T Nation

Estradiol Levels and Free T


#1


Hi there,

I have been pretty much managing my own TRT since my PCP gave me a choice, T-Cyp 200mg E14D or gels. And no self administration. So I found a nice Urologist who I showed my labs to, who gave me a script for 10ml (2000mg).. Score! at least I thought. I went in for some labs at his office, fairly confident that they would be ok because I had been getting them myself... but 2 weeks later they said my Free T was too high (I think 28) and that they would like me to cut my dose in half.

I'm not going to cut my dose in 1/2 because I know what that will do to my levels.. I keep a spreadsheet that plots where my TT should be given my dose, and it comes out almost exactly right... But I have to say I have not been paying much attention at all to FREE t. So I am cutting back about 30% (to 26mg EOD from 35mg).

The catch is that I wanted to get my E2 level checked, because I have been putting on weight magically (to my dismay)...201 to 211 in a week of normal eating... So I got T / FT/ E2 test the other day- E2 was at 57, just one day after my EOD shot (TT was 820 and FT 25.7) This has me freaking out a bit. One other time I had E2 in the 50's is when I was doing weekly 100mg shots, when my TT was >1300. So having this high of an E2 with what I consider "smooth" T dosing is a surprise.

I faxed the urologist the labs, with a note "would an Aromatase inhibitor be appropriate?" His nurse called and said to talk to the doctor who ordered the E2 test. I told her it was a retail lab, but didn't hear anything back. I've gotten the impression twice now that this guy wants to treat my T only..

Without a PCP to fall back on, I'm stuck with "how to get my E2 down on my own". I'm hoping this reduction will help. I'm going to get tested this week and see how it's trending. I know fat loss is a big one too.. So I'm jumping on with that. If I have to, I'll start shopping for a sympathetic PCP who will manage the other aspects of my hormone therapy. My T is 100% covered by insurance, so an Anti Aging Clinic is not an option.

I don't see any Gyno, thank goodness. just some moodiness, total offsetting of the T benefits, and lack of libido.

I'd fly to anywhere in the southeast if someone know of a good PCP / Endo / Whatever who is cool about digging in to understanding what is really at play and not just throwing protocols at me.

If you're curious, I'm attaching my labs and recent T levels.


#2

Some are forced to find a liquid anastrozole product on the WWW.

Please read these stickies:

  • advice for new guys
    – provide more info about you, with all labs with ranges, how old are you?
  • things that damage your hormones
  • protocol for injections

Weight gain can be:

  • increased fat
  • increased muscle
  • low thyroid function

Check overall thyroid function via oral body temperatures:

  • when you first wake up, 97.7-97.8 is good, higher is OK, 97.3 is a problem
  • also check that you hit 98.6 mid-afternoon
  • can be low if not using iodized salt long term and/or vitamins listing iodine.

Labs:
TT
FT
E2
LH/FSH - should be pre-TRT!
prolactin if younger
CBC
hematocrit
PSA if +45
AST/ALT
fasting cholesterol - can be too low
fasting glucose

E2 management is mission critical for you


#3

Thanks Ksman for these leads for me to read. Re basic info:

40 y/0 6’ tall ~208lbs no significant medical hx

I’ve had T levels sub 300 since 35y/o but pcp encouraged (lets retest in a year, here is some cialis.)

I recently had my full thyroid test (all of the t’s and they were right in the middle.)

I started tRT in march, and had these labs done prior to that:

LH: 7.1

E2: 6.3
Prolactin 14.8
Alt 23
Ast 25
Blood glucose. 102

What i experience when TrT is working and not being counteracted is clarity, precision of thought. Motivation to take appropriate action, yes, libido. People comment that i am smiling when my levels are good.

Is a week long enough for e2 to drop ? I am tempted to get a test tomorrow. My doc called today and said ari idex could be an option but that my t was “through the roof” and that is likely my problem, and by cutting my t levels, all will be well. Too relaxed? Seems to be for my anxiety, im holding off on supplements during this period of evaluation and tuning ( argaline, dhea, pregnenolone, fish oil, nettle extract) in case any of that is spiking the e2.

I work out 3x a week with trainer and do a blend of crossfit and weight training. Looking to add more pure cardio.

Thanks,
Graham


#4

Your last labs were good except E2.

Liver does not show issues with AST/ALT that would point to reduced liver clearance of E2, but that still seems possible if something that you are taking is competing for the same liver enzyme pathways that deal with E2.

Please post thyroid number with ranges.

