T Nation

High Estradiol & Gynecomastia / Bottom Range T


#1

Hi
n your case/thread opening post:
-age 37
-height 5’ 11"
-waist 40
-weight 115kg
Complete facial hair and not much at body
Much fat at upper body suffering from gynecomastia also belly fat and very soft body

-health conditions, symptoms [history] diagnosed diabetes 7 years ago but now in control with changes in food intake
Hypertension
Faat heart rate
Lipids high (now controlled )
Acid reflux (now ok)
Depression anxiety
Chronic fatigue

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
Amlodipine +valsartin 5/80 mg
Concor 5 mg as beta blocker
Statins 20 mg (now stopped)
Fenoget for tryglecriods(not now)
Nexum 40 mg
Insulin 70/30 (stopped) because of control by diet
Paroxeten 20 mg and lomtrigen 50 mg for stress (now stopped)
Multivitamin
Resveratrol
Fish oil
B 6 and b12

-lab results with ranges…(after changing diet and well managed now)
Cholesterol 165 (upto 200)
Tryglecriods 175 (50 to 150)
HbA1c 6.7( upto 7)
Testosterone 3.1 (normal range is 3 to 10.7)
estradiol 65 (up to 39)

No physical activity

-testes ache, ever, with a fever? ( no)
No morning wood
I m 37 male 5’ 11" 235 pounds weight. I m new here and desperately need help. I m suffering from complete metabolic syndrom. But since 2 months i have controlled my 7 years earlier diagnosed diabetes to 6.7 hba1c now. My lipids which were quite high now controlled. Blood pressure is also controlled taking amlodipine+ valsartin for this. All this could be possible by changing better food intake advised by dr Mark hyman and reduced 10 pounds of weight also. My current issue which i cant been to address is chronic fatigue and less sex drive and gynecomastia for which i did liposuction twice but it grows again.

So i studied at net and come to know it could be due to hormonal imbalance so i checked my hormons and i found an abnormalities in estradiol which is 65 (normal is upto 39) and testosterone is in lower normal range 3.1 (normal is 3 to 10). I m taking supplement of Resveratrol 250 mg daily and good multivitamin and fish oil daily. I don’t have any endocrinologist in my area. . I need ur help guyz.


#2

@KSman plz help me. I m very much inspired from ur knowledge


#4

@KSman help me brother…


#5

Hi. Fellow noob here. You have a lot of stuff going on, so I am hesitant to comment, but here goes.

Start with reading the stickies, paying special attention to the thyroid one and the HPTA restart one.

If you have more labs, you should post them, look at KSMan’s posts for a list of the important ones. With what you have posted, we can’t tell if you are primary or secondary hypogonadism. You may need more bloodwork.

There is some research that says low T can be causative in diabetes. Excess fat also pushes your E2 high.


#6

Thanks @gonadthebarbarian for reply.
Let me know what lab test should be taken in my case and should i think to take arimidax and Trt.?


#7

Nexium: can create multiple vitamin and mineral deficiencies

Labs:
TT
FT
E2
LH/FSH
prolactin
CBC
hematocrit
vit-D25
AM cortisol [at 8AM please]
TSH
fT3
fT4 [please not T3, T4]
SHBG
CRP
Homocysteine

Where are you located?

Please follow these links found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Endo’s can be the worst.

Your metabolism is slow. This can be from:

  • low thyroid function
  • low T
  • low cortisol

The statin drugs could have created a CoQ10- deficiency that would slow down your mitochondria.
Did that give you a low level chronic cough?

Need labs in list format with ranges.

Try to get Rx for 1mg anastrozole per week and take 1/2mg twice a week.
Do E2 labs in 3 weeks.

Have you always used iodized salt?
Outer eyebrows sparse?


