E2 / SHBG High, T Level Low - What to Do

Hi everyone. I’ve been doing plenty of reading, and I still can’t find a similar case containing labs and symptoms like mine, so I thought since I am striking out with doctors here, I would get some 'net SME advice!

39 years old
270 lbs.
Body fat 26.2%
Powerbuilder - Powerlifting / Strongman strength based workouts for main lifts and hypertrophy accessory lifts. Follow Renaissance Periodization’s Diet and training methodology when I am able to (details below).

Workouts - I have been weight training for 25+ years, and have been mixing high intensity and lower weight, higher volume pump/recovery workouts (to prevent overtraining) for years working out 6x/week. In the last year, I have started breaking down and being unable to recover. I dropped to 4x/week, and I am currently unable to squat more than once/week. My hips, abductors, adductors, etc. remain too sore. Still doing cardio and lifting, but not recovering.

Sleep - I have slept for 6 hours/night for years, and now I am still tired even after 8 hours.

Libido - No more morning wood, and while I can still perform, I don’t chase the girlfriend nearly as much as I used to.

Body Comp - Always had gyno, even as a kid, but it is getting worse, even at lower bodyfat.

Mood / Cognitive - Still competitive at work and able to get things done, but not nearly as sharp.

Labs & Details:
Lab Results
SHBG 44 Range 11-56
Prolactin PROL 9.9 Range -<13.0
Luteinizing Hormone LH 6.4
Follicular Stimulating Hormone Range FSH 5.9
Testosterone TES 400 Range 175-781

Testosterone Free TESF 16.9 Range 5.1-41.5

Only medication taken is Lexapro 10mg
Supplements: Fish Oil, Joint (Glucosamine, Chondroitin, MSM, Tumeric), Raw Multi-Vitamin, Bioperine, D3 w/K2, Boron, Choline Bitartrate, Ashwaganda, Probiotic
Workout Related - Beta Alanine 5g, Creatine Monohydrate 5g, Ascorbic Acid 2g
Coffee - 2-3 cups/day

No head injuries

Gynecomastia came on during puberty while I was lean. I stayed lean throughout college (bodyfat sub 20%), but had bad gyno. Had a male breast reduction removing 400cc tissue during college. It came back to a lesser extent, and doesn’t look great now at 275 lbs. & 25% body fat.

My question, is what should I do next? I am carrying 210+ lbs of lean tissue per dexascan, so it isn’t as if I am without muscle. I am not sure if I am converting too much test to estrogen, and I just naturally need an AI, or if I need TRT + AI. I am wondering if they need to test for DHEA or ACTH to test for cortisol as they could impact how much test my body is making / keeping.

Thanks in advance for the advice!

Looks like your testes are partly not responding well to your LH/FSH.

E2=44 pg/ml is way too high, ideal is near 22pg/ml for guys on TRT with high T levels, with your depressed T levels, you are very estrogen dominant.

Can you get an Rx for anastrozole to bring this down? Suggest .75mg/week in divided doses.

E2 can be elevated from poor clearance in the liver. AST/ALT labs of interest.
Some meds, including SSRI’s can compete for enzyme pathways in liver that clear E2, thus increasing E2.

More fat means more FT–>E2.

Low thyroid function means more fat.
Not using iodized salt can be a cause of low thyroid function.

Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc
  • thyroid basics

eval overall thyroid function by checking oral body temps as per the thyroid basics sticky.

Good to see prolactin tested.

Vitamin Code Men’s Multivitamin Supplement Facts: quite light on iodine, selenium is OK

“need an AI, or if I need TRT + AI?”

  • Try to get E2 in lower 20’s and see how body responds
  • Get body temps so we know if thyroid function is part of your slump.

Many here happen to have low T and low thyroid function. Thyroid hormone fT3 regulates mitochondrial activity that makes ATP, the universal currency of cellular energy, as part of the body’s temperature control loop. See the connection? If iodine intake is low, everything can slow down and that includes function of cells, organs, systems and other hormones.

With your history, body fat and gyno, we are not looking to get you back to where you were as optimal. You would lean out a lot with high normal TT and Ft, E2 near 22pg/ml and optimal thyroid function.

Your labs were all T centric. Do you have:
fasting cholesterol
fasting glucose
AM cortisol - at 8AM

Your high E2 is causing liver to produce more SHBG so you get more SHBG+T that is not bio-availalbe that inflates TT. So your T status is worse that TT=400 suggests. FT is low and SHBG lowers FT.

Lowering E2 will increase LH/FSH while increasing FT, with a double effect on FT:E2 ratio.

Both low T and low thyroid produce similar effects so one can get double damage:

  • low libido
  • fat gain
  • brain fog
  • low energy and low initiative

These are all the labs I received. Sorry if this is a lot, but I didn’t want to miss anything else.

All my labs were fasting:
C/H 3.6 (0.0-4.0)
CHOL 174 (130-200)
dHDL 48 (29-71)
LDLmt 116 (0-130)
TRIG 51 (35-190)
VLDL 10 (0-130)
AST 16 (15-41)
ALT 40 (10-63)
BA# 0.0 (0.0-0.3)
BA% 0.6
EO# 0.1 (0.0-0.5)
EO% 1.8
HCT 47.0 (38.8-50.0)
HGB 15.7 (13.5-17.5)
LY# 2.1 (0.9-2.9)
LY% 32.1
MCH 28.7 (27.0-35.0)
MCHC 33.3 (31.0-36.0)
MCV 86.3 (81.2-95.1)
MO# 0.5 (0.3-0.9)
MO% 7.3
NE# 3.8 (1.7-7.0)
NE% 58.2
PLT 217 (150-450)
RBC 5.45 (4.32-5.72)
RDW 14.5 (11.8-15.6)
WBC 6.4 (3.5-10.5)
CA 9.4 (8.5-10.4)
CL 98.0 L (99.0-110.0)
CREA 0.80 (0.60-1.20)
ECO2 28.0 (21.0-33.0)
GFR 114.24 (60.00-255.00)
GLU 94 (70-110)
K 4.1 (3.5-5.3)
NA 139 (135-146)
UREA 13.0 (8.0-21.0)

The thyroid labs were from an earlier blood draw:
FT3 3.0 (2.1-4.1)
FT4 1.02 (0.61-1.85)
TSH 1.30 (0.34-3.00)

Other things that might make a difference: I have a full beard, and facial hair since I was 12. Same with chest hair. I was also tested for sleep apnea since both my mom & dad both have it. I don’t. I also don’t have any clotting disorders, but I have had a DVT in my right leg that I had to take xarelto for. My hemocrit always tested normal.

If I need to get labs redone or more pulled than before, can you help with what I should need? My docs seem to leave things out randomly. I was not focusing on liver function before given that my labs were normal. Any help would be great @KSman

Thanks again !

fT3 and fT4 were both below mid-range and TSH is showing expected elevation above 1.0
Please post body temps as suggested in thyroid basics sticky.
Have you, were you using iodized salt?

Suggest that you take a run at lowering E2 so next labs reflect that and allow for refinement.

I suggested labs earlier.

Write down labs and get doc to write them up and look at the lab order before you leave.

I will post the morning temp tomorrow. I checked tonight with two oral thermometers and had readings .2 degrees off. 96.1 & 96.3. Thinking back, my temp has been low for as long as I can remember. The highest it has ever been (without fever) is 97.

I have not been using iodized salt. Just like the thread said, I was counting on my vitamins to get me all the iodine I need, and I was using himalayan sea salt for food. I have started using iodized salt today. I’m going to reread the sticky tomorrow when I’m not 22 hours into my day to see what I need to do about iodine supplementation.

I will also get the cortisol test along with the other labs you mentioned. I am struggling to get my urologist / PCP to react to my requests, and I will likely end up paying for labs / diagnosis out of pocket since I can’t even get an endo to meet with me because my labs are “within normal range.” I’ve read the thread on finding a decent TRT doc, and while I’m not sure I need TRT, I am convinced I need some help to figure this out. Thanks again for the help, and I’ll post the waking temp in the AM.

Morning temp was 96 even. Stopped all supplements except fish oil, raw
vitamin, joint stuff. Now have a pronounced consistent ache in testicles
worse in right than left. Also have intermittent dull ache in prostate
area. No response from either doc. Made appointment at new urologist for
next week to try and get labs.

Anything to be done until I can get labs? I’m heading to gym to get a lift
in and see if that helps.

Thanks for the advice. I was able to get new labs. Please take a look along with anyone else and let me know your thoughts. I’m not sure which direction to go. Thanks

E2=22 was nice, but not with low FT and FT.

The only estrogen that needs to be tested is E2 estradiol.

fT3 is near mid-range. Low body temps suggest that rT3 is elevated and interfering with fT3 and TSH=~2 that then also makes sense.

Doing labs in/via a hospital can be the most costly.

IGF BP3 seems useless.
Test IGF-1 to eval GH status.

DHEA-S is sub-optimal

LH/FSH are strong, TT, FT are low, suggesting the testes are not performing.
FT low, T+SHBG makes TT higher than it should be.

Serum iodine not horrible.

ALT elevated by sore muscles?

Total protein low, suggesting catabolic state from low T

More pages to the labs?

I had them run everything they suggested plus everything that I could find on here and from excelmale.com. I basically had to google the codes and email them to my doctor and then verify them on the lab request forms. It took an extra couple of days to get the estrogen results since the doc didn’t even want to run it.

What should I do next? From the LH/FSH being strong, but FT & TT being low, is there anything I should try or is TRT my only option?

You have primary hypogonadism and TRT is the only option unless a surgically correctable vascular problem is found with the testes. Your TT and FT probably preclude you from TRT in most settings and insurance.

Are you getting iodine+selenium now? Progress?

I wasn’t sure if I had primary or secondary.

I went to a partner of my urologist, who insisted that I have high E2, and needed to take an AI to lower it which would help with T levels. He put me on 1MG/ED. I refused to take that much, and from everything I had read with an E2 level of 22, was the wrong thing. He insisted it would help, and I agreed to try .25MG/ED. After 5 days, I was completely miserable. My joints ached like crazy and I felt like absolute crap. I called and told him I was going off the meds, and he has refused to talk to me since.

I am trying to get an appointment to see Dr. Crisler in Lansing now. I am basically waiting on scheduling, everything else is filed.

I added brazil nuts, which are high in selenium to my diet along with iodized salt. I also upped my fish oil to try to help with joint issues following the AI nightmare to 7.5g / day. It seems to be helping, and I only have aches now in my elbows. I also read that overall body inflammation may be causing problems, so I added 1500 mgED curcumin and switched to a completely organic diet. Libido is still in the toilet though. Hoping that improves soon.

BTW, thanks for asking about a follow-up. Good to talk with someone who gives a damn.

You do not need Crisler to know what to do.

With E2=22pg/ml, there was small leverage left to move LH/FSH by lowering E2.
You had higher E2 before, what changed?

You could simply lay out your preferred protocol and lab goals with your local doc(s) and see if they will agree. If you work with Crisler, you still need a local doc if you are going to get an Rx.

Looking back through my labs, the label said E2 on one side and estradiol 17B on the other. I believe the initial test was not the sensitive test and was the total estrogen number. The sensitive test I got myself through Labcorp had E2 at 22 pg/ml.

I took my urologist through Crisler’s protocol for treatment, and I laid out how I would prefer to manage it…self administered test propianate 50mg EOD, hcg 100iuED to mimic as closely as I can my body’s natural testosterone production. He wants to confer with Crisler since all he normally does for patients is prescribe a compounded gel, and only then if their labs show them bottomed out below the range. My TT varies from low 300’s to low 400’s and FT at the bottom of the normal range between 8.8 - 9.7 with excellent diet, supplementation, training, and rest, so he isn’t willing to help me until I fall off the bottom of the scale. I am just hoping Dr. Crisler sees what I see, or hell can find any way to help. This is miserable, especially after that AI crap…my elbows are still hurting me 3 weeks later!