Advice of Lab Results-High Estradiol

[HootSnik]

Comments on Recent Lab Results

I just received my latest lab results and would like to get input from the “brain trust” on my proposed adjustments and plan of action.

Background: I started TRT back in June due to a very low free T (LabCorp 5.3 on scale of 6.6-18.1) and the traditional symptoms. We started testosterone enanthate (IM) at a very low dose (at my request) and over the last five months and two labs have adjusted the dosing based on how I feel and the lab results. My current protocol is 40 mg every 3.5 days which has resulted in a total T (blood draw 1 hour prior to dose) of 1045 and a free t of 17.4—I am obviously very sensitive to exogenous testosterone as I understand that this is a fairly low dose for those results. At this level I am now feeling healthy, all save two (important) symptoms have disappeared, energy is up, motivation/initiative is up, and mood is stable. The two remaining symptoms are that I still have lingering E.D. and delayed ejaculation — I am wearing my wife out trying to finish. However, I think the current labs show the basis of these remaining symptoms.

Current Labs: All lab results were within LabCorp’s range except hematocrit which was 52.1 against their scale of 37.5 to 51 and estradiol (ultra sensitive) which was 62 against their scale of 7.6 to 42.6. It appears that I convert a significant amount of the exogenous testosterone to estrogen which we think could be the reason for the lingering symptoms—my pre t estradiol was 23.

The adjustments I am considering are to reduce the dose from 80mg/wk to 70mg/wk and add 0.25 mg of anastrozole once per week. I am hoping that the reduced dose and resulting reduced total t will drop the hematocrit down (my blood pressure has crept up slightly) and the anastrozole will drop the estradiol and address the two lingering symptoms. Since I will be converting less of the testosterone to estrogen with the anastrozole, I am hoping that we will not have a significant effect on free t—as I feel good at the current free t level of 17.4.

Comments-suggestions??

 

[Systemlord]

It's possible you're just overdosed on Test. I wouldn't touch the AI, I would just play around with your Test dosage.

 

[Vince]

Overweight? Fat cells contain aromatase, so higher body fat can lead to increased estrogen production.

 

[HootSnik]

Overweight? Fat cells contain aromatase, so higher body fat can lead to increased estrogen production.

Hi Vince--5'9", wt 182, 16% body fat, waist 32".

 

[Nelson Vergel]

estradiol (ultra sensitive) which was 62 against their scale of 7.6 to 42.6. It appears that I convert a significant amount of the exogenous testosterone to estrogen which we think could be the reason for the lingering symptoms—my pre t estradiol was 23.

Please don't make that assumption. Read these posts:

Estradiol and DHT Levels on TRT: How to Predict

Testosterone Replacement Therapy (TRT) is a common treatment for men with low testosterone levels. While TRT can have numerous benefits, such as increased energy, libido, and muscle mass, it is import

www.discountedlabs.com

Effect of Estradiol on Men's Libido

Descriptions of the roles of estradiol in men and its management in men on testosterone therapy.

www.discountedlabs.com

High Estradiol in Men: Myths and Realities

Discover the dangers of high estradiol in men and learn how to identify when levels are too high. Explore more on our blog at DiscountedLabs.com

www.discountedlabs.com

 

[HootSnik]

Thanks Nelson--I have some research to do!!

 

[HootSnik]

Homework done!

OK, I have read through the referenced articles/reviews mentioned in Nelson’s post above to include the sources used for the articles looking for any information on “optimal estradiol ranges” for men on TRT. I have reached some conclusions based on that reading which I would appreciate any comments/corrections from the “brain trust” as this subject matter is new to me.

First off it should be pointed out that most of the reference material makes it clear that typical estradiol lab ranges (such as Lab Corps range of 7.6 to 42.6 pg/mL) were developed based on men not on TRT and that those men on TRT could easily have absolute blood counts of estradiol above that range without suffering any negative side effects due mainly to their typically higher range total testosterone levels.

Reference any information/guidance on “optimum” estradiol blood counts: On the low end it appears that there is some basis noted in the source material for keeping the absolute estradiol blood count above 10 pg/mL to avoid negative symptoms.

Reference the upper limit to absolute estradiol blood counts in pg/mL: There is little to no guidance in the reference material. However, there is some discussion/opinion (of one clinic in particular) that one should not let the ratio of total testosterone in ng/dL to estradiol (sensitive) in pg/mL to drop below 10:1 else symptoms may result.

