done last week. Only took 3 ml but I guess thats normal. My Ferritin levels were good, right in the middle at 141 ng/ml and also in April it was about the same, 148 ng/ml.

Just 3ml? A whole blood donation is about 500ml/1 pint. Maybe they were doing preliminary labs or something?

[Cuz]

Little update, had my Phlebotomy done last week. Only took 3 ml but I guess thats normal. My Ferritin levels were good, right in the middle at 141 ng/ml and also in April it was about the same, 148 ng/ml.

My ferratin levels were 4. Thats pretty awesome.

[lovbyts]

My bad. LoL. 300

[lovbyts]

Another update, going in soon for my 2nd Phlebotomy. And had my testosterone done. Total doesn't matter all that much but was a little high, 240 - 940 range, 1010 My Bioavailable range was 40 - 168?? It was 732. A bit high?

[lovbyts]

2nd phlebotomy done and now I know what they mean by Thick blood. Looked like sticky paint. They had to stop 1/2 way through because it stopped coming out. Flushed the line 3x, no change. Tried to pull it out with a Big syringe and it wouldn't come out. Moved the needle a little, no change. Finally it sucked in the clot or whatever was blocking and they were able to take out another 150 ml of so of blood.Hopefully its a little thinner next time.Feritin dropped a bit but still within normal range.

[Bio-Active]

How high was your crit? Mine was high snd I went through that. First phlebotomy was a nightmare had to flush the line over and over but it dropped my crit by 8 points. Second one was way better and put my crit to about 55 but only dropped my crit a point or two. By the next week without a phlebotomy my crit was 54.4 and dr said that was acceptable, after that my crit dropped on its own down to 47.6 over the course of another month

[lovbyts]

How high was your crit? Mine was high snd I went through that. First phlebotomy was a nightmare had to flush the line over and over but it dropped my crit by 8 points. Second one was way better and put my crit to about 55 but only dropped my crit a point or two. By the next week without a phlebotomy my crit was 54.4 and dr said that was acceptable, after that my crit dropped on its own down to 47.6 over the course of another month

My last test my Hematocrit was, Normal range: 39.0 - 50.0 % = 56.7My test 2 weeks before Normal range: 39.0 - 50.0 % = 57.7The one before that was Normal range: 39.0 - 50.0 % = 60.7and one more in June was Normal range: 39.0 - 50.0 % = 61.9Its coming down slowly but I have at least 2 more phlebotomy to go.

[Bio-Active]

How many phlebotomy’s have you done? I only had to go 2 to get me to 54. I started at 62.6 after the first phlebotomy I dropped to 55.6 and then after the second one I dropped to 54.6 or close to, my hematologist said bring on trt and hematocrit at 54 is okay but my last lab was 50.4. Once I got it back in range it has stayed right on track for the last 8 months. I’m only doing 100 mg of test every 5 days now and it doesn’t go up. Hang in there you will get there

[lovbyts]

I just did my 3rd one today. Before the draw it was down to at 54.2 from a high of 61.9 My ferritin has dropped down from 142 when I started down to 70.9

[almostgone]

I just did my 3rd one today. Before the draw it was down to at 54.2 from a high of 61.9 My ferritin has dropped down from 142 when I started down to 70.9

Your ferritin is doing good, just stay on top of it. At one point mine got down to 19. Kind of takes the wind out out of your sails.

[almostgone]

My ferritin was back in range and I haven't donated or had a phlebotomy since then. Just got my ferritin panel a little while ago. It is 13 ng/ml. Range is 38-380 ng/ml.

Back on the Vitron C and eat lots of collards, spinach, steelhead, beef.

Still waiting on total iron, TIBC, and % saturation. They should come through today.

