i've attached a lab report. but the following picture is the part i'm curious about:
they've been testing me for hormones yearly since i've been on them, but they never tested me for iron. according to these results, i'm dangerously anemic.
now, i should point out that they tested me with normal male references. that number - 12 ug/L - is considered deficient for men, but is at the very lower end of normal female variability. i've been estrogen dominant for essentially my whole life, so it may make more sense to use female references. that said, it is low, regardless - and that shouldn't be dietary. my diet is low in meat, but i should be getting enough non-heme iron from plant sources. like, i did the research and did the math - if i can absorb it, i should be getting enough. if i was absorbing it properly, that number should be 10x that.
i remember a lot of concern about anemia when i was a kid, but i never got a clear explanation. iirc, dad seemed unconcerned that there was anything wrong with me in general, and he dropped the point altogether as i grew older, but one of the very few memories i have of his mother is her insistence that i get enough iron. she seemed to be trying to get across the idea that i may be at risk for a genetic iron deficiency. she moved out west to victoria when i was young and dad did not talk to her much after that; i have no real relationship with her and don't know how to contact her. she eased up over time, but the stepmother didn't get along with anybody in his family. at all. that side of the family just sort of disappeared around the time he married her and didn't reappear until the last months of his life, when i'd been mostly cast aside due to religiosity around my gender identity.
i can't remember the last time anybody tested me for iron, but those results are definitely suggesting something is wrong - either i'm not absorbing it, or i'm bleeding somewhere.
my cholesterol is outstanding, as usual. my white blood count seems high, and i'm going to assume it's allergies for now, but i want to keep an eye on that - it's an early warning sign for leukemia. but, it's also a symptom of ms, which i'm more concerned about and have been concerned about for a long time.
j
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hi.
i got my blood test, and i'm going to to type a little after, but the reason i'm sending the fax is due to the covid screening. my eosinophil count seems high, and that took me by surprise. but, it would suggest i'm fighting something off.
at the end of februrary, i suggested i was dealing with an indigestion-like gastric discomfort and cancelled due to overcaution. while i haven't developed anything like covid symptoms since, and have no known cause of exposure to it, i've spent much of the last two weeks cleaning out a basement that has built up large amounts of what looks like soot and ash, but what at times might have also been mould and fungus. so, i've been exposed to large amounts of dust and potentially some more traditional airborne pathogens. while this is now really the most pressing component in the blood work (by far), and i honestly need medical guidance to correctly understand it, i've never had these levels tested before and realize i should relax before i start freaking out about cancer - although i'll remind you that i've been concerned about symptoms of ms for years, and this is potentially consistent with that.
i've been breathing in dust all week and have been coughing it up, and blowing and sneezing it out. i have a slightly raw throat from it. it makes sense.
that said, i'll leave it up to dr ===== and to the office as to how to react - as it could be consistent with an infection, as well - although i insist that i have no discernible symptoms, if true, and no known cause of exposure.
i saw a dentist on thursday.
regarding the estradiol results, i should point out that i've switched to taking 4 mg twice daily instead of 2 mg 4x daily. the logic is if that if absorption is lower with the generic then lets give it more to discard, and, while it still seems low, that seems to have worked well enough, even if it's at the very bottom of the reference range. i'd still be looking for supplemental sublingual application with the generics, if feasible.
regarding the iron, these results are surprising to me. i sent you detailed dietary information that indicates that my iron levels should be more than sufficient - if i'm low, it's not due to my diet. so, i'm now concerned about this. that being said, most of the numbers fall into the low end of the range for normal female references, even if they're low for male references, and i wonder what the right reference to use is.
nonetheless, if my iron is this low after taking this much, then supplements don't seem to be a useful approach - i'm either not absorbing it, or i'm suffering from internal bleeding. so, i either have a genetic condition or some kind of ulcer somewhere. i mean, it has to be one or the other.
my father is dead and i don't know how to contact my grandmother, but i've emailed my mother. there is actually good reason to suggest that i may have a genetic condition that prevents me from absorbing iron, and i knew that, but i didn't realize it was that bad.
that being said, if there's something that can be done to check for bleeding...
so, i'm good to come in on friday and i'll let the office decide.
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...and, then i crashed again, but only for a few hours. i tried to get up, but i fell back asleep.
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i crashed this morning, but that wasn't unexpected.
so, should i eat meat?
i don't have any good reason, at this point, to think it'll help much. i'd rather rule out bleeding and genetics first, and then resort to meat only in the end, if i absolutely have to.
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i should get some heme supplements, for now.
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i mean, i don't think it's going to work, but i need to try something until we can get a better idea of it.
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when i woke back up early in the afternoon, i intended to get out to the metro to get soy on my bike in the warmer weather, and both found myself disappointed (it wasn't that warm) and missing out on the warmest part of the day. i did finally get out, but not until it was almost dark. my soy was no longer on sale there, but it was still the only place selling the light. but, i stopped at a different store to get chocolate and normal vanilla, for the coffee and pasta bowls.
i then found myself back at home in the dark, with the need to get out one more time to the shopper's to get bathroom supplies. again, i found myself with an overbearing manager following me around, telling me to hurry up - something they'll need to get used to doing. but, i got what i needed from the store and was up and out and home by about 21:00.
i wanted cheap heme in the supplement section just to try it, but instead found myself needing to buy something expensive over the counter, and refused it, hoping to get an rx, if necessary, instead.
i made some eggs and intended to catch up, but instead found myself bogged down with concerns about the blood test, and spent the night posting here & sending emails to family members, including to my uncle and my sister:
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i could be just eating too much wheat, too:
i need to do some typing, but i'm exhausted. i'm still convinced that the second-hand smoke is the primary problem - i didn't develop an iron deficiency recently. whatever exists was always there. and, i was frequently cold before i started eating all this bran, too. - but it's certainly not helping.
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i mean, look at the fruit bowl.
yes, it has a lot of wheat bran.
but, it has 100% of the iron (some of it fortified in the bran), 250% of the vitamin c + high fat, premium ice cream. that should be good enough.
obviously, it isn't - obviously, something is going wrong along the way. but, i don't think that removing the bran is the right argument.
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hi.
i am distant with everybody and will continue to be but i legitimately hope you are well.
i recently got a routine blood test to check for estrogen levels (i've attached it) and they did an iron test on a hunch and i'm coming face to face with the fact that i am dangerously anemic. i remember hearing people talk about that when i was a kid, and being sent home with salami, but i was never diagnosed with anything and i largely haven't thought much about it...
i get tons of iron in my diet. but, on some reflection, i have been dealing with the symptoms of anemia for most of my life, and diet doesn't seem to be a factor.
my father was idiosyncratically cold all of the time, although i don't recall him ever saying "i'm anemic" to me in so many terms. he just complained it was cold and put layers on and yelled to turn up the heat - and the general understanding was that it was "poor circulation". i've long realized that i inherited this "poor circulation", but these iron levels are so low that they're going to kill me. like, i might need a blood infusion.
there are genes that lead to an inability to absorb iron by screwing with your hormones, but the science is relatively new. nonetheless, if that's what i have and what he had, it may very well also be something you have, and something your own father had.
one of the very few memories i have of your mother before she moved to victoria is her being concerned about me being anemic. like, she mentioned it every time i saw her.
so, i'm trying to get as much information to bring to a doctor as i can. is there anything you can clarify about any anemia that your father (or mine.) may have had? what kind of family history can you give me in terms of anemia?
j
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wait.
i'm low in iron. i just got a blood test. now i'm tired. obviously?
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i guess i can't spare much blood, huh?
what am i doing about this?
well, i went to the store looking for heme iron and the only option was an expensive supplement with a measly 11 mg/tab. if i do the math on my diet, i'm already getting more than that. so, that struck me as a waste of money - if i can't absorb it in my diet, what's the use of taking a pill?
i'm checking the formulary and, while heme is not covered, they have these, like, 200 mg tablets of elemental iron that are. well, that's at least worth a shot, i guess - it's at least a substantial increase from what i'm getting, even if i can only absorb 10% of it. that seems like a crapshoot, and i wonder what the side effects might be, but if i can't absorb it...
i sent an email to my mom and she's feigning ignorance. i sent one to my uncle, who may be more useful. i'm trying to avoid contacting my stepmother, if i even can. i'm going to send something to my sister.
what else can i do?
well, i need to figure out if i'm bleeding, but the more i've processed this, the more obvious it is that this is a genetic concern. my dad never said to me "i'm anemic", but it's pretty obvious that he was.
so, if i'm not bleeding, and i can't absorb it, it seems logical to look at injections. unfortunately, that seems like a really bad idea - we need iron to create blood, but introducing it into the blood directly seems to have a large amount of dangerous side effects. the preferred approach seems to be iv, but that doesn't seem to be less dangerous.
so, these high potency supplements might be a crapshoot, but it's probably the best choice i've got.
i just wish i could take 50 mg of heme instead of 200 mg of elemental.
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does estrogen affect iron levels?
it seems to be unclear, with studies arguing both positions.
what i'm going to say is this: while it's certainly possible that estrogen may be exacerbating an underlying issue, i just got an email back from my uncle confirming that this issue with "poor circulation" is something that he has experienced, his mother has experienced, and two of his sisters have experienced.
so, everybody on that side of the family has this condition.
there's clearly an underlying mechanism, and it needs to be addressed, regardless.
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but, my position is actually as follows, and i'm going to double down on it - i think i'm poorly evolved for the canadian climate. which means what, exactly?
supposedly, something like 30% of the global population is unable to absorb "sufficient" levels of iron, and that is something that is strongly correlated with being brown. when 30% of the population has a disorder, that sounds more like variation than a disease - and that you'd only call it a disease if you're white.
while people have migrated around all over the place for thousands of years, and trying to build strong geographic correlations is no doubt futile, it seems like increased iron absorption is probably an adaptation to colder climates. i wouldn't even be surprised to find out it's neanderthal in origin. it follows that people with genetic backgrounds in warmer climates may just not need as much iron - until they move north, and find themselves up against a wall they can't scale.
the actual best solution is for me to move south, and i know that. if i get some source of wealth, right?
in the mean time, i'm stuck between figuring out a way to warm up and figuring out a way to adjust - and want to lean towards the former more than the latter.
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this isn't exactly what i'm thinking, but it's in the right neighbourhood:
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i'm attaching some lab work.
i get yearly estrogen test results, which is what the point of the lab work was. and, you can admire my impeccable cholesterol levels if you'd like - something i've taken great care to get under control, given that i think dad had had two heart attacks by the time he turned 40, which i did a few months ago. they couldn't be better. and, it's just through diet and exercise.
but, they did a random ferritin count and rbc test and it turns out i'm dangerously anemic.
i need to present a tad of caution here - the numbers are using male references and they get a little less scary if you use female references, which is probably the right answer, scientifically. i've had essentially no testosterone production for almost my entire life. this is blurry, but when the numbers come in 1% below the male reference value and 10% above the female reference value, there's some reason to be moderate in my response.
but, the numbers are very low, regardless.
i don't want to jump to conclusions until i work out the different options, but it's clear enough that the issue is going to turn out to be genetic. i don't eat red meat anymore, but i get tons of non-heme iron in my diet and i should at least be able to get above the amount i'm at, even i was a little low. i don't have any reason to think i'm suffering from an ulcer, but i need to actually check to see if i am or not, and that's what i'll do over the next few weeks. so, what's left is the unavoidable conclusion that it sort of doesn't matter how much iron i consume in a diet, i just can't absorb it. and, the result is that i'm constantly cold - which should sound familiar.
i remember his mother telling me i need to be especially concerned about anemia, but i was never diagnosed with it, and this is the first time in my memory that i've ever been tested for it. dad was always evasive about it, speaking about it in vague ways. he never said to me "i'm anemic". but, his whole side of the family is telling me they're suffering from the same thing, so it seems more or less obvious that he was - even if he didn't want to admit it.
the stepmother would know that. that's the information i'm looking for.
and, she would also have some information regarding his white blood counts. my white blood counts have just come in very high. the combination of low iron and high white blood is something that is very concerning, regarding the potential for blood related cancer. it should be obvious why i want the stepmother to look at this - and see if she can provide any information about dad that i can present to my doctor.
she can respond to this address or to koala.central.command@gmail.com. they should both forward to the latter.
fwiw, my perception of the situation is that that side of the family probably has southern genes that restrict iron production. now, we live in a white, northern european society, so we're going to approach this from a specific perspective - we're going to decide that the ability to absorb large amounts of iron is "normal", and that if you can't absorb iron then there's something wrong with you. but, this is actually a backwards approach. the fact is that we evolved in africa, where it's warm all of the time, and had to adjust to the climate as we moved north. it actually follows that we would have evolved to absorb more iron as we became lighter-skinned and not the other way around.
this study maps an allele that codes for excess iron production, which is not exactly what i'm saying, but follows the same sort of logic. it shows pretty clearly that the ability to absorb iron increases as you move north through europe:
it would follow that if i can't absorb enough iron to stay warm in canada, then the correct conclusion is probably not that i have an iron deficiency but that i'm living in a climate that i'm not evolved to live in - and the right answer is to move back to sicily, not to bombard my stomach with excess iron.
