T Nation

E2 Testing - Sensitive vs. Ultra-Sensitive


#1

hey guys, i was wondering if the "sensitive" E2 test is accurate and can be used to dial in E2. i'm 42 years old and i've been on TRT for the past year. here's my current protocol:

Daily
50mg DHEA
50mg Zinc
5000iu Vit D
Multi-Vit

Weekly
Mon - 140mg T Cyp + .5mg Arimidex
Thu - 1000iu B12 Injectable + .5mg Arimidex

so far the sensitive test is all my doc has been using and even when all my numbers look good i don't have the libido and EQ i'm expecting. i've read on a few boards that the only accurate test is the "ultra-sensitive".

a buddy just got tested and he ran both at the same time. the sensitive came back showing he was high, and the ultra came back showing he was low.

i'm wondering if this is why most guys have such a hard time dialing in E2. your thoughts...


#2

My opinion is, after now three years of TRT, is that blood work is totally useless. It's a 1 second snapshot of 24 hours of fluctuating levels. Levels change during the day and hormone concentrations are not consistent in your blood. It not s symmetrical system that can be tested accurately at any given moment.. The ranges on blood labs are to see if you fall within the "normal" range not pin down a specific number you're searching for. The only way to tune in E2 is by small dose changes and then wait two weeks to see the results. It takes patients. Increase your Adex dose by .25mg a week and wait two weeks. Get to know your body and be aware of small changes.


#3

have you tried the 24 hour urine test before?

i know what you mean about the hormone levels fluctuating but how much can they fluctuate on replacement?. i can understand them fluctuating more when natural but i would think while on TRT they shouldn't be that bad. i can't figure out why guys have such a hard time getting E2 in a good place.

this seems to one of the hardest things for guys on TRT. is something very fundemental being missed here?

when my buddy got his results back i was surprised by how far off the sensitive was from the ultra-sensitive and the blood was drawn at the same time. i always thought the ultra was just on a smaller scale when E2 was suspected to be low.

most of the guys i know are in the upper part of the sensitive range, around 40-60 so i don't get why you would want to use the ultra.

i just check his email he sent and i'm not sure if there is a regular, sensistive and ultra-sensitive but these were his results:


Estradiol = 44 (range 0-56)
Estradiol Sensative = 11 (range 3-70)


i've always been using the 0-56 range and never tried the other one yet. so as you can see if he went with the first one he would increase his adex dose, but if the sensitive one was coorect then that would drive his already low E2 even lower.

i'm in the same boat. i just got my results back and my E2 was 35 (range 0-56). i still had low libido and ED so i increased my adex from .5mg 2x/week to .5mg EOD (mon/wed/fri) but a week later my symptoms got really bad! so, i stopped taking adex for a week to see what happens then i'm going to add a lower dose and slowly increase it like you suggested, maybe .25mg 2x/week to start...

i've also read conflicting info about the half-life of adex. some say it's 50 hours some say more, some say less. if it is 50 hours it seems that EOD would be best. my last doc and current one both wanted me to take it 2x/week but i wondered if that would cause too much fluctuation in E2.


#4

anyone else have any input on the two tests?


#5

Adex is best taken EOD.

1.0mg adex per week is typically a decent starting dose which can be adjusted by serum E2 lab results.

With 140mg T cyp, as a competitive drug, one would expect that 1.4mg of adex would be a good first start. Clearly your dose of adex, as a normal responder, was too low.

Based on your E2=35 and a target serum E2=22, we can take advantage the linearity of competitive drug response:

New dose = old dose X 35/22 = 1.0 * 1.6 = 1.6mg/week

Your finding an adex dose of 1.5mg/week should have had a good result.

Taking .5mg EOD for three days in a row might be a factor. But did look sound stacked to your weekly 140mg T cyp injection.

You need to inject T twice a week or even EOD. With T levels all over the map, serum adex levels will sometimes be to low and often too high. More frequent injections will lower T spikes which spike E2 levels which increase SHBG and lower FT.

The problems from injecting T cyp [only] once a week are probably greatly compounded by injecting 140mg.

I suggest injecting T cyp 40mg EOD. That will be .2ml EOD for a 200mg/ml product. You can inject that with a .5" .5ml[50iu] #29 insulin syringe, perhaps the same size that you use for your injectable B12. You can inject into the vastus lateralis or SC. SC works well for many, but not all.

You can then inject T and dose adex on the same EOD. Ditto for hCG if you add that.

You might have felt bad with 1.5mg/wk of adex as the adex levels accumulated and the T levels dropped and E2 levels went too low for your brain.

When you were young and felt great, your body did not release a weeks work of T in one big pulse. The time release feature of T esters in oil is not good enough to support weekly injections! Many feel like crap with weekly injections. Many EOD injections in various overlapping release curves will make you feel a lot better and allow for steady T levels that will allow for matched adex levels.


#6

DAve your e2 is low. Stop adex till erections come back then start at .25 mgs lower goto .25 mgs m,w,f hold that for 3 weeks and then retest again. Lab corp sensitive is dead on as it is noted in your symptoms of getting worse. When e2 goes up then one may have PE or may have trouble staying had or getting hard.

0-56 test picks up all metabolite floating (androsteione, e2, progesterone) it can not distinguish between the difference that is why this one gives false highs.


#7

thanks for the input guys. i recently switched to E3D T shots so i'll see how this goes. he's my current protocol:

Weekly
60mg T Cyp (Mon/Thu)
.25mg Adex (Mon/Wed/Fri)
1000iu B-12 (Thu)

Daily
50mg DHEA
50mg Zinc
5000iu Vit D
Multi-Vitamin

i'm injecting with 5/8 insulin needles in my delts with success. do you think switching to EOD T shots will make that much of a difference? this is something i haven't tried yet but have been reading alot about it. do guys on EOD shots have to use three different injection sites or do they just rotate between two? for example: left delt on monday, right delt on wednesday, left delt again on friday.


#8

I inject T EOD in vastus lateralis as the longer injection times are hard for me in the arms as I can't hold the needle dead steady.

5/8th insulin needles... gauge? ml/cc?


#9

i do very well with delt shots using a BD 329412 which is a 1cc, 27g, 5/8" needle. this is the needle my doc prescribe to do my B-12 shots. i never told him i was using it for T also. there's virtually no pain during or after the shot. i was actually pretty surprised how easy it was to push the T through a needle that small. i had a harder time with the 25g, 1" needle in the thigh than i do with the insulin needle in the shoulder. i kneel next to the counter and rest my arm on the top to relax it, then inject.

i just started back on the E3D schedule last week but was thinking about trying the EOD for a few months to see if i can feel a difference.

in the year since i've been on TRT i haven't had full return of libido and i'm pretty sure it's T and/or E. i know stabilizing T is the first step but i don't know if shooting that extra day makes that much of a difference.


#10

Most doing EOD injections are using #29 .5" .5ml. The smaller piston diameter creates higher pressures when injecting. Slow to load, but injection times are OK. [If one uses a 1ml syringe, it will be slower to inject, but same time to load.] The #29 .5" .5ml [50iu] syringes at Sam's Club or Walmart are $12.60 per 100 for their house brand. These needles are quite economical. B-12 injects OK with .5" #29 syringes.

I use the same size syringe for T and hCG.

But 0.5ml is not enough for weekly B-12 injections. But what I do is load .375ml of B-12 then co-load .125ml of [2000iu/ml = 250iu] hCG and inject that SC EOD. That delivers 1.3 ml of B-12 per week. I do not inject B-12 IM.

Having T, adex and hCG all on the same EOD schedule seems to be an easy routine.

In many cases, E2 levels are more critical for libido than T levels. Injecting EOD VS E3D will not have much of an effect. You need to test serum E2 and then use anastrozole to get near serum E2=22pg/ml. Get E2 labs via LEF.org and pay out of pocket if your doctor will not cooperate.

With E2=37pg/ml [0-54] and TT=1000, I was struggling with mood/personality, energy and libido issues. Introducing anastrozole can be a life changing event. E2 management can easily be the biggest factor in QOL.