[Bio-Active]

I just did my 3rd one today. Before the draw it was down to at 54.2 from a high of 61.9 My ferritin has dropped down from 142 when I started down to 70.9

Ferritin is weird. On my last lab mine was 305 but my hematocrit was 50.4 and hemoglobin was 16.4. My hematologist never measured it back when I was doing my phlebotomies. My hematologist says as long as my hematocrit stays 54 or lower it’s okay. I like to keep it at or below 52. My trt dose is 100 mg every 4 days and I been staying right around 50. It’s been as low as 47 and the highest is 50.5 but I’m not cycling anymore. I am sticking strictly to just trt moving forward

[lovbyts]

Ferritin is weird. On my last lab mine was 305 but my hematocrit was 50.4 and hemoglobin was 16.4. My hematologist never measured it back when I was doing my phlebotomies. My hematologist says as long as my hematocrit stays 54 or lower it’s okay. I like to keep it at or below 52. My trt dose is 100 mg every 4 days and I been staying right around 50. It’s been as low as 47 and the highest is 50.5 but I’m not cycling anymore. I am sticking strictly to just trt moving forward

Are you using any estrogen blockers or anything along with your TRT

[Bio-Active]

Are you using any estrogen blockers or anything along with your TRT

No my dose is only 100 mg every 5 to 7 days. Do not need one. My last lab came back with my estro less then 15 which is to low

[lovbyts]

4th Phlebotomy done and the test right before showed its still dropping, almost to the normal limits. Hemoglobin range 13.2 - 17 is at 17.1 Hematocrit range 39 - 50 is down to 49.7 now. Started out at 61.9. Ferritin is still in the good range, 11 - 450 is at 36.2. Started out at 141.2 but still in range.So far so good. Hoping to get a bit more energy back but on a plus my blood doesn't look like Goo now and actually flows. lol

[Bio-Active]

That’s great usually crit is hemoglobin x 3. Are you making sure to drink lots of water before pulling labs. My hematologist said anyone on trt at 54 or lower crit is okay but I wanted my lower too. Mine was 62.6 like I stated earlier and I’m keeping it at about 49-50 now. They like me to run labs first thing in the am which makes my crit a little higher cause I don’t have the fluid snd food intake all day long

[almostgone]

4th Phlebotomy done and the test right before showed its still dropping, almost to the normal limits. Hemoglobin range 13.2 - 17 is at 17.1 Hematocrit range 39 - 50 is down to 49.7 now. Started out at 61.9. Ferritin is still in the good range, 11 - 450 is at 36.2. Started out at 141.2 but still in range.So far so good. Hoping to get a bit more energy back but on a plus my blood doesn't look like Goo now and actually flows. lol

You're doing pretty darn good.

My labs this week:

Ferritin @ 11. Range is 38-370. (Really makes me fatigued).
Iron is at 40. Range is
50-180mcg/dL

On the plus side my Hgb is back in range @ 16.7g/dL. Range is 13.2-17.1.
Finally my Hct has drifted back down almost into range @51.8% . Reference range is 38.5-50. As an added bonus, my MCV and MCH are in range. RDW, and RBC are just a tad over the high, but I'll get that in control soon.

Now it's just a matter of managing iron in vs Hct increase.

[Bio-Active]

I don’t understand how you guys are getting the ferritin so low. My last labs showed my ferritin at 305 with my crit at 50.2 and hemo at 16.7. Niw I’m not doing any phlebotomy’s anymore haven’t since December

[almostgone]

I don’t understand how you guys are getting the ferritin so low. My last labs showed my ferritin at 305 with my crit at 50.2 and hemo at 16.7. Niw I’m not doing any phlebotomy’s anymore haven’t since December

I've always had upper end to over top end Hct levels, even before any cycling or TRT.

Part of that may be my congestive heart failure is worsening, plus polycythemia, and about 5 other cardiac issues. I go see the cardiologist later this year.

That's one reason I've been working on trying to keep my Hct down; ease the workload on my heart. Since I've been having some chest pain and shortness of breath, I went after the hematocrit rather aggressively.

Hematocrit is down 7%+ in 3 weeks. Also, I slightly lowered my TRT dose from 80mg 2x/week to 50mg 2x/week until I get this under control.


