T Nation

JPT365’s TRT Log


#41

Maybe look into adrenal hormones something may be out of whack there. Try some Ashwagandah get your cortisol leveled out it may help with the panic feeling.


#42

Thanks, I was aware of John Crisler’s position. This is the position I have:

The ECLIA test (aka immunoassay or IA) for E2 management is commonly used for those on TRT. It is not an incorrect test or a test for women, but simply one way to check estradiol levels. The other commonly utilized test is the LC/MS/MS method (aka liquid chromatography dual mass spectrometry, sensitive or ultrasensitive. It is the more expensive of the two. There are inherent advantages and disadvantages to each of these two methods. I have been fortunate to be able to speak with professionals who work with both methods. One is a PhD researcher for Pfizer and the other is a medical doctor at Quest. I’ll summarize their comments.

The ECLIA method is the more reliable of the two in terms of consistent results. The equipment is easier to operate thus accuracy is less reliant on the skill of the operator. If the same sample were to be tested twenty times, there would be very little, if any, difference in the results.

The ECLIA method is not as “sensitive” in that it will not pick up E2 levels below 15pg/mL. If your E2 level with this test is 1-14pg/mL, the reported result will be “<15”. Because of this, it is not recommended for menopausal women, men in whom very low levels of E2 are suspected, or children. In other words, if your levels are below 15pg/mL, and it is important to know if the level is 1 or 14pg/mL, you do not want this test. For us, this is likely moot, as if you are experiencing low E2 symptoms and your test comes back at <15, you have your answer. For a woman being treated with anti-estrogen therapy for breast cancer, it may be necessary to know if the E2 level is zero or fourteen because therapeutically, they want zero estrogen.

A disadvantage to IA testing is that it may pick up other steroid metabolites, which in men would be very low levels, but still could alter the result. Another potential disadvantage is that elevated levels of C-reactive protein (CRP) may elevate the result. CRP is elevated in serious infections, cancer, auto-immune diseases, like rheumatoid arthritis and other rheumatoid diseases, cardiovascular disease and morbid obesity. Even birth control pills could increase CRP. A normal CRP level is 0-5 to 10mg/L. In the referenced illnesses, CRP can go over 100, or even over 200mg/L. Unless battling one of these serious conditions, CRP interference is unlikely.

The LC/MS/MS method will pick up lower E2 levels and would be indicated in menopausal women and some men if very low E2 levels are suspected and it is desired to know exactly how low, children and the previously mentioned women on anti-estrogen therapy. It will not be influenced by elevated CRP levels or other steroid metabolites.

On the other side of the coin, the equipment is “temperamental” (as stated by the PhD who operates both) and results are more likely to be inconsistent. Because of this, researchers will often run the same sample multiple times.

It is not clear if FDA approval is significant, but this appears on Quest’s lab reports: This test was developed, and its analytical performance characteristics have been determined by Quest Diagnostics Nichols Institute San Juan Capistrano. It has not been cleared or approved by FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes. This statement is on LabCorp’s results: This test was developed and its performance characteristics determined by LabCorp. It has not been cleared by the Food and Drug Administration.

I’ve added two recent E2 reports, both using IA and LC/MS/MS testing. As of now, my position is that any difference in these two tests would not be significant enough to warrant a change in protocol. Also, interesting in that both of them show higher E2 with LC/MS methodology than with immunoassay, not the other way around. One is on anastrozole, the other is not. I’m going to hit up some more guys, so I’ll be adding to this. I also know a woman on HRT and she is going to get both tests. Next time my wife gets tested she will as well.

IA%20LC%2037-49

IA%20LC%2041-53


#43

I want to, I’ve taken it in the past, but I take an SSRI right now that it may interact with.


#44

It can be as dangerous as an AI, in my case it was. As far as lowering e2.


#45

I would seriously doubt that, DIM is not an aromatase inhibitor. It’s a natural derivative of broccoli and it’s function is to remove excess xeno & phyto estrogens from the liver through the colon. AI is a pharmaceutical potent cancer medication that binds to aromatase enzyme to prevent conversion to e2. Night & day. There is literally no notes side effects of DIM and you cannot crash your e2 levels. The only thing I noticed once is doses over 200mg ED caused a slight headache and that’s because the liver gets overworked trying to detox too much too fast.


#46

Fellas, I need your help, was already starting to feel more off than usual yesterday and woke up this morning depressed. Having some unwanted, messed up thoughts. No energy, no motivation, feeling tearful, everything feels like an effort, etc. Don’t mean to sound dramatic or to flood the board. I do apologize for going into panic mode.

