High Estradiol - Labs - Advice Request

[Saul]

Hello everyone. I have been away for a bit. I need some help with labs and advice. My recent labs had some values that were too high. I am male, early 50’s - 6’4” – 218 lbs – 17% body fat, in gym about 4 days per week.

For years I was at about .21 ml (200mg/ml Test Cyp) every 3 days (SubQ) for a weekly total of about 98 mg per week. T ranges from 600 to 750 and Estradiol (sensitive test) was in the 30 to 50 range. Overall, this was a good spot. Everything was good but I was losing my hair.

My Dr. prescribed .5 mg of dutasteride every 4 days. This is a low dose and been great for my hair with some re-growth. I shifted injections to .3 ml every 4 days for a weekly total of about 105 mg.

A year later however, my recent labs (Quest) were out of range. Labs taken on 3rd day after shot

Total T - 1138 - range of 260 - 916

Free T - 290 - range of 40 - 250

DHT 19 - range of 12 - 65

Estradiol (ultrasensitive test using LC/MS) - 98 - range of < 29

T to E ratio – 11.6

Prolactin - 8.8 - range of 2 – 18

Hemoglobin – 17.7 – range of 13 – 17.7

I think that the T went up because the T dose went up a bit and the blocking of T conversion to DHT increases T levels (based on a study I read), which in turn increases conversion to E. Maybe I tested at peak as well. Not sure when T levels peak on E4D sub q injections.

The main side effects were waking up at night hot and sweaty, maybe more difficult to lose some covid fat (but could also be age – early 50s), perhaps more emotional. Until I get this sorted, I cut my dose of T to 70 mg / week (E4D, SQ) on my own to bring down the E and T and the night sweats / waking up is gone.

The Dr. agreed that a small dose of AI (Anastrozole ) would be in order to bring down the E. I don’t mind a higher E value, but 98 is too high, IMO

My main questions are:

• Overall, any comments or suggestions on my labs?
• What AI dose do you recommend? The Dr. is flexible but suggested .5 mg every 4 days at time of injection. I think it would better to start lower – perhaps at .25 every 4 days. I don’t want to crash my E levels.
• With all this data, what T dose to you recommend? With the DHT and E conversion blockers I believe need to go down from 105 per week. Maybe to 90 per week? I want to stay in the 600 to 800 T level range.

Thanks for your advice.

 

[Vince]

Hello everyone. I have been away for a bit. I need some help with labs and advice. My recent labs had some values that were too high. I am male, early 50’s - 6’4” – 218 lbs – 17% body fat, in gym about 4 days per week.

For years I was at about .21 ml (200mg/ml Test Cyp) every 3 days (SubQ) for a weekly total of about 98 mg per week. T ranges from 600 to 750 and Estradiol (sensitive test) was in the 30 to 50 range. Overall, this was a good spot. Everything was good but I was losing my hair.

My Dr. prescribed .5 mg of dutasteride every 4 days. This is a low dose and been great for my hair with some re-growth. I shifted injections to .3 ml every 4 days for a weekly total of about 105 mg.

A year later however, my recent labs (Quest) were out of range. Labs taken on 3rd day after shot

Total T - 1138 - range of 260 - 916

Free T - 290 - range of 40 - 250

DHT 19 - range of 12 - 65

Estradiol (ultrasensitive test using LC/MS) - 98 - range of < 29

T to E ratio – 11.6

Prolactin - 8.8 - range of 2 – 18

Hemoglobin – 17.7 – range of 13 – 17.7

I think that the T went up because the T dose went up a bit and the blocking of T conversion to DHT increases T levels (based on a study I read), which in turn increases conversion to E. Maybe I tested at peak as well. Not sure when T levels peak on E4D sub q injections.

The main side effects were waking up at night hot and sweaty, maybe more difficult to lose some covid fat (but could also be age – early 50s), perhaps more emotional. Until I get this sorted, I cut my dose of T to 70 mg / week (E4D, SQ) on my own to bring down the E and T and the night sweats / waking up is gone.

The Dr. agreed that a small dose of AI (Anastrozole ) would be in order to bring down the E. I don’t mind a higher E value, but 98 is too high, IMO

My main questions are:

• Overall, any comments or suggestions on my labs?
• What AI dose do you recommend? The Dr. is flexible but suggested .5 mg every 4 days at time of injection. I think it would better to start lower – perhaps at .25 every 4 days. I don’t want to crash my E levels.
• With all this data, what T dose to you recommend? With the DHT and E conversion blockers I believe need to go down from 105 per week. Maybe to 90 per week? I want to stay in the 600 to 800 T level range.

Thanks for your advice.

First thing I would do, consider giving up dutasteride. It can be a total disaster for men.

 

[Vince]

Testosterone and Hair Loss: What You Need to Know

Testosterone and Hair Loss: What You Need to Know Testosterone replacement therapy (TRT) is one of the most effective methods for treating hypogonadism, erectile and sexual dysfunction. Sadly, as with any treatment, a minority of men may experience hair loss. A small but concerning...

www.excelmale.com

 

[Systemlord]

My Dr. prescribed .5 mg of dutasteride every 4 days.

Health Risks Associated with Long-Term Finasteride and Dutasteride Use

https://wjmh.org/DOIx.php?id=10.5534/wjmh.200012 Health Risks Associated with Long-Term Finasteride and Dutasteride Use: It’s Time to Sound the Alarm 5α-dihydrotestosterone (5α-DHT) is the most potent natural androgen. 5α-DHT elicits a multitude of physiological actions, in a host of tissues...

www.excelmale.com

 

[Saul]

First thing I would do, consider giving up dutasteride. It can be a total disaster for men.

Thanks Vince. I was hesitant to go on it as I don't want crash DHT. That study that was linked was interesting. In that study the dose was 400% high than my dose, if my math is right, and at that dose, the DHT levels listed were below the normal range. I read that dutasteride can cut DHT by 98% so if someone's DHT was at 25 taking, it would drop it to .5 !! That would crash DHT so it is no joke. We have been careful to keep DHT in range. I guess I figured it is like an AI, dosing and watching the lab numbers really matters. Good advice though and I could cut back some more to 1/5 or 1/6 dose or cut it out all together, although I do prefer to keep my hair (100% turn around for me) and not getting up in the night to pee also has me feeling better.

Any thoughts on my high estradiol and possible AI usage?

 

[Systemlord]

I guess I figured it is like an AI, dosing and watching the lab numbers really matters.

A lot of the guys that got screwed up on DHT blockers had healthy DHT numbers on repeated testing and still got PFS.

 

[Saul]

A lot of the guys that got screwed up on DHT blockers had healthy DHT numbers on repeated testing and still got PFS.

Good info. I will look into PFS more closely if it can occur even when DHT is in range. I don't want to cause myself more problems down the road. Any thoughts on the high E2 or use of AI? Thanks.

 

[Systemlord]

Any thoughts on the high E2 or use of AI? Thanks.

As a last word on the use of dutasteride, the wellbeing and higher libido benefits on TRT come from the increase in DHT.

As for the AI dosing .5 might not sound like a high dosage, but trust me anastrozole is powerful stuff and a lower dosage is prudent if you are experiencing symptoms as a result of the higher estrogen, but in my experience treating numbers because they are high almost always ends in treatment failure.

You can get 0.050 and .125 mg anastrozole at Empower Pharmacy which your doctor can write a prescription.

 

[Gman86]

Just remember, that the 5AR enzyme does more things in the body than just convert testosterone into DHT, which could be why some people get PFS even when DHT levels return to normal. They could of messed up some other process in the body that they’re unaware of

 

[madman]

Hello everyone. I have been away for a bit. I need some help with labs and advice. My recent labs had some values that were too high. I am male, early 50’s - 6’4” – 218 lbs – 17% body fat, in gym about 4 days per week.

For years I was at about .21 ml (200mg/ml Test Cyp) every 3 days (SubQ) for a weekly total of about 98 mg per week. T ranges from 600 to 750 and Estradiol (sensitive test) was in the 30 to 50 range. Overall, this was a good spot. Everything was good but I was losing my hair.

My Dr. prescribed .5 mg of dutasteride every 4 days. This is a low dose and been great for my hair with some re-growth. I shifted injections to .3 ml every 4 days for a weekly total of about 105 mg.

A year later however, my recent labs (Quest) were out of range. Labs taken on 3rd day after shot

Total T - 1138 - range of 260 - 916

Free T - 290 - range of 40 - 250

DHT 19 - range of 12 - 65

Estradiol (ultrasensitive test using LC/MS) - 98 - range of < 29

T to E ratio – 11.6

Prolactin - 8.8 - range of 2 – 18

Hemoglobin – 17.7 – range of 13 – 17.7

I think that the T went up because the T dose went up a bit and the blocking of T conversion to DHT increases T levels (based on a study I read), which in turn increases conversion to E. Maybe I tested at peak as well. Not sure when T levels peak on E4D sub q injections.

The main side effects were waking up at night hot and sweaty, maybe more difficult to lose some covid fat (but could also be age – early 50s), perhaps more emotional. Until I get this sorted, I cut my dose of T to 70 mg / week (E4D, SQ) on my own to bring down the E and T and the night sweats / waking up is gone.

The Dr. agreed that a small dose of AI (Anastrozole ) would be in order to bring down the E. I don’t mind a higher E value, but 98 is too high, IMO

My main questions are:

• Overall, any comments or suggestions on my labs?
• What AI dose do you recommend? The Dr. is flexible but suggested .5 mg every 4 days at time of injection. I think it would better to start lower – perhaps at .25 every 4 days. I don’t want to crash my E levels.
• With all this data, what T dose to you recommend? With the DHT and E conversion blockers I believe need to go down from 105 per week. Maybe to 90 per week? I want to stay in the 600 to 800 T level range.

Thanks for your advice.

For years I was at about .21 ml (200mg/ml Test Cyp) every 3 days (SubQ) for a weekly total of about 98 mg per week. T ranges from 600 to 750 and Estradiol (sensitive test) was in the 30 to 50 range. Overall, this was a good spot. Everything was good but I was losing my hair.

A year later however, my recent labs (Quest) were out of range. Labs taken on 3rd day after shot

Total T - 1138 - range of 260 - 916

Free T - 290 - range of 40 - 250

DHT 19 - range of 12 - 65

Estradiol (ultrasensitive test using LC/MS) - 98 - range of < 29

T to E ratio – 11.6

Prolactin - 8.8 - range of 2 – 18

Hemoglobin – 17.7 – range of 13 – 17.7




The only way to know where your FT truly sits is to have it tested using the most accurate assays (ED or UF).

Unfortunately, you did not have your FT tested using an accurate assay such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best).

Regardless you are hitting trough TT 1138ng/dL (3 days post-injection) and not sure where your SHBG sits but even if it was highish your FT level would still be very high.

Your peak TT/FT/estradiol levels will be higher.

High FT will result in high estradiol let alone hemoglobin/hematocrit.

I know it is much easier said than done but I would try to avoid the use of a 5ARi let alone an aromatase inhibitor.

As you can see from your most recent labs although DHT is still in range it sits on the lower end (well below the mean) and as you should know T's metabolites estradiol and DHT are critical and needed in healthy amounts to experience the full spectrum of testosterones beneficial effects.

Lowering your T dose and bringing down your trough FT level will have a big impact on lowering estradiol let alone hemoglobin/hematocrit but the downfall is your already low-end DHT 12 will most likely be driven down further if you stay on the 5ARi.

You are hitting a TT 1138 ng/dL (3 days post-injection) which will have your trough FT very high and the addition of a 5ARi has your DHT sitting at 12.....you are planning on taking your TT from 1138--->600-750.

Let alone throwing in an AI would be a bad move if you plan on lowering your dose as you want to see where your estradiol will sit before deciding on your next move.

This is key as you stated.....For years I was at about .21 ml (200mg/ml Test Cyp) every 3 days (SubQ) for a weekly total of about 98 mg per week. T ranges from 600 to 750 and Estradiol (sensitive test) was in the 30 to 50 range. Overall, this was a good spot. Everything was good but I was losing my hair.

The only downfall was hair loss which can be devastating to some.

Personally, I would avoid the use of an AI let alone a 5ARi.

Would rather reap the full beneficial effects of having a healthy FT level without having to manipulate DHT/estradiol even if I was genetically prone to balding which I am but that is just me though.

 

[madman]

The clinical applications of 5ARi's

Introduction: Five-alpha reductase (5-AR) deficiency was first identified by Imperato-McGinley and Walsh as the cause of pseudohermaphroditism in two separate studies. The discoveries led to the development of finasteride (inhibitor of type 2 isoenzyme of 5-AR) and dutasteride (inhibitor of type...

www.excelmale.com

*Dutasteride (Avodart) is an inhibitor of both isoenzymes (type 1 and type 2) of 5-AR. Nonselective inhibition of both isoenzymes produces more than a 90% reduction in serum DHT.

*The half-life of finasteride is 5 to 8 hours, whereas the half-life of dutasteride is about 180 hours.8,9

*The most common side effects of 5-ARIs include impotence, decreased libido, ejaculatory disorders, and gynecomastia.14 Less common side effects that have been reported include infertility, breast tenderness, depression, anxiety, dementia, and suicide. 15-18

 

[madman]

Effects of dutasteride on sex hormones and cerebrospinal steroids in patients treated for BPH

Abstract Purpose Neuroactive steroids may have a role in regulating sexual function. This case-control study assessed whether dutasteride, a 5α-reductase inhibitor used for the treatment of patients with benign prostate hyperplasia (BPH), impacts the levels of neuroactive steroids, leading to...

www.excelmale.com

*The adverse effects of 5ARI on the sexual sphere are mainly ascribed to their known antiandrogenic properties. However, the possible mechanisms of action by which 5ARI causes adverse effects on sexuality have not still clearly elucidated.

*Experimental evidence conducted on both animals and humans have also suggested that the onset of adverse sexual effects after treatment with 5ARI may be partly attributable to their central effect and, in particular, to the 5ARI ability to inhibit the levels of some CNS neurosteroids probably implicated in the regulation of sexual desire and erection

*These neurosteroids, which are produced by both the testis and the CNS, are implicated not only in the regulation of sexual function but also in cognitive, behavioral, and reproductive aspects, and possibly also in neurodegenerative diseases