T Nation

29 Y/O with Natural High E2, and Low T


#1

No libido, DE, fatigue, weak bones; i feel very letargic in many aspect, but i don’t think that i have depression, cause I feel happy and not sad.

But everything that i have ir want to do, i need to force my self to do it.

I don’t have doubt, that symphtons are create by low testosterone.

I will take arimidex to low e2 (1/4 e3d) than clomid to increase T (12.5mg eod) for 4 weeks.

If this doesn’t work, i would try cyp 50mg 2x Week.

Any suggetion?

Gym: 3x week
Height: 1.75
Weight: 70kg

Blood exam: 26/11/2015

Estradiol: 53.53 pg/mg (0,0 - 39,8)
Testosterone: 192.73 ng/dL (242 - 872)
Testosterone free: 53 pg/m (34 - 246)
Testosterone bio-avaliable: 124 ng/dL (82 - 626)
LH: 2.89 mUI/mL (1.5 - 9.3)
FSH: no exam
TSH: 1.84 mUI/mL (0.35 - 5.50)
DHT: 85.1 pg/mL (122 - 473)
SBHG: 15.2 nmol/L (10 - 57)
T4 free: 1.45 ng/dL (0.89 - 1.76)
T3: 0.91 ng/mL (0.6 - 1.81)
T3 free: 3.59 pg/mL (2.3 - 4.20)

T3 reverse: 0.19 ng/mL (0.09 - 0.35)
Cortisol in the Morging: 17.81 ug/dL (4.30 - 22.40)
Prolactin: 7.75 ng/mL (2.10 - 17.70)

AST/tgo: 30 U/L (<35)
ALT/tgp: 31 U/L (10 - 41)

SDHEA: 188.0 ug/dL (80 - 560)
IGFBP-3: 4.1 ug/mL (3.5 - 7.6)
IGF-1: 298 ng/mL (117 - 329)

25-hydroxyvitamin D: 15.70 ng/mL


Blood exam: 09/12/2016

Estradiol: 47.31 pg/mg (11.6 - 41.2)
Testosterone Total: 361.8 ng/dL (249 - 836)
Testosterone free: 10.15 ng/dl (5.7 - 17.8)

FSH: 3.05 mUI/ml (1.4 - 18.1)
LH: 4.20 mUI/mL (1.5 - 9.3)
TSH: 1.44 mUI/L (0.35 - 5.50)
DHT: no exam
SBHG: 16.5 nmol/L (10 - 57)
T4 free: 1.21 ng/dL (0.7 - 1.80)
T3: no exam
T3 free: no exam

T3 reverse: no exam
Cortisol in the Morging: 24.77 ng/dL (4.30 - 22.40)
Prolactin: 9.7 ng/mL (2.10 - 17.70)

AST/tgo: 25 U/L (<35)
ALT/tgp: 22 U/L (10 - 41)

SDHEA: no exam
IGFBP-3: no exam
IGF-1: 378 ng/mL (117 - 329)

25-hydroxyvitamin D: 25,32 ng/mL


#2

Please find the pencil icon above and edit the labs in your post above to add lab ranges, always needed.

When T is low, FT–>E2 generation is low, so high or elevated E2 suggests that liver clearance may be impaired. That can be from a liver condition or medications, Rx or OTC that compete for the same enzyme pathways that metabolize estrogens.

  • Get AST/ALT tested.

TSH should be closer to 1.0
What is your history of using iodized salt?
Please see last paragraph in this post.

Odd to see mixed ng, pg with nmol
Where are you located? Affects diagnostic and treatment options.

Weak bones: While E2 is protective, T is needed to support protein generation, specifically collagen which forms the matrix of your bones that support mineralization. You also need vitamin-D and most people are sub-optimal. With the catabolic effects of low T, you may find that your skin is thinner and a bit fragile or aged looking, which is totally reversable. When T is low for a longer period of time, hair is lost below the knees and skin may appear shiny.