#8

Thanks for ur precious response @KSman.
Yes the drugs have these side effects u told. So should discontine these? I have discontinued most of them like statins and Fenoget for tryglecriods Paroxeten lamotrigen and controlled the issues by taking right diet which is organic poultry vegetables nuts and seeds and loss 10 pounds.
I am from a small town of pakistan and don’t have good physician in access.as far as endo is concerned i have found the best endo and its @KSman.
Yes very soon i m going to lab tests which u told above and will inform you by results.
Your findings about my metabolism is 100% true. Its very slow and i feel it is slow from my child hood.
Yes iodized salt is used in cooking and taking good quality supplements of Multivitamin along with fish oil caps co q 10 cap 50 mg and b6 as cynacobolmin and b12 and resveratrol 250 mg daily but have worse kind of fatigue dizziness lack of concontration anxiety and even its difficult to make my self walking. Now losing my sex drive and zero libido. Eyebrows are not much sparsed.
Will this anastrozle only be solution of all my problems? And i cant find a good endo or physician but getting what about trt ?medicine without prescription is not a big deal here so plz suggest me complete solution but diagnosis is important to cure and i know you are capable to diagnose the root cause of my problems.
Ur prompt reply is oxygen for me
Bundle of thanks again.


#9

There are problems in that part of the world from natural arsenic in well water and as the water table is depressed the problem gets worse and surfaces in new areas. It is a huge problem. Try to find out if your area and water supplies are affected.

https://www.google.com/search?q=pakistan+arsnic&ie=utf-8&oe=utf-8#q=pakistan+arsenic

As you walk down the road to TRT and things do not seem to be working well; there is the possibility that your medications are holding you down. This complicates things.

As for TRT its still the same:
50mg T cypionate or ethanate, injected SC or IM with #29 0.5ml 1/2"-12mm insulin syringe
0.5mg anastrozole at time of each injection
250iu hCG SC EOD

hCG must be kept refrigerated after reconstitution. If your electrical supply stable?

TRT will help with insulin sensitivity.
You need to avoid a lot of grains and rice and eat more proteins.


#10

Thanks @KSman for ur advice. Yes u r right about arsenic issue in this region. I use filtered water mostly.
I have done all labs u told previously. Hope i will get reports soon and post here. But tt and ft was not available in lab so couldn’t do that. Also Labs are very much expensive in this region and i hardly managed the amount of 25 k approximately.
Also a new update is that i was operated for mastectomy of my acute and chronic gynecomastia of approximately 3 pounds of eached side. Regarding this any good advise u can give me will be very valuable for me. Also i have sent the tissue for biopsy in lab. I will update by repoert when i get. So my concern is that can it be still grow after mastectomy again ? And what kind of safety measures should i take?
Also plz tell me with this range of testosterone should i go for trt or should take arimidax only to control estradiol. I think i should wait untill complete labs will come. What u say ?


#11

@KSman here are the lab tests u advised

SERUM 25-HYDROXY VITAMIN D … 53.5 ng/ml
REFERENCE RANGES

Vitamin D DEFICIENCY : <20 ng/mL
Vitamin D INSUFFICIENCY : 21 - 29 ng/mL
Vitamin D SUFFICIENCY := or >30 ng/mL
Vitamin D INTOXICATION : >150 ng/mL

SERUM CALCIUM …9.3 mg/dl … (8.6-10.2)

HAEMOGLOBIN … 15.2 g/dl … (13.7-16.3)
HAEMATOCRIT … 49.2 % … (41.9-48.7)
R.B.C. … 5.74 x10E12/L … (4.5-6.5)
M.C.V. … 85.7 fL … (76.0-96.0)
M.C.H. … 26.5 pg … (26-32)
M.C.H.C. … 30.9 g/dL … (32-36)
W.B.C. … 9.8 x10E9/L … (4.0-10.0)
NEUTROPHILS … 51 % … (40-75)
LYMPHOCYTES … 40 % … (20-45)
EOSINOPHILS … 03 % … (1-6)
MONOCYTES … 06 % … (2-10)
BASOPHILS … 00 % … (0-1)
TOTAL CELLS COUNTED … 100
PLATELETS … 309 x10E9/L … (150-400)
PERIPHERAL FILM … ANISOCYTOSIS,POIKILOCYTOSIS
ELLIPTICAL CELLS,TEAR DROP CELLS,FRAGMENTED RBC
HIGH HCT.
? CAUSE

PLASMA HOMOCYSTEINE … 17.40 umol/L … (5-12)
Please note the change in the reference range effective from
26/06/2013

SERUM TSH … 1.76 uIU/ml
AGE RANGE uIU/ml
Premature,28-36 weeks 0.7—27.0
CORD BLOOD (>37 weeks) 2.3—13.2
Birth-4 days 1.0—39.0
2 weeks-20 weeks 1.7—9.1
21 weeks-20 years 0.7—6.4
ADULTS
21-54 years 0.4—4.2
55-87 years 0.5—8.9
PLEASE NOTE THE CHANGE IN REFERENCE RANGES.
SERUM FSH … 2.65 mIU/ml
REFERENCE RANGE

Male

1-9 years 0.0-5.0 mlU/ml
10-11 years 0.0-6.0 mIU/ml
12-18 years 0.0-10.0 mIU/ml
Adults 1.4-15.4 mIU/ml

(Please note the change in the reference range effective from
13/03/2013)

SERUM LH … 4.37 mIU/ml
REFERENCE RANGE

Male

Up to 1 week 1.5-5.0 mIU/ml
1 week-1 year 3-22 mIU/ml
Pre-pubertal children 1.0-3.5 mIU/ml
Adults 1.2-7.8 mIU/ml

(Please note the change in the reference range effective from
13/03/2013)

SERUM C-REACTIVE PROTEIN … 0.58 mg/dl … (0-0.5)
Sensitivity of the assay is 0.012 mg/dl.
Reference : Teitz textbook of clinical chemistry 4th edition 2006
page number 2263)

Ft3 2.60 (2.1-2.4)
Ft4 1.07 (0.8-1.7)
Cortisol 8:00Am 17.9 (4.3-22.4)
Homocysteine 17.4 umol/L (5-12)
Prolactin 12.65 ng/ml ( 3-25ng/ml)
Testosterone 3.10ng/ml (3.0-10.6)
Estradiol 65pg/ml (39.8pg/ml)

HbA1c 6.7 (upto 7 )
S. Cholesterol 168 mg/dl(150-200)
Tryglecriods 207 (50-150)
LdL 102 (upto 150)
HdL44 (45)
Uric acid 5.4 (3-6)

Bp 130/80

So that was labs and doctor examined the testicle and said its fine. He advised for MRI of brain for pituitary gland and suggested 125 mg weekly testosterone im.but i m going to take ur suggested dose of 100 mg/week in divided doses. He didn’t replied to my question about anastrozle need. (Idiot doc u say right about them).
Plz tell me what would be the next step. I mean after starting therapy how long it will be continue and should i take hcg with this or not ? I have completed my family by the way. And what about hgh usage. If yes then tell me generic names of hgh.
Plz @KSman i hope ur prompt reply also about previously asked about gynecomastia surgery.
Thanks.


#12

Your prolactin doesn’t seem to indicate a pituitary tumor.

TSH would be better lower. Read the thyroid sticky, consider supplementing iodine.

Your FSH / LH aren’t high. I’d guess your are secondary hypogonadism and could possibly treat with SERM instead of injections.

Your E2 is higher than I could tolerate. You are likely going to want to get on an AI asap, as that’s only going to go higher when there is more T in your system.


#13

Thanks @gonadthebarbarian so in ur opinion i should treat with serm and Ai. What should be use in serm reloxifen or tamoxifen and could only this increase my t ?
Should i treat symptoms only or try to investigate further the cause of hypogonadism like one reason could be genticaly extra chromosome ? And is it necessary to Go for Mri of brain because its expensive and i don’t have insurance who can bear all these expenses. More investigation causes more confusion. @KSman opinion also important for this concern. Plz reply


#14

@KSman seeking ur attention brother…plz check last 3 stickies…


#15

Please read the above and see if any suggested causes might apply to you.
What digestive issues do you currently have?

Nexum can cause malabsorption of vitamins and minerals.

I think that the problem involves your liver.
I made a mistake by not suggested that you get AST/ALT tested. These can be high from a liver problem.

Could your gyno have been caused by some of the drugs you were taking?

So liver issues and whatever is causing malformed blood cells.
TRT could be done now, but you will have to use anastrozole and keep E2 near E2=22pg/ml
You will have to watch hematocrit. You might need to have blood removed routinely.

I think the wisest thing to do would be to take anastrozole only to try to get near E2=22pgml and see if your LH, FSH and T increase as E2=65 is probably why T is low. While you are working on that, work on AST/ALT and digestive issues that may be causing blood problems. Try to get a sub-lingual b12 cyanocobalamin product. You could also inject B12.

These conditions may also be reducing E2 clearance by the liver and that could explain problems with breast tissue.

These probably affecting hematocrit.

C-reactive protein [CRP] does not indicate a general problem that produces inflammation.

fT4 is below mid range, which might be from low iodine [hopefully]

Homocysteine is high, indicating a problem with endothelial lining of your arteries; which causes hardening of the arteries and high blood pressure. Might be vitamin absorption related.

Estradiol E2=65 is horrible, a major factor in your gyno.
Prolactin does not seem to be a cause of your gyno.

High E2 is reducing your TT, FT, LH/FSH
HbA!c [A1C] is not high enough to indicate diabetes, but may be indicating too many simple carbohydrates and decreased insulin sensitivity.
TRT can improve insulin sensitivity.

You will be in major problem if you do TRT without anastrozole. For you, anastrozole is essential. Try to get it.

I suggest hCG with TRT. But should you do TRT?
You would take hGH if IGF-1 tested low, indicating low GH.


#16

Thanks for ur reply
Now i m no longor taking nexum since a couple of month. I was taking just for acidity and acid reflux and this was due to bad food habits like eating late at night or over eating at night. Since i started good carbs and left bad carbs my diabetes is not an issue now.
So ur recommendation is arimidax only and not to tske testosterone initially if i understand u properly. I will start it soon. So what dose i should start with?and after start taking arimidax when to take labs again ?
And what about fatigue low sex drive from early age and now facing no morning erections and low libido. Will arimidax only helpful in this ?


#17

There are studies which show doubling of T on arimidex only. Since your E2 is so high, it could easily be causing your pituitary to throttle down LH / FSH, with the resultant low T.

Definitiely listen to KSMan in regards to liver and the other stuff he suggested. This is far beyond my noob knowledge.


#18

Start with 0.5mg/week in divided doses, so 0.25 twice a week.

Watch for changes in 7 days.
If you feel crashed or maybe better then crash next day, you are an anastrozole over-responder and will need to take 1/4th the suggested doses.

If feeling better, just stay on that dose and do not do labs soon. Let your body make changes. Your testes would need to make changes that you want to reach an end point before spending more money on labs.

Do not ignore the blood problems and do try to find the B-12 as suggested.

You may have a Hiatal hernia.


The heart burn can easily be misinterpreted as hunger and eating pushes the acid down and provides relief. So when you feel hunger at night, you may be feeding your hernia.
Weight loss can really help with this. TRT can help as well as anything that improves your metabolic rate.


#19

Thanks @KSman. I m going to start the anastrozle soon but couldn’t understand that how can i adjust weekly. I mean for example i take a dose Saturday then when should take second dose to complete week cycle. A week is of 7 days.
2nd u mentioned previously that i should have blood Removal routinely. How could i do this and what will be the benefits.
3rd i have purchased a supplement today. Link is given below check it and tell me can these be helpful for me

http://m.gnc.com/King-Fisher-HighT-Black-Hardcore-Formulation-Testosterone-Booster-25-MORE-8-DAYS-FREE/product.jsp?productId=29442126&green=75193364-0A31-531C-BB2B-670EAEFFC0DB

https://www.vitabiotics.com/Diabetone/Original
Zinc 50 mg
Glutathione 50 mg
Siberian ginseng
Fish oil
B 12 as methycobalamin

One more thing to ask my Homocysteine level could be high becoz of my smoking.(one pack daily)


#20

Smoking contributes to heart disease. But it is the inflammatory processes damaging the endothelial lining of the arteries that increases homocysteine.

http://www.lifeextension.com/search#q=homocysteine&sort=relevancy&f:hierarchicalcategory=[Magazines]

Large amounts of ibuprofen can increase homocysteine, that is bad.


#21

Started anastrozle 0.5mg every 3rd day as advised by u @KSman. So far i have taken 3 doses only. Feeling better in short time. I felt morning wood back from previous morning. Anastrozle only without testosterone is working for me. Also i lost 12 kg approximate weight in 2 months. Should i go for same dose or increase it 1mg twice in a week for better and faster control of my increased E2 level. My body has well tolerated 0.5 mg dose so far and thats why m thinking to increase dose for get back my libido as well.