Sleeping much better on Kyzatrex vs injections

[Vman]

Nice to see another Kyzatrex user

What sort of meal do you take the Kyzatrex with and how long after your dose did you get labs drawn?

My breakfast dose is with yogurt, berries and walnuts. My lunch dose is with grilled chicken and broccoli or some sort of scramble. My doc has me do labs 3-5 hours after my lunch dose.

Got my first real lab results on Kyzatrex 400mg twice daily:

5/11/2026 @ 3pm:
Total T: 2069 (250-1100 ng/dL)
Free T: 570.2 (35-155 pg/mL)
SHBG: 21 (10-50 nmol/L)
Hemoglobin: 17.6 (13.2-17.1 g/dL)
Hematocrit: 52.7 (39.4-51.1 %)
Ferritin: 31 (38-380 ng/mL)




I started taking Kyzatrex on 3/11/2026. My last blood donation was on 4/30/2026 and I did the Vorck protocol starting on that day and for 7 total days ending on 5/7/2026.


You need to stop donating to see where your hematocrit would truly sit on oral TU.

You started Kyzatrex March 11th and 50 days in donated blood on April 30th so 11 days before getting blood work done on May 11th.

Your hematocrit would have been higher than 52.7% if you never donated.

The goal here is to bring down your hematocrit and ditch the frequent blood donations which are tanking your ferritin.

My goal is exactly what you stated...to bring down hematocrit which will allow me to stop donating blood which will hopefully allow my ferritin to rise. And I want to thank you @madman! Your posts are what led me to gradually lower my daily dose from 14mg to 8mg and then to finally give Kyzatrex a try.

Unfortunately, I have had to donate blood at least every 2 months for close to 3 years now and my hematocrit is almost always at or above 54 whenever I have labs drawn. So my expectation was that my hematocrit would still be at or above 54 even with a blood donation right before labs since that's what it's always been and since there was still T cyp in my system for some of the last 2 months. I was hoping my hematocrit would be lower than 54 but I was definitely not expecting it.

So I am extremely happy that my hematocrit was only 52.7. Especially given that I had insanely high peak TT & FT on Kyzatrex! And my sleep is amazing as a completely unexpected bonus!

It's still early, but I'm hoping once my doc and I get my Kyzatrex dose dialed in I'll never need to donate blood again.

 

[Systemlord]

Got my first real lab results on Kyzatrex 400mg twice daily:

5/11/2026 @ 3pm:
Total T: 2069 (250-1100 ng/dL)
Free T: 570.2 (35-155 pg/mL)
SHBG: 21 (10-50 nmol/L)
Hemoglobin: 17.6 (13.2-17.1 g/dL)
Hematocrit: 52.7 (39.4-51.1 %)
Ferritin: 31 (38-380 ng/mL)

Lab was drawn 3.5 hours after my lunch dose as advised by my doc to measure peak. My last T cyp subq injection was on 3/4/2026 and I started taking Kyzatrex on 3/11/2026. My last blood donation was on 4/30/2026 and I did the Vorck protocol starting on that day and for 7 total days ending on 5/7/2026.

I clearly have no problem achieving crazy high peak TT and Free T on Kyzatrex! In addition, my Hematocrit of 52.7 is the lowest it's been in years. My performance in the gym is the same or slightly better compared to injections. But most importantly, I feel amazing and I'm sleeping great every night!

For reference, here are my last few labs on 10mg subq daily T cyp injections @ 8:30am:

6/26/2025 @ 9:01am:
Total T: 585 (250-1100 ng/dL)
Free T: 110.4 (35-155 pg/mL)
SHBG: 24 (10-50 nmol/L)
Hemoglobin: 18.9 (13.2-17.1 g/dL)
Hematocrit: 57.4 (39.4-51.1 %)
Ferritin: 29 (38-380 ng/mL)

10/2/2025 @ 9:23am:
Total T: 610 (250-1100 ng/dL)
Free T: 121.7 (35-155 pg/mL)
SHBG: 24 (10-50 nmol/L)
Hemoglobin: 18.4 (13.2-17.1 g/dL)
Hematocrit: 56.2 (39.4-51.1 %)
Ferritin: 43 (38-380 ng/mL)

1/20/2026 @ 3:10pm:
Total T: 1142 (250-1100 ng/dL)
Free T: 161 (35-155 pg/mL)
SHBG: 26 (10-50 nmol/L)
Hemoglobin: 18.0 (13.2-17.1 g/dL)
Hematocrit: 54.2 (39.4-51.1 %)
Ferritin: 25 (38-380 ng/mL)

Clearly an over responder here as you are hitting an absurdly high peak TT and more importantly FT 57 ng/dL.

Your first peak post morning dose would still be impressive!

This is where one needs to keep in mind starting doses as some men can achieve stellar levels on the standard starting dose 200 mg BID.

Even then the true peak post noon dose will be pushed higher due to overlapping absorption when following the hybrid protocol (breakfast/lunch).

After you hit the true peak levels will start coming down fairly quick.

Would be interesting to see where you bottom out 8-12 hrs post dose or better yet your true trough (pre-AM) dose!

Your ferritin is still too low.




Your reply from post #5 (this thread)

I don't have accurate TT/FT levels on orals yet as they were taken while I still had T cyp in my system. The numbers I do have are above top of range by 15% or so at peak 4 hours post lunch dose. These were taken one week after starting Kyzatrex and two weeks after stopping daily injections. I will have updated labs in about two weeks.


Something off here when comparing your labs as you stated the numbers I do have are above top of range by 15% or so at peak 4 hours post lunch dose.

This was 2 weeks after starting so you would have easily hit steady-state a week before you had the labs done yet on your most recent labs your numbers are well beyond 15% over the top-end of the refernce range LOL as you are hitting a. ridiculous peak TT 2069 ng/dL and more importantly absurdly high peak FT 57 ng/dL 3.5 hrs post noon dose!

His low ferritin could be the result his body trying to balance out the hemoglobin and hematocrit. Remember, high ferritin is correlated with low testosterone, high testosterone is correlated with lower ferritin. I actually feel better with lower ferritin below 30 on Jatenzo. Above 30 I don’t feel as good and I have issues with heart rate and blood pressure with middle of the road total testosterone (TT 490). My response to Jatenzo above 30 ferritin my dick and muscles get soft and response to therapy is subpar.

 

[madman]

My breakfast dose is with yogurt, berries and walnuts. My lunch dose is with grilled chicken and broccoli or some sort of scramble. My doc has me do labs 3-5 hours after my lunch dose.

My goal is exactly what you stated...to bring down hematocrit which will allow me to stop donating blood which will hopefully allow my ferritin to rise. And I want to thank you @madman! Your posts are what led me to gradually lower my daily dose from 14mg to 8mg and then to finally give Kyzatrex a try.

Unfortunately, I have had to donate blood at least every 2 months for close to 3 years now and my hematocrit is almost always at or above 54 whenever I have labs drawn. So my expectation was that my hematocrit would still be at or above 54 even with a blood donation right before labs since that's what it's always been and since there was still T cyp in my system for some of the last 2 months. I was hoping my hematocrit would be lower than 54 but I was definitely not expecting it.

So I am extremely happy that my hematocrit was only 52.7. Especially given that I had insanely high peak TT & FT on Kyzatrex! And my sleep is amazing as a completely unexpected bonus!

It's still early, but I'm hoping once my doc and I get my Kyzatrex dose dialed in I'll never need to donate blood again.

His low ferritin could be the result his body trying to balance out the hemoglobin and hematocrit. Remember, high ferritin is correlated with low testosterone, high testosterone is correlated with lower ferritin. I actually feel better with lower ferritin below 30 on Jatenzo. Above 30 I don’t feel as good and I have issues with heart rate issues and blood pressure.

The frequent blood donations is hammering down his ferritin.

I have been on T for over 9 years and have always run a high-end trough FT and my hematocrits hovers around 50-51% and more importantly I have never had to rely on donating blood and my ferritin sits at 150.

Even though more ferritin/iron will be used up to make new RBCs when using exogenous T as long as one is getting in enough iron through diet or supplementation and they have no underlying issues that would negatively effect absorption or Gi issues cause blood loss it's far from common one would end up with low ferritin on exogenous T.

The people who run into issues with low ferritin on therapy are the ones who donate too frequently or do not get enough iron through diet/supplementation or have absorption issues!

It is a given donating too frequently will crash your iron/ferritin!

 

[Systemlord]

The frequent blood donations is hammering down his ferritin.

I have been on T for over 9 years and have always run a high-end trough FT and my hematocrits hovers around 50-51% and more importantly I have never had to rely on donating blood and my ferritin sits at 150.

Even though more ferritin will be used up to make new RBCs when using exogenous T as long as one is getting in enough iron through diet or supplementation and they have no underlying issues that would negatively effect absorption no one would end up with low ferritin on exogenous T.

The people who run into issues with low ferritin on therapy are the ones who donate too frequently or do not get enough iron through diet/supplementation or have absorption issues!

It is a given donating too frequently will crash your iron/ferritin!

I guess it depends on what’s lowering the ferritin, TRT or excessive blood donations.

Got it!

 

[madman]

I guess it depends on what’s lowering the ferritin, TRT or excessive blood donations.

Got it!

I would put my money on the frequent blood donations!

 

[Mastodont]

Yet there are multiple examples IRL of guys who never donated but are very low in ferritin, granted these guys are usually on 250mg per week or close to it.

 

[madman]

Yet there are multiple examples IRL of guys who never donated but are very low in ferritin, granted these guys are usually on 250mg per week or close to it.

T therapy increases iron utilization because of increased RBC production but clinically significant low ferritin is most often driven by repeated blood donation/phlebotomy, inadequate iron intake, impaired absorption, or ongoing blood loss.

Hematocrit response to testosterone is highly individual and while many men can reach hematocrit levels in the low-mid 50% range even on standard or higher doses the rise in hematocrit is not strictly linear and varies between individuals and over time rather than increasing indefinitely with dose alone.

Men using therapeutic or supraphysiologic doses with adequate iron intake, normal absorption, and no ongoing blood loss clinically significant ferritin depletion would be uncommon.

 

[Guided_by_Voices]

Yet there are multiple examples IRL of guys who never donated but are very low in ferritin, granted these guys are usually on 250mg per week or close to it.

As I understand it, this does not mean someone is low in Iron. Ferritin is a carrier for Iron but the amount it carries can vary widely. AFAIK, the only likely way other than blood donation that one can lose iron is via ultra-endurance activity. This has been discussed a lot in the context of Iron overload which for most men is a much greater risk than low iron.. Total Iron Binding Capacity is a better measure of Iron (TIBC) but absent blood donation, it would be very hard for someone to be low in iron. Perhaps our local Ferritin expert (whose handle I've forgotten) will chime in. Mainstream medicine has generated a lot of confusion on this topic by focusing on low iron and using Ferritin as an indicator rather than focusing on Iron overload.

 

[Partapradip]

Were you taking your daily subq cypionate in the morning or at night? If morning, then the flat profile still meant some T was present all night. If night, that's an even stronger argument against steady-state protocols for sleep-sensitive men.

 

[Mastodont]

T therapy increases iron utilization because of increased RBC production but clinically significant low ferritin is most often driven by repeated blood donation/phlebotomy, inadequate iron intake, impaired absorption, or ongoing blood loss.

Hematocrit response to testosterone is highly individual and while many men can reach hematocrit levels in the low-mid 50% range even on standard or higher doses the rise in hematocrit is not strictly linear and varies between individuals and over time rather than increasing indefinitely with dose alone.

Men using therapeutic or supraphysiologic doses with adequate iron intake, normal absorption, and no ongoing blood loss clinically significant ferritin depletion would be uncommon.

Actually very common, but varies hugely by individual, exogenous testosterone has a direct effect on hepcidin, but more for some than others...you see plenty of cases where on natural low t ferritin is 250, and with the same diet and no donations it goes to around 50...myself included.
There seems to be a trend where high hematocrit is a tell of lowered ferritin.
As said, not necessarily anything to worry about as long as transferrin and other iron markers are in check.

 

[madman]

Actually very common, but varies hugely by individual, exogenous testosterone has a direct effect on hepcidin, but more for some than others...you see plenty of cases where on natural low t ferritin is 250, and with the same diet and no donations it goes to around 50...myself included.
There seems to be a trend where high hematocrit is a tell of lowered ferritin.
As said, not necessarily anything to worry about as long as transferrin and other iron markers are in check.

Actually very common

It's not very common!

Again most healthy men on T therapy with (normal iron status, no blood loss, no frequent phlebotomy, normal iron absorption and adequate dietary or supplemental intake) do not experience ferritin falling into clearly low or iron-deficient ranges purely as a result of T therapy!

