Bloodwork: High E2 and Low Ferritin

Hi all, my biggest issues right now are my high estrogen and low iron. I’m getting significant symptoms from the estrogen and wondering what to do about it. My HRV has also dropped significantly over the past week or so even with high sleep (right now is 62ms and normal for me is 79 ms).

My ideal is not to have to use an aromatase inhibitor since I haven’t had to over the 5 years I’ve been on TRT.

My recent changes diet / health wise are the daily use of supplements like AG1, magnesium, b12, etc and generally moving to a vegan diet more than normal (avoidance of all red meat). I’m also working out 7 days a week instead of before which was more like 3-4 times per week.

My current TRT regimen is:
Testosterone enanthate 100mg per week
HCG 350 iu / units per week
I inject both every second day.

January 12, 2023

  • Testosterone: 20.4 nmol/L (Reference Range: 8.4 - 28.8 nmol/L)
  • Free Testosterone: 472 pmol/L (Reference Range: 196 - 636 pmol/L)
  • Ferritin: 58 ug/L (Reference Range: 15 - 275 ug/L)
  • Estradiol: 103 pmol/L (Reference Range: <162 pmol/L)
  • DHEA-S: 8.7 umol/L (Reference Range: <15.0 umol/L)
  • TSH (Thyroid Stimulating Hormone): 0.62 mIU/L (Reference Range: 0.32-4.00 mIU/L)
  • Free T4 (Thyroxine Free): 16 pmol/L (Reference Range: 9-19 pmol/L)
  • Free T3 (Triiodothyronine Free): 4.5 pmol/L (Reference Range: 2.6-5.8 pmol/L)

May 1, 2023

  • Testosterone: 21.2 nmol/L (Reference Range: 8.4 - 28.8 nmol/L)
  • Free Testosterone: 555 pmol/L (Reference Range: 196 - 636 pmol/L)
  • Ferritin: 71 ug/L (Reference Range: 15 - 275 ug/L)
  • Estradiol: 67 pmol/L (Reference Range: <162 pmol/L)
  • DHEA-S: 6.3 umol/L (Reference Range: <15.0 umol/L)
  • TSH (Thyroid Stimulating Hormone): 0.41 mIU/L (Reference Range: 0.32-4.00 mIU/L)
  • Free T4 (Thyroxine Free): 14 pmol/L (Reference Range: 9-19 pmol/L)
  • Free T3 (Triiodothyronine Free): 3.8 pmol/L (Reference Range: 2.6-5.8 pmol/L)

February 11, 2024

  • Testosterone: 20.2 nmol/L (Reference Range: 8.4 - 28.8 nmol/L)
  • Free Testosterone: 444 pmol/L (Reference Range: 196 - 636 pmol/L)
  • Ferritin: 19 ug/L (Reference Range: 15 - 275 ug/L)
  • Estradiol: 122 pmol/L (Reference Range: <162 pmol/L)

March 15, 2024 (most recent)

  • Testosterone: 21.8 (7.6 - 31.4 nmol/L)
  • Free Testosterone: 476 pmol/L (160 - 699 pmol/L)
  • Free T3 (Thyroid): 6.0 pmol/L (3.4 - 5.9 pmol/L)
  • Ferritin: 21ug/L (Reference Range: 24 - 453 ug/L)
  • Estradiol: 166 pmol/L (Reference Range <159 pmol/L)
  • DHEA-S 8.7 (Reference Range: <15.0 umol/L)

Your symptoms are likely coming from low iron and not high estrogen.

How did you conclude your symptoms are coming from slightly elevated estrogen?

https://journals.sagepub.com/doi/10.1177/1557988314539000

Our study did not link high estradiol levels with diminished sexual performance. Paradoxically, patients with low estradiol below 42.6 pg/ml had more patients complaining of low libido as defined by ICD-9 of 799.81 in the problem list. Patients with higher estradiol levels above 42.6 pg/ml had less sexual dysfunction problems identified by their providers.

Could removing the most bioavailable source of iron from your diet relate to your low iron levels? Would bringing red meat back into the diet support your recovery?

2 Likes

My ferritin more than doubled on the carnivore diet in just 4-5 months, 98->222.

Thank you for the reply @systemlord remember following your advice when I first got on TRT and the past 5 years have generally been great other than this experience.

A couple of questions:

(1) Why did my estrogen keep creeping up even though I haven’t changed my testosterone protocol? Could this have anything to do with diet or supplements (I switched to a vegan / Mediterranean diet and supplement heavily with AG1 for the past year or so).

(2) Low Ferritin has been difficult and I’m currently supplementing; has anyone used this guide? Fixing High Hemoglobin or Hematocrit and Low Ferritin While on TRT
It seems like something worth trying potentially.

Your body is ever changing. Diet can affect estrogen levels.

Newest bloodwork done yesterday showed my lipase high at 85 and the following values.

Lipase 89 HI <60 U/L

Hematology

  • WBC: LO 3.7 [4.0 - 11.0 x E9/L]
  • RBC: 5.19 [4.50 - 6.0 x E12/L]
  • Hemoglobin: 168 [135 - 175 g/L]
  • Hematocrit: 0.484 [0.400 - 0.500]
  • MCV: 93.3 [80 - 100 fL]
  • MCH: 32.4 [27.5 - 33.0 pg]
  • MCHC: 343 [305 - 360 g/L]
  • RDW: 11.6 [11.5 - 14.5 %]
  • Platelet Count: 193 [150 - 400 x E9/L]

Differential

  • Neutrophils: 2.2 [2.0 - 7.5 x E9/L]
  • Lymphocytes: 1.0 [1.0 - 3.5 x E9/L]
  • Monocytes: 0.4 [0.2 - 1.0 x E9/L]
  • Eosinophils: 0.1 [0.0 - 0.5 x E9/L]
  • Basophils: 0.0 [0.0 - 0.2 x E9/L]
  • Immature Granulocytes: 0.1 [0.0 - 0.1 x E9/L]
  • Nucleated RBC: 0 [0/100 WBC]

Biochemical Investigation of Anemias

  • Vitamin B12: >1500 [138-652 pmol/L]
  • Ferritin: 15 [15-275 ug/L]

General Chemistry

  • Glucose Fasting: 4.6 [3.6 - 6.0 mmol/L]
  • Hemoglobin A1c: Results are pending…
  • Creatinine: 90 [67-117 umol/L]
  • Glomerular Filtration Rate (eGFR): 95 [>90 mL/min/1.73 m2]

Liver Function

  • Alkaline Phosphatase: 68 [40-129 U/L]
  • Alanine Aminotransferase: 16 [<50 U/L]

Lipids

  • Hours After Meal: 14
  • Triglyceride: 0.63 [mmol/L]
  • Cholesterol: 3.36 [<5.20 mmol/L]
  • HDL Cholesterol: 1.08 [>1.00 mmol/L]
  • Non HDL Cholesterol: 2.28 [<4.20 mmol/L]
  • LDL Cholesterol: 1.51 [<3.50 mmol/L]
  • Cholesterol/HDL Ratio: 3.1

Thyroid Function

  • Thyroid Stimulating Hormone (Free T4): 0.83 [0.32-4.00 mIU/L]
  • Free T4: 13 [9-19 pmol/L]
  • Free T3: 4.2 [2.6-5.8 pmol/L]

Pituitary Function

  • FSH: LO <0.1 [1.0-8.0 IU/L]
  • LH: LO <0.1 [1.0-7.0 IU/L]
  • Prolactin: 5.9 [4.0-19.0 ug/L]

Tumor Markers

  • Prostate-Specific Antigen (PSA): 0.16 [<4.00 ug/L]

Reproductive and Gonadal

  • Estradiol: 150 <162 pmol/L
  • Testosterone: 30.5 [8.4 - 28.8 nmol/L]
  • Testosterone Free: 706 [196-636 pmol/L]

This is after reducing my dose down on enanthate to 80 mg per week (only one injection on this protocol done).

I was taking iron supplements for the past few days and surprised my iron even lowered from where it was before… definitely no blood donations and looking at iron IV there. Estrogen is lowering but is still higher than I would like it to be.

B12 is off on the above - should be 351 [138-652
pmol/L]