My conclusions are that the source material suggests, for most men on TRT, to keep the low range estradiol blood count number above 10 pg/mL and the high range number should be such that the TT to estradiol ratio is 10:1 or higher.

I am interested in this subject as my protocol of 40 mg testosterone enanthate every 3.5 days has produced a trough absolute estradiol count of 62 (pre trt it was 23-both sensitive measures). However, after reading through the articles and calculating my ratio against my total testosterone trough level of 1045 I get a ratio slightly below 17:1. It appears that I should not be too concerned about the absolute count of 62.

Even though I feel better today (6 months on TRT) than I have felt in 6 years I do still have a couple of nagging symptoms remaining. Given that fact and the fact that my total t. is high range, free t is 17.4 (Labcorp) and 23.8 calculated I felt I have room to adjust dosing downward (as opposed to adding Anastrozole) to see if that might impact the remaining symptoms. In that regard I have adjusted the total weekly down from 80 mg/wk to 74 mg/wk, will monitor symptoms, and will pull labs again in 3 months.

If I am missing something please let me know.

 

[Cataceous]

I'll begin with my usual admonitions: contrary to popular perception, 80 mg/week of TE is not a low dose, physiologically speaking. That's over 8 mg/day of testosterone, while typical natural production for healthy young guys is 6-7 mg/day. In some cases injecting twice weekly can make a dose appear low, as faster absorption can lead to higher peak levels and reduced trough levels. However, your trough level is still quite high, so you definitely have leeway for a significant dose reduction.

I agree with the others that high estradiol should not automatically be blamed for your remaining issues. However, you're still in uncharted territory, with estradiol being high in absolute terms and top-of-range in relative terms. I would address this with a dose reduction. The drop to 74 mg TE/week is a good start, but more such reductions may be needed.

I think at one time or another we're all guilty of projecting our own experiences onto others, which isn't always justified. At risk of doing this, I'll say that having had the symptoms you describe, I found it impossible to fully correct them with the basic tools: dose and ester adjustments, AIs, cabergoline, etc. My hypothesis is that the symptoms are consequences of TRT's disruption of other hormones, which number upwards of 20. I have adopted an overly complicated protocol that attempts to remedy the imbalances. This approach is unsustainable for most people. There is an alternative, which is one that I've maintained should be the first-line treatment for hypogonadism. This is the use of fast-acting testosterone, such as testosterone nasal gel. Such treatments resolve the symptoms of hypogonadism with less interference with other hormones.

As you're already well along in your current treatment, I suspect that you and/or your doctor are going to want to stay the course. Hopefully the minor adjustments will do the job. But in case not I hope you will make a mental note to revisit this and consider alternatives.

 

[Nelson Vergel]

Homework done!

OK, I have read through the referenced articles/reviews mentioned in Nelson’s post above to include the sources used for the articles looking for any information on “optimal estradiol ranges” for men on TRT. I have reached some conclusions based on that reading which I would appreciate any comments/corrections from the “brain trust” as this subject matter is new to me.

First off it should be pointed out that most of the reference material makes it clear that typical estradiol lab ranges (such as Lab Corps range of 7.6 to 42.6 pg/mL) were developed based on men not on TRT and that those men on TRT could easily have absolute blood counts of estradiol above that range without suffering any negative side effects due mainly to their typically higher range total testosterone levels.

Reference any information/guidance on “optimum” estradiol blood counts: On the low end it appears that there is some basis noted in the source material for keeping the absolute estradiol blood count above 10 pg/mL to avoid negative symptoms.

Reference the upper limit to absolute estradiol blood counts in pg/mL: There is little to no guidance in the reference material. However, there is some discussion/opinion (of one clinic in particular) that one should not let the ratio of total testosterone in ng/dL to estradiol (sensitive) in pg/mL to drop below 10:1 else symptoms may result.

My conclusions are that the source material suggests, for most men on TRT, to keep the low range estradiol blood count number above 10 pg/mL and the high range number should be such that the TT to estradiol ratio is 10:1 or higher.

I am interested in this subject as my protocol of 40 mg testosterone enanthate every 3.5 days has produced a trough absolute estradiol count of 62 (pre trt it was 23-both sensitive measures). However, after reading through the articles and calculating my ratio against my total testosterone trough level of 1045 I get a ratio slightly below 17:1. It appears that I should not be too concerned about the absolute count of 62.

