T Nation

Joint Pain. E2 Advice?

Long story short, I have issues managing E2. My esterone is always high and I am sensitive to AIs. In November last year we upped my AI to combat gyno (.1 mg a day from compounding pharmacy for a total of .7 armidex a week). Starting in about February I experienced elbow and knee pains. It eventually subsided but now its back. My elbows are always popping / hurt and my knees always feel achy. I just had new labs taken with results pending. My last labs are below. My E2 wasn’t really that low but on the low end. Do you think I could still be having joint problems from E2? My T is always higher end so could the ratio of high T to E2 be the problem or is it just a measure of E2 that affects joints

Still see no need to test estrone or worry about it.

E2=15 was on 0.7mg anastrozole per week?
E2=15 is considered low. AI dose should have been reduced, not increased.

Are you on TRT or AI only?

T4 1.12 / .82-1.77
TSH 2.32 / .450-4.5
IGF-1 121 / 88-246
T3 15.1 / 9.2-24.1
Triiodothryronine 3.3 / 2.0-4.4

GH status is getting low. [IGF-1]

TSH should be closer to 1.0
fT3=3.3 is strong mid-range and should be able to support good body temperatures, but I have suspicions.

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

E2 was 15.2 after increasing my dose, so it probably hasn’t gotten worse but I just ran some more labs today to check. I’m on 130mg test cyp per week. I divide it into two shots and take .1mg Arimadex per day. The compounding pharmacy does that for me. I used to have tabs and take a quarter tab with each shot for a total of .5mg per week. That was after 1mg drove my E2 below measurable.

Got my new labs…

T Total 1118 (348-1197)
T free 14.9 (8.7-25.1)
SHBG 61.1 (16.5-55.9)
Estradiol 11.8 (7.6-42.6)
Estrone 50 (12-72)
IGF-1 166 (88-246)
DHT 65 (30-85)
TSH 1.52 (.45-4.50)
T4 Free 1.32 (.82-1.77)

As suspected, my E2 was low. My lipids I didn’t post above but they are not great, side effect of TRT I guess. HDL 38 (>39) and LDL 131(0-99)

The only two other weird readings was a high BUN 21 (6-20) and high AG Ratio 2.3 (1.2-2.2). These were both barely high. My SHBG actually got higher since TRT which is weird because I thought it was supposed to be lower. It was previously in the upper 50s.

Think E2 is the culprit for my joints?

SHBG is very high. Reduces FT and inflates TT with more non-bioavailable SHBG+T.


Yes, E2 is too low, so is FT.
How many times per week do you inject T? - TWO
What is lab timing relative to prior injections? Halfway always?
Changing lab timing does affect lab results.

I would like to see you increase T dose to try to get FT near top of range. That will increase FT–>E2 and E2 will be better. Increase T dose by 25.1/14.9 and that may increase E2 by ~ same factor, so you may get near E2=20. With your joint issues, you should try larger E2 to address joint issues. You can try taking .3mg anastrozole at time of T injections. Or .2mg at time of T injections to get nearer to E2=30. Taking anastrozole at time of injections [twice a week] allows this competitive drug’s blood levels to rise and fall with T levels to maintain a better balance to T. If your injections are 3 days 4 days a week, you could take .2mg and .3mg.

I have taken oral temps per your protocol a month or two ago. High 97s in the morn mid 98s in the day for two weeks straight.

I inject 65mg twice per week, IM. Not a fan of trying sub Q. My capsules have DIM in them too, can’t remember the amount. I figured I could either switch to every other day for a total of .35mg arimadex per week or take them the day of and day after each inject for .4 mg per week. Right now I will try the every other day protocol for half the dose I have right now unless you think otherwise.

As far as timing goes, I inject on Sunday morning and test on Weds morning. That’s my farthest trough day. I did a test a month ago and got 1339 total T and 23.7 free T. This is actually my lowest test in awhile so I don’t think I can increase dose. In fact the docs have talked about lowering it.

Injecting T twice a week provides steady FT levels and FT can be a dosing guide. In your case, TT may be inflated by more SHBG+T which is not bio-availalbe. This is why I suggested getting FT near top of range, TT can be ignored. Or you can test Bio-T and run it to high end. We know your SHBG is very high, so that I suggest is very valid.

When you split your case, we do get duplication of effort… :wink: