Serum Iron

When high

When elevated (iron overload):

• Therapeutic phlebotomy -- 500mL every 8-12 weeks until ferritin <50 ug/L; first-line for confirmed overload; for haemochromatosis, weekly until depleted then maintenance every 2-4 months
• Investigate hereditary haemochromatosis (HFE gene screening) if transferrin saturation is persistently >50%
• Iron chelation (deferasirox / Exjade 20-40mg/kg/day, or deferoxamine) -- reserved for severe overload where phlebotomy is contraindicated; physician-supervised; significant side effect profile (GI upset, renal/liver stress, retinal toxicity)
• Avoid high-dose vitamin C with meals (enhances iron absorption further)
• Monitor liver function; iron overload compounds any AAS-induced hepatotoxicity
• Note: AAS-driven erythropoiesis paradoxically increases iron utilisation, so true iron overload in active cycle users is uncommon and usually signals hereditary haemochromatosis

When low

When low (deficiency):

Supplements:

• Iron Bisglycinate -- 25-50mg elemental iron/day; better absorbed, fewer GI side effects than ferrous sulfate
• Vitamin C -- 500mg with iron to enhance absorption
• See Ferritin marker for alternate-day dosing, lactoferrin, and heme iron polypeptide options; same protocol applies

Tips:

• Take iron on empty stomach or with Vitamin C
• Avoid calcium, coffee, and tea with iron (inhibit absorption)

Pharmacological options (severe deficiency or intolerance):

• IV iron (Ferinject / Monoferric) -- see Ferritin marker for full IV iron protocol; same indications apply when serum iron is persistently low despite oral supplementation