Prepared 2026-07-15 from bloodtest.test production data (2023–2026) · with donation history. Working summary for discussion with prescriber / hematologist — not medical advice.
Bottom line. Before TRT you were iron-loaded, not deficient — ferritin 193→252 in 2023 with TSAT 52%, while already running hematocrit 48–50 and Hgb 17. So your iron deficiency is a consequence of the post-TRT donation schedule, not a baseline trait. TRT then stacked supraphysiologic free-T (245–295, flagged high) onto that pre-existing high-blood-count tendency and drove hematocrit to 58.3 / Hgb 20.7 (Nov 2025 — genuine clot-risk territory). You handled that correctly: donated + halved the dose, and hematocrit settled to 46–48. What's left is an iron + donation-timing problem, made worse because you've been steering on ferritin — the one unreliable gauge — since your last real iron panel in January.
Blood donations shown as grey markers; earlier ones (2021-09-30, annual-ish) precede the window. Note how TSAT (teal) falls to 20–21% — true deficiency — even while ferritin bounces back to 127–146.
| Date | Ferr | Iron | TSAT | TIBC | HCT | Hgb | Retic | Ret% | Note |
|---|---|---|---|---|---|---|---|---|---|
| 2023-08-31 | 193 | 50.1 | 17.2 | pre-TRT | |||||
| 2023-09-20 | 🩸 Blood donation · Red Cross | ||||||||
| 2023-11-29 | 252* | 164 | 52 | 313 | 46.5 | 16.4 | 92,910 | 1.9 | pre-TRT · iron-loaded |
| 2024-01-12 | 98 | 145 | 46 | 315 | 45.3 | 16.2 | 121,000 | 2.5 | |
| 2024-03-28 | 140 | 131 | 37 | 350 | 48.6 | 16.7 | 116,610 | 2.3 | CRP 0.6 |
| 2024-06-25 | 🩸 Blood donation · Red Cross | ||||||||
| 2024-09-05 | 120 | 51.0 | 17.6 | ≈ TRT starts | |||||
| 2024-09-17 | 51.3 | 17.3 | T 1321 H · fT 295 H | ||||||
| 2024-09-24 | 🩸 Blood donation · Red Cross | ||||||||
| 2024-12-11 | 🩸 Blood donation · Red Cross | ||||||||
| 2025-02-28 | 20 | 52.3 | 17.6 | 105,600 | 2.0 | T 1077 · fT 272 H | |||
| 2025-03-22 | 🩸 Blood donation · Red Cross | ||||||||
| 2025-05-15 | 68 | 48.2 | 17.3 | T 627 | |||||
| 2025-07-02 | 104 | 47.8 | 16.7 | iron self-recovered | |||||
| 2025-08-27 | 🩸 Blood donation · Red Cross | ||||||||
| 2025-11-14 | 39 | 58.3 | 20.7 | PEAK · T 1224 H · fT 245 H | |||||
| 2025-11-15 | 🩸 Blood donation · Red Cross | ||||||||
| 2025-11-20 | 64 | 71 | 21 | 340 | 47.3 | 16.2 | 161,500 | 3.4 | post-donation · hsCRP 2.7 |
| 2025-12-15 | 19 | 158 | 40 | 396 | 53.4 | 18.2 | 119,020 | 2.2 | T 386 |
| 2026-01-12 | 41 | 64 | 20 | 315 | 49.7 | 16.8 | 110,220 | 2.2 | last real iron panel |
| 2026-02-19 | 127 | 51.3 | 18.0 | 122,130 | 2.3 | T 562 | |||
| 2026-02-20 | 🩸 Blood donation · Red Cross | ||||||||
| 2026-04-03 | 146 | 47.6 | 16.4 | 166,260 | 3.4 | T 636 | |||
| 2026-06-20 | 🩸 Blood donation · Red Cross | ||||||||
| 2026-07-14 | 19 | 46.5 | 15.8 | lowest Hgb on record |
Teal 🩸 Blood donation rows are interleaved by date (numeric cells blank so columns stay aligned). One earlier donation (2021-09-30) precedes the first lab row. * 2023-11 ferritin 252 & 193 are pre-TRT, iron-replete (TSAT 52%). T = testosterone total ng/dL, fT = free-T pg/mL (H = above range).
ironThe swings are mostly real.
You natively carry ferritin 120–250 and have crashed to ~20 and recovered to 100+ more than once (20→104 across spring 2025, diet-paced, genuine). The only reading that outruns iron math is Jan→Feb 2026 (41→127 in 5 weeks) — either you took iron then or that one's modestly inflated. Ferritin overshoots a little at the top; it does not swing 19↔146 in real stored iron.
reticNo reticulocyte disorder.
Your retic percentage sat 1.9–2.5% (normal) when iron-replete; the "H" flags were on the absolute count tripping a conservative 90k ceiling. The genuine 3.4% readings (Nov 2025, Apr 2026) are iron-limited, prolonged post-donation recovery — a depleted marrow rebuilds slower, so it holds a high retic fraction for weeks. That's why April was still high 6 weeks out.
HCTThe driver is dose × a pre-existing tendency.
You ran high-normal Hgb and donated before TRT ever started. Supraphysiologic free-T amplified it to Hgb 20.7. The dose cut (T 1224→370–636) is the real lever and it worked — hematocrit is back to 46–48.
gaugeYou're flying without an iron gauge.
Last TSAT/TIBC was Jan 12 (TSAT 20% — deficient). Everything since (Feb 127, Apr 146, Jul 19) is ferritin-only. Jul 14 Hgb 15.8 is your lowest ever — deficiency may now be capping Hgb, i.e. controlling hematocrit the costly way.
Ferritin + TSAT + TIBC + CRP — same tube. TSAT/TIBC + CRP tell you what ferritin can't; stop steering on ferritin alone.B12 + folate — MCV runs 99–100 (mildly macrocytic); rule these out.EPO level — explains the pre-TRT high-Hgb set point.Sleep-apnea screen — the common, treatable driver of erythrocytosis that would have primed you before TRT.Two decisions to raise: