T Nation

Advice on Blood Test Results, E2 Levels and Adex


Hi all

New to the forum and to TRT and looking for some help with understanding my blood test results and prescription.

I am 48 and train 4-6 times per week, eat clean and am in good health - 72kg and 12% BF
I have been concerned over the past 12 months about low libido along with glacial progress in putting on muscle and losing belly fat. My coach suggested it was likely attributable to my age and suggested checking T levels. Fast forward and I have now had bloods and a consultation at a local urology clinic.

Blood results were;

Total test : 340 (249-836)
SHBG : 24.7 (19.3-54.1)
E2 : <5 (25.8-60.7)
Albumin : 4.6 (3.5-5.2)
FSH : 5.03 (1.5-12.4)
LH : 4.46 (1.7-8.6)
Prolactin : 8.21
PSA : 0.083 (0-1.04)
TSH : 1.35 (0.27-4.2)

After reviewing these the Dr decided he did not want to prescribe TRT just yet and instead wrote me a script for 1g/day of Adex for 3 months - then come back and get some more bloods.

On review and reading all I can I am now confused on a few levels;

  1. Why would he prescribe Adex when my E2 level is already close to zero - is there any logic to this? (I have taken 3 days worth but have now decided to stop until I can get in front of him again as I don’t want to crash my E2 levels)

  2. Apart from low libido I don’t seem to be showing any of the classic low E2 symptoms I have read about - could the test be a false result or could I simply not be symptomatic? (I dont have any erectile dysfunction or problems with sex - just don’t want it very much)

  3. My feeling is that based on these results I would benefit from some decent TRT in some form or other to get both T and E2 up to the right levels?

Any insights much appreciated - this is a complex subject…


I agree re Adex/anastrozole vs your low E2.
Doc is mindless. Anastrozole can increase LH/FSH and T, in guys when E2 might be elevated.
Most docs are idiots when dealing with these issues. Endo’s and urologists seem to be the worst.

Please edit your post above and add lab ranges. This is important.

Labs should include:
CBC with hematocrit

Thyroid controls your base metabolic rate:
You can eval overall thyroid function by checking oral body temperatures:

  • when you wake up, should be 97.7-97.8, higher is OK, 97.3 is a problem
  • also check for 98.6 mid-afternoon
  • if low you can do these labs:

Thyroid problems can be caused by not using iodized salt.

Please follow these links in the 2nd post of the 1st topic in this forum:

  • advice for new guys — need more info about you
  • things that damage your hormones
  • finding a TRT doc
  • thyroid basics explained - if body temps are low or not using iodized salt.

Where are you located?


Thanks K Sman - I have added lab ranges and also PSA (Low) and TSH (Low) - Dr also did a DRE and confirmed prostate is not enlarged.

How do you suggest I proceed?

I have asked him to re-consider and pointed out my concerns - his answer was that Adex “Has a dual effect” and will raise available T regardless of low E2.

It is unlikely he will change is prescription I feel - if he doesn’t should I walk away and stop the Adex or continue to take it (maybe reduce dose) and monitor effects, then get bloods done again in 3 months?

Location is Istanbul (I am English)


Another stupid Dr unfortunately. Arimidex’ dual action works to increase T by reducing aromatization rates of T to E.

You’re already having very little T to E conversion as shown by your blood tests and this will likely have no effect and may make you feel worse.

More labs are needed but by what is shown and if all other labs are optimal, more T would likely leave you feeling better if balanced. It would likely increase your e2 which as long as not too high would make you feel better as well.

When my e2 gets too low, the only symptoms I experience are sleepiness all day and lack of motivation. Many respond differently to different situations.


This was my understanding too.

I have requested to see him next week and will try to shift his thinking - wish me luck :wink:


Most Dr’s rarely wish to discuss matters of knowledge with their lowly patients. Good luck. I’d suggest searching for another Dr in the meantime.

Call around pharmacies and compounding pharmacies and ask if they can suggest a Dr who seems to be prescribing TRT, hCG, adex etc for males.

You can also do this with standard pharmacies, which will often prescribe trt and adex, but not hcg, at least that’s my understanding.


Not many options here in Istanbul - especially English speakers!

I have an appointment on Monday to discuss the options - I will report back…


Just an update on the situation - I had a consult with the Doc and told him I had some concerns around Adex and low E2. The net result was a prescription for a shot of Nebido with a follow up in 6 weeks as a booster.

He recommended to drop the Adex - any advice on this, should I consider a small dose along with the Nebido?


How many mg’s were injected? I believe Nebido is normally 1000mg’s/4 ml’s.


Yes, that’s correct…



I would really appreciate some guidance on what dose (or even if at all) of Adex following the initial injection of Nebido on Tues this week?

E2 levels appeared to be very low (<5) on last bloods, but I want to see them rise to optimum levels but not higher - should I wait and see what E2 is doing in 12 weeks at next blood draw, or would I be better off taking a small dose (0.5g E3D) right now to keep things in check?