T Nation

Bioavailable Testosterone and Estradiol Results


#1

I've just had E2 and bioavailable testosterone tested (just these as I've had to pay for them out of my own pocket), decided to pay as I've had real trouble putting on weight for the last year and a half or so and at 6' and about 88 kg (194 lbs) and only 20 yrs old I didn't think I should be having any issues.

Just not feeling good at the moment, libido is also down, strength increases are slow on the rare occasion they come and I have also suffered from night sweats and tiredness during the day.

E2 came back as 29 pg/ml (14-54). I should add that at the time this test was taken I was taking one spray of arimidex a day (1 mg/ml concentration) on the sugestion of someone on this board that I trust. Bioavailable testosterone came back as 89 ng/dl (range: 40 - 250).

Are these levels an issue for somone my age and what should be my next course of action? I live in the UK so doctors are not exactly sympathetic to this particular type of issue should this be required. Thanks.

(I think I've converted the units properly, if not, these are the actualy values I recieved:

e2: 106 pmol/l (range: 44-156)
3.1 nmol/l (range: 2-9)).


Low Testosterone Cause - 20 yrs
#2

With lower E2 levels E2=29pg/ml can be a problem.

Try 0.5mg/week anastrozole. It has high bio-availability, skip the nasal route. This may help but would seem to be masking the problem, not solving it.

Any signs of gyno?

Any history of gear or PH use?
Ever used hair loss drugs?

Some drugs increase E2 levels, and lower T. This can be Rx drugs or OTC.

Thyroid:
-do you get cold easily?
-pattern of waking body temps near or below 97F?
-dry skin or brittle nails/hair?
-not using iodized salt?

Adrenals:
-stress leaves you feeling physically unwell?
-DHEA-S low?
-feeling down for a long time after surgeries, illnesses, major stress events?
-craving salt or sugar?
-bouncing on caffeine and sweets?


#3

[quote]KSman wrote:
With lower E2 levels E2=29pg/ml can be a problem.

Try 0.5mg/week anastrozole. It has high bio-availability, skip the nasal route. This may help but would seem to be masking the problem, not solving it.

Any signs of gyno?

Any history of gear or PH use?
Ever used hair loss drugs?

Some drugs increase E2 levels, and lower T. This can be Rx drugs or OTC.

Thyroid:
-do you get cold easily?
-pattern of waking body temps near or below 97F?
-dry skin or brittle nails/hair?
-not using iodized salt?

Adrenals:
-stress leaves you feeling physically unwell?
-DHEA-S low?
-feeling down for a long time after surgeries, illnesses, major stress events?
-craving salt or sugar?
-bouncing on caffeine and sweets?[/quote]

No real signs of gyno, a biosig picked up a high pec fold but no tenderness etc.

No gear/hair loss drugs.

No issues with the cold.

The body temperature I have not monitored, would a simple digital cooking thermometer in the mouth be accurate enough?

Not entirely sure with brittle nails, nothing hugely noticeable, some lengthways raised lines across most of them.

I don’t use iodized salt ever.

I have had periods of feeling down increasingly regularly over the last year or two, especially when stressed or ill.

I crave sugar but never salt, rarely have caffeine and never really have sweets.

Appreciate the help mate.

I will try the arimidex in the meantime, thanks.


#4

Do you consume milk or alot of diary products
Do you consume any soy protein?
What is your cruciferous vegetables intake like?
I would do DIM and zinc 30-50 mgs a day before adding in adex.
I would also look at adrenals more closely and thyroid functioning as well
Insulin could also be an issue as well all these variables need to be ruled out.


#5

[quote]jk270 wrote:
I’ve just had E2 and bioavailable testosterone tested (just these as I’ve had to pay for them out of my own pocket), decided to pay as I’ve had real trouble putting on weight for the last year and a half or so and at 6’ and about 88 kg (194 lbs) and only 20 yrs old I didn’t think I should be having any issues.

Just not feeling good at the moment, libido is also down, strength increases are slow on the rare occasion they come and I have also suffered from night sweats and tiredness during the day.

E2 came back as 29 pg/ml (14-54). I should add that at the time this test was taken I was taking one spray of arimidex a day (1 mg/ml concentration) on the sugestion of someone on this board that I trust. Bioavailable testosterone came back as 89 ng/dl (range: 40 - 250).

