44M on TRT (200mg/wk): Trapped between high hematocrit and low iron/ferritin. How did you handle this?
Hi everyone,
I’m a 44-year-old male and have been on TRT for two years. My protocol is 100 mg intramuscular (IM) twice a week (200 mg total/week).
I just got my latest lab results back, and I’m facing a classic dilemma: my hematocrit is high, but my iron and ferritin are low/depleted.
I have an appointment with my doctor next week to go over this, but I wanted to see if anyone who has been in this exact situation can share what worked for them. If I donate blood to bring my hematocrit down, my iron will crash further. But if I take iron supplements, my hematocrit could jump even higher.
For context, the last time I donated blood was 6 months ago (February 2026). Also, I don't feel tired or low on energy.
Latest Lab Results:
RBC: 6.96 M/uL (Ref: 4.63 – 6.08) [HIGH]
Hematocrit: 55.7% (Ref: 40.1 – 51.0%) [HIGH]
RDW: 18.4% (Ref: 11.6 – 14.4%) [HIGH]
Iron Level: 39 µg/dL (Ref: 65 – 170) [LOW]
Iron Saturation: 8% (Ref: 20 – 50%) [LOW]
TIBC (Calculated): 496 µg/dL (Ref: 250 – 450) [HIGH]
Ferritin: 27.44 ng/mL (Ref: 22.00 – 275.00) [LOW END]
Total Testosterone: 820 ng/dL (Ref: 249 – 836)
Free Testosterone: 2.85% (Ref: 1.20 – 3.30%)
What are the typical next steps in a situation like this? Has anyone had success lowering the Hematocrit and increasing the Iron using specific strategies to balance these out?
Thanks in advance for any insights!