What can I do to reverse this? The DIM arrives today but I don’t want to take it and feel worse. If I were to lower my dose (20mg EOD) temporarily to bring down these symptoms, how long would I do that and what would it look like? I plan on calling Defy on Monday to discuss ED vs EOD dosing to see if that helps.


#47

Anyone have advice for the above?


#48

Sorry but I have personal experience that says otherwise. While on various amounts of DIM my e2 regularly showed up on the 15-17 range and I felt like shit. Normally 30-32.

Headache is a sign of low e2. Never heard the liver thing. Have you checked your e2 on DIM? I have. Not sure where you are getting your info that it has no side effects.

Are you getting DIM and CDG confused?

CDG is the one that helps remove through liver/colon by providing the liver more glucaric acid to remove toxins, e2 being one of them. CDG is suppose to help it not be absorbed again in the intestines.
DIM shunts e2 into the other 2 estrogens through different liver pathways. Which are then excreted.


#49

I have only ever used DIM a long with CDG never alone. That may be why I never felt negative sides from it because the e2 was actually removed from the body without recirculating. DIM is not an aromatase inhibitor so I’m not sure why it would be lowering your e2 levels that drastically. My example is also personal and it seems to be for the majority. You might be an exception.


#50

Does this mean DIM without CDG could cause a rebound effect if you stopped taking the DIM?


#51

It could. Fibre should also be increased to 30g a day along with water.


#52

Update: Consulted with Defy today. They feel my body is not liking my E2 level and that I should try DIM. However, they seem confused by my symptoms. I’ve been experiencing severe anxiety, rapid heart rate, intrusive thoughts and fatigue but it’s combined with a very high libido. They also mentioned cytomel since they thought my initial thyroid blood work was off. I told them I’d like to hold off on that for now, change one factor at a time.

One thing I’ve noticed is that I feel much better the further away I get from my injection. Anyone have any idea why this would be? Is it the E2 bring spiked due to the test shot?


#53

You may need to lower dose.


#54

I think you’re absolutely right, that’s my contention as well. But I was also told that my free T should be in the 20’s and mine is 16. They wanted to increase dose.

I’m stuck in place not knowing what to do.


#55

Restate your protocol and age.

  1. What is the range for that lab

#56

30 y/o, 20mg EOD test cyp subQ. No AI atm.

Most recent labs:

Total Test: 555 Range 229-902
Free T: 16.4 Range 4.4-16.8
E2 Sensitive: 34 Range 0-40
SHBG: 16.5 Range 14.55-94.64


#57

That free t is great.
Am sorry I totally disagree with defy. I’ve always critized their treatment.

Your free t is high that can cause symptoms esp since you low shbg.

I also really can’t understand dosing cypionate more than 2x a week. It has a 7 day 1/2 life.
If that is required, it is making/masking other issues. Like why is shbg so low? Rhetorical question.

For some reason defy thinks you and many others want to be at the very high end of t and free t. Probably because your paying.

R u constipated?
Did you ever try im?
You should go down to like 16mg.


#58

Funny you mention the half-life, I just asked that question on here a day or two ago. I also thought my free T was fine and not sure why I would want to exceed the ref range.

No constipation, bowel movements are actually perfect for the first time in a while.

I tried IM on my first go round with TRT. That protocol failed because it was being dictated by a urologist who had me on 200mg every two weeks.

I actually did around 15mg yesterday, had horrific symptoms right after the shot and into early today. Could have just been because my levels are currently elevated.


#59

Ik man this sucks dialing in.
I wouldn’t think you got that reaction from a single 15 mg injection.

Maybe do another 15 on your next Injection date as well. What if you skip an injection see if you feel better. Then you know it’s too much.

I mean you can listen to defy but I just don’t get it.


#60

I’m thinking I’ll do a lower dose again. I’ll probably call Defy again tomorrow and tell them my plan.

I was also considering ED shots at a very low dose like 7mg, meant to ask them about it today but I had a lot on my mind. I’ve seen you say before that even ED shots doesn’t mean E2 won’t still rise.

I think the irony here is that I’ve always had low SHBG but was fine for 6 months on the 200mg every two weeks protocol. It took that long for my E2 to hit 47. On this protocol my E2 went from around 21 to 34 in 8 weeks. Not sure I understand what’s going on.