Are these levels an issue for somone my age and what should be my next course of action? I live in the UK so doctors are not exactly sympathetic to this particular type of issue should this be required. Thanks.

(I think I’ve converted the units properly, if not, these are the actualy values I recieved:

e2: 106 pmol/l (range: 44-156)
3.1 nmol/l (range: 2-9)).[/quote]

Your bioavailable testosterone is borderline low…actually, it’s just plain low for your age. Normal for your age is 83-257 ng/dl. So, it looks like you are hypogonadal. You may have to take a trip to Belgium and see Thierry Hertoghe. A lot of men in the UK go to see him for hormone help.

FYI, when my Bio T levels were at 100ng/dl, I had bad signs and symptoms of hypogonadism.

Reference:

http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/83686


#6

[quote]Hardasnails wrote:
Do you consume milk or alot of diary products
Do you consume any soy protein?
What is your cruciferous vegetables intake like?
I would do DIM and zinc 30-50 mgs a day before adding in adex.
I would also look at adrenals more closely and thyroid functioning as well
Insulin could also be an issue as well all these variables need to be ruled out. [/quote]

No diary products or soy protein. Cruciferous vegetable intake is generally good., I already supplement with upwards of 30 mg zinc per day. How would DIM have an impact upon bioavailable t levels apart from reducing aromatisation which I assume adex is already doing? Genuine question, not trying to be clever.

When you day adrenals, thyroid and insulin need to be looked at, I assume you mean bloods? Cheers.


#7

Iodine deficient! Get an iodine supplement or iodine rich supplement and take a lot a first to build levels, then a maintenance dose. Others in your family may be deficient too. Yes a basic digital fever thermo works well too. Also check temp during the day when no food, drink or talking. Hypothyroidism can lower T levels.

Get iodized salt or find iodized sea salt if possible.

Adrenals may be weak. Have you tested DHEA-S levels? Are sweet cravings new or tracking your not feeling well?

At your age, you clearly have hypogonadism. You need to get tests to determine if primary or secondary. If secondary, tests to determine if a pituitary adinoma is responsible. High prolactin levels would also point to that.


#8

[quote]KSman wrote:
Iodine deficient! Get an iodine supplement or iodine rich supplement and take a lot a first to build levels, then a maintenance dose. Others in your family may be deficient too. Yes a basic digital fever thermo works well too. Also check temp during the day when no food, drink or talking. Hypothyroidism can lower T levels.

Get iodized salt or find iodized sea salt if possible.

Adrenals may be weak. Have you tested DHEA-S levels? Are sweet cravings new or tracking your not feeling well?

At your age, you clearly have hypogonadism. You need to get tests to determine if primary or secondary. If secondary, tests to determine if a pituitary adinoma is responsible. High prolactin levels would also point to that.

[/quote]

DHEA-S levels have not been tested, just couldn’t afford it at the time, if I can’t get them tested I will pay out though. Sweet cravings are not new, can’t remember not having them. I am seeing a doctor on Monday morning, is it a good idea to bring up the test results or should I just describe my symptoms and let the good doctor decide on appropriate tests?

-TT
-FT or bio-T
-E2
-PSA
-DRE: the dreaded digital rectal exam, doc gives you the finger.

In terms of tests, TT, bio-T, e2, PSA are all preferable I assume?If none or some of these tests are not deemed needed should I make a point of asking? Not sure if you are familiar with docs on the NHS in the UK but they can be fairly unsympathetic/stubborn. Again, appreciate your time. Are their any texts/books that may be of help to me?


#9

there is a sticky on recommended blood test and one about finding doctors (that includes how to approach your doctor - symptom descriptions, etc.) I would definitely have specific tests in mind, but first see what the doctor requests then recommend extra tests if needed along with the reason you are asking for the test.

I bring all of my tests results with me every time I go to the doctor in an excel summary format (as the 50+ pages of results would be a bit much to flip through).


#10

[quote]jk270 wrote:

[quote]KSman wrote:
Iodine deficient! Get an iodine supplement or iodine rich supplement and take a lot a first to build levels, then a maintenance dose. Others in your family may be deficient too. Yes a basic digital fever thermo works well too. Also check temp during the day when no food, drink or talking. Hypothyroidism can lower T levels.

Get iodized salt or find iodized sea salt if possible.

Adrenals may be weak. Have you tested DHEA-S levels? Are sweet cravings new or tracking your not feeling well?

