T Nation

26 Yr Old w/ Low T & High E


Hi everyone,
I have read through many of the threads on this forum so hopefully I don't come off as too much of a newb and at least follow the guidelines. A little about myself...
Age: 26
Weight: 185lbs
Height: 5'8"
Waist: 33-34"
Facial & Body Hair: Hairy
Fat: Stomach, Chest, Face
Health Conditions: None
Meds: Was on chronic pain mess (opioids) for past 4 years. No more thankfully for past month.
Diet: Healthy now and not bad for past year.
Training: Light weights & short cardio (working at both)

TESTOSTERONE: 199 ng/dL (range 348-1197)
ESTROGEN: 122 pg/mL (range 40-115)

So I've always had a problem putting on muscle, loosing weight, low energy and depression. Have had a gut and puffy nipples/fat chest since I was a teen. They aren't all out "man boobs" but enough to bother me. I wish I had my levels checked out years ago but such is life. My erections aren't bad but not like they were when I was like 18. For the past 4 years I was on opioid mess which I hear can definitely add to some of these problems. Thankfully with the assistance of Ibogaine I was able to stop these meds as it was getting out of hand. I went to my GP last week to request blood work as I spoke to a friend of mine in his low 30s who has similar issues and said TRT changed his life. I went to a urologist a physician friend recommended a few days ago who requested I get my blood work done again as my GP did it in the evening after I ate the entire day and he wanted results with me fasting. I think his concern about this was more about my Trigylcerides which came to 243 mg/dL (range 0-149). My other cholesterol levels were in range but on the higher side, I got the blood work done again and will be seeing him on Tuesday.

I will update this thread with my new results, but just wanted to get everyone's advice regarding my plans. I am hoping to start with some type of T cream and if the doctor prescribes me Arimidex I will go ahead with that. If he chooses not to prescribe me Arimidex I plan on ordering it as it seems like a terrible idea to use the cream alone. Was planning on taking 1/4 mg a day - does that sound about right for my levels? I have also been reading about HCG as I definitely don't want to jeopardize my fertility. Is this something someone my age should add? Seems to be a yes from my research but would really appreciate some personal advice. I have read about HCG drops as an alternative to injecting. I know I should get over my needle phobia but hopefully someone can advise if this would be okay to start. I am hoping to start this way and then if need be go to injectables for both the T and HCG. With my T levels that low I don't know how effective the cream would be but can't hurt to give it a shot. What type of dosage would you guys recommend for the various creams? I'm sure this doc will start me low but if I feel he isn't providing good treatment I will look elsewhere.

I would just love to get my body into better shape, shred some fat, have more energy and feel just more manly! It's about time. Thanks in advance to anyone who can help guide me with getting things rolling. It seems like a solid community here!


Post all your labs. We are absolutely flying blind without labs. Yes, you are estrogen dominant and this isn't good. What's your SHGB?

Yes, your T is low, but you are young. Opiates may have messed up your HPTA. Supplementing T will only further inhibit your HPTA. You've only been off opiates for a month. Anyone here will tell you that you don't want to travel down this road unless you HAVE TO.

Instead of the T cream, could you possible try a SERM like nolvadex or clomid to see if you can stimulate your body's own production mechanisms?

Low T is a symptom of a problem. It is not THE PROBLEM.

EDIT: This is a good read for you. Heroin is also an opiate.

  1. Mendelson JH , Mello NK. Plasma testosterone levels during chronic
    heroin use and protracted abstinence. A study of Hong Kong addicts.
    Clin Pharmacol Ther 1975;17(5):529-33.


Thank you for the reply and the article - very good and interesting read. I was pretty surprised to find out that buprenorphine (better known as Suboxone) didn't seem to cause low T in individuals compared to other opiods. I know this isn't the forum to talk about opiods but I think anyone who is familiar with them would find that interesting. The article did mention that opiod users seemed to return to their normal T levels after a month of stopping use. Prior to my opiod use I definitely still had issues with fat, muscle and energy. Had some signs of gyno in the chest area since I was a teen. I was never extremely overweight - usually 15-20lbs more than I thought was ideal. My sex drive was pretty good.

Regarding the blood work I apologize for the incomplete information. As mentioned, my GP ordered the initial blood work and several of the tests recommended in the blood work thread were not performed. The new report I will have on Monday or Tuesday will cover most of these. I am not sure of my SHGB and I don't believe it was tested in the new blood work either. I could be mistaken though as I don't have a copy of the prescription. The only other results which may be of interest is my:
Prolactin 6.9 ng/mL (range 4.0-15.2)
Free Testosterone 10.9 pg/mL (range 9.3-26.5)
Vitamin D 14.4 ng/mL (range 30-100) - currently treating this with 50,000iu 1x week for 4 weeks + 5,000iu daily.

Again, I will update this thread with the latest results including FH & LSH which was ordered.

I am definitely not opposed to trying a SERM like nolvadex or clomid if it is recommended. I'm not sure if it is something the doctor would consider so I would have to rely on the expertise here. From my understanding nolvadex or clomid are fine if taking alone but not recommended if doing some form of TRT, correct? In that case Arimidex would be the best choice or is that more true for those with low T and "normal" E who don't want the TRT to cause in an increase in their E?

If going solely the nolvadex or clomid route, do you have any specific recommendation between the two? Dosage? Duration? I've read the consensus of most doctors being idiots and am not too hopeful on mine. If nolvadex or clomid can be as effective and better in the long run for my specific case, I don't see why I would go another route to start off.

After years of this opiod crap I just want to start feeling like a normal 26 year old male. Been missing out on too much and working on getting my life back. Again, I really appreciate the help. Thanks.


SERMs are part of an HRT. It wouldn't be considered TRT, though. SERMs work by increasing the LH output, hopefully increasing T using the body's own mechanisms. This still causes a rise in E2 so a proper AI (aromatase inhibitor - arimidex anastrozole) will still be needed. Selective Estrogen Receptor Modulators only block estrogen to specific tissues. They are not an "estrogen blocker" as a whole. If you do decide to go this route you will need to continue the use of an AI after stopping the SERM to prevent estrogen rebound.

Nolvadex is primarily recommended here due to the negative side effects some experience with Clomid. 20mg/day of tamoxifen citrate generally produces good results IF one is secondary hypogonadism. I can only assume you are due to age because I still don't know your LH and FSH numbers. If they are near the top end of the range, this would be considered primary hypogonadism and TRT is pretty much your only option.

Doctors get "T tunnel vision" when someone's T is low and supplement with T without ever figuring out what was wrong in the first place. Here, we try to pursue the root cause. If you can get your body working properly without having to go on life-long TRT, that's your best bet.

On a side note, you could also try AI-only treatment. You could take .5mg of anastrozole/week in divided doses. This has been shown to raise T levels while lowering estradiol, therefore reversing your estrogen dominance. However, many have not reported an improvement in symptoms despite the reversal.

Just some options for you. Let us know how it goes.

EDIT: You need more labs!


Thank you so much again for the help. It is sad to see the tunnel vision of doctors and the detrimental effects for various treatments. A bit off topic but if I had stuck with western medicine for trying to stop my use of pain meds I would not be where I am today. Ibogaine is an amazing substance and does wonders on the brain. I think anyone would find a google search of it to be extremely interesting, not just for opiod treatment.

Back on topic, I just called LabCorp today and my preliminary results are in and the remaining ones such as Free T should be ready by tomorrow. I also have an appointment with the urologist tomorrow so I will post on here after coming back with more updated lab work as well as his recommendations. I hope that I can go for a Nolvadex & AI treatment based on my LH & FSH...will see tomorrow.

Again, I can't thank you enough for the help thus far and look forward to hearing from you tomorrow after I post my new labs, etc.


Well I'm at the doctor's office now waiting as usual but figured I would update my blood work:
Testosterone 226 ng/dL. Range: 348-1197.
Free Testosterone 12 pg/mL. Range 9.3-26.5.
LH 3.1 mIU/mL. Range 1.7-8.6.
FSH 2.0 mIU/mL. Range 1.5-12.4.
Thyroxine T4 7.4 ug/dL. Range 4.5-12.
T3 Uptake 35%. Range 24-39.
Free Thyroxine 2.6. Range 1.2-4.9.
Estradiol 22.2 pg/mL. Range 7.6-42.6.

My total Estrogens wasn't tested for this time but my previous results came out as 122 pg/mL (Range 40-115) as mentioned above. I'm not too sure what to make with the Estradiol being in the middle of the range but total estrogens tested a week earlier being high.

Looking forward to your advice and I'll update this with the doctors recommendations - although we all know how that can go.

EDIT: I'm an idiot - I shouldn't have listed my "Estrogen" in the first post as it wasn't E2. Forgive my first beginner mistake. So maybe I just have low testosterone? What do you guys think of my E2 level?


Okay so my Urologist ended up prescribing me Testim. I asked him about T converting to E and he just said no. Now my E2 levels don't seem terrible but I obviously want to avoid an increase. Based on my levels would you still recommend the Anastrozole .5mg / week with the Testim or was that the dose if taken by itself? He mentioned in the future I could possibly have an issue having kids if on T and this would be a huge concern for me. I'm probably 4-5 years away but want to be careful of course. His opinion was that after stopping the T for sometime I would be fine in that department. He kind of hinted we may have to do something else but definitely wasn't specific. Please let me know your thoughts based on my updated lab work. If HCG is recommended, do the drops work? I see them on some sites and haven't got over my fear of injecting.

Also, please let me know if based on my E2 numbers (which I should have clarified in post 1) if it still could be a good plan to just start with Nolvadex + AI?

Now that I have the proper bloodwork, clarified my first post and have seen the doc, I am really eager to get a good game plan started. Thanks so much.

EDIT: Manged to find real HCG that can be mixed for oral use. Just unsure on dosage. Thanks.


I haven't personally used testim, but I haven't heard a lot of good things about it. Who knows, you may like it and benefit from it. I preferred androgel if I had to use a topical. It dries quickly and leaves no smell. Sometimes insurance won't cover it though, opting for cheaper options like fortesta, etc.

You may not need an AI. Everyone is different. You could add in .5mg/week and retest E2 when you retest TT. High E2 comes with problems as does low E2. You just have to get to know your body and understand how it reacts to E2 levels. When my E2 is low, I have zero libido. When my E2 is too high, I'm a hormonal crazy bitch. These are my indicators. Yours may be different.

I have yet to see someone actually report success with subligual hCG troches. There have been a fews guys say that they are trying them, but I never see if they are actually working. Are these "real" hCG drops from a reputable source like a compounding pharmacy? If not, they probably don't contain any hCG and won't help you at all. After you inject hCG into yourself the first time you'll completely get over the fear. The needle is tiny and half the time I don't even feel it. If you want to keep your ability to be fertile, you're going to have to be able to give yourself an injection.

Go get a tattoo. That will get you over needles in a hurry.


Thanks for the help Kaynon. So I found out my new insurance sucks for brand medication and therefore no coverage at all. I called a local compounding pharmacy and my doc is supposed to send them a script tomorrow. If he is being difficult I'll just fill this once and switch docs. I plan on switching anyway as I want a doc that understands TRT better and will write out AI & HCG.

Most of the HCG drops are total scams I agree. This is from an actual pharmacy where I am getting the Anastrozole and appears to be the same HCG as people inject, however there are instructions on an HCG forum on how to mix it with bacteriostatic water to be able to use it orally. This seems like a very popular method for those on HCG diets. What kind of dose would you recommend? The weight loss people seem to use 200-500iu. Obviously I would like to lose weight but am not using HCG primarily for that. Wouldn't be a bad thing if you think it could help me shred some fat!

Also, how can I tell if the HCG is or isn't working? What tests should I get and look out for?

I know I need to get over this needle phobia. At least I was scared of them while I was on pain meds or it could have became a bigger problem. If it comes down to my fertility then I will inject no problem. As you said and many have told me, just do it once ans you're fine.

Thanks again for the help.


The testes take a little bit after beginning androgen use to start shrinking, so only time will tell. If they DON'T start shrinking, then it's working. We recommend 250iu/EOD. That's pretty standard among those who understand its benefits with TRT.

If your doc is giving you hCG and anastrozole, I would stick with him. Doctors who are open to these things can be very difficult to find. There is an entire sticky at the top of the page dedicated to finding doctors who are willing to prescribe these things. I would stick with him and educate yourself as best you can to get the treatment you need.

Just my two cents.


Thanks Kaynon. Just to clarify, my doctor is not willing to prescribe anything else. I am just going to fill my test script from him and start finding a better doctor. I found this forum after I saw him and figured I'd give him a shot. I found another name from a friend who is supposed to be very good with this stuff. I'm going to try seeing him next week but if that fails I will just have to locate the HCG and Anastrozole.

I obviously want to get going ASAP on my treatment, however will it hurt to not have HCG & Anastrozole for the first week or so? I figure its not ideal but shouldn't be too bad especially after seeing my E2 numbers.


You'll be fine for a couple of weeks without them.