Many are force to get liquid anastrozole on the WWW


#5

So I took the suggestion and have been working on getting my E2 down for about 2.5 weeks. Since my MD isn’t interested in being aggressive about E2 control, I went with the alternatives on www. This means 2 weeks of 1/4 mg EOD anastrozole “research grade”. I now have some pharmaceutical grade so I’m moving to that, just to be on the safe side.

Here are my recent lab results (drawn on the day of my normal T injection but before my shot):

Testosterone, Serum: 735 ng/dL [[ 348 - 1197 ]]
Free Testosterone(Direct): 18.2 pg/mL [[ 6.8 - 21.5 ]]
Estradiol: 12.1 pg/mL [[ 7.6 - 42.6 ]]

This is good, I think, unless the anastrozole isn’t yet at peak and is still falling. What do you think KSman?

I’m also starting to get a little concerned about testicular size. Any alternatives to hcg that can kick up LH to help this? I am open to non-MD sourcing for oral meds but with injectables I am a bit reluctant.

Thanks KSman for helping me get this E2 on track!


#6

Graham,

You said you’d fly anywhere in the SE.

I’d recommend my Dr.'s practice in Jacksonville, Florida.

Not sure if I can post his website here. If I can, I will.


#7

No problem with Dr references if the Dr does not object to be referenced on a BB site. [Not posting sources is all about not referencing sources that law enforcement might object to; as this creates real risks for people running web sites.]

Graham: Your E2 is too low. Anastrozole effect is quite linear as a competitive drug. To get near E2=22pg/ml, change dose by a factor of 12.1/22. Easy if dispensing by the drop. Things take time to reach steady state, this would be a good mid-course correction.

Your T levels seem a bit low. How long on EOD for this lab work?


#8

[quote]KSman wrote:
Anastrozole effect is quite linear as a competitive drug. To get near E2=22pg/ml, change dose by a factor of 12.1/22. Easy if dispensing by the drop.
[/quote]

Can you elaborate more on applying the above dosing to get E2=22pg/ml? 12.1/22 does not compute with my average brain capabilities.


#9

[quote]KSman wrote:
No problem with Dr references if the Dr does not object to be referenced on a BB site. [Not posting sources is all about not referencing sources that law enforcement might object to; as this creates real risks for people running web sites.]

Graham: Your E2 is too low. Anastrozole effect is quite linear as a competitive drug. To get near E2=22pg/ml, change dose by a factor of 12.1/22. Easy if dispensing by the drop. Things take time to reach steady state, this would be a good mid-course correction.

Your T levels seem a bit low. How long on EOD for this lab work?

[/quote]

So after applying myself 12.1/22 = 0.55. Are you then suggesting dosing with 0.55mg adex per week to allow his E levels to rise to 22pg/ml?


#10

Exactly.

To get proper dosing increments, dispense anastrozole by the drop.

Dissolve pills in vodka, 1mg/ml. Add x pills to a dropper bottle, add vodka to get x ml’s.
First add x ml’s water to bottle and mark level. Drain bottle. You should get mix to that level.
Count the drops per ml and do the math
Shake before dispensing
Put drops into a shot glass, add water and drink, repeat water.

Some find liquid anastrozole on the WWW and that seems to work well.


#11

[quote]KSman wrote:
Exactly.

To get proper dosing increments, dispense anastrozole by the drop.

Dissolve pills in vodka, 1mg/ml. Add x pills to a dropper bottle, add vodka to get x ml’s.
First add x ml’s water to bottle and mark level. Drain bottle. You should get mix to that level.
Count the drops per ml and do the math
Shake before dispensing
Put drops into a shot glass, add water and drink, repeat water.

Some find liquid anastrozole on the WWW and that seems to work well.[/quote]

So if someone’s e2 was 34, (34/22=1.55) you’d suggest around 1.5mg of Adex per week and not 1mg?


#12

[quote]KSman wrote:
Exactly.

To get proper dosing increments, dispense anastrozole by the drop.

Dissolve pills in vodka, 1mg/ml. Add x pills to a dropper bottle, add vodka to get x ml’s.
First add x ml’s water to bottle and mark level. Drain bottle. You should get mix to that level.
Count the drops per ml and do the math
Shake before dispensing
Put drops into a shot glass, add water and drink, repeat water.

Some find liquid anastrozole on the WWW and that seems to work well.[/quote]

Or would you only suggest the 1.5mg per week if 1mg per week had only been successful at reducing e2 to 34?


#13

[quote]Davinci.v2 wrote:

[quote]KSman wrote:
Exactly.

To get proper dosing increments, dispense anastrozole by the drop.