At your age, you clearly have hypogonadism. You need to get tests to determine if primary or secondary. If secondary, tests to determine if a pituitary adinoma is responsible. High prolactin levels would also point to that.

[/quote]

DHEA-S levels have not been tested, just couldn’t afford it at the time, if I can’t get them tested I will pay out though. Sweet cravings are not new, can’t remember not having them. I am seeing a doctor on Monday morning, is it a good idea to bring up the test results or should I just describe my symptoms and let the good doctor decide on appropriate tests?

-TT
-FT or bio-T
-E2
-PSA
-DRE: the dreaded digital rectal exam, doc gives you the finger.

In terms of tests, TT, bio-T, e2, PSA are all preferable I assume?If none or some of these tests are not deemed needed should I make a point of asking? Not sure if you are familiar with docs on the NHS in the UK but they can be fairly unsympathetic/stubborn. Again, appreciate your time. Are their any texts/books that may be of help to me?[/quote]

TT, bio-T, E2, LH, FSH are the bare minimum. There are many more tests you should have, but you definitely need those when dealing with hypogonadism. A good recent book on the subject is “Testosterone for Life” by Abraham Morgentaler. Better yet, here is a LEF article that covers the basics of his book:

lef.org/magazine/mag2010/jun2010_Abraham-
Morgentaler-Testosterone-Therapy-for-Life_02.htm

In it he states that low normal free testosterone levels deserve a trial of trt. Also, print out the Mayo clinic age dependent ranges that I posted above. You now have more than enough ammunition to get some help if you so desire (and if your doctor has half a brain).


#11

[quote]neurolift wrote:

[quote]jk270 wrote:

[quote]KSman wrote:
Iodine deficient! Get an iodine supplement or iodine rich supplement and take a lot a first to build levels, then a maintenance dose. Others in your family may be deficient too. Yes a basic digital fever thermo works well too. Also check temp during the day when no food, drink or talking. Hypothyroidism can lower T levels.

Get iodized salt or find iodized sea salt if possible.

Adrenals may be weak. Have you tested DHEA-S levels? Are sweet cravings new or tracking your not feeling well?

At your age, you clearly have hypogonadism. You need to get tests to determine if primary or secondary. If secondary, tests to determine if a pituitary adinoma is responsible. High prolactin levels would also point to that.

[/quote]

DHEA-S levels have not been tested, just couldn’t afford it at the time, if I can’t get them tested I will pay out though. Sweet cravings are not new, can’t remember not having them. I am seeing a doctor on Monday morning, is it a good idea to bring up the test results or should I just describe my symptoms and let the good doctor decide on appropriate tests?

-TT
-FT or bio-T
-E2
-PSA
-DRE: the dreaded digital rectal exam, doc gives you the finger.

In terms of tests, TT, bio-T, e2, PSA are all preferable I assume?If none or some of these tests are not deemed needed should I make a point of asking? Not sure if you are familiar with docs on the NHS in the UK but they can be fairly unsympathetic/stubborn. Again, appreciate your time. Are their any texts/books that may be of help to me?[/quote]

TT, bio-T, E2, LH, FSH are the bare minimum. There are many more tests you should have, but you definitely need those when dealing with hypogonadism. A good recent book on the subject is “Testosterone for Life” by Abraham Morgentaler. Better yet, here is a LEF article that covers the basics of his book:

lef.org/magazine/mag2010/jun2010_Abraham-
Morgentaler-Testosterone-Therapy-for-Life_02.htm

In it he states that low normal free testosterone levels deserve a trial of trt. Also, print out the Mayo clinic age dependent ranges that I posted above. You now have more than enough ammunition to get some help if you so desire (and if your doctor has half a brain).[/quote]

Thank you, interesting read. I will angle for adrenal and thyroid labs too if not suggested in order to identify the cause of the low testosterone levels. I’ll update on Monday. Also, I am nearly always carrying an injury of some sort, not broken bones etc but just muscle pulls etc that don’t heal, could low T be correlated with this in your opinion, I have seen them connected. Thanks.


#12

Night sweats.

Chronic fatigue, ie. no energy and just want to sleep.

Frequent feelings of depression/feeling down/lack of motivation to do anything.

Weight loss over the last month.

Reduced libido.

Poor sleep quality.

Brain fog/lack of concentration.

Social withdrawal.

Mood swings/Irritable.

Reduced self-esteem.

Testes ache.

Unable to put on weight/muscle mass.

Went to see GP today with the above list of symptoms. He asked me what I thought was the matter and what my father (who I mentioned was also a GP) thought the issue may be, after the 4th or 5th time of him asking me to diagnose myself I mentioned the Bio-T and E2 results making clear that I felt these results may indicate an underlying issue, possibly thyroid or adrenal related. He seemed to ignore this, said that the list was classical of someone suffering from depression, especially as many of the symptoms were psychological and not physiological.

He did order the following bloods:

CRP
TSH
Full blood count
Urea and electrolytes
Calcium (I think)
Liver values

This is all I can remember, no adrenal or other thyroid tests and definitely no T related tests. He made it clear he expected all tests to come back normal and that when they did he would deal with the low mood/depression which I assume means anti-depressants or the like. It seems like low T etc is not an issue in this country and Doc’s don’t care about dealing with/treating it. Next step?


#13
  1. low T or high E or an imbalance between T & E can easily cause depression. everything you described fits hormone/thyroid/adrenal problems.

  2. taking anti-depressants is the same as putting a cast on a broken leg without setting the bone (the underlying problem is still there).

  3. can you afford to take the lef.org blood test? Is is not perfect but at least it is a start and might give you some numbers to talk with your doctor about - evidence for more detailed follow up tests.

  4. any chance you can see another doctor? most doctors are clueless when it comes to HRT (like the one you are currently seeing - ruling something out without even running a simple blood test to confirm if it is a possibility).


#14

[quote]PureChance wrote:

  1. low T or high E or an imbalance between T & E can easily cause depression. everything you described fits hormone/thyroid/adrenal problems.

  2. taking anti-depressants is the same as putting a cast on a broken leg without setting the bone (the underlying problem is still there).

  3. can you afford to take the lef.org blood test? Is is not perfect but at least it is a start and might give you some numbers to talk with your doctor about - evidence for more detailed follow up tests.

  4. any chance you can see another doctor? most doctors are clueless when it comes to HRT (like the one you are currently seeing - ruling something out without even running a simple blood test to confirm if it is a possibility).[/quote]

  5. I have read research on this subject and am aware of the relationship, I didn’t bring it up at the time as I felt he basically would think I was trying to score steroids. It is something I will bring up next time if he continues with this depression line of thought. I need to read up on how the thyroid and adrenals can affect T levels though, think me knowing more than him might convince him to run the tests…

  6. Exactly my thoughts’

  7. Which test? Male hormone panel? I assume DHEA-S FSH etc …I am in England (London) but I used medichecks last time so can get equivalent test done.

  8. It is a possibility, do you think seeing someone else in the same practice would be worth it or? A good GP is so hard to find though, anyone know of someone I could see in London?


#15
  1. it is a fine line, but I would push a little harder. I mean if he won’t run the tests for you now, what do you have to lose if he thinks you are trying to score? Maybe print some of the articles here or elsewhere to back up your suggestion + you are not asking for drugs right now - you are only asking to confirm or rule out a ‘possible’ cause of your symptoms.

I would ask saying that it would ease your mind if you could rule out the possibility of your symptoms being caused by low T or high E.

  1. I’m not 100% sure. Ksman mentions it a lot in his posts. I have never used it, and it seems like a limited panel, but at least it is a start. If you did that, and the numbers showed low, you could take that to your doctor and based on that evidence request a full blood hormone panel with detailed Thyroid and additional hormone tests. I think it is under the blood testing sticky.

I have good insurance coverage and have been mostly successful in getting doctors to run the tests I want (well 90% of the tests I want more or less).

  1. It is my experience (and other’s experience from what I have read on forums) that doctors don’t “allow” patients to see other doctors in the same practice. It seems ludicris<spl?> but I guess even though they are still in the same practice they are still competitors I guess and don’t want the other doctors poaching their patients plus egos come into play.

#16

[quote]PureChance wrote:

  1. it is a fine line, but I would push a little harder. I mean if he won’t run the tests for you now, what do you have to lose if he thinks you are trying to score? Maybe print some of the articles here or elsewhere to back up your suggestion + you are not asking for drugs right now - you are only asking to confirm or rule out a ‘possible’ cause of your symptoms.

I would ask saying that it would ease your mind if you could rule out the possibility of your symptoms being caused by low T or high E.

