Estradiol: Why You Should Care

@KSman

How long after starting/changing adex dosage should one wait to retest for E2 blood levels?

How long is normal to feels the effects of the dosage change?

E2 levels would be steady enough to do labs after 3 weeks. But if you are feeling great, you can wait longer.

If the dose is getting you into the lower 20’s you can expect to feel a good change in 5-7 days on a steady anastrozole dose. Other changes can progress over 4 weeks depending on how long one was compromised with elevated E2 levels.

My doc says a person can take 75% less of an AI when on a compounded script because of it bypassing the liver. Is this true? Meanwhile my Total Estrogen is 60pg/ml out of range high. After much discussion I convinced her to check E2. SIAP. I searched with no luck.

What is compounded script? Just a smaller dose?

Many make up a solution 1mg/ml in vodka and dispense by volume or by the drop.

Compounded was my doctors words and I assumed she meant when they combine the T and the AI in the same vial. I could be wrong.

Yesterday, functional medicine doc indicated a quick and dirty method for determining what range one’s estrogen should be in. Said to determine the low E, take total T and divide by 20. Likewise, high E is total T divided by 14. If you look at my January 2017 labs in the spreadsheet in my post (HRT - Beyond the Basics) total T is 1323. 1323/20 = 66.15. 1323/14 = 94.5. Using this method, acceptable range for estradiol is roughly 66 to 95. This is a lot more than 20-30, which I believe is reported as ideal on this site. I have no idea if this is a good method or even if this represents optimal range. I do like that it accounts for changes in total T. Anyone have any thoughts on this? I believe what I am asking, is whether 20-30 range for estrogen is always optimal in spite of changes in total T or free T or other labs?

This is why, in my practice, in the unlikely instances where I prescribe an AI (under 5% of the time and to patients who don’t respond to the typical use of NAC, methylated b vitamins and zinc therapies to assist in liver clearance of estrogen metabolites), the only AI EVER used is aromasin.

Your functional doctor is correct. Most of my patients feel best with an e2 around 70. I posted a good video on the Pharm forum from Eric serrano taken by John meadows explaining this as well.

What testosterone levels are most of your patients being kept at?

Hi Verne - we try to keep everyone between 1000-1200 ng. But again that’s total. We go MUCH more by how the patients feel.

Thanks. Just getting a handle on your general goals

You are welcome. Labs can be a dangerous thing, especially blood only labs. They only show a snapshot of a moment in time. They don’t show metabolism of the hormones into downstream metabolites or which pathways are being used etc. this is extremely important info. I have some patients who feel their best at 600 and some who feel amazing at 1400. It just depends and there are loads of factors but never once has an e2 range been locked in for us.

I find just over 850 makes me a whole new me and if I hit 40 I get emotional. It takes me 200mg a week to get there. And .5g a week of an AI which has me at 22 That keeps dropping with my body fat

It makes sense that your estradiol drops with body fat reduction. You need to do what makes you feel good! But estrogen clearance has much more to do with overall liver function and digestion. Everyone on this forum needs to go back and read meadows article liver let die. Here is a link. Basic tips.

Have you ever done a zinc status test? Almost 100 % of our patients test super deficient in it and when you normalize zinc you most of the time take away needs for an AI

@physioLojik

If you could put it into one comprehensive post, I would be interested to hear your take on E2 control.

PhysioLojik, thanks for the reply on e2 range. I believe a lot of the followers on this forum are shooting for the 20-30 range. I know there was a JAMA article in 2009 that concluded those men with chronic heart disease faired better in the 20-30s as opposed to higher or lower. They were not healthy men though. Here is a comment from that article.

“The U-shaped relationship between serum estradiol concentrations and mortality in men with chronic HF and reduced LVEF is not easily explained. The major problem in attempting to discern a mechanism is the issue of whether the estradiol concentrations are related to critical body changes in the progression of HF or merely markers of that progression without a mechanistic role. There were differences in the characteristics of those men with low and high serum estradiol concentrations. In previous studies in normal male populations, mortality was highest in those men with estradiol concentrations toward the low end of the normal range.”

Correct. It also didn’t say where their testosterone levels were. Having elevated estrogen with Low tetsotstone is bad. Having elevated estrogen with elevated testosterone makes sense.

I don’t want to hijack this thread with my own specifics, but I find that I have not felt well enough (due to other causes) to discern the seemingly subtle affects of e2 moving higher or lower. If I can get my thyroid stable, I hope to be more sensitive to what feels good and let’s me perform well in regards to e2. That’s hard to do when there are other factors at play.

Not to hijack this but … I have not tested for zinc though I have been on a multi mineral for a year now. I did have lack of iodine which is what started me on the multi. I only take extra zinc if a feel a cold coming on. Originally I was on .5g of anastrozole and 165mgs of trt. That had me at 800 TT and 45 E2. I was a bit tired of crying at old George Jones songs (not joking) So I doubled the AI bringing things down into the 20s. Over this last year my body fat has dropped a great deal and muscle is almost back to my old normal self. Now am using 200mg TRT and .5g anastrozole and weighing in at 214 I am thinking I may not need any anastrozole at all by the time I hit 190 (estimated at a little less than 10% body fat).

Personal experience tells me that controlling E2 is important to me. While 40+ was not growing boobs, it was still not fun. I do not seem to be an average 60 year old fat guy. I have had no increase in Hematocrit so 850 is easy for me to manage.

Anything special I would need to know about a liver function test?