Transferrin Saturation

When low (<15%) -- confirms iron deficiency:

Supplements:

• Iron Bisglycinate -- 25-50mg elemental iron/day
• Vitamin C -- 500mg with iron dose to enhance absorption
• Low transferrin saturation + low ferritin = true iron deficiency -- supplementation is indicated
• Low transferrin saturation + normal/high ferritin = functional iron deficiency (iron trapped in stores, often from inflammation)

Context for AAS users:

• Regular blood donation to manage high haematocrit depletes iron stores rapidly
• Monitor transferrin saturation alongside ferritin every 8-12 weeks if donating regularly
• Target transferrin saturation 20-35% for optimal erythropoiesis

When high (>45%) -- possible iron overload:

• Investigate hereditary haemochromatosis (HFE gene testing) if persistently >50%
• Reduce or stop iron supplementation
• Avoid Vitamin C supplements in excess (enhances iron absorption further)
• Blood donation is therapeutic for iron overload
• Check liver function -- iron overload causes hepatotoxicity (compounding oral AAS liver stress)

References:

• Camaschella, C. (2015). Iron-deficiency anemia. New England Journal of Medicine, 372(19), 1832-1843. DOI: 10.1056/NEJMra1401038
• Solimini, R., Rotolo, M. C., Mastrobattista, L., et al. (2017). Hepatotoxicity associated with illicit use of anabolic androgenic steroids in doping. European Review for Medical and Pharmacological Sciences, 21(1 Suppl), 7-16. PubMed: 28379599