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19. Low Test, High Estradiol with Sides. High Cortisol, Normal Thyroid


#1

I am a 19-year-old straight male with little to no facial hair and an hourglass shape body fat deposition. I am always tired, unmotivated and have been treated for Major Depressive Disorder with several antidepressants for the last 2 years until 4 months ago. I try my best to socialize but fail due to a combination of social anxiety and a lack of confidence.

I had a very severe case of acne which only isotretinoin(Accutane) could fix, and this is why I previously thought I didn’t have a testosterone problem. I have a very feminine body shape, very wide hips (not bone but fat deposition) and slight breast development which I think could be grade I gynecomastia. I previously thought my symptoms were due to hypothyroidism but my thyroid panel came back normal. I have very little fat on my belly and anywhere else on my body. Almost all my fat is stored on my hips. This is especially embarrassing although not as much as the breast development as the defective shape is visible through clothes if I don’t wear loose shirts. You could also say I have a moon face but not to a very large extent. I also have little to no facial hair growth and it takes 4-5 months to grow visible hair and even that is patchy all over. No hair on cheeks though, only under the jaw and a mustache with no hair in the middle.I have maybe 20-40% of secondary male characteristics that males my age usually have. I have maybe a third of the masculinity that I should have at this age.

I also occasionally take armodafinil(Nuvigil) for the fatigue and tiredness and it does help quite a bit if not entirely. For those who care, its primarily a mild DRI(dopamine reuptake inhibitor), partial D2 agonist and also increases orexin(hypocretin) in the brain. I also have a low libido, much lower than most boys my age that I know of. This makes me very insecure and I can barely speak with girls. I also used to lose hair but I have it under control at the moment with zinc supplements. The zinc supplements are supposed to help with low testosterone or high estrogen levels if I had them but I’ve seen very little difference in anything but my hair. Also, I’m quite anhedonic, I enjoy no activity. Antidepressants failed to fix this but armodafinil helps although temporarily. I’ve tried playing sports and I’m actually a very hard worker at everything I do but I see very little physical results if any. I workout with weights daily and also do cardio for one hour each.

Since I have low levels of LH and FSH, I probably have a pituitary or a hypothalamic problem? What I don’t understand is why I have such a high level of both estradiol and cortisol. From what I’ve read, testosterone levels should be peaking at my age. What could be wrong with my endocrine system?

I went to an endocrinologist for body shape and possible delayed puberty concerns and here are the results of the tests he asked me to do:

Serum Testosterone: 349 ng/dL
Prepubertal: 2 - 30
Tanner Stage 1: 2 - 23
Tanner Stage 2: 5 - 70
Tanner Stage 3: 15 - 280
Tanner Stage 4: 105 - 545
Tanner Stage 5: 265 - 800

Serum Estradiol: 54 pg/mL
Adult Men: Non detectable - 56

LH: 1.42 mIU/mL
1.50 - 9.30

FSH: 0.56 mIU/mL
1.40 - 18.10

Morning Serum Cortisol: 21.45 mcg/dL
4.30 - 22.40

Total T3: 1.0 ng/ml
0.7 - 2.04

Total T4: 4.7 mcg/dl
4.6 - 10.5

TSH: 2.0 mcIU/ml
0.35 -4.2

He said I have mild gynecomastia and hinted at puberty being delayed but didn’t say anything about it. He did inspect my genitals and said that I’m not hypogonadic in the literal sense since I don’t have shrunken testicles. He prescribed tamoxifen 10mg per day and to see him again after 2 months. I know I shoudn’t do this but I have also been taking letrozole 2.5 mg every third day(2 days gap) with it on my own. Tamoxifen would increase estradiol levels even more so I really think I need an AI. I chose letrozole because neither exemestane nor anastrozole is available easily where I live. I have been taking them for a little over 20 days now. My breast size has decreased by approximately 20-30% but less on one side but I have not observed any beneficial effects in energy, mood or body shape so far. Also, I haven’t had any of the classic side effects of letrozole that I’ve read most get. I have had no effects so far except for the slight breast reduction.

Also, since I have very little facial hair growth, do I have DHT problems? If yes, why and how did I have such severe acne that I had to take isotretinoin for?

Any help or advice would be appreciated. Thank you!

P.S: Never taken steroids.


#2

Please post lab ranges…


#3

That is too much letrozole. E2 will be very low and that has its own problems. Your “no effects” means that the effects of that are not too severe. [or you do not notice]

Your knowledge and command of writing is amazing.

You clearly are lacking virilization and something is wrong. Possibly genetic. TRT will make major changes in your body and mood. TRT can put one’s fertility at risk and you might be wanting that later on. Might be a good idea to has a semen sample examined at some point to confirm fertility to some extent before you make life-long efforts to preserver fertility.

How tall are you?
When did you stop getting taller?
Did you start growing taller early or late?

On Tamoxifen you should be getting LH/FSH quite soon to see how the hypothalamus and pituitary are responding. With increased LH/FSH,

Thyroid: Your labs may be normal, but there is a problem. The lab normal ranges are quite useless and misleading. TSH should be closer to 1.0 and T3, T4, fT3, fT4 should be mid-range or a bit higher. Your levels might be reflecting iodine deficiency caused by not using iodized salt.

Please eval overall thyroid function via oral body temperature as requested below. You might also be feeling cold easily, dry skin and have sparse outer eyebrows.

Low thyroid function is a strong contributor to:

  • mood
  • energy
  • weight gain or inability to loose fat

Really do need lab ranges, you can edit your post to add the ranges.
Please post other labs as available: CBC, hematocrit, DHEA-S, AST/ALT, fasting cholesterol, fasting glucose

Labs should also include:
FT - free testosterone, or bioavailable T
SHBG
DHEA-S
prolactin !!!
AST/ALT
fT3 the active thyroid hormone
fT4

  • many docs may refuse further thyroid labs because you are ‘normal’

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

Location: Where are you? Affects how iodine is made available as well as diagnostic and treatment options.


#4

That is too much letrozole. E2 will be very low and that has its own problems. Your “no effects” means that the effects of that are not too severe. [or you do not notice]

Would that mean I can continue on that dosage until I get any side effects?

Your knowledge and command of writing is amazing.

Thank the armodafinil for that! :stuck_out_tongue:

How tall are you?
When did you stop getting taller?
Did you start growing taller early or late?

177 cm tall, stopped growing somewhere around 2015-2016. I’m not sure at what age I started getting taller but I’m sure it was normal as my friends were no different.

On Tamoxifen you should be getting LH/FSH quite soon to see how the hypothalamus and pituitary are responding.

It’s been 20 days since I started it, when should I test LH FSH? 60 day mark? Also, what if my LH and FSH don’t go up? Would that make a pituitary tumor likely?

Please eval overall thyroid function via oral body temperature as requested below. You might also be feeling cold easily, dry skin and have sparse outer eyebrows.

Had exactly this before I started letrozole. Letrozole seems to raise my body temperature slightly. I’m not sure but it could be the tamoxifen as well.

Really do need lab ranges, you can edit your post to add the ranges.

Done!

CBC

Haemoglobin: 14.5 gm/dl
12 - 18

Total Leucocyte Count: 6800 /cumm
4000 - 10000

Total Erythrocyte Count: 6.17 million/cumm HIGH
4.0 - 5.9

PCV(HCT): 49.2%
34 - 54

Total Platelet Count: 2.94 10,000/cumm
1.5 - 4.5

Red Cell Distribution Width: 15.3 %
12 - 17

MCV: 79.7 fl LOW
82 - 100

MCH: 23.5 Pg LOW
27 - 32

MCHC: 29.5 %
28 - 40

DIFFERENTIAL COUNT:

Neutrophils: 60 %
30 - 70

Lymphocytes: 32 %
15 - 40

Eosinophils: 06 %
0 - 6

Basophils: 00 %
0 - 1

Monocytes: 02 %
2 - 10

AST/ALT

LFT results from 3 days ago:

Total Bilirubin: 0.94 mg/dl
<1.0

Direct Bilirubin: 0.17 mg/dl
<0.3

Indirect Bilirubin: 0.77 mg/dl HIGH
0.2 - 0.7

Aspartate Transaminase (AST/SGOT): 51.1 U/L HIGH
<40

Serum Alanine Transaminase (ALT/SGPT): 46.2 U/L HIGH
5 - 40

Alkaline Phosphatase: 196.0 IU/L
70 - 300

Total Protein: 7.2 gm/dl
6.2 - 8.4

Albumin: 4 gm/dl
3.5 - 5.1

Globulin: 3.2 gm/dl
2.3 - 3.6

I did show the elevated AST, ALT and the unconjugated bilirubin values to my doctor but he said it isn’t significant and I shouldn’t be concerned about it.

