TRT and low estrogen

[CKO]

Struggling to keep my estrogen levels up. Weekly protocol 30mg test cyp x 3, HCG 450 IU x 2, Oxandrolone (for joint pain) 12.5mg x 5. I was on nandrolone 50mg a week and had similar issues. My joints feel like they are running l dry, especially my knees. Everything feels normal after hcg for 1-1.5 days, then I dry out again.

I should add that I've been drinking a bit more than normal, mostly red wine. I'm wondering if alcohol reduces aromatization to estrogen.

Most recent labs 1.5 days after injection (LabCorp)
Total T: 1323 NG/dL
Free T Direct: 33 pg/ML
Estradiol sensitive (LC/MS/MS) 18.3 pg/mL
Shbg: 21 nmol/L

 

[Seagal]

"Oxandrolone (for joint pain) 12.5mg x 5". Did you mean 12.5mg x 2 ? IMHO it's too much oxandrolone, I would start with 5mg daily.
Reducing the frequency of TC injection could increase E2.

 

[CKO]

12.5 mg roughly 4-5 doses a week or 50mg-62.5mg a week. Good call on reducing injection frequency.

 

[Jerajera]

As far as I know alcohol increases aromatization, but I could be wrong.

Amazing that your E2 is that low with Free T that high and some hCG on top. With that Free T number and the hCG my E2 would probably be around 60-70pg/mL and I'd be a walking bloated panic attack.

@madman will almost certainly drop by in a bit to trash the Direct Free T method. I'm honestly not sure how inaccurate it is; personally the few times I used it before I knew about equilibrium dialysis, the numbers came out as expected if you used all the equilibrium dialysis results as data points and built a predictive model off of those, so at least in my case I didn't see a difference in accuracy.

Is the hCG pharma grade? there was a thread recently about indian pharma hCG being severely underdosed. That would be one thing to look at.
If your hCG is actual pharma (Pregnyl, for ex) then increasing the dose should increase aromatization. You could lower your Test dose and increase hCG; in my experience that should skew the T:E ratio slightly towards E.

Oxandrolone being a DHT derivative could possibly antagonize E2. Most DHT derivatives do to a significant degree, but Oxandrolone is the one DHT-derivative I've never heard mentioned as having that effect on e2. Doesn't mean it's not doing it though.

One thing you could try is switch to a shorter ester, Test Propionate or Phenylpropionate (you'd have to go UGL for the latter).
Even though a lot of guys say shorter esters aromatize less for them, it had the opposite effect on me and I think those guys don't actually do labs to confirm; they feel better on Prop and assume it aromatizes less but I'm not sure labs would confirm that.

In my case, Test Prop significantly increased aromatization and skewed my T:E ratio towards E. For example on 15mg/day Test C I would be at 25ng/dL Free T and 40pg/mL E2. When I tried 15mg/day Test P, my trough was 17ng/dL and 70pg/mL E2.

@Gman86 had a similar experience I'm pretty sure, and I've read many anecdotes from guys actually doing labs on Test Prop reporting the same effects, so that might be a good thing to try for you.

 

[Seagal]

12.5 mg roughly 4-5 doses a week or 50mg-62.5mg a week. Good call on reducing injection frequency.

If that causes other issues then I would increase T dosage for the sake of increasing E2.

 

[CKO]

HCG is pregnyl brand. Hilarious, I didn't want to post the free T lab knowing madman would chime in. I don't order the labs, my doc does....sorry

 

[madman]

HCG is pregnyl brand. Hilarious, I didn't want to post the free T lab knowing madman would chime in. I don't order the labs, my doc does....sorry

Struggling to keep my estrogen levels up. Weekly protocol 30mg test cyp x 3, HCG 450 IU x 2, Oxandrolone (for joint pain) 12.5mg x 5. I was on nandrolone 50mg a week and had similar issues. My joints feel like they are running l dry, especially my knees. Everything feels normal after hcg for 1-1.5 days, then I dry out again.

I should add that I've been drinking a bit more than normal, mostly red wine. I'm wondering if alcohol reduces aromatization to estrogen.

Most recent labs 1.5 days after injection (LabCorp)
Total T: 1323 NG/dL
Free T Direct: 33 pg/ML
Estradiol sensitive (LC/MS/MS) 18.3 pg/mL
Shbg: 21 nmol/L




It is eh especially when most have no clue what the f**k they are talking about when it comes to free testosterone testing methods let alone those absurd troughs many are running!

Man up so someone can at least kick some sense your way.

Lots of nonsense still being spewed on here let alone those bumass so called men's health forums littered on the net LMFAO!

Yes it's the wrong FT assay let alone tends to underestimate FT.

Equilibrium Dialysis is where it's at when it comes to knowing where your FT truly sits especially in cases of altered SHBG.

Otherwise you would need to use/rely upon the linear law-of-mass action cFTV.

Put more weight behind it then the piss poor direct.....why because it has already been validated twice over the past 2 decades against Equilibrium Dialysis and the second time around was against an ED higher order reference method let alone has most recently been validated against CDC higher order reference method standardized ED assay!

It has been shown to overestimate slightly but it is nothing to fret about!

Seeing as you had blood drawn 1.5 days post-injection this is not your true trough which would be 72 hrs post-injection if you are following a M/W/F injection frequency.

Even then with a very high TT 1323 ng/dL and lowish SHBG 21 nmol/L your FT is going to be sky-high!

If we take your very high TT 1323 ng/dL, lowish SHBG 21 nmol/L and Albumin 4.3g/dL (default) your cFTV 41.5 ng/dL is sky-high plain and simple!

If you had it tested using the most accurate assay the gold standard ED it would most likely be around 39 ng/dL.

Just to put this in perspective most healthy young males would be hitting a cFTV 12-15 ng/dL and this is a short f**king lived daily peak!

A FT 20 ng/dL is high!

Regardless would be wise move to lower the weekly oxo dose or if anything you easily have room to lower your FT and increase the weekly dose of hCG seeing where your estradiol sits with an absurdly high FT!

If the dose of oxo is too high it can easily backfire on you!

Even then not the best move if someone was already struggling with low/lowish estradiol.

Age-stratified reference ranges for directly measured (ED LC-MS/MS) serum free testosterone in healthy men

Just to be clear up any confusion this is Fiers camps data for mFT reference ranges not the harmonized reference range being worked on by the CDC. *Serum samples were analyzed from healthy men participating in the SIBLOS/SIBEX and EMAS studies, both population-based cohort studies * mFT...

www.excelmale.com

*We established mFT reference ranges for healthy men aged 18 to 69 years




We present 95% mFT age-stratified reference ranges

Age category (years)	Median mFT (ng/dl)	95% mFT reference range (ng/dl)
25-29 (n=148)	10.3	5.6 - 17.1
30-39 (n=252)	9.7	4.9 - 18.1
40-49 (n=207)	8.0	4.3 - 13.5
50-59 (n=146)	7.0	3.8 - 12.6
60-69 (n=114)	5.9	3.3 - 11.9

*The gold-standard for the determination of FT levels is considered to be directly measured free testosterone (mFT) using equilibrium dialysis followed by mass spectrometry (ED LC-MS/MS). However, no widely accepted reference ranges are available for this clinical parameter. We established mFT reference ranges for healthy men aged 18 to 69 years











*Serum samples were analyzed from healthy men participating in the SIBLOS/SIBEX and EMAS studies, both population-based cohort studies


* mFT levels were measured in 867 men using ED LC-MS/MS as previously reported (1).

Reference: 1. Fiers T, Wu F, Moghetti P, Vanderschueren D, Lapauw B, Kaufman JM. Reassessing Free-Testosterone Calculation by Liquid Chromatography–Tandem Mass Spectrometry Direct Equilibrium Dialysis. J Clin Endocrinol Metab. 2018;103(6). doi:10.1210/jc.2017-02360

Reassessing Free-Testosterone Calculation by Liquid Chromatography–Tandem Mass Spectrometry Direct Equilibrium Dialysis

Reassessment of FT in women and men with state-of-the-art methodology confirms previously established FT percentages but highlights limitations of differen

academic.oup.com

In the current study, we used a state-of-the-art direct ED method to reassess FT in sets of representative serum samples. This method takes advantage of the ability of a highly sensitive and accurate measurement of T by liquid chromatography–tandem mass spectrometry (LC-MS/MS) to reliably measure the low FT concentration directly in the dialysate after ED. This more straightforward method avoids potential sources of inaccuracy in indirect ED, such as those resulting from tracer impurities or from measures to limit their impact (e.g., sample dilution). We then used the measured FT results to re-evaluate some characteristics of two more established and a more recently proposed calculations for estimation of FT.

 

[madman]

As far as I know alcohol increases aromatization, but I could be wrong.

Amazing that your E2 is that low with Free T that high and some hCG on top. With that Free T number and the hCG my E2 would probably be around 60-70pg/mL and I'd be a walking bloated panic attack.

@madman will almost certainly drop by in a bit to trash the Direct Free T method. I'm honestly not sure how inaccurate it is; personally the few times I used it before I knew about equilibrium dialysis, the numbers came out as expected if you used all the equilibrium dialysis results as data points and built a predictive model off of those, so at least in my case I didn't see a difference in accuracy.

Is the hCG pharma grade? there was a thread recently about indian pharma hCG being severely underdosed. That would be one thing to look at.
If your hCG is actual pharma (Pregnyl, for ex) then increasing the dose should increase aromatization. You could lower your Test dose and increase hCG; in my experience that should skew the T:E ratio slightly towards E.

Oxandrolone being a DHT derivative could possibly antagonize E2. Most DHT derivatives do to a significant degree, but Oxandrolone is the one DHT-derivative I've never heard mentioned as having that effect on e2. Doesn't mean it's not doing it though.

One thing you could try is switch to a shorter ester, Test Propionate or Phenylpropionate (you'd have to go UGL for the latter).
Even though a lot of guys say shorter esters aromatize less for them, it had the opposite effect on me and I think those guys don't actually do labs to confirm; they feel better on Prop and assume it aromatizes less but I'm not sure labs would confirm that.

In my case, Test Prop significantly increased aromatization and skewed my T:E ratio towards E. For example on 15mg/day Test C I would be at 25ng/dL Free T and 40pg/mL E2. When I tried 15mg/day Test P, my trough was 17ng/dL and 70pg/mL E2.

@Gman86 had a similar experience I'm pretty sure, and I've read many anecdotes from guys actually doing labs on Test Prop reporting the same effects, so that might be a good thing to try for you.

No one in the know is recommending it!

It's a known to be inaccurate assay plain and f**king simple!

Adding to that it has recently been shown to underestimate FT when compared against ED methods (CDC’s Clinical Standardization Programs (CDC CSP) interlaboratory comparison study).

*FT concentrations obtained by IAs were in average 6 times lower compared to the ED-LC-MS/MS methods

Anyone it the know will tell you that if you do not have access to ED (some countries) than cFTV is the default!

CDC is going to be rolling out the new standardized ED-UHPLC-MS/MS assay soon, time to put this to shit show to rest!


*CDC CSP developed an accurate, automated method using ED coupled with isotope dilution ultra-high-performance liquid chromatography tandem mass spectrometry (ED-UHPLC-MS/MS). The ED step follows an internationally recognized procedure. The method is calibrated with primary reference material (National Measurement Institute-M914)

 

[CKO]

Regarding the labs above I should have been more clear. They reflect my previous protocol with nandrolone, which was: 25 mg test cyp, 10mg nandrolone x 3 times a week. 450 HCG IU x 2 week. This will drive up the total T and free T.

Good suggestion on lowering oxo and FT. I'll probably eliminate oxo all together and lower my t dose. However, I'm not sure I'm tracking the correlation between high FT and my low E2 symptoms.

Now I'm curious how do you get equilibrium dialysis ft test? This is obviously a passionate issue.

 

[Systemlord]

High ferritin, iron levels can decrease estrogen. Women have higher estrogen when ferritin is lower and when they age, iron and ferritin increases as estrogen decreases.

Vitamin C and D have a tug or war with balancing estrogen. Vitamin D decreases estrogen and vitamin C increases estrogen. DHEA can potentially increase estrogen in men.

 

[madman]

Regarding the labs above I should have been more clear. They reflect my previous protocol with nandrolone, which was: 25 mg test cyp, 10mg nandrolone x 3 times a week. 450 HCG IU x 2 week. This will drive up the total T and free T.

Good suggestion on lowering oxo and FT. I'll probably eliminate oxo all together and lower my t dose. However, I'm not sure I'm tracking the correlation between high FT and my low E2 symptoms.

Now I'm curious how do you get equilibrium dialysis ft test? This is obviously a passionate issue.

Regarding the labs above I should have been more clear. They reflect my previous protocol with nandrolone, which was: 25 mg test cyp, 10mg nandrolone x 3 times a week. 450 HCG IU x 2 week.

Most recent labs 1.5 days after injection (LabCorp)
Total T: 1323 NG/dL
Free T Direct: 33 pg/ML
Estradiol sensitive (LC/MS/MS) 18.3 pg/mL
Shbg: 21 nmol/L




These labs were from this protocol (25 mg test cyp, 10mg nandrolone x 3 times a week. 450 HCG IU x 2 week)?

