new guy--been on TRT for 1 year (blood test results)

[Dr Justin Saya MD]

I stand corrected then.

Out of curiosity, do the risks not apply if the person doesn't have symptoms? As in, lack of symptoms shows enough E2 for him, so no risks of osteoporosis and su?ch

The longterm potential risks are still there, assuming an accurate LC/MS-MS estradiol test confirms such low results (although it is commonly believed the RIA methodology overestimates estradiol levels [and often does], I have seen many cases where the LC/MS-MS result came out HIGHER than the RIA on simultaneous draws --- the RIA is simply less accurate, either up or down but neither predictably).

It is the responsibility of the treating physician to counsel the patient on the risks vs benefits. Personally, I wouldn't be excited about a patient having a confirmed LC/MS-MS estradiol < 10pg/mL longterm in almost all cases...but never say never.

 

[johndoesmith]

The longterm potential risks are still there, assuming an accurate LC/MS-MS estradiol test confirms such low results (although it is commonly believed the RIA methodology overestimates estradiol levels [and often does], I have seen many cases where the LC/MS-MS result came out HIGHER than the RIA on simultaneous draws --- the RIA is simply less accurate, either up or down but neither predictably).

It is the responsibility of the treating physician to counsel the patient on the risks vs benefits. Personally, I wouldn't be excited about a patient having a confirmed LC/MS-MS estradiol < 10pg/mL longterm in almost all cases...but never say never.

I have seen a few of those posted, where RIA is lower than LC/MS-MS, it's inaccuracy is unreliable. Terrible situation.

Another thing I've seen a few times recently, is people claiming they feel better with <5 E2 on RIA, and I simply can't understand it. I had low E2 and was just miserable. It has to be the test being wrong, I just don't see how anyone can feel good with almost undetectable E2. I assume they have very sensitive receptors then, it's the only way it makes sense.

Is it true that testosterone and E2 somewhat act as antagonists? As in, would a higher level of test allow for a higher level of E2, that with an otherwise lower level of test, would cause symptoms of high E2?

 

[pfuked]

Thanks for the input Dr. Saya. My physician is working with me to get my e2 up in the normal range. He wants me to go back to 2x 0.5 mg arimidex per week and see what the tests reveal. I haven't asked for the more sensitive LC/MS-MS test yet, but I will the next time I speak with him. I just worry that with the lower dose of ai that my e2 symptoms will come back, which I do no like at all.

Best Regards

 

[Dr Justin Saya MD]

Thanks for the input Dr. Saya. My physician is working with me to get my e2 up in the normal range. He wants me to go back to 2x 0.5 mg arimidex per week and see what the tests reveal. I haven't asked for the more sensitive LC/MS-MS test yet, but I will the next time I speak with him. I just worry that with the lower dose of ai that my e2 symptoms will come back, which I do no like at all.

Best Regards

Absolutely, best of luck pfuked.

 

[Dr Justin Saya MD]

I have seen a few of those posted, where RIA is lower than LC/MS-MS, it's inaccuracy is unreliable. Terrible situation.

Another thing I've seen a few times recently, is people claiming they feel better with <5 E2 on RIA, and I simply can't understand it. I had low E2 and was just miserable. It has to be the test being wrong, I just don't see how anyone can feel good with almost undetectable E2. I assume they have very sensitive receptors then, it's the only way it makes sense.

Is it true that testosterone and E2 somewhat act as antagonists? As in, would a higher level of test allow for a higher level of E2, that with an otherwise lower level of test, would cause symptoms of high E2?

I wouldn't necessarily call them antagonists, but we certainly see high E symptoms (including gyno) more commonly in guys with lower T (hypogonadal guys) even at comparable E levels. For instance, I see guys presenting initially with E2 of 35pg/mL and concurrent T < 350ng/dL WITH symptoms of high estrogen whereas many men with higher T levels (either naturally or via TRT) will not have E symptoms at those levels.

 

[johndoesmith]

I wouldn't necessarily call them antagonists, but we certainly see high E symptoms (including gyno) more commonly in guys with lower T (hypogonadal guys) even at comparable E levels. For instance, I see guys presenting initially with E2 of 35pg/mL and concurrent T < 350ng/dL WITH symptoms of high estrogen whereas many men with higher T levels (either naturally or via TRT) will not have E symptoms at those levels.

Would that same guy, say you put him on TRT with an AI, have high E2 symptoms at 35 pg/ml E2 with 1000 total test?

 

[Dr Justin Saya MD]

Would that same guy, say you put him on TRT with an AI, have high E2 symptoms at 35 pg/ml E2 with 1000 total test?

Not usually, that's what I was referring to in the previous post.

 

[johndoesmith]

Not usually, that's what I was referring to in the previous post.

That's what I thought. Although they have antagonistic qualities to each other, they're not antagonists as you consider them, so what would you call this relationship?

I appreciate you taking the time to explain this.

 

[Dr Justin Saya MD]

That's what I thought. Although they have antagonistic qualities to each other, they're not antagonists as you consider them, so what would you call this relationship?

I appreciate you taking the time to explain this.

I would describe it as guys, on average, seem to be able to "tolerate" higher estradiol levels without symptoms when their T is higher.