T Nation

Help High E2 After PCT - Female


#1

Desperate for help that Dr.s aren’t giving. My fiance’ took supplements for about week that her trainer suggested to build muscle after having the baby. Some off the shelf testosterone booster but she doesn’t remember the name. She stopped after a week cause of developing acne and increased aggression. After 1-2 months off the supplements she started complaining about brain fog. Asked around a bit and thought maybe a PCT would help due to possibly low T. Took aromastin and apparently had bad estradiol rebound determined by lab work. We’ve been to several Dr.s who feel women should have high estrogen so they feel it’s not a concern and since all other labs are normal they think the symptoms are imagined. We’ve been together 7yrs and I’ve seen how this has changed her. She made a huge mistake taking those supplements and is paying a huge price…not enjoying as much time with our son due to these issues. She is tired all the time and complains about brain fog and weight gain. Labs below all in follicular phase during time of test:

LH 2.4-12.6 range/ result 8.3 MIU/ml
FSH 3.5-12.5 range/ result 3.2 MIU/ml
Estradiol 12.5-166.0/ result 236.2 pg/ml
Progesterone 0.2-1.5/ result 0.2 ng/ml
Testosterone, serum (total) 8-48 ng/dl result 15
Testosterone, free 0.0-4.2 pg/ml result 2.2
Unusually high Igf1 but don’t have that#
Prolactin, cortisol, thyroid panel, CBC with differential, metabolic panel including liver function test - all normal.

Any beneficial advice would be helpful.


#2

Please post numbers for CBC, thyroid, cortisol, prolactin etc. There can be problems/answers hidden in the “normal”. We are looking for things that her doctor[s] did not see.

Need time of day when labs were done [cortisol].

Day of her cycle is also important for labs. Best done near day 18.

She is estrogen dominant.

At amazon dot com, find KAL brand progesterone cream and apply on inner arms and breasts or thighs. Do not transfer to your child[ren].!

Progesterone can also increase adrenal progesterone–>cortisol. For some women, that can interfere with sleep. For others, helps with sleep.

You both need to be using iodized salt to get iodine.
Did she take prenatal vitamins and during nursing?

Is she now on oral birth control?

  • for the labs?

Painful breasts or difficult periods?
PMS?

Has she been able to loose any “baby fat”?


#3

CBC
White blood cell range 180-425 result 4.9 K/ul
Red blood cell range 3.8-5.5 result 3.82 m/ul
Hemoglobin range 11.5-15.2 result 11.3 g/dl
Hematocrit range 34.0-47.0 result 34.5 %
MCV range 80.0-100.0 result 90 fl
MCH range 26.0-34.0 result 29.6 pg
MCHC range 31.0-37.0 result 32.8 g/dl
RDW range 11.0-15.5 result 16.8 %
Platelet count 140-400 result 257 K/ul
MPV range 7.5-11.6 result 9.0 fl

General chemistry
Glucose range 65-100 result 95 mg/dl
BUN range 6-20 result 10 mg/dl
Creatinine, serum range 0.4-1.1 result 0.7 mg/dl
Sodium range 133-145 result 138 mmol/L
Potassium range 3.3-5.1 result 3.7 mmol/L
Chloride range 96-108 result 104 mmol/L
CO2 range 22-32 result 22 mmol/L
Calcium range 8.5-10.5 result 9.1 mg/dl
Total protein range 6.4-8.3 result 6.7 g/dl
Albumin range 3.2-4.8 result 4.3 g/dl
Globulin range 2.2-3.7 result 2.4 g/dl
Bilirubin, total range 0.0-1.0 result 0.3 mg/dl
Alkaline phosphatase range 30-104 result 70U/L
ALT range <32 result 23U/L
AST range <33 result 18 U/L
Albumin/goblin ratio range 0.8-2.0 result 1.8
BUN/creat ratio range 7.3 -21.7 result 14.3

Thyroid
T3,free range 1.8-4.6 result 2.5 pg/ml
T4,total range 5.1-14.1 result 7.0 Ug/dl
T4,free range 0.9-1.7 result 1.14 ng/dl
TSH range 0.27-4.2 result 2.860 uIU/ml

Cortisol _ collection time 12:06 p.m.
Cortisol plasma range 2.3-19.4 result 10.4
Cortisol a.m. 6.2-19.4
Cortisol p.m. 2.3-11.9

Can’t locate the prolactin that showed normal range but the high
Igf-1 test were range 101-267 result 490 ng/ml

Test were then on day 21 of cycle per drs request.

No oral birth control pills.

Lost all baby weight. She has always lifted weights and been very athletic. She wanted to tone up so she got a trainer after about six months after our son.

She said her cycle is not painful but is lighter than it normally is. She actually stopped having a cycle for a month or two when she first stopped the PCT. Do you think she may have been given aas that could have caused this or just like a regular muscle enhancement supplement? Is there anything she needs to do to reduce estrogen? She has been using progesterone cream but said it hasn’t helped. We can try KAL brand instead.


#4

I had someone on KAL who was menopausal, stopped cycling. She resumed her periods. That may be atypical. But she ran out of KAL because the shop that carried is discontinued it and she tried another progesterone cream product that did not work and her periods and symptoms got messed up. Then with KAL, things were good again. The bio-availability is the issue.

Thyroid
T3,free range 1.8-4.6 result 2.5 pg/ml
T4,total range 5.1-14.1 result 7.0 Ug/dl
T4,free range 0.9-1.7 result 1.14 ng/dl
TSH range 0.27-4.2 result 2.860 uIU/ml

Thyroid ranges are useless.
TSH should be closer to 1.0, TSH=2.86 is a real problem.
T3, T4, fT3, ft4 should be mid-range or a bit higher.

fT3 is what supports one’s metabolic rate and fT3 is well below 3.2 midrange. Things could be worse than that if rT3 is elevated.

You both need to be using iodized salt to get iodine.
Did she take prenatal vitamins and during nursing?
Low iodine can cause this condition.
Prenatal vitamins do have higher iodine levels, for her and the baby. Iodine is stored in breast tissue to support the baby during nursing.

Please read this sticky and evaluate her overall thyroid function by checking oral body temperatures as suggested: Thyroid Basics Explained

White blood cell range 180-425 result 4.9 K/ul
Is this low=4.9 or high=4900?

Red blood cell range 3.8-5.5 result 3.82 m/ul
Hemoglobin range 11.5-15.2 result 11.3 g/dl
Hematocrit range 34.0-47.0 result 34.5 %
Total protein range 6.4-8.3 result 6.7 g/dl

The above suggests possible iron deficiency. Does she eat red meat? Takes an iron supplement or vitamins that list iron? Alternatively, a low level GI bleed from a food/digestive issue can do this. An occult blood test can rule that in/out.

She probably has a diet with lots of proteins and that makes lowish total proteins a point of interest.

AST/ALT do not suggest a liver issue that would reduce E2 clearance. But do keep in mind that it is the liver that removes estrogens from the blood stream.

It would have been interesting to see if LH/FSH were high, seeing that GH secretion appears hyperactive.
We would also want to see if prolactin is elevated.

Any changes to vision or reduced width of peripheral vision which should be around 180 degrees? Not concerned with refractive issues and needing corrective lenses.

I have seen some young guys messed up with prohormones that alter gene expression. So things like that are possible.

If E2 is elevated and LH/FSH are low, then E2 is inhibiting her HPOA and impaired E2 clearance is suspected. In that case, lower T is also a consequence and that can contribute to lower HTC and total proteins.

Edit: We know that low thyroid function causes some skin changes that can interfere with transdermal hormone delivery. We see that in males. This may be a factor. To overcome that, oral progesterone can be used [prometrium]. This also overcome possible problems from training/sweating and showering. If LH/FSH is elevated and responsible for high E2, that can be reduced by the inhibition of the HPAO by progesterone.


#5

She does complain of vision problems. We went to get a test and her vision is perfect but she complains of blurred vision and not seeing as well. If gene expression was effected is that permanent? What course of action could we take?

The white blood count was low 4.9.

She said she took prenatal vitamins but every day. She doesn’t eat a lot but her overall diet is very high in protein.


#6

Prolactin suggests possible pituitary adinoma and that can easily be managed with 0.5mg/week Dostinex/cabergoline if needed.

An adinoma might be causing high GH levels.

In either case, or both, pituitary can press on both optic nerves and create vision artifacts. A MRI is needed to evaluate this. There is some urgency to avoid possible serous consequences. This has nothing to do with gene expression. Pregnancy might have sped up this development.

You can see where my vision fishing expedition was going…

Note that LH/FSH if high has some implications for the pituitary.

If her testosterone was low, her libido during ovulation could be reduced. Perhaps another clue there.

Labs: etc
LH/FSH - do not know when to test
testosterone
MRI
occult blood test
post oral body temperatures
post iodized salt use and/or vitamins that list iodine+selenium