Even though I feel better today (6 months on TRT) than I have felt in 6 years I do still have a couple of nagging symptoms remaining. Given that fact and the fact that my total t. is high range, free t is 17.4 (Labcorp) and 23.8 calculated I felt I have room to adjust dosing downward (as opposed to adding Anastrozole) to see if that might impact the remaining symptoms. In that regard I have adjusted the total weekly down from 80 mg/wk to 74 mg/wk, will monitor symptoms, and will pull labs again in 3 months.

If I am missing something please let me know.

It is so great to have someone digest all the info we have posted here. All of your statements are right!

What nagging symptoms are you experiencing? Have you also checked your thyroid function?

 

[Seagal]

Homework done!

OK, I have read through the referenced articles/reviews mentioned in Nelson’s post above to include the sources used for the articles looking for any information on “optimal estradiol ranges” for men on TRT. I have reached some conclusions based on that reading which I would appreciate any comments/corrections from the “brain trust” as this subject matter is new to me.

First off it should be pointed out that most of the reference material makes it clear that typical estradiol lab ranges (such as Lab Corps range of 7.6 to 42.6 pg/mL) were developed based on men not on TRT and that those men on TRT could easily have absolute blood counts of estradiol above that range without suffering any negative side effects due mainly to their typically higher range total testosterone levels.

Reference any information/guidance on “optimum” estradiol blood counts: On the low end it appears that there is some basis noted in the source material for keeping the absolute estradiol blood count above 10 pg/mL to avoid negative symptoms.

Reference the upper limit to absolute estradiol blood counts in pg/mL: There is little to no guidance in the reference material. However, there is some discussion/opinion (of one clinic in particular) that one should not let the ratio of total testosterone in ng/dL to estradiol (sensitive) in pg/mL to drop below 10:1 else symptoms may result.

My conclusions are that the source material suggests, for most men on TRT, to keep the low range estradiol blood count number above 10 pg/mL and the high range number should be such that the TT to estradiol ratio is 10:1 or higher.

I am interested in this subject as my protocol of 40 mg testosterone enanthate every 3.5 days has produced a trough absolute estradiol count of 62 (pre trt it was 23-both sensitive measures). However, after reading through the articles and calculating my ratio against my total testosterone trough level of 1045 I get a ratio slightly below 17:1. It appears that I should not be too concerned about the absolute count of 62.

Even though I feel better today (6 months on TRT) than I have felt in 6 years I do still have a couple of nagging symptoms remaining. Given that fact and the fact that my total t. is high range, free t is 17.4 (Labcorp) and 23.8 calculated I felt I have room to adjust dosing downward (as opposed to adding Anastrozole) to see if that might impact the remaining symptoms. In that regard I have adjusted the total weekly down from 80 mg/wk to 74 mg/wk, will monitor symptoms, and will pull labs again in 3 months.

If I am missing something please let me know.

Like others said, since you started with 80mg, achieving max youthful T levels, you should try a lower dose.
In my opinion it's also ok to try low dose anastrozol (quarter tablet per week) in order to see how it feels and if limiting E2 has any benefit regarding ED.

 

[t_spacemonkey]

what is your symptoms again, i've been running 60-70 pg/ml E2 sensitive test at 140-210mg Tprop weekly. i don't have e2 symptoms whatsoever, in fact, when i run tests lowering it i got issues

 

[HootSnik]

A wealth of informative contributors on Nelson’s site!!

Cataceous-Thank you for your thoughtful comments. Correct me if I am wrong but I think you are saying that, given the high absolute estradiol count, it might be worthwhile for me to experiment with simple actions to reduce that number somewhat in an attempt to address the remaining symptoms. It is my hope that the dose reduction will do just that without affecting the benefits that I have achieved to date. Also, thanks for the information on the nasal gel—I did not know it had fewer “down stream” affects—I will keep it in mind.

Nelson— I am frequently accused of being a little “over the top” on items of research. However, in this particular area (hormone replacement) the downsides of errors justifies extensive individual research/education.
Per your question, the remaining symptoms are erection quality and delayed ejaculation, the later of which I think is the result of reduced sensitivity. If I could improve these two issues without affecting my improvements to date in the areas of mood, energy, initiative, and the simple feeling of health I would have a home run!!
You mentioned thyroid testing—I see that the last labs did have TSH which was 1.036 against a range of 0.55 to 4.78. That was the only thyroid marker I noted.

Seagal—Actually I started, not at 80mg/wk but at 40mg/wk in hopes that I was one of those lucky guys who could augment my testosterone with small amounts of exogenous without shutting down natural production. Unfortunately that did not happen as my body shut down most of the endogenous production (LH went from 12.2 pre-t to 2.3 at the first labs) and my numbers and symptoms were worse that before I started TRT. After those first labs we adjusted the dose to the 80mg/wk and saw significant improvement in most symptoms save the two areas mentioned.
Ref the anastrozole—my doctor has prescribed a small number of 1 mg tablets and, if the reduction in testosterone dose to 74mg/wk does not address the symptoms I am prepared to try the anastrozole at 0.25 mg/wk as you suggested.

t-spacemonkey—It appears that my absolute estradiol count is similar to yours on a much lower testosterone dose and I am not sure if this is the basis for the remaining symptoms—hence my posting on this subject. I am curious as to your total t and free t counts on your protocol—I would like to compare the ratios to mine since you are reporting no adverse symptoms.

One additional thought--could a change in dosing frequency have any affect on the mentioned symptoms?? I currently split the weekly dose every 3.5 days.

Gentlemen—thank you for your contributions!

 

[t_spacemonkey]

what is your symptoms again, i've been running 60-70 pg/ml E2 sensitive test at 140-210mg Tprop weekly. i don't have e2 symptoms whatsoever, in fact, when i run tests lowering it i got issues

here is my last blood work from July, i expect new one within couple days. I have been variating my doses from 20-30mg Tprop daily. this is the low-end reading before the next injection, expect those values to be double at peak. bear in mind, i feel way better on daily Tprop. when I overdo HCG (currently on 3x1000IU/week), i get anxious, and this is 100% due to e2, since on those rare occasions when I played with 3x2-3k IU hcg, an AI fixed the anxiety within 6h so I know what my limits are. you can figure out if its e2 just pop an AI and the effects should be noticeable fairly quick.

 

[Cataceous]

...
Cataceous-Thank you for your thoughtful comments. Correct me if I am wrong but I think you are saying that, given the high absolute estradiol count, it might be worthwhile for me to experiment with simple actions to reduce that number somewhat in an attempt to address the remaining symptoms. It is my hope that the dose reduction will do just that without affecting the benefits that I have achieved to date. Also, thanks for the information on the nasal gel—I did not know it had fewer “down stream” [e]ffects—I will keep it in mind.
...

High estradiol, whether absolute or relative, is a concern because the long-term effects are not well studied. There are at least some hints that it is problematic.

Elevated estradiol levels result in vacuolization and increased glycoprotein production impairing Sertoli cell function. It also disturbs communication with germ cells, increases collagen synthesis and fatty degeneration in the testicular connective tissue. All these actions collectively result in the induction of germ cell death (Leavy et al., 2017). Oestradiol also plays a critical role in round spermatid chromatin reorganization during spermiogenesis through its action on Estrogen Receptor Alpha (ERα) present on Sertoli cells (Cacciola et al., 2013). Overexposure to estrogens reduces the expression of ERα on Sertoli cells, impacting this critical action. Moreover, it has been recognized that supraphysiological concentrations of estrogen act as powerful apoptotic triggers that induce germ cell apoptosis (Correia et al., 2015).​

However, we can express similar concerns about AI use; it's unclear what may happen with long-term use. For all we know AIs could be causing some localized estrogen imbalances even when serum levels are fine.

The uncertainties are why a testosterone dose reduction — and weight loss if needed — are preferred methods for reducing estradiol.

TRT's hormonal effects are both upstream and downstream. Upstream hormones include kisspeptin, GnRH, LH and FSH. The main direct downstream hormones are estradiol and DHT. But there are many indirect downstream hormones due to effects on the adrenal axis, the thyroid hormones, prolactin, neurotransmitters, etc.

 

[WhiteMale]

Remember lab ranges are representative of the population that that lab tests, not what is healthy, by most standards. Taking Anastrozole once per week is a flawed strategy, the half life is in the 48hr range.

But note more than anything, your E is ~approaching twice the lab range, and that was at your LOW point prior to your E3.5d shot regimen. E follows T and you can be realatively certain that your E is very very high.

You obviously convert a lot, a little dose change isn't going to appreciably change that. A little AI use is certainly prudent in some situations, which is what I would do here: 40mg E3.5D with .25mg Anastrozole. do that for a month and judge your symptoms.

Current Labs: All lab results were within LabCorp’s range except hematocrit which was 52.1 against their scale of 37.5 to 51 and estradiol (ultra sensitive) which was 62 against their scale of 7.6 to 42.6. It appears that I convert a significant amount of the exogenous testosterone to estrogen which we think could be the reason for the lingering symptoms—my pre t estradiol was 23.