What is the time line for your feeling there effects?
Was there a blow to the head that might have caused this?

So far, your post suggests that stress may be factor and elevated rT3.
Do you have to ramp up adrenalin to get things done? [force my self]
Does caffeine play a major role in your life?

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

  • advice for new guys
  • 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.


#3

@KSman, I appreciate your attention, thanks.

Reviewing the exams to add the ranges, I realized that I confused myself between the recent and the old exams, I already correct in the first post. Sorry.

But testosterone and e2 remain almost the same.

And I also added the AST / ALT test.

I live in Brazil, here our salt is iodized.

About your questions:

What is the time line for your feeling there effects?
Some years

Was there a blow to the head that might have caused this?
No Blow in my head

About hair loss or skin shiny, none of theses, but i think that my face skin is some oily for my age.

Do you have to ramp up adrenalin to get things done? [force my self]

Yes, I think that’s some true in these sentence about me.

Does caffeine play a major role in your life?
I rarely drink coffee

In the next week, i will buy a thermometer to check my oral body temp.


#4

But worst of all is the lack of libido, which makes me very worried, especially in sexual relationships, because with low libido, I end up having ED.


#5

I assume that SDHEA means serum DHEA.
Can you confirm?

DHEA is released in pulses with a shorter half life as it gets converted to DHEA-S -sulfate that has steady levels. Testing DHEA-S is a better indicator of DHEA status than DHEA itself. At your age, DHEA-S levels should be quite high.

DHEA is made in the adrenal glands from pregnenolone. So there is a problem with that in your adrenals or pregnenolone is very low. Cortisol is very strong and that is an adrenal hormone, so something is strange.

Your low DHEA may be limiting ability for DHEA–>T inside your testicles/testes. In the USA we can purchase DHEA on the shelf beside the vitamins. 25mg/day would be a good start.

This is below optimal. Do you avoid sun exposure there? With a darker skin, you need a higher exposure than those with whiter skin. Try to find some Vit-D3 supplements. Here we can find tiny oil based gel capsules, 5000-6000iu. Take 25,000iu for first 5 days.

You did not respond to possible liver-E2 issues caused by medications.


#6

@KSman
In the paper, the name is: DHEA-S (dehydroepiandrosterone sulfate)

And the right result is: 188.0 ug/dL (80 - 560), and not 15.2 nmol/L, but it’s still low if compare with thre range.

I know, there is something strange occurring, I do not feel that I live my life in all its plenitude.

You are right, i exposure to sun very little, but i will start it, and buy this supplemts to help my body to produce more teste.

But i think this is all kind of palliative, in your experience, do you think that if i take the supplements and exposure me to sunlight will resolve all my problems? will increase my teste to high range e lower my e2?

By the way, I don’t take any medication.


#7

My mother remember me thay in my 14 years old, in the school, i fell in the ground with my head, in the same day she leaves me to the hospital to make an radiography, but the doc so analyzed and said that was all fine.


#8

By blood exams, i have
E2 high
SHBG low

I found something interesting to adjust this imbalance, i already started with the doses mentioned in the first post, i’m in the third day, and i don’t feel any difference so far.

"4. Natural Cure #2 (For Men With High Estradiol)? I had a report from a long time poster who was suffering with low SHBG and high estradiol levels. This man actually took an AI (aromatase inhibitor which lowers estradiol) and found that his SHBG increased significantly, an outcome that is counterintuitive in my mind. This is a little scary, because I think the original poster did estradiol conversions incorrectly and the man did not have high estradiol. Thus an AI could drive his estradiol too low and possibly lead to bone loss if done long enough.

In any event, it seem to have cured this man’s low SHBG. The description and possible explanation is as follows:

"A young male presented with chronically elevated E2 [estradiol] and low SHBG. Physicians prescribed testosterone, which only exacerbated the SHBG/E2 imbalance. His problems persisted for years. His entire youth, in fact. I suggested that he try an AI-only mode of treatment.