A smaller subset may still develop low ferritin due to individual variability in erythropoietic response, lower baseline iron reserves, or unrecognized contributing factors.

Hope you understand that exogenous T lowers hepcidin primarily through an indirect erythropoiesis driven mechanism.

If your baseline fell in a healthy range before you jumped on T and all the boxes check here as in (no blood loss, no frequent phlebotomy, normal iron absorption and adequate dietary or supplemental intake then you can easily bring it back up.

 

[Mastodont]

Actually very common

It's not very common!

Again most healthy men on T therapy with (normal iron status, no blood loss, no frequent phlebotomy, normal iron absorption and adequate dietary or supplemental intake) do not experience ferritin falling into clearly low or iron-deficient ranges purely as a result of T therapy!

A smaller subset may still develop low ferritin due to individual variability in erythropoietic response, lower baseline iron reserves, or unrecognized contributing factors.

Hope you understand that exogenous T lowers hepcidin primarily through an indirect erythropoiesis driven mechanism.

If your baseline fell in a healthy range before you jumped on T and all the boxes check here as in (no blood loss, no frequent phlebotomy, normal iron absorption and adequate dietary or supplemental intake then you can easily bring it back up.

"We showed previously, however, that testosterone dose-dependently increases hemoglobin and hematocrit, but without an associated increase in erythropoietin (5). In addition, testosterone has minimal proliferative effect on purified (CD34+) erythroid progenitors ex vivo (6). We considered the hypothesis that testosterone increases hematocrit by suppressing the master iron regulatory peptide hepcidin, thus resulting in increased bioavailable iron."

Testosterone Suppresses Hepcidin in Men: A Potential Mechanism for Testosterone-Induced Erythrocytosis - PMC

Context: The mechanisms by which testosterone increases hemoglobin and hematocrit are unknown. Objective: The aim was to test the hypothesis that testosterone-induced increase in hematocrit is associated with suppression of the iron regulatory ...

pmc.ncbi.nlm.nih.gov

Cataceous also provided labworks where he had a direct inverse relationship between t-levels and ferritin.

 

[Mastodont]

So I am extremely happy that my hematocrit was only 52.7. Especially given that I had insanely high peak TT & FT on Kyzatrex! And my sleep is amazing as a completely unexpected bonus!

Can you tell if you are experiencing nocturnal erections? When you wake up do you feel fresh, full of energy? Currently been experiencing waking up too early and thinking of lowering my dose, some nights also bit of restless sleep.

 

[madman]

"We showed previously, however, that testosterone dose-dependently increases hemoglobin and hematocrit, but without an associated increase in erythropoietin (5). In addition, testosterone has minimal proliferative effect on purified (CD34+) erythroid progenitors ex vivo (6). We considered the hypothesis that testosterone increases hematocrit by suppressing the master iron regulatory peptide hepcidin, thus resulting in increased bioavailable iron."

Testosterone Suppresses Hepcidin in Men: A Potential Mechanism for Testosterone-Induced Erythrocytosis - PMC

Context: The mechanisms by which testosterone increases hemoglobin and hematocrit are unknown. Objective: The aim was to test the hypothesis that testosterone-induced increase in hematocrit is associated with suppression of the iron regulatory ...

pmc.ncbi.nlm.nih.gov

Cataceous also provided labworks where he had a direct inverse relationship between t-levels and ferritin.

That was my read of the data but the mechanism in humans is still not definitively established.

Numerous papers T/hematocrit littered on the forum that I have posted over the years!

Look over some of Bhasin's more recent studies instead of getting caught up on that one from 2010!

Sift through the most recent literature.

Human studies show T suppresses hepcidin in parallel with increased erythropoietic activity and iron utilization.

Importantly whether this reflects indirect erythropoietic/EPO-mediated signaling, direct hepatic androgen effects, or a combination of both remains unresolved.

Again as I stated previously most healthy men on T therapy with (normal iron status, no blood loss, no frequent phlebotomy, normal iron absorption and adequate dietary or supplemental intake) do not experience ferritin falling into clearly low or iron-deficient ranges purely as a result of T therapy!

A smaller subset may still develop low ferritin due to individual variability in erythropoietic response, lower baseline iron reserves, or unrecognized contributing factors.

https://academic.oup.com/jcem/article/105/4/e1316/5693356?utm_source=chatgpt.com&login=false

“It is unclear whether testosterone directly suppresses hepcidin or indirectly suppresses hepcidin through its effects on EPO“

Thread 'From Phlebotomy to Formulation: Optimizing Hematocrit Control in Testosterone Therapy'

Apr 1, 2025

Briefing Document: Optimizing Hematocrit Control in Testosterone Therapy​

Source: Excerpts from "From Phlebotomy to Formulation: Optimizing Hematocrit Control in Testosterone Therapy - Excel Male TRT Forum"

1. Executive Summary​

Testosterone Replacement Therapy (TRT) offers significant benefits for hypogonadal men, including improved body composition, metabolic function, and mental well-being. However, a notable side effect is the increase in hematocrit (HCT) and hemoglobin levels, driven by testosterone's stimulation of erythropoiesis. Elevated hematocrit...

• madman
• hypogonadism; testosterone; hematocrit; cvd
• Replies: 19
• Forum: Testosterone Side Effect Management

• 

 

[FunkOdyssey]

What happened with mine: ferritin dropped when I first started TRT and my hematocrit was rising. After hematocrit stabilized, my ferritin quickly recovered to its normal baseline. I theorize that ferritin can drop temporarily when demand is high to produce a bunch of new blood cells.

I think this probably happens to most people, but you won't catch it unless you're testing ferritin often during your early days of TRT.

 

[Cataceous]

Cataceous also provided labworks where he had a direct inverse relationship between t-levels and ferritin.

I'd forgotten about that post. I have another data point from last year that continues to support the trend:

 

[Mastodont]

Human studies show T suppresses hepcidin in parallel with increased erythropoietic activity and iron utilization.

Regardless, even that study you shared still states "Findings from the current study indicate that testosterone supplementation suppresses hepcidin in healthy human adults". So it is to be expected that ferritin also drops.

You say healthy men on t-therapy, with the current epidemic of secondary hypogonadism, most people getting on t are not too healthy, years of hypogonadism wreaks havoc in many cases.

As Funk said, there seems to also be many cases where the ferritin came back up eventually, one i know personally did say he took supplemental iron on top of red meat. Then again i know someone who's ferritin rose back on it's own, as did his hematocrit creep back down, makes sense. The latter had been on t-therapy for a good six months or so when it balanced and did lower his dose(longer injection frequency) a tiny bit as well.

This was interesting;

"Other possibilities include a direct effect of testosterone on bone morphogenetic protein (BMP)–sons of mother against decapentaplegic (SMAD) signaling (11) and/or the aromatization of testosterone to estradiol, which suppresses hepcidin transcription (22, 23)."

chatgpt:

Key study: direct suppression of hepcidin by estradiol​

A 2012 paper in The Endocrine Society’s journal Endocrinology showed that 17β-estradiol (E2) directly reduced hepcidin transcription in liver cells. Researchers found:

• Lower hepcidin mRNA in human hepatocyte cell lines after estradiol exposure
• Suppression was blocked by an estrogen receptor antagonist
• Estradiol acted through an estrogen response element (ERE) in the hepcidin promoter
• Estradiol also reduced hepatic hepcidin expression in mice

Mechanistically, the paper proposed:


E2→ER→↓HAMP (hepcidin) transcriptionE2 \rightarrow ER \rightarrow \downarrow HAMP\,(hepcidin)\ transcriptionE2→ER→↓HAMP(hepcidin) transcription


where:

• E2E2E2 = estradiol
• ERERER = estrogen receptor
• HAMP = the hepcidin gene

The authors explicitly concluded that estradiol suppresses hepcidin to increase iron availability.

 

[Mastodont]

I'd forgotten about that post. I have another data point from last year that continues to support the trend:

View attachment 57066

It certainly is a strong case for many men just simply being on too much T for their physiology.

 

[FunkOdyssey]

It certainly is a strong case for many men just simply being on too much T for their physiology.

I think that's overstating the case. Provided you remain above 50 ng/mL in the longer term, movement of ferritin within the normal range is pretty inconsequential. If anything, the high end has been associated with increased mortality risks.

 

[FunkOdyssey]

Just to make sure my PSA is in every thread about TRT and sleep issues, if you haven't eliminated caffeine, that should be step one. The measurable benefits of caffeine disappear completely with chronic use, unlike testosterone. So, if you need to get rid of one to fix your sleep, let it be the caffeine that goes.