With the phlebotomies, the iron and ferritin tank, so I take supplement elemental iron and folate to bring it back up. It generally takes about 3-4 weeks.

There's another long time member on here that is having the same issues, but I don't think he has any cardiac issues.

I'll pull CBC and iron panel in 2 weeks.

My lipids are kind of good, lol.

Total cholesterol = 102 mg/dL
HDL= 48 mg/dL
Triglycerides 67 mg/dL
LDL = 40 mg/dL

My eGFR was down in the 38 or so range due to cysts on my kidneys, but the last ultrasound showed I only have 1 cyst now on my right kidney that is 1.9cm x 1.8 cm x 2.5 cm.

Also, there is a small spot that I went for a CT scan to get better imaging. I'll get more info from my nephrologist on that soon.
However, my eGFR that was 38 (CKD 3b) is back up to 91 ml/min/1.73m2, so I'll take any wins I can get, lol.

I'll be 60 this month, so I may be reaching my expiration date?

[Bio-Active]

I here ya but my ferritin never tanked. It stays about 300 all the time. My egfr is always around 100 I think. I’m 52 thinking the same about reaching my expiration date ugh

[almostgone]

I here ya but my ferritin never tanked. It stays about 300 all the time. My egfr is always around 100 I think. I’m 52 thinking the same about reaching my expiration date ugh

We have a fellow Hall of Famer that I've been comparing notes with that has the same problem I'm having. Actually, he's been quite helpful. Hell of a nice guy.

Frequent phlebotomies for those with clotting disorders and high Hct and high platelets depletes ferritin. You'll also see it quite often in people that have severe hemochromatosis.

I have to say it seems to be more of a struggle as we age,
i.e., become old enough to fart dust.

LOL, the additional vascularity of high HCT was nice, but too much workload for my old heart, even though I stay well hydrated. In addition to drinking 4-5 big Bubba mugs of ice water at work, the last thing I do before bed is drink 500ml of water and the first thing I do in the morning is down 500 ml of water followed by 8 oz. of grapefruit juice.

[Bio-Active]

We have a fellow Hall of Famer that I've been comparing notes with that has the same problem I'm having. Actually, he's been quite helpful. Hell of a nice guy.

Frequent phlebotomies for those with clotting disorders and high Hct and high platelets depletes ferritin. You'll also see it quite often in people that have severe hemochromatosis.

I have to say it seems to be more of a struggle as we age,
i.e., become old enough to fart dust.

LOL, the additional vascularity of high HCT was nice, but too much workload for my old heart, even though I stay well hydrated. In addition to drinking 4-5 big Bubba mugs of ice water at work, the last thing I do before bed is drink 500ml of water and the first thing I do in the morning is down 500 ml of water followed by 8 oz. of grapefruit juice.

100 correct when my hematocrit was 62.6 I was in afib too. It’s really hard on your heart. I guess I got lucky. I stopped cycling came off the test for 9 months and did the two phlebotomy’s and everything came back together. I’m old snd my cycling days are over. I do my 100 mg trt every 5 days now and that is it. I have no desire to cycle or ever go through that again

[lovbyts]

100 correct when my hematocrit was 62.6 I was in afib too. It’s really hard on your heart. I guess I got lucky. I stopped cycling came off the test for 9 months and did the two phlebotomy’s and everything came back together. I’m old snd my cycling days are over. I do my 100 mg trt every 5 days now and that is it. I have no desire to cycle or ever go through that again

Well I'm defiantly what you could consider old also, 62 next month but I hope to have 1 or 2 more cycles left in my once my shoulders stop being tweaky. I might just push through it.

[Bio-Active]

Well I'm defiantly what you could consider old also, 62 next month but I hope to have 1 or 2 more cycles left in my once my shoulders stop being tweaky. I might just push through it.