 

[Ribeye]

Comments on Recent Lab Results

I just received my latest lab results and would like to get input from the “brain trust” on my proposed adjustments and plan of action.

Background: I started TRT back in June due to a very low free T (LabCorp 5.3 on scale of 6.6-18.1) and the traditional symptoms. We started testosterone enanthate (IM) at a very low dose (at my request) and over the last five months and two labs have adjusted the dosing based on how I feel and the lab results. My current protocol is 40 mg every 3.5 days which has resulted in a total T (blood draw 1 hour prior to dose) of 1045 and a free t of 17.4—I am obviously very sensitive to exogenous testosterone as I understand that this is a fairly low dose for those results. At this level I am now feeling healthy, all save two (important) symptoms have disappeared, energy is up, motivation/initiative is up, and mood is stable. The two remaining symptoms are that I still have lingering E.D. and delayed ejaculation — I am wearing my wife out trying to finish. However, I think the current labs show the basis of these remaining symptoms.

Current Labs: All lab results were within LabCorp’s range except hematocrit which was 52.1 against their scale of 37.5 to 51 and estradiol (ultra sensitive) which was 62 against their scale of 7.6 to 42.6. It appears that I convert a significant amount of the exogenous testosterone to estrogen which we think could be the reason for the lingering symptoms—my pre t estradiol was 23.

The adjustments I am considering are to reduce the dose from 80mg/wk to 70mg/wk and add 0.25 mg of anastrozole once per week. I am hoping that the reduced dose and resulting reduced total t will drop the hematocrit down (my blood pressure has crept up slightly) and the anastrozole will drop the estradiol and address the two lingering symptoms. Since I will be converting less of the testosterone to estrogen with the anastrozole, I am hoping that we will not have a significant effect on free t—as I feel good at the current free t level of 17.4.

Comments-suggestions??

It's not likely the estrogen that is causing the delayed ejaculation. Delayed ejaculation can be extremely difficult to diagnose. You could have back problems, higher prolactin, blood flow issues in your penis or prostate, or around the nerves in your genitals, and its seems those who use PD5 inhibitors or injections for erection, can have delayed ejaculation as well. Not really well understood. It could even be related to low dopamine in your brain. Some of the leading sexual medicine docs suggest trying vibrating cock rings. If you don't use or need one currently, you can find silicone ones that are not very tight, but still use a bullet type vibrator and are battery operated. I have delayed ED, and have used on in the past. It helps some, but not a lot. But then, it also doesn't....hurt either! LOL. The best thing it seems for me, is to try to get in a lot of foreplay before moving to the main event. fortunately for me, my wife doesn't mind extended foreplay. The more excited she gets me first, the less time I seem to need with coitus.

 

[Cataceous]

Remember lab ranges are representative of the population that that lab tests, not what is healthy, by most standards. ...

That's not quite how it works. A reference range is supposed to be established by sampling the healthy portion of the subject population. Now you can argue on an individual basis whether the criteria for being considered healthy are sufficiently rigorous. But don't make a blanket statement implying that the reference ranges are derived from the entire population that the lab tests, which on average might be expected to be less healthy even than the overall population.

 

[HootSnik]

estradiol (ultra sensitive) which was 62 against their scale of 7.6 to 42.6.

Found an error in my lab (discussed in first post above) which reported a trough estradiol level of 62 at a testosterone enanthate dose of 80mg/wk. Although we asked for the "sensitive" measure, the lab used something noted as "Roche ECLIA"methodology. I just noticed this!! All my other estradiol labs were the "sensitive" method. Doing some research on the difference in measurement methodology I find that the "ECLIA" method used is not very accurate and it appears, based on user comments, that it typically reports too high. Anyone else know if this level and direction of inaccuracy is correct??

Luckily, I have not used the AI but simply reduced the T.E. dose down 10% (80mg/wk to 72mg/wk) to address the hematocrit, high estradiol, and remaining symptoms. I prefer to only change one thing at a time and will be getting new labs in a couple of weeks (6 wks after dose adjustment). Interested to see the impact on T.T., F.T., hematocrit, and estradiol. I am hoping the sensitive estradiol is lower, the hematocrit is down, the remaining symptoms subside, and the F.T. is not reduced too much. I feel good at a F.T. level of 16-20 pg/mL lab corp which is 23.8 calculated.

Comments?

Cheers