  1. I’m not 100% sure. Ksman mentions it a lot in his posts. I have never used it, and it seems like a limited panel, but at least it is a start. If you did that, and the numbers showed low, you could take that to your doctor and based on that evidence request a full blood hormone panel with detailed Thyroid and additional hormone tests. I think it is under the blood testing sticky.

I have good insurance coverage and have been mostly successful in getting doctors to run the tests I want (well 90% of the tests I want more or less).

  1. It is my experience (and other’s experience from what I have read on forums) that doctors don’t “allow” patients to see other doctors in the same practice. It seems ludicris<spl?> but I guess even though they are still in the same practice they are still competitors I guess and don’t want the other doctors poaching their patients plus egos come into play.[/quote]

  2. Yea I’m planning to print out several studies linking my symptoms with low T, nothing to lose I guess.

  3. I will get the basics done myself if need be.

Quick questions though, TSH is presumably a very general and non-specific thyroid test. Am I right in saying this could be high but T3, T4 could still be low?

Secondly, I can’t find much on how the adrenal’s cause low T, is it just a case of increased cortisol causing this or more complicated? Perhaps I am not looking in the right place but a point in the right direction would be appreciated? Any more on the thyroid and low T would also be good. Thanks.


#17

high TSH = hypothyroidism = low T4 and low T3. TSH stimulates the Thyroid to release T4, the body then converts ft4 to T3, and your body can use any unbound or free T3.

The ideal level (I have been told) is .5 IU/mL even though the labs have a .5 to 5 IU range.

If you are on Thyroid medication then you need to test ft4, ft3, and Reverse T3. Excess ft4 converts to reverse T3 which block ft3 from working. If you have high Reverse T3, your TSH, ft4, and ft3 levels can look amazing, but you will still feel like crap.

I like the info on wikipedia search for pregnenelone. They have a great hormone conversion chart.

Here is my take on it (WARNING this is just how I think of it, and I could be completely off base).

per the wiki chart/graph:
Cholesterol converts to Pregnenelone.
Pregnenelone converts to Progesterone, DHEA, and cortisol.
DHEA converts to T.
T converts to DHT and Estrogen.

If your body diverts pregnenelone away from DHEA conversion to deal with inefficient/stressed cortisol production then you have less DHEA which means less T production.

Or if your body diverts pregnenelone away from cortisol conversion to deal with inefficient/stressed Testosterone production then you have less cortisol which means your entire system suffers at the cellular level (since cortisol is necessary for correct cellular functioning).

Thyroid issues and low T just seem to be common. I am not sure about causation. If you have low T, there seems to be a greater than normal chance that you also have Thyroid issues, vitamin D issues, ferritin issues, etc. I am sure others here have a lot more specific details.

and I just read that cortisol is needed to convert ft4 to T3 (according the stopthethryoidmadness.com section on adrenal fatigue.) - which I just now stumbled back across and think that it can answer my hydrocortisone questions that I had.


#18

I also think I read somewhere that this is the same problem with cholesterol lowering drugs.

Your body senses that you have low T (or low something), so it kicks up Cholesterol production to try and provide a larger raw supply of pregnenelone to feed through your system - then doctors see the high cholesterol and they artificially lower it through medication which still leaves your body in even worse overall shape because you still have the underlying imbalance.

Doctors for the most part don’t care about the source of the problem, they have a quick fix on hand (cholesterol lowering medication) pushed by the pharma companies - so why not just dole that out, collect their $200 and move onto the next patient. Finding and fixing the problem would actual mean spending time with the patient - and there are few quick fixes when you try to actual find the root cause of a problem.


#19

Thanks PC, very helpful. Quick question, as the GP seems to be poised to do nothing, I’m thinking of getting a salivary cortisol (4 X) test, how accurate is salivary testing for DHEA-S? I read the testing sticky:

-DO NOT do saliva testing for T, DHT, DHEA, pregnenolone if taking sublingual/buccal T, pregnenolone OR DHEA OR other steroid. The tests will be wrong and you do not want cross reactivity unknowns

this makes it sound like it’s ok for me given I’m not taking anything. Want to be 100% sure though before I waste money.


#20

Bump.

Can anyone at all shed any light on whether an AM and PM DHEA saliva test is worth having done or is DHEA-S the go-to test as it were? Thanks.