I think what I am thinking as I get older is my body just can’t handle the cycles anymore snd my goals are different. My goal now is to be lean and look good. My tendons can’t handle the heavy Wright lifting anymore anyway, it’s time for me to be smarter

[lovbyts]

I am liking this oncologist. We seem to be on the same track. I was thinking I needed to do 1 or 2 more Phlebotomy and he agreed. I also said I think it would be a good idea to do it every 6 months or so after than and watching the levels of course. He agreed to that also.

[almostgone]

I am liking this oncologist. We seem to be on the same track. I was thinking I needed to do 1 or 2 more Phlebotomy and he agreed. I also said I think it would be a good idea to do it every 6 months or so after than and watching the levels of course. He agreed to that also.

Definitely monitor and address as needed. Small changes are much easier on the system than sudden changes. I'm slowly working my way back down after the initial drop from HCT of 57% down to 51% in one blood dump.

[Bio-Active]

I am liking this oncologist. We seem to be on the same track. I was thinking I needed to do 1 or 2 more Phlebotomy and he agreed. I also said I think it would be a good idea to do it every 6 months or so after than and watching the levels of course. He agreed to that also.

That’s good news. You need yo be comfortable with your treatment snd also have a say in it

[lovbyts]

Well my Ferritin has definitely gone down. It started at 141 and Im down to 27 (range 11 - 450) and my Hematocrit is just barely under the top, still at 49.7 Im thinking of starting some methyl folate to see if that helps the ferritin.

[almostgone]

Well my Ferritin has definitely gone down. It started at 141 and Im down to 27 (range 11 - 450) and my Hematocrit is just barely under the top, still at 49.7 Im thinking of starting some methyl folate to see if that helps the ferritin.

A friend suggested I try these. Both are available on Amazon.


L Methylfolate 15MG in 5-MTHF Form (Bioactive B9 Folate) plus Methyl B12 - Methylated Folate Supplement to Support Brain, Mood, & Energy - MTHFR Support Enhanced with NAC, Taurine & D3 - 60 Capsules

NOW Supplements, Iron 36 mg, Double Strength, Non-Constipating*, Essential Mineral, 90 Veg Capsules

[lovbyts]

A friend suggested I try these. Both are available on Amazon.L Methylfolate 15MG in 5-MTHF Form (Bioactive B9 Folate) plus Methyl B12 - Methylated Folate Supplement to Support Brain, Mood, & Energy - MTHFR Support Enhanced with NAC, Taurine & D3 - 60 CapsulesNOW Supplements, Iron 36 mg, Double Strength, Non-Constipating*, Essential Mineral, 90 Veg Capsules

Thanks for the advice. Ive got them on order.

[Bio-Active]

Well my Ferritin has definitely gone down. It started at 141 and Im down to 27 (range 11 - 450) and my Hematocrit is just barely under the top, still at 49.7 Im thinking of starting some methyl folate to see if that helps the ferritin.

Honestly 49.7 is a good number. Mine didn’t get much lower then that off all Anabolics for ten months and my total testosterone was below 200 ng/dl. My hematologist said 54 and lower was okay. My last lab showed it at 50.2

[lovbyts]

Well after a few more weeks of phlebotomies my levels are down to about mid normal but Yup my Ferritin dropped down quite a bit also. I have been taking the L Methylfolate 15MG in 5-MTHF Form (Bioactive B9 Folate) but I havent been taking them Every day like I should. I need to do it more regular and maybe up my dose because Im at the bottom end of my Ferritin levels.

[almostgone]

Well after a few more weeks of phlebotomies my levels are down to about mid normal but Yup my Ferritin dropped down quite a bit also. I have been taking the L Methylfolate 15MG in 5-MTHF Form (Bioactive B9 Folate) but I havent been taking them Every day like I should. I need to do it more regular and maybe up my dose because Im at the bottom end of my Ferritin levels.

It's still a constant battle here as well, particularly with ferritin. If you're supplementing with iron, monitor it frequently. Iron overload can come on quickly.