T Nation

E2 and Prolactine Issues While On TRT

Hi,

i’m a 37 year old male from Belgium, currently three months on TRT
my protocol: 500mg Test undecanoate (= UG Nebido) every three weeks

these were my numbers before the start

test: 3 (ref 2,8-11 ng/ml)
test free : 1,19 ( 1.86-8.24 index)
E2: 15 (0-40 ng/l)
prolactine: 10 (2-17.7ng/ml)
shbg:2.61 ( 0.4-1.98)

my numbers 3 days after injection (three months on TRT)
test: 11.3
test free: 6.46
E2: 55
prolactine 18.2
shbg: 1.75

numbers 18th day after injection
test: 6
test free: 3.5
E2: 33

I don’t inject every week, cause some very bad cases of test flu in the past. undecanoate esther is meant for TRT (German Nebido) and i’m ok with the test-numbers in my bloodwork.

It’s very difficult to control E2 numbers. I’ve done a week of Arofixen (=nolva and aromasin)now but I think my E2 is too low now. I sweat a lot and my skin is very itchy. That was also the case before the start of TRT and a lack of E2 can definetely cause this abnormal sweating.

I now want to control E2 but without dropping them beneath 20, cause I definitely need some E2.
Also i want to control prolactin. Some suggestions on this board?

Please read the stickies. Start with advice for new guys and protocol for injections.

E2 is killing you. Controlling E2 requires an AI dose that matched your serum T levels that are not steady, so your E2 will never be properly managed.

Read posts of others and see what is going on.

You will need a third prolactin test to clarify this.

Do not test prolactin after orgasms, hugging babies etc, these things can cause prolactin release.

[quote]KSman wrote:
Please read the stickies. Start with advice for new guys and protocol for injections.

E2 is killing you. Controlling E2 requires an AI dose that matched your serum T levels that are not steady, so your E2 will never be properly managed.

Read posts of others and see what is going on.[/quote]

i’ve read several stickies concerning inj protocol and controlling E2
I’m from Europe and this undecanoate is very different from the weekly 100mg test cyp/enanth TRT protocol which is advised (even divided in EOD injections). I tried that protocol but that did’nt work for me. I got too many test flu form the UG enanthate (sick for two, three days on a row, even with slin needles eod )
.So I have to keep the amount of injections low and that’s why I choose the undecanoate with a long esther

In my case with a very long esther, is it better to start with

-1mg arimidex divided over the week?

  • 10mg nolva every day?

okay, the t-serum levels are not steady as with EOD injections so the amount of AI needed will steadely decrease I presume, but are there any guys out there who succeeded in controlling there E2 on a long acting esther with some kind of decreasing ai-protocol?

sorry if my English isn’t that good btw…

T esters cannot aromatize. But when the esters are removed, then T can aromatize.

Try injecting more than E3W. You may have a problem with something in the injection other than the ester; maybe the oil or something else.

I agree with your suggestions.

At what time were the two tests taken in relation to when you woke up? Prolactin levels are naturally at their highest in the morning after you wake up. Levels will decline throughout the day. So, if the first test was drawn, let’s say, 6 hours after you woke up, and the second test was drawn an hour after waking, that might explain the fluctuation.

Also, to add to what KSman said about the orgasms, babies, etc,

Certain medications can also raise prolactin levels, including:

Antidepressants
Butyrophenones
Estrogens
H2 blockers
Methyldopa
Metoclopramide
Phenothiazines
Reserpine
Risperidone
Verapamil

The following can temporarily increase prolactin levels:

Emotional or physical stress (occasionally)
High-protein meals
Intense breast stimulation
Recent breast exam
Recent exercise

Just some things for you to consider what might be the cause.

thanks guys for the replies
ok, so the elevated prolactin levels are explained, cause I did that bloodwork with high prolactin in the early morning!

Untill today my protocol was 500mg test undecanoate every three weeks
Now I will try the following protocol:

250mg test undecanoate every two weeks. Less testosterone in total but hopefully also less fluctuations in serumlevels.( especially E2)

Within two months i will ask for some more bloodwork.

If the results of that future bloodwork don’t satisfy me, I’ll give EOD-SQ injections another try.

last question for now: can exsessive sweating be the result of fluctuations in Tes/E2 levels, or a lack of E2?

Not trying to alarm you by any means, because it’s not too outside the range, but your prolactin level is still elevated.

For your “last question for now” (there will be PLENTY more):

Uncommon side effects (between 1 and 10 in every 1000 patients are likely to get these):

tiredness, general feeling of weakness, excessive sweating, or night sweats

The oily liquid Nebido may reach the lungs (pulmonary microembolism of oily solutions) which can in rare cases lead to signs and symptoms such as cough, shortness of breath, feeling generally unwell, excessive sweating, chest pain, dizziness, ?pins and needles?, or fainting. These reactions may occur during or immediately after the injection and are reversible.

from— http://xpil.medicines.org.uk/ViewPil.aspx?DocID=15662

Just a possibility…

Also, low testosterone cane cause sweating. When exactly do you sweat excessively?

Any oil bases testosterone ester can get into the blood when the needle hits a vein. So nothing unique about undecanoate there. However, the larger the volume injected, the more severe the event can be. The effect in the lungs is a tickle and cough that lasts for 15 minutes or so. No need to panic.

undecanoate is a slow release product and with the heavier ester group, less T is delivered compared to the shorter acting esters like ethanate or cypionate. Do not get fooled by the mg’s injected.

There is still a release curve/drop. I suggest injecting once a week and try SC for an even smoother result.

When these heavy esters and other delivery systems are promoted, the criteria is that the patient gets serum levels that remain in the lab normal range. So the levels can vary between 900 and 300, that sucks. The criteria for these products is to make money, not deliver optimal results. Getting optimal results is your doing.

I started with my new protocol yesterday, so 250mg every two weeks of test undecanoate.
I guess the amount of test released weekly is in the range of 100mg when it’s esther is dropped? or am I too optimistic? I will get soms bloodwork in a month or two of even sooner when I’m feeling bad E2 sides

@Kman: In your opinion, I should give once a week SC a try? seems interesting. I haven’t seen guys doing undecanoate SC but if enanthate/cypionate works, undecanoate will work also.You’re right about the commercial side of nebido. The don’t mind about E2 sides and curves in het serumlevels. Very few doctors here who understand TRT…

The sweating started a few months after my last cycle, in march 2012. I guess my test levels were low at that time, cause in november my free testosterone was still too low. Also, i have a low body temp, when I get up, it’s around 95 and max 96.

Also check mid afternoon body temperatures. Read the thyroid basics sticky and describe your iodine intake. You may be iodine deficient.

Lab work:
TSH
fT3
fT4

http://en.wikipedia.org/wiki/Testosterone_undecanoate Mol. mass 456.70032

http://en.wikipedia.org/wiki/Testosterone Mol. mass 288.42

288/457==>63%
250mg undecanoate -->157mg T

Try every two weeks and get stable and understand how you feel over that period of time. This will take a while. Later on, try once a week and note if there is any benefit.

I do not know the volumes involved and how larger volumes work out with SC. SC would be expected to be an even longer/smoother time release. Also, avoiding a life time of muscle damage needs to be considered. I have not idea if undecanoate is more viscous and that might make the smaller gauge needles a problem.

[quote]KSman wrote:
Also check mid afternoon body temperatures. Read the thyroid basics sticky and describe your iodine intake. You may be iodine deficient.

Lab work:
TSH
fT3
fT4

http://en.wikipedia.org/wiki/Testosterone_undecanoate Mol. mass 456.70032

http://en.wikipedia.org/wiki/Testosterone Mol. mass 288.42

288/457==>63%
250mg undecanoate -->157mg T

Try every two weeks and get stable and understand how you feel over that period of time. This will take a while. Later on, try once a week and note if there is any benefit.

I do not know the volumes involved and how larger volumes work out with SC. SC would be expected to be an even longer/smoother time release. Also, avoiding a life time of muscle damage needs to be considered. I have not idea if undecanoate is more viscous and that might make the smaller gauge needles a problem.

[/quote]

Thanks , i will give it a try every two weeks, and see if my bloodlevels are satisfying.157mg in 2weeks hopefully brings me in the area between 600 and 800 with E2 under control. I’m curious!

Concerning thyroid-issue, i’d read your sticky.
Last labwork (jus before the start of TRT, in november) at which they did check two of those values

TSH: 2.470 mu/l
Free T4: 1.24ng/dl

I took my bodytemperature in de midafternoon and it was still (too?)low :96.3 (35.7C)

I have an allergy on iodine used in contrastfluids, should I be concerned about iodine supplementation, or is this quite a different story and very safe?

You can safely consume reasonable amounts of inorganic iodine. No harm in starting small in any case.

TSH=2.4 is a concern. Need range for T4 lab work.

With the amount of globulin bound T4 as a unknown, we need the free levels to know what is bio-available.

Contrast fluids can be dangerous for a few. If the kidneys are in a circulatory problem state to begin with, some contrast agents can cause kidney failure from free radical damage. That can be prevented with a small amount of anti-oxidants [NAC], but that is not done and thousands have avoidable kidney failure.

At this point, it is important to use the same thermometer on some other family members, used the same way that you do and see if they get normal body temperature. With the oral thermometer, you cannot be mouth breathing, eating, drinking, exercising, snoring or smoking for 1/2 hour before.

Those temperatures are very low. We need to eliminate measurement error as a possibility.

So you get cold or feel cold easily?
Brittle hair or nails?
Hair falling out? [not male pattern baldness]
Dry or weak skin?

With this long ester, you would never need EOD. One a week would work well. In the USA, T ethanate and cypionate are the basic T drugs. With these faster acting esters, twice a week or EOD is a good option to be considered. With these faster acting esters, many suffer who only inject once a week.

What is your history of using iodine in salt or vitamins? This is helpful data.

[quote]KSman wrote:
You can safely consume reasonable amounts of inorganic iodine. No harm in starting small in any case.

TSH=2.4 is a concern. Need range for T4 lab work.

With the amount of globulin bound T4 as a unknown, we need the free levels to know what is bio-available.

Contrast fluids can be dangerous for a few. If the kidneys are in a circulatory problem state to begin with, some contrast agents can cause kidney failure from free radical damage. That can be prevented with a small amount of anti-oxidants [NAC], but that is not done and thousands have avoidable kidney failure.

At this point, it is important to use the same thermometer on some other family members, used the same way that you do and see if they get normal body temperature. With the oral thermometer, you cannot be mouth breathing, eating, drinking, exercising, snoring or smoking for 1/2 hour before.

Those temperatures are very low. We need to eliminate measurement error as a possibility.

So you get cold or feel cold easily?
Brittle hair or nails?
Hair falling out? [not male pattern baldness]
Dry or weak skin?

With this long ester, you would never need EOD. One a week would work well. In the USA, T ethanate and cypionate are the basic T drugs. With these faster acting esters, twice a week or EOD is a good option to be considered. With these faster acting esters, many suffer who only inject once a week.

What is your history of using iodine in salt or vitamins? This is helpful data.[/quote]

I will ask for fT4 next time for sure. I cann ask whatever I want for bloodwork . My docter just fills in the form. so i can’t complain about that. Last time, when I asked for DHT, she even didn’t know what is was…

Well, my hands and feet always feel very cold, and my skin is very dry , I have to hydrate every day two days . otherwise it starts to itch a lot. After i run, some areaes stay very red for a while.

I will let my girlfriend use the same thermometer for the next week. Than i can rule out any malfunctionning.

I never used any extra salt nor vitamines. I will start to look out for some supplementation.

I used T3 in the past while cycling, but i don’t think this is the cause of any thyroidproblems i may suffer in the present.

It is reasonable to assume that you are iodine deficient. If temps are low, then you have a degree of functional hypothyroidism. Your feeling cold and skin problems are also indicating thyroid problems.

Please review the sticky for info re iodine replenishment.

two days ago my body temp was 96.3 at the hospital in the afternoon, measured with professional tools, so I can assume my home thermometer is correct.

I started to take multivitamins (with iodine) and i’m curious for the results.

The only thing i don’t understand is why i still sweat so much (even when i sit, on my belly, my back…it becomes pretty embarassing) while my body temperature is too low.
To sweat= to get rid of the excessive warmth in your body i tought?