Advice of Lab Results-High Estradiol

[WhiteMale]

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.

Thats exactly how it works but i do like your style.

 

[WhiteMale]

Its a plausible way to start this but youre not going to manage E with an 8mg/ dose reduction and .25mg once per week. Anastrozole has a 48hr half life, dont overlook that and don't get trapped by the anti AI oriented population here.
I would have added the AI alone .25 E3.5D and evaluate symptoms and retest.

 

[Cataceous]

Thats exactly how it works but i do like your style.

Evidence? For what it's worth, ChatGPT agrees with me. Reference ranges are supposed to be representative of the healthy portion of the subject population, not the entire population. Identifying who is healthy is the tricky part.

4. Challenges in Establishing Normal Ranges:​

• Finding a truly “healthy” population: Identifying a large group of individuals with no underlying health issues can be difficult.

 

[HootSnik]

Advice Requested-New Labs on Adjusted Protocol

Just got my labs back after 3 months on an adjusted protocol and have a couple of questions on the results and corrective action.

The following are the prior and current protocols and the lab results from each. Blood draw on both were one hour prior to scheduled dosing—ie trough. I was on each protocol for 3 months. The a.i. is anastrozole. All other markers were unremarkable (LabCorp). Also note we had requested the sensitive measure for estradiol both times but LabCorp gave us the ECLIA measure on the first protocol.

80mg/wk 76mg/wk
40mg/3.5 days T.E. 38mg/3.5 days T.E. + 0.25mg a.i.

Total T. 1045 966

Free T. 17.4 14.0

Free T. (calc). 23.9 21.2

Estradiol 62.0 (ECLIA) 11.6 (sensitive)

Hematocrit 52.1 52.5

SHBG 38.6 39.0

Albumin 4.2 4.3

TT/E2 Ratio. 17:1 83:1

Although I felt good on the 80mg protocol, I did have a couple of lingering symptoms that were noted in prior postings, plus my hematocrit was borderline high, and my estradiol was very high. We therefore reduced the dose slightly to see if it would affect the hematocrit and, after a great deal of research and self reflection, added the anastrozole to deal with the high estradiol. I don’t know if I felt slightly better on the 80 mg dose due to the higher free testosterone it gave me or because of the significant difference in estradiol.??

Questions:

1. Should I be concerned about hematocrit of 52.5?? My inclination is that I should and maybe going to 3x week dosing might help by reducing the peaks?? Note that I do take low dose nebivolol (Bystolic) for bp and it is controlled.
2. Should I be concerned about the big swing in the estradiol?? My inclination is yes since it is now at the low end of the range and that an elimination or reduction of the a.i. along with the 3x week dosing might help that also. Note that my pre-TRT estradiol was 23.6 (sensitive).

Comments, advice, or relevant research data appreciated.

Cheers,

HootSnik

 

[Nelson Vergel]

1. Should I be concerned about hematocrit of 52.5?? My inclination is that I should and maybe going to 3x week dosing might help by reducing the peaks?? Note that I do take low dose nebivolol (Bystolic) for bp and it is controlled.
2. Should I be concerned about the big swing in the estradiol?? My inclination is yes since it is now at the low end of the range and that an elimination or reduction of the a.i. along with the 3x week dosing might help that also. Note that my pre-TRT estradiol was 23.6 (sensitive).

If your blood pressure is not high, do not alarm yourself about a hematocrit of 52.5. Drink lots of water and get another CMP or a simple hematocrit test.

Your sensitive estradiol is 11.6 pg/mL. Too low if you want to preserve bone and sex drive. What "lingering symptoms" did you have?

 

[HootSnik]

Darn—I should know better! In my draft response above I had nice headers with neat rows/columns of data below the headers. When posted the system eliminated all the spacings and pushed the data to the left margin. For those who had a hard time reading the data in the post please know that the first lab data entry to the right of Total T., Free T., etc is for my old protocol of 80mg T.E. a week via two equal doses of 40mg every 3.5 days. The second entry to the right is the lab data from my most recent protocol of 76mg T.E. a week plus an a.i. via two equal doses of 38mg T.E. and 0.25 mg of anastrozole every 3.5 days. Both protocols were run for 3 months and blood draws at trough.

Nelson, thanks for the response. My blood pressure is well controlled with the low dose Nebivolol 2.5mg. The lingering symptoms, which have mostly resolved with the latest protocol, were erection quality and delayed “completion”. Reference the hematocrit, I am still somewhat concerned about it as I am just 9 months into TRT and I understand it can take up to a year for this to level off—don’t want it going higher. I am also puzzled by the huge swing in estradiol (62 to 11.6) on only 0.5 mg anastrozole per week.

At this point I am considering going with the same weekly T.E. volume but splitting it into 3 doses as opposed to 2 to clip the peak and thereby reduce hematocrit, eliminate or reduce the a.i., and maintain a healthy trough free testosterone level—I feel best with trough free testosterone of 17+ pg/mL.

Comments/advice appreciated.

Cheers,
HootSnik

 

[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??

In my own experience, tweaking the T dosing isn't likely to change the hematocrit much, and yours isn't quite to the 54% mark where most of the experts would suggest either lowering the dose, or giving blood or phlebotomy. However, If you are able, the hematocrit issues could be easily resolved by donating blood, probably every 3-4 months, maybe less often even. If you do, be sure to follow the HCT lab work and check your iron related bloodwork too. You don't want to give blood so often you crash your iron reserves, because then you will feel like crap. My own case, the estrogen has been higher than we like, but generally, most men get into more trouble trying to correct it, then from having higher estrogen. Remember, estrogen does bring a lot of good things for men too. I would drop the Anastrozole. My feeling personally is better a little high (if you don't have concerns about side effects) than to low with estrogen for cardiac benefit, among the others. Regarding your ED and delayed ejaculation concerns. Brother I hear you! I am a post prostate cancer survivor. I have the same issues. But know there is help out there. Lots of help. If anyone would have told me when it started this journey 4-5 years ago, that I would have as good a sex life as I do now, I would not have believed them. My suggestion is if you have an academic health system close to you, which a really good urologist treating these issues, go see them. If not, go to the Sexual medicine society website, click the left table for "home", then click "for patients" at the next screen towards the right hand side of the screen see and click "find a provider". It will help you find an expert that is close to you. Some of these docs, who are all experts, also provide telemedicine. If you cannot find anyone close to you, I can suggest Dr. Rachel Rubin and her team via telemedicine. I have been seeing her for years now, and she is fabulous. She knows her stuff, is aggressive in treating, and is willing to use all the tools to help you. What I can say is, don't increase the T in order to help the ED. It doesn't work and it leads to more problems. SMSNA - Home.

 

[HootSnik]

In my own experience, tweaking the T dosing isn't likely to change the hematocrit much, and yours isn't quite to the 54% mark where most of the experts would suggest either lowering the dose, or giving blood or phlebotomy. However, If you are able, the hematocrit issues could be easily resolved by donating blood, probably every 3-4 months, maybe less often even. If you do, be sure to follow the HCT lab work and check your iron related bloodwork too. You don't want to give blood so often you crash your iron reserves, because then you will feel like crap. My own case, the estrogen has been higher than we like, but generally, most men get into more trouble trying to correct it, then from having higher estrogen. Remember, estrogen does bring a lot of good things for men too. My feeling personally is better a little high (if you don't have concerns about side effects) than to low with estrogen for cardiac benefit, among the others.

Thanks Ribeye--I am relatively new to this and appreciate input those of you with years of experience!!
Cheers,
Hoot