New Guy Here. TRT has been prescribed--but does my bloodwork warrant it?

[Gizmo12]

Thanks, Chris. The LabCorp estradiol line reads, "Estradiol - Roche ECLIA Methodology" along with the level and range. No mentio of E2.

Still going to consult with a doc Monday about my thyroid/pituitary levels. Still experiencing some ED, libido/motivation issues, but don't know if TRT is practical at this point.

 

[Nelson Vergel]

Gizmo

The ECLIA methodology can over estimate estradiol in many men who have high CRP levels.

Here is some information previously posted on ExcelMale.com about estradiol testing in men

RECOMMENDED ULTRASENSITIVE ESTRADIOL BLOOD TESTS FOR MEN:


Comparisons of Immunoassay and Mass Spectrometry Measurements of Serum Estradiol Levels and Their Influence on Clinical Association Studies in Men


"In conclusion, our findings suggest interference in the standard immunoassay-based E2 analyses, possibly by CRP or a CRP-associated factor. Although this interference does not seem to affect association studies between immunoassay E2 levels and skeletal parameters, we propose a reevaluation of previous association studies between immunoassay-based E2 levels and inflammation-related outcomes. In addition, MS-based assays are to be preferred for the quantification of E2 levels in men."

This is the most precise estradiol test for me provided by Labcorp:

Estradiol, LCMS (Endocrine Sciences)

Test Number: 500108 CPT Code: 82670

[TD="colspan: 2"]	[/TD]
Specimen:	Serum (preferred) or plasma, frozen
Volume:	3 mL
Minimum Volume:	1.5 mL (Note: This volume does not allow for repeat testing.)
Container:	Gel-barrier tube, lavender-top (EDTA) tube, or green-top (heparin) tube
Collection:	Serum/plasma must be separated from cells within 45 minutes of venipuncture. Send serum/plasma in a plastic transport tube. To avoid delays in turnaround time when requesting multiple tests on frozen samples, please submit separate frozen specimens for each test requested.
Storage Instructions:	Freeze. Stable at room temperature or refrigerated for two days. Stable for two years frozen.
Methodology:	Liquid chromatography/tandem mass spectrometry (LC/MS-MS)

This is the test performed by Quest Diagnostics:

Estradiol, Ultrasensitive, LC/MS/MS

Test Code
30289

CPT Code(s)
82670

Preferred Specimen(s)
0.5 mL serum collected in a red-top tube (no gel)

Minimum Volume
0.2 mL

Collection Instructions
Specify age and sex on test request form. Plasma, fluid and serum collected in SST's are not acceptable specimen types.Ship frozen. Do not thaw.

Transport Temperature
Frozen

Specimen Stability
Room temperature: 48 hours
Refrigerated: 7 days
Frozen: 2 years

Methodology
Liquid Chromatography Tandem Mass Spectrometry (LC/MS/MS)

 

[Gizmo12]

So, Doc consult has come and gone and I'm feeling good about moving forward.

Because my testes responded to a bump in LH from my last blood work, the doctor feels a restart trial with Clomid is the best first step. I'm also being prescribed an AI as a preventative measure to ward off any increase in estrogen, which he felt was already a little high relative to my total T. Trial will be for 30 days, then a taper, and then we'll see if it "holds." If not, a maintenance dose of Clomid or possibly TRT could be indicated.

For my adrenals, he suggested DHEA and pregnenolone for support.

I'm aware some men have reported a bump in test but no subjective benefit (more muscle mass, libido, energy, etc.) while on Clomid. In another thread here, someone linked to a Doctor Crisler message that said a bump in SHBG might be to blame, and that free T will need to be watched. I agree with this, and providing both free/total T are raised and estrogen is under control, I don't see why I wouldn't experience similar results to exogenous testosterone.

As Chris mentioned--will it hold? Dunno. Maybe I'll fall off after, maybe not. But I feel it's a valid and conservative approach, and one I'm happy to try.

 

[Gizmo12]

Another update: before starting the recommended Clomid/preg/DHEA therapy, I had a third testosterone lab done last week. (Three weeks after my last.) Total T went to 511 from 498, while LH was steady at 2.7 (from 2.8). At this point, I'm reconsidering the Clomid trial, since I don't know if it's wise to address a problem I may have fixed with diet, exercise, and possibly Vitamin D3.

I believe I still suffer from adrenal burnout, but I was hoping to take a more measured dose of preg (not the 50mg prescribed). Anyone who's taken pregnenolone or DHEA who can comment?