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky

Will do!

Location: Where are you? Affects how iodine is made available as well as diagnostic and treatment options.

India.

A few questions if you wouldn’t mind answering:

  1. Would aromatase inhibition increase 5-alpha-reductase activity and hence increase levels of DHT?
  2. What if I use letrozole at this dosage for longer periods of time like 6 months if I don’t get any side effects?
  3. What exactly do you think could be my problem? What genetic defect causes these symptoms? I have an intact sense of smell.
  4. If the tamoxifen and letrozole do in fact restart my HPTA somehow, will the effect remain after I stop taking them?

Thank you so much for the advice!


#5

With a SERM, LH/FSH will increase withing hours. Labs for LH/FSH can be done quite soon. TT, FT and E2 can take longer if the testes need to recover form and function.

Sometimes we see a younger guy who actually gets a HPTA restart, often not. How the HPTA gets stuck is not understood.

There is a great deal of genetic variation and these variations can combine and interact. Understood? Not really. They there are major genetic aberrations which are not rare. Your height sort of rules out some of those.

You may not feel the effects of very low E2 because you do not have a reference point where you felt great. Low E2 and high E2 are both evil. You need to sort this out. Your letro dose is scaring people.

Yes, changes to FT–>E2 may slightly indirectly affect T–>DHT, but a minor concern, focus on other things. E2 should be tested to allow dose refinement. However there is a problem if E2 is low and you get something like E2<15 where you have no idea where E2 is and then the lab result has little value as you cannot calculate a dose change.

Who suggested letrozole 2.5mg E3D?

  • you did
  • everyone thinks this is foolish and expect that you do have low E2 side effects
  • quality of that letrozole???
  • “seems to raise my body temperature” may be side effect of low E2.

India:
Are you using iodized salt?
Are you exposed to the arsenic in well water from Himalayan alluvial soils?
Lead exposure?

Low MCV seems odd VS elevated HTC. Just observing.

AST/ALT can be elevated from sore muscles and training.

HTC=49.2 is high VS low-T. With TRT, your blood may get too thick and it would be good if you were able to donate blood if needed. Some guys are this way.

Please follow up discussing your history of using iodized salt and post AM and mid-afternoon oral body temperatures. Read again my post above re thyroid labs.


#6

Body temperatures:

Just after waking up: 97.8 F
Mid Afternoon: 99.0 F
Bedtime: 98.2 F

You may not feel the effects of very low E2 because you do not have a reference point where you felt great. Low E2 and high E2 are both evil. You need to sort this out. Your letro dose is scaring people.

I totally understand that this is a high dose for my purposes. But I feel better if not ideal, than before the letrozole. At what dosage would I need to take letrozole to not crush E2 and maintain ideal levels? It’s not possible for me to obtain anastrozole or exemestane as they are way more expensive and although I wouldn’t mind spending if it would help me, I can’t find it in any pharmacy. Is it dangerous to continue at this dose if I see no negative effects at age 19? I ask this because I also want to get rid of my slight gynecomastia which only reduced in size after I started letrozole and I can’t afford to risk reversing that.

Yes, changes to FT–>E2 may slightly indirectly affect T–>DHT

Tbh that would be nice. I have very little facial hair or any other androgenic effects for that matter.

quality of that letrozole???
It’s called “Letroz” by sun pharmaceuticals. I don’t think I can get any better quality letrozole in my country.

Are you using iodized salt?

Yes! All my life.

Are you exposed to the arsenic in well water from Himalayan alluvial soils?
Lead exposure?

Not a chance.

Since using letrozole isn’t a good idea, what exactly do you suggest I do? What are my treatment options?

Thanks a lot for spending so much effort into helping me. :slight_smile: