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E2 Management - Understanding Lab Results, Need Help

Hello everyone… I’m really struggling to understand these lab results. My doctors seem to be just as confused. I’ll start by giving all the info I can thing of, but according to these results I’m either too high… or too low. But, don’t understand which. All I know is I’m not balanced!

Age: 44
Height: 6’
Weight: 190 lbs
Test C Dose: .35 cc every four days
Amdex dose: .3 mg every other day (vodka method)

lab results (LabCorp):

Testosterone, Total, LC/MS: 648 (Normal), Reference Range: 264.0-916.0 ng/dL
Testost., F+W Bound: 268 (High), Reference Range: 40.0-250.0 ng/dL
Testost., % Free+Weakly Bound: 41.4 (Normal), Reference Range: 9.0-46.0 %

Estradiol, Serum (Roche ECLIA methodology): 57 (High), Reference Range: 7.6-42.6 pg/mL
Estradiol, Sensitive (Methodology: Liquid chromatography tandem mass spectrometry(LC/MS/MS)): 7.5 (Low); Reference Range: 8.0-35.0 pg/mL
Free Estradiol, Percent: 3.4 (Normal); Reference Range: Adult Males: 1.7 - 5.4
Free Estradiol, Serum: .17 ; Reference Range: Adult Males: 0.2 - 1.5
Estradiol, Serum, MS: 5.1; Reference Range: Adult Males: 8.0 - 35

I have one Estradiol test saying I’m too high, and the Sensitive saying I’m too low. Which do I believe? Can anyone help? Very open to feedback on ANY of these numbers as well.



The Roche ECLIA (standard assay) tends to overstate actual estradiol values, while the sensitive tests tend to be more precise especially for men. It’s very strange that your TT and FT are high while your E2 is low, in either case your Amdex dose is suspected to be too high. We see a lot of guys coming in here with too aggressive AI dosing. I can understand your doctor being confused as he order both sensitive and standard E2 tests, it’s time to find another endo as this one seems inexperienced in TRT as a lot are horrible behind the curve when it comes to male hormones. How long you been on this protocol?

Thanks System.

Been about a year thus far and been fighting with E2 the entire time. I just switched over to LabCorp from Quest… So the reference ranges, and even the values were a bit different.

So, it sounds like I should be looking at the Sensitive and adjusting accordingly? Is the low 20’s were I should be targeting for this test?

Again, I really appreciate the help here!

Yes sensitive essay is what you need to have tested, a lot of guys seem to feel best near 22pg/ml, however your mileage may vary because some feel just fine in the 30-35 range while some can feel alright in the 40 range without much side effects. You need to become more informed than your doctors since most have no clue when it comes to male hormones, you’re better able to know whether or not the doctor you’re interviewing is skilled enough to provide you the care you require.

You need SHBG tested as this will tell you which protocol will work best for you, every 4 days is a little strange. Most inject M/W/F, twice weekly, or EOD to keep levels more stable as the body likes regularity and consistency, low SHBG means you must inject EOD and if it’s really low ED. More testosterone means you’ll convert more of your testosterone to estrogen. Your dose seems a little on the low side, what the mg of testosterone? Example my protocol is 100mg .5ml twice weekly, however if I was taking 200mg .5ml I’d be taking an effective dose of 100mg of testosterone.

You may not even need an AI, didn’t you present with elevated E2 symptom early in your protocol? Most doctors prescribe an AI when one doesn’t even have symptoms of high E2.

This is very helpful. Thank you.

Yes… Early in the protocol my e2 went through the roof with no AI. I was having terrible sleep, water retention, and prostate complaints.

You are correct - I’m on the 200 mg/ML dosage which puts me at 70mg every 4 days if my math is correct.
As far as SHBG, yes… I’m one of those guys with idiopathic low SHBG. Last time I got it checked (about six months ago) it was 13 (reference range 10-50 nmol/L). I have no blood sugar issues, liver problems, or any of the other culprits typically seen (unless its doing a great job of hiding). I do have sleep apnea, but not sure if that can affect this all that much.

With the low SHBG I get a lot of the free testosterone and E2. The every four days is one day short of twice per week but the numbers come out relatively clean so I have stuck to that routine. If there is something better like EOD I guess I could, but sticking my thigh that often kinda blows.

I’ve been taking the Amdex on opposite sides of the days of the shots for example:
Monday: Shots (70mg test + 250 IU of HCG [forgot to mention that]), Tuesday: Amdex .3mg, Wednesday: Nothing, Thursday: Amdex, Friday: Shots, Saturday: Amdex, Sunday: Nothing, etc…

Also, I know some guys do the AI only once or twice a week… Been there and had terrible results. I have gone to the every 48 hours with the Amdex to smooth it out based on the drugs 1/2 life which seems to be working, but I guess I still need to cut back the dosage. I’m guessing maybe .25 mg EOD, or even more?

Well there’s your problem, larger doses of test will further drive SHBG downwards, that’s a horrible protocol your doctor put you on. You need much smaller doses more frequently, with an SHBG of 13 you require at a minimum EOD or better every day injections! You’re practically dumping your free testosterone out before you body utilises it. I inject in my outer thighs and it’s painless. Ever wonder why recovery is taking longer than you would have hoped for? Your doctor should have put you on EOD or ED injections with an SHBG that low. Breaking up those doses into small ones should make a world of difference for you. My SHBG a few months ago was @18 (11-78 nmol) and since I switched to twice weekly injections I’m noticing changes already after 5 weeks, after my next set of labs I’m going to switch to EOD injections after I see where my SHBG is at.


Thanks System.

Sounds like EOD injections is where I should be. What would you think of this:

Test C: 35mg EOD (~.18CC)… This is just my current dosage divided by 2 to account for the time difference)
Amdex: .2 mg EOD (not on shot days)… Dropping this to 2/3rd what I was doing
HCG: 250 IU 2 times per week

Retest in 6 weeks and adjust from there.

Yes, very confusing.

Free estradiol is not so important as SHBG+E2 is not bio unavailable. SHBG+T is not bio-available.

Liver affects E2 clearance. Any AST/ALT lab results?
What meds are you taking, Rx or OTC. These can affect liver E2 clearance.

Why were so many different labs ordered?
Why does doc order if he does not understand these?

Were these all done at same day?

If not same day, any protocol changes?

T Labs suggest moderate-low SHBG. Ever tested in the past?
E labs suggest the opposite.

How are:
sexual function - orgasm
tolerance you are easily irritated or the opposite
how have fat patterns changed?
Any loss on belly and other resistant areas?

Hey KS… Hope you have been well!

I do have those AST/ALT labs. They were all done on the same date (other then the SHBG test I noted above).

AST: 17; Reference Range: 0-40 IU/L
ALT: 26; Reference Range: 0-44 IU/L

My SHBG was 13 (reference range 10-50 nmol/L) which was done this past April.

For you other questions:

How are:
libido - Meh… sometimes great, sometimes not.
sexual function - orgasm - It’s not all that easy for me to orgasm… Possible, but I’m definitely not the 2 minute guy
mood - Pretty good
energy - Id say a little on the tired side… “Spacy” or “Cloudy” would be good descriptors most of the time
tolerance you are easily irritated or the opposite - I don’t think this is out of the normal. I’m really pretty level headed.
how have fat patterns changed? I’m carrying a little more then usual, but haven’t been to the gym for a couple weeks and am just getting back from vacation.
Any loss on belly and other resistant areas? I struggle with the last little bit of belly fat, but I’m also 44…

Only other weird symptom is I have terrible dark circles under my eyes. I know without a doubt this is E2 (but don’t know if its caused from high or low).

Then women would all have that? Maybe something that affects circles under eyes also affects E2 levels. Could be toxins or inadequate liver or kidney clearance of toxins. AST/ALT shows no liver issues. Circles under your eyes comes and goes? [I did some painting once in a basement with a water based lacquer and thought that ventilation would not be an issue. Next day had dark bags under my eyes. Eyes can be a window to what going on inside your body, but a very obscure window.] Medications can be a factor and all the more if one does not metabolize the medications as expected.

I just assumed it was E2 as I NEVER had them until going on TRT.

Do you agree with systemlord that I should go to EOD shots at least with the low SHBG? Just trying to get a plan together and then take that to my doctor for “permission”. :slight_smile:

You mentioned “you may not even need an AI”. Everything I’ve ready says TRT will in turn raise E2 levels. I am waiting on my first set of labs to come back and meet with the doc in a few days.

I plan to ask for the starting protocol of Test and hCG that KSman recommends. But I am confused as to whether or not my initial requested protocol should include arimidex

You don’t need an AI, what you need to do if high E2 symptoms are encountered is increase injections frequencies, AI’s bad for estrogen metabolism. The studies show men who take AI’s moderate doses have decrease mineral bone density.

I was able to lower my estrogen significantly by injecting 10mg daily (E2 26) v.s 50mg (E2 70) twice weekly.