T Nation

E2 Explosion? Panic Attacks!

First, thanks to everyone on the forum. Your insight has been extremely helpful. TRT feels like the wild west of man-medicine to me. You guys have been a big help.

I have been on TRT for about 2.5 months now. It has NOT been great (at all). Several times I just wished that I had never started down this path.

I had about a week where energy levels, libido, and mental clarity were improved. I am an extremely athletic guy (endurance sports and weight training) with a BF of <10% pre-TRT, and now I’d bet I’m at the 16% mark. Belly fat has gone through the roof since starting (with diet/exercise remaining largely unchanged). I’ve been on gels, now compounded creams. Gels shut me down completely after about 2 weeks. Cream (200mg/day) seems a lot better in terms of strength, but I never did have the overall “life boost” like I did with the gels. Dr. added AI after 1 month after E2 levels were very high and Total Test had gone to 65. (Initially at 261). **BW is below.

So, let me say that I think I’m a high aromatizer of Test to E2. Addition of the AI seemed to help a bit, but nothing great.

Ok, so 1.5 weeks ago I started low dosage of HCG due to testicular atrophy. On day 3 of HCG, I felt like I was going to croak. Dizzy, confused, extreme fatigue, mental fog x 1000, zero libido, etc. I read other posts that introduction of HCG can cause E2 aromatization which an AI doesn’t really do much for. Welcome panic attacks! Bazinga.

Ok, here are my labs (again, I’ve only got what I’ve posted):

1-7-13: Pre TRT BW

White blood cells – 4.9 (3.3-10.5)
Red blood cells – 5.36 (4.15-5.75)
Hemo – 15.9 (12.8-16.9)
Hemato – 46.7 (38.8-50.2)
MCV – 87.2 (78-100)
MCH – 29.6 (27-31)
MCHC – 33.9 (32-36)
RDW – 12.9 (11.5-14.5)
Platelet – 175 (150-450)
MPV – 8.1 (6-9.5)
Neutrophils – 55 (44-74)
Lymphocytes – 35 (20-50
Monocytes – 8 (2-13)
Eosinophils 1 (0-7)
Basophils 1 (0-2)

TOTAL TEST: 261 (240-827 ng/dL)

TSH: 1.14 (.35-4.94 uIU/mL)

PSA: .4 ng/mL (0-4.00)

1-29-13 Bloodwork: nearly one month on TRT (60 mg Axiron applied daily).

DHEA – 156 (110-370)
Estradiol – 49.5 (0-39 pg/mL) (Feels like #*$&#).
Total Test: 65 ng/dL (Shutdown.)

2-5-13 Bloodwork: (120 mg Axiron applied daily)

Total Test: 261 (240-827).
Dr at the time did not run E2, but I’d bet my left nut it’s out of the park now. Symptoms all match high E2.

Current protocol:

100 IU HCG daily
50,000 IU Vitamin D 1x/week (prescription…doc said I was low)
Compounded cream: 200 mg/day, ED
50 mg DHEA
50 mg Preg
high-end fish oil
.25 Arimidex 4 times/week

2-22-13 Bloodwork (Protocol is listed immediately above)

DHEA: 452 (110-370 mcg/dL)

Estradiol (sensitive) 9 pg/mL (<29)

FSH: 1.2 mIU/mL (.9-11.9)

T4: free: 1.3 (.7-1.5 ng/dL)

TSH: 1.32 (.35-4.94 uIU/mL)

T3: free: 3.6 (1.7-3.7 pg/mL)

Total TEST: 386 (241-827 ng/dL)

Subjectively, I feel like #*$(&#. I have since beginning TRT (save about 7 days in). I have always suspected based on the way I feel and symptoms that I am a high aromatizer to E2. Dosage of the AI confirms this (in my mind) the following day. I always feel slightly better on the day after taking the AI.

I think the worst thing has been the panic attacks. I’m having them very frequently. I did not take the HCG yesterday and I have not had an attack today. Anxious, yes. Feeling like I need to run out of the building? No.

Thoughts? Obviously I cannot wait to see the Estradiol level. Is there any other clues in the other numbers? I defer to the experts…

What AI and at what dosage?

I am taking .25mg of Arimidex 4 times per week. I was prescribed 1 mg, once a week, but decided to get a pill splitter.

You are still on the creams? If so, get rid of the creams and start injections twice a week. I’ve never been on creams myself but have read plenty about creams aromatizing more than the injections and this sounds like exactly what is happening in your case.

Let us know on your e2 #'s when you get your labs back.

Thanks, Ned. I “hope” to get my BW on the E2 (sensitive) tomorrow. The gels/creams are NOT working. Horrible.

I do not know where to start.

So start here, CAREFULLY read the advice for new guys sticky.

  • some do not respond to transdermal T
  • FSH should be zero, your TRT is not very effective
  • you probably need to inject
  • possible thyroid or iodine deficiency issues.
  • DHEA can create a lot of E2 in some guys
  • hCG can crate a lot of E@ in some guys
  • stop DHEA for now and see what happens with E2

Not sure what protocol goes with what labs, please fix that, use [edit] to fix the first post.

Thank you, KSman. I have made edits to reflect protocols with each BW.

I have read all of the stickies (I think), but will go back for another round. As a former engineer myself, this process has been an attempt to adjust one variable at a time with little/no success. I understand that you counsel patience, but my functionality has been so hampered that it has been a challenge to continue TRT.

I understand that some men respond poorly to TDs, that my TRT is not working, that I need to try injections and that hCG can cause high intra-testicular E2 which AI’s are largely ineffective at combating. I’ve been reading your thoughts on iodine deficiencies and will start measuring temps asap. Based on T3 and T4 numbers, I didn’t think I was having any thyroid issues, but I defer to you.

I will immediately cease DHEA supplementation and see how that goes. Would you stop all hCG as well? I was hoping that my low dosage (100 IU daily) would not cause a huge E2 spike, but again, I’m just learning. I left a message with the doc to get on shots ASAP. Still waiting on sensitive E2 assay. Bah.

Hi KSMan (and everyone),

I read up on your thyroid sticky and decided to track my temperatures throughout the day. Interestingly, my temp has never gone above 97.4 all day. Waking temp was 96.7 and high today has been 97.4.

One step at a time, see what hCG is like without DHEA.

Low body temps. Verify that someone can hit 98.6 with that thermo.

What are your iodine intakes?

With your thyroid labs looking good, we need to check rT3 to see if that is the problem. If rT3 is up, adrenal fatigue can be suspected.

So you appear to have a case of ‘functional hypothyroidism’. I don’t know what happens if you google that, because I made that up to be inclusive of typical hypothyroidism or this situation. TRT can make you feel bad because your thyroid function will not keep pace with the increased metabolic demands that TRT is calling for. Same can happen with adrenal fatigue.

I will give hCG another go tonight. I have stopped using DHEA, but continued the 50 mg Preg.

I’m going to go and buy a new thermometer. I can’t move this one into a normal range.

Iodine intake is 150 micrograms (daily multi-vitamin) + whatever negligible amount I’m getting from iodized table salt. I’m off to get some Kelp supplement now.

Thank you.

The new thermometer says the same as the old: 97.1 F.

I’m looking at stickies now, but do you have a recommendation for iodine dosage. Current tablets are 225 mcg/pill.

Note that iodine deficiency cannot be resolved with small amounts. If one does a .75 GRAM iodine replenishment [IR], it would take 5000 150mcg doses to get there. Many are taking 50mg for two weeks. Kelp will not get you there, but a good maintenance dose if iodine stores are adequate. Most in the USA are iodine deficient.

Maybe stop the Preg too. It makes me feel aweful within a few days of taking it even in low dosages. Feels like elevated estrogen symptoms.

Interesting. I have stopped DHEA, and dialed back use of creams as well. I will lay off of the pregnenolone and see if that helps as well. No more panic attacks, but I assumed it was due to cutting my dose of T by half. So now, I’m just dog tired. BUT, I’ll take that anyday over the anxiety.

Well, just got my E2 numbers back. 9 pg/mL! I would have sworn based on symptoms that I was a high aromatizer, and that I was suffering from HIGH E2, not LOW E2.

I was sorely mistaken.

Now what? Hmmm. I’m switching to shots on Monday, because in any event I am a poor absorber of the TDs. I know this because 2.5 hours after a 200 mg application, my Total Test was only 384. That’s only a 100 points higher than my pre-TRT levels. DHEA and Preg are out (for now). No more panic attacks, but again, I’ve cut my T dose in half. Now I’m just dog tired.

Anyone else have similar issues with controlling E2?

Some guys have trouble finding a balance. Injections will be a whole new game, see what happens with that.

I have been having some trouble with finding the balance about 3 weeks ago my e2 dropped to 39 down from 68. I just got another set of bloods to see if I am low or high but a few days ago I had some more of the normal feeling says and havent taken my adex in about 3 days now and im starting to loose a drive so I can only assume it’s high. It’s been very tough getting balanced out and keeping it there…

[quote]zerodarkthirty wrote:
Anyone else have similar issues with controlling E2? [/quote]

Low E2 can make some feel as bad as high E2. I went down to 9 and felt terrible so I went off of the AI for a week and then started back at half of the prescribed dosage. It made a huge difference and I seem to be on track now. I will be getting labs done again this month and will be interested to see but regardless I feel much better…libido improved…nocturnal erections and morning wood are outrageous…haven’t had them like this in 20 yrs.

I’m going tomorrow to get bloodwork I’m interested to see what happens. I have been on .25mg adex since early feb and still havent had a “normal” feeling yet I’ve been close but must of missed the sweet spot. Im not on TRT i ran my first cycle had had rebound months after. I’m contemplating on trying aromasin to see if it helps maintain a balance? Not to sure yet I’m getting frustrated with the whole thing. I’ve been reading all the stickys so I can be better informed and learned alot. One thing that I will say is weird and may be in my head but when I start tapering off the AI and the libido drops I get a strange feeling in my chest tissue. My mips arent puffy sensitive or sore so it weird its probably just being inside my own head to much…sighs