Hello all! I have lurked this forum for a long time and appreciated everyone's info and experiences, but now I've made an account to ask some questions. I'm currently 21 months post-op traditional duodenal switch.

I'm very confused about fatigue and iron levels. I've been experiencing increasingly worse fatigue over the past year, but I can't get my primary care physician to do anything about it. I recently asked him to test my iron levels because I suspect the symptoms I've been having are related (intense fatigue, always cold, dizzy when standing).

• My lab's reference range for iron is 27ug/dL to 159ug/dl. It's only labeled "iron", but I assume it's the test for serum.
• Since surgery, my iron has gone from 46 to 44 to 42.
• The reference range for hemoglobin is 11.1g/dL to 15.9g/dL.
• My hemoglobin has gone from 11.7 to 12.4 to 11.9 to 11.4.
• Within the same amount of time, I have increased my iron supplementation from 0 to 30 to 45 to 60. The last increase was at the request of my surgeon, who did say my iron was on the low end.
• When I look up normal ranges online for iron, a majority says my (adult female) iron I should be over 50 and hemoglobin should be over 12 at the lowest. I also get the impression from looking at older posts here that my iron is, in fact, low.
• My Vit D was the only other thing low on my last labs, and I've since added a supplement for that, but have not yet had it tested.

I will get my next full panel of labs with my surgeon in November. However, my pcp nurse calls and tells me "Your levels are fine" based on the lab ranges. They're making me feel like I'm insane and I feel like I'm being gaslit. If my iron isn't low, what could be causing this awful fatigue and why can't I get my doctor to do anything about it? I'm pulling my hair out in frustration at this point. I would switch pcp, but I live in a very small town and don't have access to another doctor at the moment. Not being able to stay awake the entire day is not how I intend to live the rest of my life.

In the meantime, I have decided to increase my iron again and will now be taking 130mg/day of carbonyl iron and 36 mg/day of ferrous fumarate. Previously, I was taking 60mg of ferrous fumarate. I can't think of anything else to do.

I would appreciate any thoughts or advice. Does it seem like the iron or might there be a deficiency in something else causing those symptoms that I haven't heard of? Thank you!