Dissolve pills in vodka, 1mg/ml. Add x pills to a dropper bottle, add vodka to get x ml’s.
First add x ml’s water to bottle and mark level. Drain bottle. You should get mix to that level.
Count the drops per ml and do the math
Shake before dispensing
Put drops into a shot glass, add water and drink, repeat water.

Some find liquid anastrozole on the WWW and that seems to work well.[/quote]

Or would you only suggest the 1.5mg per week if 1mg per week had only been successful at reducing e2 to 34?
[/quote]

This. KsMan equation is only useful for adjusting the dosing amount. It doesn’t help for a starting point.


#14

Exactly. So if one is able to start anastrozole before the first TRT followup lab, that lab can get you on target. Otherwise you need to wait until your second E2 lab work. This all assumes that the proper E2 lab was ordered. The lab needs to resolve to a valid in-range result. If the lab reports E2<7, then you do not know where you are and you can assume that you are an anastrozole over-responder and go to 1/4mg per week and try again.

If wrong lab and reports E2<29, you have no idea where you are and doctor does not know his labs very well. E2 labs for fertile women do not resolve low E2 levels found in TRT context. E2 for menopausal women will resolve low E2 levels. And every lab company presents its own limitations and traps.

There can be lab errors. We had a lot of false below range results with LabCorp a few years ago. Someone had blood drawn for Labcorp and Quest at the same time and the numbers were not near each other. I think that Quest sensitive and Quest ultra-sensitive results can also not match. So its sometimes difficult.


#15

Hi Guys,

So I had the dreadful experience of running out of T sooner than I thought I would, and CVS, even though online said I could refill it “early” (3 months after last fill) the “by the book” pharmacist was not gonna do it. So I learned that lesson… fortunately the Doctor called in an authorization.

So having my fresh new 10ml bottle, I decided to try the recommended protocol of using insulin 30gauge 1/2" 50iu… But the pharmacy only had 31 gauge 5/16". So I thought I would give the “subQ” approach a try. Having read about slower absorption and potentially less required T, it seemed like a good thing to try.

Here’s what my schedule was like going into my shortage, and then the recovery (granted I am early in the recovery):

(30 mg IM EOD prior to this for many weeks)
10/25/2015 30 mg IM
10/26/2015
10/27/2015 15 mg SQ
10/28/2015
10/29/2015 10 mg SQ
10/30/2015 30 mg SQ
10/31/2015
11/1/2015 30 mg SQ
11/2/2015
11/3/2015 30 mg SQ

I had a lab done yesterday morning before my 30mg SQ, so this lab should reflect approximately 2 doses of my normal T volume, though administered differently and after a slight dry spell.

Here is how they came back (today)

TT: 494 ng/dL (348-1197)
E2: 8.9 pg/mL (7.6 - 42.6)

to be consistent and make it easier to see this in the context of my previous labs, I’m attaching an image with a table as I previously have.

Certainly my E2 is low, as it was just over a month ago. On 9/22 I switched to .16 mg of Anastrazole EOD (down from .25mg). It seems I am an overresponder, and need to reduce that. So given 8.9 / 22 is .40, I am left with .064 mg. Still doable with my oral syringe. This is my plan for the moment.

Now about the Testosterone. I haven’t been below 500 in quite a while. But I’m not sure if the low reading is because of the recent missed / short doses, or because of the new SQ administration route. Having had two 30mg eod SQ injections prior to the test, I was hoping to be back in the target range. But the low number has me questioning dose and route. Today is an “off” day and I’m tempted to give myself a boost… Or should I stay the course and keep up 30 EOD SQ and test in a week and see how things have changed? What would you do?

thanks!

Graham

ps. this is just an aside and for entertainment… my doctors nurse called yesterday to tell me that the doctor has decided to move me from the 30 mg EOD to 30mg e4D. She couldn’t tell me a reason but just “because of your september levels”… Why would a doctor make a change in a prescribed regimen a month after seeing me and without having any labs, discussion, etc? Rhetorical of course… and of course I am not making that change!


#16

Doctors are the biggest problem. Not much else to say. Have no explanation for the wild E2 numbers.

How do you feel across those two days?


#17

I started with IM for a few weeks, and then switched to sub-q. I did the labs after 2 weeks of sub-q thinking it’s enough to stabilize, and then another test a month later (keeping the same regimen). Second test T and Free T were almost double of the first one! People did say that it takes way over two weeks for the sub-q levels to stabilize, due to slower absorption - and in my case definitely seems to be the case. So I would keep at it some more, and test again.