but, you know.
at the least, i think it's ultimately a better idea to wear a sweater than to try to force my body to accept a mineral it doesn't seem to be programmed to accept.
my understanding is that this science is still developing and there isn't a clear deduction or treatment plan to follow. but, if she can help me understand the genetic background, it can help me understand how to react.
j
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see, when i look at a study like this...
what are they doing, here? they're defining the amount of iron that africans need by looking at the amount that europeans need, and then deciding that africans are anemic because they don't get the amount of iron that europeans do.
but, the reason that europeans need all of this iron is an adaptation to the colder climate! some of these african cultures live exclusively on meat. if they're not absorbing the iron, perhaps it's because they didn't evolve the need for it, because they aren't living in climates that required it.
so, if you follow this line of thinking, what is there to say about the need for "intervention strategies" in african populations to increase their iron levels? it would be racist, if it wasn't clueless.
so, i need to form a position on this. i've sent an email to my sister asking her to contact my stepmother, who is both an expert on bone marrow cancer and the person best positioned to provide information about my father's health. once i get that information, i'm going to need to make a choice:
1) am i actually iron deficient? if so, i guess the only thing i can do is bombard my stomach lining and try to force it to absorb more than it's designed to - to try to break my programming, so to speak.
2) or am i just evolved to thrive in a warmer climate, where all of this excess iron absorption is not just unnecessary but potentially even harmful? i mean, i don't want to give myself alzheimer's...which seems to be correlated with high iron absorption. if so, i should just accept that my ferritin is low due to genetic variation, and try to adjust my environment so it's warmer.
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yeah.
the more i look into this, the less concerned i am about it.
this is a different reference range:
The normal range for ferritin in your blood serum is:
20 to 250 ng/mL for adult males
10 to 120 ng/mL for adult females, 18 to 39 years
12 to 263 ng/mL for females, 40 years and older
25 to 200 ng/mL for newborns
200 to 600 ng/mL at 1 month old
50 to 200 ng/mL at 2 to 5 months old
7 to 140 ng/mL for children 6 months to 15 years
i'm at 12 ng/ml - or 12 ug/l, same thing. i don't menstruate, so the 12 is a more appropriate lower bound than the 10.
see - it's the very lower limit, regardless. but, i was fasting.
if my body doesn't know what to do with the iron, it doesn't know what to do with the iron - and i need more warmth, not supplements.
but, i need to make sure i'm not bleeding.
and, how much does your ferritin go up and down, on average?
Serum ferritin levels in normal individuals have been reported to vary by 15% in men and 27% in women on a day-to-day basis [54], with variations of up to 62% when measured over a longer term [55].
so, if 12 is the amount measured when i'm fasting at 10 hours, it would be the absolute minimum amount. right? before i accept any sort of iron bombardment, i'm going to request another blood test, but done without fasting. if that number comes up into the 50+ range, i think i have nothing to worry about - i'm just demonstrating variability, and need more warmth than other people that are better adapted for colder climates.
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conversely, if i do another test with iron levels right after i eat and it's still exceedingly low, then i'm going to need to react differently.
what about testosterone suppression? could that affect iron levels?
again - i don't think that's the primary cause because there's so much evidence pointing to the genetics, but testosterone suppression should actually increase ferritin levels, from what i can see. the mechanism seems to be that taking the testosterone out of the process would limit the conversion of ferritin into red blood cells. that is, the ferritin is a precursor to the red blood cells, so what you end up with is more ferritin and less red blood cells. that's the opposite of what i'm seeing.
if anything, the fact that my rbc count was a little bit deficient and my ferritin count was extremely deficient seems to point to the idea that my ferritin got used up making red blood cells and what the test really suggests is that i was hungry. that might be over-simplifying, but i think it makes sense of it.
and, if that's the case, it would suggest that it was just a function of the distance between eating.
so, while fasting is good for testing glucose, it seems to be bad for testing ferritin - or, at least, bad for testing it once and drawing conclusions from it. i need a post-meal test...
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i then found myself feeling overwhelmed and decided to force myself to sleep in until the afternoon, without accomplishing anything overnight or even making my morning fruit bowl. but, i got a fax out to my doctor first, because i hadn't heard anything back from the one i sent the previous day:
