T Nation

Finally Saw New Endocrinologist


#1

Previous threads:

FINALLY met with a new endocrinologist who seems to know what she is doing. Gave her my whole life story yesterday and she treated me like a new patient who never seen a doc before. Finally got someone to test my Estrogen levels. She ran a lot of bloods, thinks I'm secondary as well. She says TRT is a bad idea for anyone at my age who wants to have more children (32). She says I may be a good candidate for Clomid + AI. I'm on no TRT now, been off all TRT for 14 months. Took Androgel for two years previous with no raise in testosterone.

New labs:

ESTRADOL: 35 (11-40 range) (could this be why I feel like shit? Why is my E2 so high and I'm on NO protocol)
LH 2.8
FSH 3.8
Prolactin: 4.9
TSH: 1.7
Free T4: .9
Testosterone: 210

Still waiting on results..

Anyone had luck with a SERM? I know Gonadthebarbarian has..

Current issues are brain fog, no sex drive, awful muscle fatigue, depression, headaches, panic attacks, anxierty, exhaustion


#2

Realize that most people who have success with their regimen disappear. They aren't the ones burning up the forums, so there's a certain level of bias here.


#3

E2 can be elevated from meds, Rx and OTC, that interfere with liver clearance of E2, or a liver problem.

Inability to absorb transdermal T is a symptom of thyroid problems and thyroid function needs to be investigated. Thyroid levels may drive secondary hypogonadism.

T+AI+hCG is quite good at preserving the testes.

SERM cannot work with busted pituitary or primary hypogonadism.

See the HPTA restart link found here: https://forums.t-nation.com/t/about-the-t-replacement-category/38/2?u=ksman
which discussed dosing issues and clomid VS nolvadex


#4

ksman

would you consider estradiol 35 with no protocol high for me?

last time my SBGH was checked it was only 11 isn't usually E2 low when SBGH is low?


#5

ksman

Endo (and GP) both say my thyroid is fine.. all my thyroid bloods are perfect.. which is frustrating?


#6

Yes, lower E2 should lead to lower SHBG, if things are working right. Sometimes SHBG seems disconnected and high or low.

E2=35: Many guys with good T levels feel rotten with E2 near there. So its really about chasing the best quality of life [QOL] and that requires optimizing some things. With your low T, E2:T ratio makes you very estrogen dominant. Low SHBG could be from another problem. You would do better right now with 0.5mg anastrozole per week as a single change. Would not fix everything. Your symptoms seem consistent with the lab numbers.

TSH should be nearer to 1.0
fT4 well below midrange ?lab range? ALWAYS POST LAB RANGES https://en.wikipedia.org/wiki/Thyroid_function_tests#Free_thyroxine

Read the thyroid basics link and check oral body temperatures as suggested?
Iodine deficient from not using iodized salt?
This causes low energy.

Are you diabetic? High fasting serum glucose or A1C?
Hypothyroid - yes, but not major/

Thyroid is not fine. The lab ranges are bogus and mislead most doctors.


#7

My glucose has stayed around 98-104 (reference is anything over 100 isn't ideal) for the last four years or so. I do not really eat sugary foods and watch white carbs. Which is why I don't understand my high sugar level.

A1c is around 5.5 at the moment.

175lbs, 5'10.

I do used iodized table salt

My TSH seems to fluctuate between 1.3-1.7 over last three years


#8

Nothing there connects to low SHBG, but there are still concerns with your thyroid.

Unfortunately, in USA, we have containers of non-iodized beside the iodized in packaging that is very similar. My wife switched salts years ago and that hit me hard. Your TSH=1.3-1.7 variations may simply be tracking variations in your iodine intake.

Try to get those oral body temperatures and will will have more evidence.


#9

OK thank you sir

can you assist with how I take oral temps again, morning midday and night via oral thermometer?


#10

E2 of 32 had me wanting to rip my nipples off they itched so bad. I wouldn't be surprised if you were feeling side effects from E2 that high.


#11

9:30am oral temp: 97.8


#12

12:30pm oral temp: 98.4


#13

Those oral body temperatures are good! So we can assume that you do not have issues driven by low thyroid function. But I am still worried about TSH and fT4 levels. So your TSH is up a bit pushing your thyroid harder, but fT3 levels must be adequate. Maybe TSH is up because iodine intake is below optimal [whatever that is].

Your symptoms are mostly driven by low T levels, but complicated by high E2 levels. With low T, T-->E2 production rates are low and we have to be concerned about why the liver is not clearing these low E2 production rates. So the concern is meds that may interfere with E2 clearance or some liver problem. AST/ALT labs will show if there is liver stress. Do not do heavy training before that lab or have sore muscles.

In your case with low E2 liver clearance, you will need to be concerned with high dose clomid that can cause a lot of T-->E2 inside the testes. Anastrozole cannot stop that and you liver cannot clear it.


#14

So I can't take clomid either? Sounds like I am doomed to have these issues for the rest of eternity then?

AST: 20 (15-37)
ALT: 34 ( 12-78)

Had liver ultrasound, showed no physical issues.

Both appear in normal ranges


#15

Anyone have any documentation on elevated estrogen levels in men causing panic/anxiety?


#16

Well, talked with the endo regarding results.. they see no problem because my FREE testosterone levels are not bad, and my estrogen is not out of range at 35. So I get to continue feeling like crap.

Starting to think I should just find some Arimidex to take to get my estrogen level down because aparently noone seems to think 35 is bad for someone not on protocol. I do not want to self diagnose.


#17

Free t is more important than TT when it comes to symptoms. However, that is a talking point when we are talking about normal TT. 400 and above. Your TT is very low and shbg being low while being a positive within a particular range, TT being low indicates low bio available T. Both are important for evaluating testosterone deficiency. Neither numbers should be looked in isolation. Normal TT with low FT leads to symptoms, so does low TT with okay FT also means low bio T which is important. Keep finding a doc if you're certain that you have TD symptoms.


#18

What about my estrogen @35 is that not a concern?

I probably shouldn't go on a clomid/AI regimen without some sort of doc approval and cant find any docs to do that.

My SHBG was 12, and is now 15.. any idea what causes this to rise?

Also my IGF-1 came back high at 270 or so which has me MAJORLY FREAKED OUT about some condition that they talked about. (Rare pituatary GH where bones get bigger etc). Went into a full blown panic attack when they told me that. They are going to do a glucose tolerance test, and possible MRI on my pituitary. They said there is a surgery option (albeit last resort down the road if thats what I have which I am praying I don't).

I have a new daughter and I don't want to leave my family behind.


#19

Don't panic, what's the range for IGF-1 test, with normal testes 270 does not seem high.

High E2 is bad even with good T levels, with your almost non existing T levels, 35 is very bad. Higher E2 may have increased SHBG a little, but it's low. Low SHBG is not the best for TRT and you will need to work out a suitable protocol with your medical advisor. Your anxiety seems very bad though, some of it is there with low T but maybe a personality trait as well which low T amplifies.

You need to find better a better healthcare provider, i am sure even regular conservative docs will help you with such low T levels. Keep looking. Don't let this affect you, i know how you feel with this barrage of information, reduce time online reading about this and try to keep yourself busy. Keep looking for a doc, you'll be better for it and do not overthink to this point about surgeries and what not.


#20

equalo, thanks for your advice. It's nice to know I have some sane people here who can offer advice. Sometimes I sit home and get really upset about my current condition when I feel like there is no hope.

I do suffer from Panic/Anxiety/Slight Depresion. Used to take Lexapro, may start needing it again. Xanax only thing keeping me afloat. I thought my high Estrogen levels were causing a lot of my panic and anxiety

I'm only 32 and it's wearing on me.

Range is 88-248, I was 270.

Is there ANY negative to me figuring out a Arimidex dosage (i have a script never filled). Will that raise Test levels and slightly reduce Estradiol levels?