#11

KSman,
My local lab uses Quest for hormonal testing. The last test I had run was the Extra Sensitive Estrogen test with the range of 0 or <=29. The result was 13, and I don't believe it. At the time it taken I was on 150mg's a week of T-Cyp and 150mg's of Nandrolone, along with 125iu's of HCG EOD. My adex dosage was 1-1/2mg's a week then too.
I have gone through the side effects of too much adex, and don't want to go there again.
Quite a while back with 200mg's of T-Cyp a week, 250iu's of HCG and 1mg of adex my E2 came in at 69 after waiting three months between tests using the "non-sensitive" test (0 <=54). The thing I don't understand is: 2 years ago on that same protocol I was always in the mood for sex, now once a day is enough and that just doesn't seem right to me. Or my wife. I have noticed if I cut back on my HCG dosage to say 125iu's EOD, after a week or so I start to get "grumpy", or just real easy to snap at the wife or kid over stupid stuff.
I'm really feeling stuck here; I don't feel bad per se, but I don't feel "right" either.
I currently am taking 150mg's of T-Cyp with 50mg's of Nandrolone a week, along with 250iu's of HCG EOD, and either 1-3/4 or 2mg's of adex a week as well. (There is no obvious difference in how I feel)

So what's my point? Is there another E2 test that Quest offers that is more reliable than the Extra Sensitive I used before that seems to cause so much question?
Due to my past history of "high" E2 readings, should I bump my adex dosage up to 2-1/2mg's a week for a couple of weeks and see how I feel then? I know what happens if I have taken too much adex, for me the one sign is really obvious; the inability to orgasm. Not have sex... the erection is there and won't go away, I just can't seem to finish no matter what. Thanks for your help once again.


#12

KNB: Why are you taking deca when it has known sexual side effects?

Negative effects of deca may build up over time. These things will never be well understood. Deca is does not increase one's sex drive, typically the opposite. It is not androgenic.

As to what Quest labs to use; I have no idea. I have tried to understand the merits and conflicts but I am non the wiser. And to add insult to injury, I think that I have see three LabCorp [0-54] labs that have failed and reported <15. One showed a relatively high result on a retest.

Mood changes with less hCG might be suggesting problems from a drop in pregnenolone and perhaps from a resulting drop in DHEA. So your pregnenolone levels might be marginal and you do not tolerate less. Are you supplementing pregnenolone or progesterone?

"""
It has been concluded that both nandrolone2 and several of its metabolites3,4 do indeed activate the progesterone receptor and are altered by it. On the one hand progestagenic activity decreases the estrogen receptor concentration in some tissues, it also mediates estrogenic action in other tissues5. So while estrogenic side-effects are fairly uncommon with nandrolone use alone, they can indeed occur and the implications of nandrolone's activity as a progesterone indicate these potential side-effects aren't to be solved with an aromatase inhibitor alone (like Cytadren). As long as there is estrogen in the system (indicating a possible increase of the problem when stacked with another aromatizing compound) progesterone can agonize its effects. And since progesterone receptors are found in breast tissue and have been linked to the formation of milk ducts, progestagenic activity may aggravate possibly gynocomastia. So while such problems are rare, when they occur they aren't easily treated.
"""


#13

i guess my question was, will changing shots from E3D to EOD level out T and E significantly or is E3D flat enough? i think the reason i'm having problems dialing in my E2 is because the weekly T shot was probably putting it all over the place. i might have been too high somedays and too low on others.

i agree that E2 management is probably one of the hardest things about TRT. i would also think that the first step to E2 management is to get levels as stabil as possible with T dosage and frequency.

so many people on boards are having the same issues which leads me to believe we are missing something very fundimental.

i still haven't quite figured out the differences between the symptoms of high E2 compared to low E2. to me they are pretty much the same. i think i drove my E2 too low before and i was waiting to get the "sore joint" symptom but never got it. it might have something to do with living in arizona...not sure.

since starting TRT a year ago i've only had short periods of good libido and good EQ so i assumed i was passing through a sweet spot of T:E ratio.

one annoying symptom is low dick sensitivity and these half-boners. even taking viagra only gets me about 3/4 hard most of the time and that's with quite a bit of effort. not sure if this is from not enough T or E2 too high/too low. my wife is really supportive and she knows it's not her but it still has a profound affect on a relationship.


#14


#15

Hey Dave,
Based on what you said here when you increased your adex dosage things got worse, maybe you are one of the "unlucky" over-responders. Excess E2 and too low E2 can sometimes look exactly the same, high E2: low penile sensitivity, excessively low E2: low penile sensitivity. Both too high and too low cause brain fog, memory "loss", lack of "joy" in doing everyday things, and the list goes on and on. Really. Just ask KSman.

BTW, not everybody gets joint pain. We used to think everybody did or would, but we found that out to not be true.

I have more than one friend that when he upped his adex dosage, it affected him sexually. Poor erections, or erections that were not sensitive enough to bring about an orgasm.
If it was me, I would get liquid adex because the dosing is so micro tunable whereas the tablets are not, and you may find relief there.
If you haven't quit the adex yet, quit for a week and see if you start to feel better. If so, then maybe the tiny-est amount of adex is right for you, as you may be an over-responder.


#16

Hey KSman, do you know why your doctor didn't prescribe folic acid to improve the absorption of the B12? Mine is adamant about folic acid to compliment the B12 shots.


#17

i guess i should give a little info about my recent experience with my new doc. he's pretty liberal with T and put me on the following protocol:

Daily
50mg Zinc + 50mg DHEA

Weekly
Mon - 200mg T Cyp + .5mg Arimidex
Thur - .5mg Arimidex + 1,000iu B-12 injectable

after a month on this protocol i had blood tested. the blood draw was on thursday afternoon so i was coming down of peak levels. here were the results:

Total T: 2440 (range = 250-1100)
Free T: 641 (range = 35-155)
%Free T: 2.63 (range = 1.5-2.2)
E2: 35 (range = 8-43)
DHT: 150 (range = 25-75)
IGF-I: 227 (range = 91-246)
DHEA: 417 (range = 95-530)

i was feeling pretty good but thought my E2 was still a little too high so i added another .5mg to the mix (.5mg EOD).

after a week i felt worse so i talked to my doc about it and he felt my levels were too high so i dropped back down to my current protocol minus the E3D shot schedule. it's possible that my adex dose of .25mg EOD is too much, especially now that i split my shots. i'm thinking about stopping it for a week or so and then lowering it to .25mg E3D. i'd like to back my decision up with bloodwork but i don't have alot of faith in the E2 test, hence the reason for this thread.


#18

my last doc use to mix the folic acid with the B-12 and she called it the "rockstar" shot...lol

my new doc didn't mention anything about folic acid when he gave me the B-12.


#19

without confirming by bloodwork i suspect my E2 is a little low right now but rather than lower the adex dose i want to try something different this time. from what i hear, the half-life of adex is approximately 50 hours so it seems logical to dose it EOD. the smallest dose i can make is .25mg (1/4 tab) using a pill cutter. at my current T dose of 60mg E3D it appears that .25mg of adex EOD is too much and i think if i took .25mg E3D it wouldn't be enough and possibly cause fluctuations in E2.

alot of people struggle with adex dose and schedule so my new strategy is to not mess with the adex and increase my T dose to 70mg E3D to see what happens.

i'm not interested in research products, been down that road before. i bought some anastrozole from a source but i hear that it's all bunk now. the problem is they aren't regulated and the company basically has no liability because they state right on the bottle that it's not for human consumption. this is hard enough without wondering if the meds are legit or not.


#20

without confirming by bloodwork i suspect my E2 is a little low right now but rather than lower the adex dose i want to try something different this time. from what i hear, the half-life of adex is approximately 50 hours so it seems logical to dose it EOD. the smallest dose i can make is .25mg (1/4 tab) using a pill cutter. at my current T dose of 60mg E3D it appears that .25mg of adex EOD is too much and i think if i took .25mg E3D it wouldn't be enough and possibly cause fluctuations in E2.

alot of people struggle with adex dose and schedule so my new strategy is to not mess with the adex and increase my T dose to 70mg E3D to see what happens.

i'm not interested in research products, been down that road before. i bought some anastrozole from a source but i hear that it's all bunk now. the problem is they aren't regulated and the company basically has no liability because they state right on the bottle that it's not for human consumption. this is hard enough without wondering if the meds are legit or not.