Was your TT tested using the most accurate assay (LC/MS-MS)?

Which panel did your doctor give you?

​

140103: Testosterone, Free, Direct With Total Testosterone | Labcorp

Labcorp test details for Testosterone, Free, Direct With Total Testosterone

www.labcorp.com

Methodology

Free: Direct analog enzyme immunoassay (EIA); Total: electrochemiluminescence immunoassay (ECLIA)

070195: Testosterone, Free, Direct With Total Testosterone, LC/MS-MS | Labcorp

Labcorp test details for Testosterone, Free, Direct With Total Testosterone, LC/MS-MS

www.labcorp.com

Methodology

Free: Direct analog enzyme immunoassay (EIA); Total: liquid chromatography/tandem mass spectrometry (LC/MS-MS)








Now I'm curious how do you get equilibrium dialysis ft test?

I have been stressing this on the forum for years, numerous threads/posts on here!

Most are using Quest Diagnostics or Labcorp.

Both labs offer the gold standard ED assay.




Your best bet as it is more cost effective would be through Nelson's discounted labs!

Nelson's discounted labs uses Quest Diagnostics

Testosterone, Free (Equilibrium Dialysis) and Total, MS - Most Affordable and Accurate Test

Get an affordable and accurate testosterone test results with our Total Testosterone, M and Free (Equilibrium Dialysis) test. Visit DiscountedLabs.com for more information.

www.discountedlabs.com

Methodology

Testosterone: high-pressure liquid chromatography (HPLC)/tandem mass spectrometry; free testosterone: equilibrium dialysis




Labcorp

500726: Testosterone, Free, Mass Spectrometry/Equilibrium Dialysis (Endocrine Sciences) | Labcorp

Labcorp test details for Testosterone, Free, Mass Spectrometry/Equilibrium Dialysis (Endocrine Sciences)

www.labcorp.com

Methodology

Testosterone: high-pressure liquid chromatography (HPLC)/tandem mass spectrometry; free testosterone: equilibrium dialysis




Are you saying that you have not had blood work done since dropping the ND and adding the oxandrolone to your protocol?

 

[CKO]

I just started oxo 2 weeks ago and logic indicates it is causing my issues. No new labs yet. I had low E2 challenges on nandrolone, but no where near this bad. Nelson posted in the past that oxo competes with estrogen in the body and causes issues for some. I'm assuming I'm one of them. It's also possible alcohol is disrupting aromatization. Either way I'm good with dropping both and seeing what happens. It's just odd because I used to use an AI to keep e2 in balance and now I'm always low E2 and feel very dry in my joints. I haven't used and AI in the last 6 weeks. It was .125 mg when I did.

I don't know what lab was ordered for Total T. LabCorp states, "Testosterone,Free and Total."

Thanks for the heads up on ferritin. My platelets are low from blood donations, but I'm not sure of my ferritin level.

 

[madman]

I just started oxo 2 weeks ago and logic indicates it is causing my issues. No new labs yet. I had low E2 challenges on nandrolone, but no where near this bad. Nelson posted in the past that oxo competes with estrogen in the body and causes issues for some. I'm assuming I'm one of them. It's also possible alcohol is disrupting aromatization. Either way I'm good with dropping both and seeing what happens. It's just odd because I used to use an AI to keep e2 in balance and now I'm always low E2 and feel very dry in my joints. I haven't used and AI in the last 6 weeks. It was .125 mg when I did.

I don't know what lab was ordered for Total T. LabCorp states, "Testosterone,Free and Total."

Thanks for the heads up on ferritin. My platelets are low from blood donations, but I'm not sure of my ferritin level.

What is the test/order code on your lab report 140103 or 070195?

If you never used the most accurate assay TT (LC/MS-MS) when using T + ND your lab your results will be skewed when using the standard immunoassays due to cross-reactivity of the exogenous compound (nandrolone).

You would have no clue where your TT let alone FT truly sit.

If you plan on adding other AAS with a T protocol than your best bet would be using the TT (LC/MS-MS) assay!

TRT + Nandrolone New Protocol

I have been on TRT for the past 5 months and it has been life changing. In my last consult with my Dr, however, I brought up my history of debilitating joint and tendon pain that I've dealt with for years and we decided to add in Nandrolone decanoate to my protocol while reducing my Test cyp...

www.excelmale.com

 

[CKO]

Thank you and that makes sense. This is what the official copy shows.