This worked to bring his E2 within normal range, and … surprisingly, his SHBG increased to from the single digits and low teens to 30! SHBG has remained at 30, even though AI has been discontinued. He claims that he is “85% cured.” His FT is now a bit low (FAI of 0.65) and I have suggested that with T supplementation, he might actually bring himself to a completely normal hormonal profile.

It seems like he was able to wake up dormant SHBG expression by simply starving E2. I have no other explanation for this case. I have never, in 10+ years of reading about these kinds of cases, seen a liver completely correct itself with regard to SHBG expression. Perhaps, like insulin receptors, receptors in the liver can become increasingly desensitized to estrogen? In these cases, a course of AI over a 3 month period can completely resensitize them… or so it seems." [17]

NOTE: Be sure to measure your estradiol with the correct test (LC-MS/MS) for men."


#9

@KSman What do you think about this protocol for clomid:

  1. www.ncbi.nlm.nih.gov/pubmed/17070201

Fertil Steril. 2006 Nov;86(5):1513.e5-9. Complete reversal of adult-onset isolated hypogonadotropic hypogonadism with clomiphene citrate. Ioannidou-Kadis S, Wright PJ, Neely RD, Quinton R. Department of Endocrinology, Royal Victoria Infirmary and University of Newcastle-upon-Tyne, Newcastle-upon-Tyne, United Kingdom.

Inhibition of pituitary gonadotropin secretion in men by T is principally mediated by aromatization to estrogen (E), which inhibits hypothalamic secretion of GnRH. We hypothesized that adult-onset isolated hypogonadotropic hypogonadism (IHH) might result from an altered central set-point for E-mediated negative feedback. Longitudinal clinical investigation unit-based evaluation of the clinical and biochemical response to E-receptor blockade.

A 31-year-old man presenting with an 18-month history of sexual dysfunction resulting from severe adult-onset IHH (LH 1.7 U/L, FSH 2.0 U/L, T 3.5 nmol/L). Initial therapy with 50 mg of clomiphene citrate (CC) three times a day for 7 days, with overnight LH pulse profiling and 9 am T levels evaluated at baseline and on completion. A 2-month washout period, followed by low-dose maintenance therapy (25-50 mg/d) for 4 months.
MAIN OUTCOME MEASURE(S):Baseline and stimulated T levels and LH pulsatility; effect on sexual function.
RESULT(S):Clomiphene therapy resulted in complete normalization of pulsatile gonadotropin secretion, serum T level, and sexual function. CONCLUSION(S):Isolated hypogonadotropic hypogonadism may result from an acquired defect of enhanced hypothalamic sensitivity to E-mediated negative feedback. Whereas direct T replacement therapy can further suppress endogenous gonadotropin secretion, treating IHH men with gonadotropins can stimulate endogenous T secretion and enhance fertility potential. On theoretical grounds, reversal of gonadotropin deficiency with CC might be expected to have a similar biological effect.


#10

Finding the problem requires asking a lot of questions and addressing possibilities. Some issues are found that need to be dealt with that are not going to address your primary problem.

You should be near your peak DHEA levels. Your low level may be connected with your low T.


#11

Focus on reducing E2 and trying to find out why E2 clearance is poor, may be a liver issue.

When E2 is E2=18-22 pg/ml, see where these go:
TT
FT
LH/FSH

With larger SERM doses, E2 may be very high and its hard to transition to not using a SERM as the high E2 levels shutdown the HPTA.

Read the HPTA restart sticky.


#12

After 4 weeks in TRT at:

All doses in the same day
Cipionate: 50mg e3d subq (belly, High thigh, love handles)
Hcg: 250 ui e3d
Anastrazolol: 0,5mg e3d


Still with weak libido, not felling full well being, despite waking up sometimes with discreetly morning wood.

I will increase the dosage of anastr to lower the e2 by 18-22.


