T Nation

Estradiol: Why You Should Care


This article was very helpful for me. I've read on here that any Doc that puts you on Test only, is setting you up for failure. I now know this is true. My Doc started me on 200mg test cyp a week, and I can tell you from personal experience that E2 can ruin your life! I'm taking a copy of this thread to my new doc on Monday.


Any opinions on this article??



IW: There are some things in the article that are quite questionable. I will not disse ct it from my mobile phone.



May be of interest. Copied from a post I made elsewhere.

We often see guys who get hit by high E2 before their followup lab work; if their doc will even look at E2. When the few who are anastrozole over-responders feel messed up from low E2, they usually know something is wrong and have read in the stickies, or have been directly advised, that they can stop taking anastrozole for 5-6 days then resume at 1/4th the expected dose and see how that feels.

Please note that if their doctor puts them on Rx anastrozole, the same events will unfold except their doc probably has no knowledge of the over-responder issue and has not provided any advice about what to look for and what to do. When a guy has very low E2, lab results may be below the reporting threshold and you do not get any lab data. In that case, one cannot then do the linear dose correction calculation to get the right dose. Note that this calculation also decreases anastrozole dosing appropriately. And this leads into dose refinement that one cannot do with 1/4mg increments by cutting the 1mg pills. The only way to appropriately small dose increments is with a liquid products that are not generally available by Rx.

However, a compounding pharmacy could make this up. For over responders, taking 1/4mg per week in EOD doses is not an easy task. We do have some who dissolve their 1mg tablets in vodka and dispense by the drop. Note the anastrozole is hydrophobic and will not dissolve in water; does dissolve well in alcohol and 80 proof vodka works well.

To do a dose calculation, one first needs get to into a reportable lab range. The over-responder needs to feel his way there. If one is not taking anastrozole and does E2 lab work, there is no dose calculation possible and the first dosing of anastrozole after E2 lab work still carries the chance that one may have low E2 as an over-responder and one then is needing to feel their way into lab range, then get E2 tested again and then the dose calculation can land a guy near target levels. In that case, two lab followup cycles with their doc can take a long time. That can be a really burden, especially those who might be depressed to begin with.

Then we get docs who Rx 1mg anastrozole per day because that is what the prescribing info states [for breast cancer].

Yes, people are different. It is amazing that that for some on TRT without an AI will report that they feel a lot worse than before. Any those events cannot all be explained away by thyroid or cortisol complicators. And the misery that guys can feel from elevated E2 can easily be shared with ones wife and kids. Coping skills can be very challenged. When I report that when I got on anastrozole years ag0, E2=37–>22, it really was like a rebirth.

The changes to brain structure created by T when one grows up makes coping with estrogen dominance very difficult, more for some than others. For those who like such reading, “The Male Brain” by Louann Brizendine is a very good read and you might also like the companion book “The Female Brain”. These books explore the roles of hormones on brain and personality development, and the effects of losses of hormones. Good info on the role of neural transmitters.

These books also explore the effects on social interaction, sexual development, sexual pursuit, competition, nurturer, mental health etc. The reading of one book, makes the next book of great value as one starts to understand the differences, one vs that other. The result is greater than the sum of the parts. But such interests are really not what many will care for.


only read the first page so far…
Had my blood tests done earlier in the year and the Oestradiol was 50 pmol/L
So does this mean I need to be talking to my doc and asking for Arimidex or similar?
Im currently taking 5 x 40mg oral caps a day of test…
Any thoughts please?


Do not post into the stickies. Create your own post for your “case”. Read the advice for new guys sticky to see what we need to see in your post.


Thanks for this info. I started t replacement 3 months ago and would go up then fall right back down. Doc didn’t know what to do but increase shot to 200mg a week. So I started reading here and came across your info. Told my doc I wanted my estrogen checked and even though the doc said no need to because I had not been on the shot long enough to worry about that.

I insisted on it and got my results back to find my estrogen at 111. 3 times normal level. Got the Med and got it down and decreased my shot to 100mg and I feel like a new man. Again feel great. So thank you. Thank you thank you. Did I mention thank you for taking the time to post.


Thanks for posting. This is a great “case story” that addresses a few issues"

  • docs are idiots
  • we have to know more than them to survive and we have to self-advocate
  • weekly injections can make things worse
    -E2 can be toxic
    -the trend that we see for Rx 200mg/week is a real problem


[quote]KSman wrote:

If I were you, I’d also be taking acetyl L-carnitine as there is good science coming in on its ability to help with androgen receptor up regulation. I buy it by the pound. Don’t bother with capsules.

Don’t get discouraged. Our bodies are incredibly complex and it takes time to get everything dialed in. You just have to be patient and keep at it.

Good luck![/quote]

I buy in bulk too. Lipoic acid with that is of great benefit. EFAs such as fish oils are also important for the maintenance of the cell wall. These things help maintain or restore cell wall permeability.

http://en.wikipedia.org/wiki/Lipoic_acid - note “mercury”


I noticed a link for Alpha Lipoic Acid above Ksman. If you have a lot of amalgam (silver) fillings you need to be careful with ALA as it is a powerful chelator of mecury. There is a lot of mercury in amalgam fillings and they should be replaced before supplementing the diet with even small amounts of ALA. I had all my amalgam fillings replaced with composite fillings a number of years ago and used ALA and another chelator to remove mercury from my blood and organs. Best thing I ever did for my health along with my current TRT protocol. I am still learning from the TRT forum but hope to get my TRT dialed in soon.


ALA would help reduce mercury that has entered your blood stream. That would be a good thing. ALA would not remove or release mercury from one’s fillings. Mercury that has entered one’s bones is mostly locked up there. But there may be some release during bone turnover. The big risk is that one can have a life time of mercury accumulation in one’s bones. Then if one has a hormone state that leads to bone loss, mercury is then released into the blood stream and can then affect the CNS.


Hey everyone. I am relatively new to the forum so if I am posting in the wrong spot please forgive me. I have been on TRT since March 2013. Male, 33, low libido, poor mood, tired. etc etc
As of the labs being posted below, I was on Test Cyp 170mg/week injections.

TT 1045 (300-1000 ng/dl)
FT: 2.55 (.95 - 4.30 ng/dL)
Prolactin: 15 (3.3 - 20.8)
Estradiol 65.0 (20 - 75 pg/ml)
SHBG-30740: 27 (10-50 nmol/L)

I do the shot once a week. The bloodwork was taken the morning I would normally do my
shot but drawn BEFORE I took my shot. That being said, these numbers are the lowest they would be during the week. The Dr. has lowered my dosage to 150mg/week but he also says he
does not treat E2. He says that number is fine and he has seen higher than that and it’s not
an issue.

I felt great when I first Started TRT… more energy… clarity of thought… started to have goals again and most importantly, libido! I would say after a month or two this slowly went away and I started to feel the same as before TRT if not worse. I am guessing it would be because E2 is so high where I am seeing guys post that optimal levels should be between 20-30 but different for every guy. I am most likely going to order Anastrozole from Purity Solutions as an AI. Since this is not a pill and I believe it is drops to be taken orally, does anyone have any advice or experience on what dosage to start with? Any and all input is greatly appreciated. Thanks!


One other question I have in relation to AIs is… has anyone had any adverse affects on their lipid profiles? I have read that AIs can cause hypercholesterolaemia but I am not sure if this applies to the doses that someone on TRT would be taking as opposed to someone using it for breast cancer purposes. Thanks!


Do not post into the stickies, please [edit] your posts above, ^A,delete


I would like to thank KSMAN and others who put effort into putting valuable information up here. I admit I was reluctant at first to self medicate but I have seen a world of difference. My E2 was in the 60s and because it was “in the range” my doc he has seen levels this high and even higher and is nothing to worry about.

my TT was like 1100 and FT was 2.5 and I was more tired and depressed than when I started. I have since tried Adex and within a week I started to feel like myself again. Energy, Clarity of thought, quick wit… etc. I am still coming off Lexapro (currently on 1.5mg) so this may still be affecting my libido somewhat… but I also felt a spike in libido but lost it. I believe I need to fine tune my Adex dose but I am confident I will get there.

Seriously tho, like night and day after getting my E2 down. I have blood work coming up in about a month so I will have a better idea as far as numbers go then for E2.

All this being said, self medicating does make me nervous and I have made another Dr. Appt with a different doc who knows what I am doing and has agreed to do blood tests. I am not on HCG and prob won’t be. That being said, this new doc will be testing other levels such as pregnenolone since these testes are the primary source of this hormone in the body.

