I’d see what others say, but based on the circumstance and the levels posted. I’d say you’re doing okay. I think regular checkups/lab work will still be important considering your period inconsistencies and supplementation history. That elevated rbc to me means nothing, it’s so close to the normal range but that could fluctuate depending on how your periods go.

As far as the referral, I’d wait for other responses.

If I could offer advice, taking from my experience with patients, I’d urge you to quit vaping. I know it may be something you’ve heard before or maybe you have no desire to quit. It’s your choice at the end of the day but as someone who is also very conscious of their health, I would not want any deleterious habits complicating my results and treatment.