Blood exam: 13/04/2017

Estradiol: 38,54 pg/mg (11.6 - 41.2)
Testosterone Total: 792,3 ng/dL (249 - 836)
Testosterone free: 24,65 ng/dl (5.7 - 17.8)
FSH: no exam
LH: no exam
TSH: 0,83 mUI/L (0.35 - 5.50)
DHT: no exam
SBHG: 16.15 nmol/L (10 - 57)
T4 free: 1.52 ng/dL (0.7 - 1.80)
T3: no exam
T3 free: 4,1 (2,3 - 4,2)
T3 reverse: no exam
Prolactin: no exam
AST/tgo: 28 U/L (<35)
ALT/tgp: 28 U/L (10 - 41)
SDHEA: 236 (80 - 560)
IGFBP-3: 5 MCG/ml (3,5 - 7,6)
IGF-1: 385 ng/mL (117 - 329)
25-hydroxyvitamin D: 28,91 ng/mL (30 - 100)


#13

Your levels looks good except for e2. In my case also e2 is high and all other levels are sub optimal only.Your TSH now is in range have you taken anything to improve it.


#14

During two weeks dhea supplemetion


#15

TSH: 0,83 mUI/L (0.35 - 5.50)
T4 free: 1.52 ng/dL (0.7 - 1.80)
T3 free: 4,1 (2,3 - 4,2)
T3 reverse: no exam

Still no AM and mid-afternoon body temperatures reported. This can be as important as thyroid lab work.

Your strongly above mid-range fT3 suggests that something odd is going on. We might see warmer temperatures and low body fat with that. Sometimes these higher values can be compensation for elevated rT3 that is stress/adrenal related.

With E2=22pg/ml as a target, new dose of anastrozole can be 1/2mg E3D * 38.53/22= .87mg E3D or .58mg E2D. You can dissolve anastrozole 1mg/ml in vodka, rum etc and dispense by volume. Pill spitting is often not workable.

With increased anastrozole dose, expect to feel a major change in 5-7 days. It will take about 5 weeks to get all benefits.

IGF-1 is quite high, even for young=29, may be a good thing and will increase the anabolic and restorative effects of TRT. Good for libido too. Check this once a year to see if there is an upward trend that might be a concern.

I do not see any effect from Vit-D3 supplements.

“”“
This is below optimal. Do you avoid sun exposure there? With a darker skin, you need a higher exposure than those with whiter skin. Try to find some Vit-D3 supplements, take one every day. Here we can find tiny oil based gel capsules, 5000-6000iu. Take 25,000iu for first 5 days.
”""


#16

Update

No improvement in libido or mood, except for my body weight that I gained 5kg
(13,22 lb).

@KSman I will still provide temperature measurement, my bad.

The last 19 days:

01/06/2017 to 16/06/2017: 20mg Cyp ED + 350ui HCG E4D
12/06/2017 to 19/06/2017: 1mg Anastrazol ED (not pharma)
17/06/2017 to 19/06/2017: 30mg Enanthate ED + 350ui HCG E4D

For 2 months: Vit d3 - 10000ui EOD

Bloodwork in 20/06/2017:

LH: 0,15 mUI/mL (1.5 - 9.3)
FSH: < 0,30 mUI/ml (1.4 - 18.1)
Total Testosterone: 1481 ng/dl (160 - 726)
Free Testosterone: 52,33 ng/dL (3.4 - 24.6)
Estradiol: 137,27 pg/ml (11.6 - 41.2)
Progesterone: 0,53 ng/mL (0.28 - 1.22)
Prolactin: 13,28 ng/mL (2.1 - 17.7)


For now, I will only change the anastrozole for pharma grade and still on 1mg ED.


#17

Update:

22mg of Arimidex in 11 days:

My E2 went down to 12 pg/mL


#19

1mg anastrozole per day is most always absolutely wrong

With E2=12pg/ml, you can cut anastrozole dose in half.
effect of changed source presents an unknown

Changing T dose changes anastrozole dose needed. Steady is important.