I don’t know if supplementing orally with pregnenolone would have a similar affect as HCG as far as making sure the other hormones are being created properly but we will find out! Anyone have any experience with that?

Anyways… just wanted to reiterate that while I have not found studies on high E2 in men on TRT and all that… night and day gentleman.


Would it be safe to say that if you are taking an AI with your TRT, you can take less testosterone? For example if I am on 140mg per week… with an AI can I perhaps go down to 120 or 100mg per week? My understanding is that E2 with bind to Androgen receptors and the Free T has no where to go. Let me ask this… does taking an AI affect what your Total T will show up as on blood work or it will it only indirectly affect Free T?
For Example, If while on 120mg T per week, but TT on the 8th day was 450… would this number have been higher If i was taking an AI? Total E2 was 32


First, this is topic specific sticky and you are off topic.
Second, please start your own thread and we will be glad to work with you there.
Third, please read the advice for new guys sticky that points out the above.


Anyone know more about the [relatively] new NEJM article? How are they defining “low Estrogen”?


Whoa. I found the NEJM article. http://www.nejm.org/doi/full/10.1056/NEJMoa1206168#t=article
When they are talking about low estrogen, they mean REALLY low estrogen.
They divided guys into two groups and prescribed Androgel to both. But for group 2, they also prescribed Anastrozole.
The wrinkle is that the Anastrozole dose was 1 mg per day! That seems like a heck of a lot, and it showed.
For the highest level of Androgel (100mg/day):
Group 1 = 805 ng/dl (T) and 33.3 pg/ml (E2)
Group 2 = 934 ng/dl (T) and 02.8 pg/ml (E2)
Not surprisingly, group 2 had such a low level of E2 that they didn’t do so hot.
In short, nothing that really changes what’s already said in this sticky.


This is an excellent thread to give the new guys (me included) a primer, thanks.

I need to spend another week or so reading all the pages of postings.

Are there any thoughts on those of us who are not body builders going on low dose Arimidix to get the most of the testosterone we create naturally, without doing TRT?

Would this approach work, or create other problems?



I’ve found this information on the internet I’d like some replies from the experts here like KSMAN because I’m in doubt some say ideal e2 is 22 pg/mL. Now maybe the ideal Estradiol should be the same as SHBG? Please I’m waiting for answers.

E2 levels the best level
for E2 if your SHBG is mid range is 20 pg/ml. If your SHBG is lower
like mine at say 20 or less you need to keep your E2 levels lower.

What causes HighE2 and high SHBG? It seems that when my SHBG is high,
around 50 at the minute then my E2 needs to be around 50 pg/ml to get
strong nocturnal and morning wood.

Is there anyway to lower SHBG and E2 at the same time. At the moment this is my sweet spot.

Today my SHBG is between 18 to 22 and I keep my E2 levels at about 15 to 20 pg/ml.
The idea that optimal e2 equals 15-25 is indeed bogus.

A) its highly individual

B) i find that optimal e2 for me is when it closely matches shbg.

For example when my shbg is 35 i need e2 about 33-36

But when my shbg is 25 then i need 23-26

Because of your low shbg you will have alot of free E2 circulating in
your body,because shbg not only binds with free test but with free E2,

so the solution to your problem is to get your E2 lower.A good rule of
thumb is if your shbg is 15 then your e2 should be 15.If your shbg is 30
then your e2 should be 30.I myself have a very low shbg of 9.9 and have
to keep my e2 around 10.

Yes i read about it on another forum and decided to try it myself cause i
wasnt feeling good,had all the symptoms of high e2 but my e2 was only
25 but i felt like crap,so i decided to lower e2 some more and it
worked,better mood,good morning wood and no more getting emotional.Thats
why its important to know your shbg levels,that way you can try to tune
up your e2 to the desired level.

If your shbg is really low you might want to try a low dose sub-q shot
every other day.THat means less e2 conversion.Also shbg binds free test
but also free e2,so if shbg is low you will have alot of free e2
floating around in your blood stream.

(This one his SHBG is 55 and E2 55)

I feel better - am more positive, good morning wood, can concentrate
better and am seeing some body recomposition that is favorable.
I don’t know whether to be worried about the higher E2 levels or not - I
don’t feel emotional (feel more testosterone effects - dominance etc) ,
have good libido, nocturnal erections, no gyno signs, so no outward
signs of problems with E2.