T Nation

8 Months on TRT, Elevated E2. Urologist Not Convinced to Give an AI


#1

Urologist is reluctant to prescribe an aromatase inhibitor, about to head back for a follow up my latest labs after bringing up the subject.

He was super defensive and argumentative when I brought it up. I mentioned how my elevated e2 is cancelling out the benefits of the increased test, mentioned androgen receptor availability, and he rudely asked me if I had a degree in endocrinology. Then said he normally only prescribes when there’s gyno, and estradiol is over 100 pg/mL.

To add to my frustration, these urologists never tested for secondary hypogonadism! I didn’t know about it then (9 months ago), but I do now. No LH or FSH tests, just free and total test, you have hypogonadism let’s do TRT… I’ve had to push them to monitor E2 at all, and they were reluctant at first (always carried fat on chest, obviously worried about this).

So basically, my short summary is:
Initial tests:

  • 3/2016
  • TT - 286 (348-1197)
  • FT - 6.1 (8.7-25.1)
  • 4/2016
  • TT - 382 (348-1197)
  • FT - 8.3 (8.7-25.1)
  • 5/2016
  • TT - 211 (348-1197)
  • FT - 9.4 (8.7-25.1)

Started TRT - Test Cyp 100mg/week (shortly moved to 50mg E3.5D)

  • 7/2016
  • TT - 355 (348-1197)
  • E2 - 26 (<29)

Increase to 150mg/week (split E3.5D)

  • 9/2016
  • TT - 843 (348-1197)
  • FT - 27.2 (8.7-25.1)

Stay here for a bit, but not feeling better at all. Finally start pushing them to investigate this more. Reading and researching online, I have a feeling that the problem is elevated E2, lots of the symptoms.

  • 1/2017
  • TT - 915 (250-1100)
  • FT - 241.6 (35-155)
  • E2 - 41 (<29)
  • Prolactin - 6.9 (2-18)
  • SHBG - 17 (10-50)
  • TSH - 1.15 (0.4-4.5)
  • T4 Free - 1.1 (0.8-1.8)
  • T3 Total - 94 (76-181)
  • AST - 17 (10-40)
  • ALT - 25 (9-46)

Had convo with other doc about AI I described above. I also moved back down to 100mg/week (split E3.5Days). For this last test, since I had to push the doc to even prescribe test E7D, instead of E14D like the medicine label recommends, I injected 100mg exactly 3.5 days before the bloodwork (had injected 50mg 3.5D before this injection).

  • 2/2017
  • TT - 1017 (250-1100)
  • FT - 252.2 (35-155)
  • E2 - 48 (<29)
  • Prolactin - 11 (2-18)

About to head to the urologist to discuss the results, and see what they have to say. Any thoughts?

KSMan, I’ll post a full rundown of all the questions from your sticking in a main thread about my TRT experience, just wanted to start off discussing the current situation, and how to deal with doctors who clearly don’t know anything besides what the pharma companies told them…


#2

No need to test prolactin again.

The problem is the doctors and urologists are often as bad as you report.

Signs of thyroid issues, please see last paragraph below.

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

Thanks KSMan, already read the stickies and planning on doing exactly this. Really appreciate all the work you do here. I learned a lot from you, and all the other contributors here.

I know I only got the basic thyroid panel, but is there something that makes you think there’s a problem, or is this the basic “baseline information please” response?

Like I said, this thread is a bit narrow in scope, more about dealing with idiots and venting my frustrations.

I’ll be posting a general “My TRT” thread, where I’ll dump 2x more labs and details.


#4

Please post requested body temperatures. T3, T4, fT3, fT4 should be mid-range or a bit better. In future test fT3 the active hormone.

Your E2 is horrible and unhealthy for cardiovascular system, prostate, mind and soul.


#5

So the urologist prescribed me Aromasin, and basically said “I don’t think you need this, but if you want to try it I’m fine with that”.

He then proceeded to write the script for 25mg/day… So he thought E2 wasn’t that high at 50, but is writing a script for 25mg/day… Maybe he thinks I’m a woman with breast cancer?

And to think he got defensive when questioned and asked me where I got my degree. I honestly think these docs only write a script for what is on the box from the manufacturer, and have no knowledge or understanding outside of that…

Well, I’m glad to have the script. Attempted to cut the pills into quarters (more like thirds), and dosing every day for now, around 8mg, will try to split better at get to 6.25mg a day.

KSMan, first temperature of the day was 96.7 °F at 8:00 AM (30 minutes after waking up). Current temperature is 98.2 °F at 10:20 AM.


#6

Isn’t that the one you can dissolve in vodka, and using a 1ml syringe, to dose better?


#7

Not a bad idea, but I don’t drink any alcohol.


#8

I think I read one (or several people) used water, but it doesn’t dissolve as well. Maybe others will chime in.