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Low E2 on TRT - Lab Guidance?

In a nut shell I have been on TRT for years and started feeling sluggish, started shedding tons hair, minimal hair growth, and anxiety through the roof. My T levels look good, Hematocrit High, as well as E1 and E2 way out of whack.

Any insight is greatly appreciated.

Protocol
20mg CYP M/W/F
200mg HCG T/Th
Arimedex .25mg M/W/F

Labs (Throwing the kitchen sink out there)
Test Serum 511 (264-916)
Test Free 10.59 (5-21)
%Free Test 2.18 (1.5-4.2)
SHBG 48.4 (16.5-55.9)
Estradiol <5 (7.6-42.6)
Estrone 98 (15-65)
RBC 6.4 (4.14-5.80)
Hemoglobin 17.4 (13-17.7)
Hematocrit 54.2 (37.5-51)
T4 Free 1.85 (.82-1.77)
T3 100 (71-180)
TSH 2.25 (.45-4.5)
ALT 71 (0-44)
AST 29 (0-40)

I feel like a broken record lately but dude…get off the AI. It is fucking you up.

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Killing yourself man. Your negative 5. That’s horrid . You neee to stop for the sake of your heart and bone health. Sanity as well.

You don’t need that ai. Take some hcg or a little extra since it creates e2 that ai cannot stop the e2 creates by hcg. This should help push it back up.

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It kinda started to get old, but then I remembered how much I would have appreciated someone giving me a heads up. You are doing God’s work @NH_Watts

Second what NH said. the AI is fucking your life.

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Appreciate the advise and I did stop the AI and T. The AI was added in Dec when I had just above the high range E2.

Thanks for the quick replies, any thought on the Hematocrit? Is this getting into the sludge range?

Kitchen sink? All I see is the bathroom toilet if you’re estrogen has anything to say about it.

Liver function is in need of improvement and might explain somewhat high SHBG which is killing your Free T. If HCT wasn’t so high I would tell you your T dose needs to be increased, are you sure you don’t have any other health problems that could explain why HCT is high relative to your testosterone levels?

Obviously you need you stop the AI. Estrone isn’t useful at all, somebody should tell your doctor to stop testing it. T3 is the old way of doing things, testing Free T3 is the new standard as it shows what’s going on at the cellular level and is more closely related to symptoms.

systemlord, thank you for the advise! I did miss my FT3 3.8 (2.0-4.4) and I did start looking into Sleep Apnea causing higher HCT, which makes sense medically. Will be interested to see in a month of using CPAP on how it effects the HCT readings.

HCT is super high for such a low dose. Maybe it was the hcg that gave him a big increase.

Are you hydrated pre test. Usually above 53 docs and people second check.

Don’t forget that if your T levels are fine and everything else is normal - then Hct might be normal. Unless you have other issues …

This is really interesting usually when HCT is 54 the Hemo is 19 or higher.
Will you be retesting your HCT from the CPAP experiment?
That 54 might be a lab error. How is your blood pressure? Is it higher than your normal?
If not I’d say lab error. It happens more than you think.

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The equation for hematocrit is RBC x MCV. Hemoglobin doesn’t have to be over 19.

Like @NH_Watts reminded us (and glad he did…) many guys are on too much AI. E2 is needed! You obv. don’t want too much, but too little is a big problem.

I used to be in a similar boat to you, as I was prescribed too high of an AI dose my first try with TRT. I didn’t know at the time, but after research + Q&A here + conversation with the new Dr. I can see that E2 levels being tanked were most of what was making me feel like shit.

In comparison to the old 1-2mg AI a week , I am now on .125mg - 2x a week - The Dr. says I can see how I feel and I may not need both doses and can step back to 1 or even none. Lots of the big AI doses people are using are just really overkill and guys then end up miserable.

.

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Can you elaborate on that for me?

Old/Labs-Protocol
20mg CYP M/W/F
200mg HCG T/Th
Arimedex .25mg M/W/F

Labs (Throwing the kitchen sink out there)
Test Serum 511 (264-916)
Test Free 10.59 (5-21)
%Free Test 2.18 (1.5-4.2)
SHBG 48.4 (16.5-55.9)
Estradiol <5 (7.6-42.6)
Estrone 98 (15-65)
RBC 6.4 (4.14-5.80)
Hemoglobin 17.4 (13-17.7)
Hematocrit 54.2 (37.5-51)
T4 Free 1.85 (.82-1.77)
T3 100 (71-180)
TSH 2.25 (.45-4.5)
ALT 71 (0-44)
AST 29 (0-40)

Current Protocol-Labs to start on a clean slate

No T CYP ,No HCG ,No AI 2+ Months and CPAP useage

Test Serum 264 (264-916)
Test Free 5.1 (6.8-21)
%Free Test (1.5-4.2)
SHBG 52.6 (16.5-55.9)
Estradiol 19.8 (7.6-42.6)
Estrone 86 (15-65)
RBC 5.59 (4.14-5.80)
Hemoglobin 16.6 (13-17.7)
Hematocrit 48.9 (37.5-51%)
T4 Free ? (.82-1.77)
T3 Free 3.1 (2-4.4)
TSH 2.28 (.45-4.5)
ALT 64 (0-44)
AST 29 (0-40)

Working with new Dr to re-introduce T CYP at a lower dose sub q, but should I be concerned with E1 still pretty high?

Guys, thanks for sharing you vast knowledge! Sometimes Dr’s scare me and cannot fully trust without vetting.

I did re-test with CPAP use and BP is ok, normally 120/80 ish.
Here is a clean slate, no T, no HCG and CPAP use.
Hemoglobin 16.6 (13-17.7)
Hematocrit 48.9 (37.5-51%)
So it dropped as expected, I think my hematocrit might just be a normal high.

So, your T still sucks. Why, exactly, did you stop the Test Cyp? You were advised (correctly) to drop the AI. Nobody told you to drop the test. Your dose was too low anyway. Even with the HCG added in your test level was only 511, 60 mg/week is not enough to get it. Most guys START at at least 100 mg/week, and usually go up a little from there. Do not take he AI, you didn’t actually need it and you over respond to it.
Try just the Test Cyp again, 100 mg/week. No HCG, no AI. Do not worry about the E2 unless you get side effects. The number going out of range is not important, this is exogynous synthetic test, your body doesn’t react exactly the same as it did to the real thing.

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Looking at your labs you are underdosed, you need more T not less. You do need to find out why HCT is so high on midrange levels.

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So this latest labs was baseline no T. Thought apnea may be a culprit, other than that I have no others

Wanted see what happened with E coming back naturally and HCT drop. Looking back at years of CBC test it seems my HCT is border high anyways. Will advise Dr and start back. Thanks man!

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If your body likes naturally high HCT levels, then perhaps your body won’t have a problem with higher each HCT levels on TRT.

I know your body doesn’t like low testosterone levels.