T Nation

Low T, High E2. HCG+Anastrozole?


I’m 33 and I have hypogonadism. My endo put me on HCG 5000 UI/week.
My labs before HCG (all ranges are male):
T: 6.35 [10.2-41.2] nmol/l
Estradiol: 303 [56-263] pmol/l
LH 2.05 [0.5-10] mIU/ml
SHBG: 11 [20-70] nmol/l

Another labs before HCG (all ranges are male):
LH 4,2 mIU/ml 0,6 — 12,1
Estradiol 19,0 pg/ml 11,0 — 44,0
FSH 2,76mIU/ml 0,70 — 11,10
Progesterone ↑ 0,30 ng/ml 0,10 — 0,20
Prolactin 11,79 ng/ml 3,46 — 19,40
PSA-total 0,726ng/ml < 4,000
Insulin ↑ 23,7 µlU/ml 2,7 — 10,4
CRP 1,10 mg/l 0,00 — 5,00
CK 131,0 U/L 38 — 174
Glucuse ↑ 111,0 mg/dl 70,0 — 99,0
Urea 36,0 mg/dl 15,0 — 39,0
Creatinine 1,00 mg/dl 0,70 — 1,20
eGFR > 60 ml/min/1,72m^2 > 60
Uric acid 5,34 mg/dl 3,50 — 7,20
Calcium 9,47 mg/dl 8,60 — 10,30
Magnesium 2,2 mg/dl 1,7 — 2,4
Cholesterol total 172,0 mg/dl < 190,0
HDL ↓ 38,4 mg/dl > 40,0
Triglyceride ↑ 185,0 mg/dl < 150,0
LDL (computed) 96,6 mg/dl
PDW ↑ 16,7 fl 9,5 — 15,5
EOS# ↑ 0,49 x10^3/µl 0,05 — 0,32
EOS% ↑ 8,6 % 0,8 — 5,5
UIBC 272,8 µg/dl 110 — 370
Iron 72,92 µg/dl 59 — 158
TIBC 346 µg/dl 228 — 428
UIBC 273 µg/dl 110 — 370
Vit B12 280,0 pg/ml 187,0 — 883,0
Homocysteine 10,6 µmol/l 5,0 — 12,0
Creatinine 1,00 mg/dl 0,70 — 1,20

After HCG:
T: 63.7 [10.2-41.2] nmol/l
Estradiol: 547 [56-263] pmol/l
LH 1.17 [0.5-10] mIU/ml
SHBG: 14 [20-70] nmol/l

After HCG and Dexamethasone (cortisol suppression test):
LH ↓ 0,1 mIU/ml 0,6 — 12,1
FSH ↓ 0,16mIU/ml 0,70 — 11,10
DHEA-S 251,300 ug/dl 167,900 — 591,900
PSA-total 0,887ng/ml < 4,000
Vit D3 /25OHD3/ 62,30ng/ml
Progesterone 0,20 ng/ml 0,10 — 0,20
Prolactine 11,79 ng/ml 3,46 — 19,40
CK 148,0 U/L 38 — 174
Ferritin ↓ 20,52 ng/ml 21,81 — 274,66
Androstenedione 3.01 ng/ml 0,3 — 3,1
Aldosterone 64 pg/ml 10.0 — 105
Cortisol 1,2 ug/dL 3,7 — 19,4 (Dexamethasone suppression test)

Old tests (2years ago)
AST 19 U/l 0-41
ALT 23 U/l 0-41

My brief history:
I had gynecomastia removed, my T levels were always low (200-300), prolactin a bit elevated
I had Hashimoto and finally thyroidectomy 4 months ago (NIFTP) and now I’m on Cytomel 75mcg (still adjusting dosage) - I have never felt any difference taking Synthroid.
All labs are done after the last surgery so they can still be worsened by post-op stress. My LDL/HDL and sugar was never as bad as now, but I hope it will change with time.

My E2 was over the range, and after HCG my T and E2 skyrocketed. I don’t feel better at all. What should I add to get rid of E2? Nolva or any AI? My endo doesn’t care about this at all but I’m fat, bloated and depressed. I’m located in Germany.

Your endo is an idiot, but when it comes to TRT, most are.

SERMs and hCG should never be high dose.

Your high E2 is terrible and expected result of stupid high dose hCG.

Please use the edit icon [pencil] below your above post and edit in the lab units, they seem a bit strange.

Are you confusing E2, estradiol, with total estrogens?
Are these female lab ranges?

Where are you located? - it affects your diagnostic and treatment options

SHBG is too low VS E2, are you diabetic?

Should test LH and FSH as LH changes a lot in a day and any single number is thus not so useful. FSH is steadier and often a better indicator of LH status than LS itself.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

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.


I know that endos dont know how to deal with TRT, I went to few and this one was the only one who even considered doing anything.

Ive updated my post.

I havent had FSH tested recently. I’m insulin resistant, but its probably due to low testosterone and low thyroid (im working on that already).

I will ready your stickies today.
What would you suggest?
Thanks for your help!

On TRT with high TT and FT levels we like to see guys near E2=80 pmol/L which seems optimal for libido, mood and energy.

Can you post fasting glucose and A1C labs?

Second set of labs were while on hCG or after and if so, how long after?

Your E2 levels are high enough to reduce LH/FSH>
Before hCG, T assumed TT=6.35 was very low, so I assume FT would be very low as well. With low FT and albumin+T, T–>E2 production rate would be low. With high E2, E2 clearance rate must be poor and that points to liver function. Liver disease/conditions or some medications can be responsible.

Liver AST/ALT, name there may be different would be useful lab results.

Second set of labs has very high E2 and SHBG still low, so something there is abnormal.

While looking for a cause, you need to try to get a prescription for anastrozole and try 0.5mg/week in divided doses, try 0.25mg twice a week.

When you were on high dose hCG, LH/FSH should have been very high and that would create a lot of T–>E2 inside the testes. Anastrozole cannot control T–>E2 inside the testes, only in peripheral tissues.

Nolvadex or Clomid [SERMs] increase E2. Only an AI can reduce T–>E2. SERMs interfere with E2 receptors in Selected tissues, not all tissues.

Doctors and there ignorance and stupidity are universal. Hard to get around that in many countries. Doctors are the biggest problem, endo’s are often the worst.

Thyroid can easily be a contributor to fat gain. Please get those body temperatures posted.

Post all available lab work+ranges. There are often some general health issues that need to be addressed and often overlooked by doctors who are trained to deal with diseases and not health optimization.


can you check my last labs?
I’m on testosterone enanthate 50mg/E3D+0,5mg anastrozole ED+HGC 250UI/E2D.
Additionally thyroid hormones (I’m thyroidless) + zinc, magnesium, melatonin.
First few weeks when taking such combo I felt great - morning wood every day and motivation. Now not so great anymore. And still, I can’t get lean. Isn’t my SHBG too low?

TSH) ↓ 0.127 μl / ml 0.550 - 4.780
FT3 3.93 pg / ml 2.30 - 4.20
FT4 1.16 ng / dl 0.89 - 1.76
E2 20.70 pg / ml 11.80 - 39.80
PRL 11.6 ng / ml 2.1 - 17.7
Insulin 10.70 mU / l 3.00 - 25.00
SHBG 17.6 nmol / l healthy men (21-55 years) - 17.3 - 65.8 nmol / l
Testosterone ↑ 943 ng / d 241 - 827
Ferritin 30.6 ng / ml 22 - 322
HbA1c 4.6%
HbA1c 26 mmol / mol
Total PSA 1.19 ng / ml <4.00
Calcium total serum 9.5 mg / dl 8.1 - 10.4
Inorganic phosphorus in the serum 3.7 mg / dl 2.6 - 4.5
Iron serum 115 μg / dl 59 - 158
Albumin serum 4.6 g / d 3.5 - 5.2
Glucose 93 mg / dl 70-99

Ferritin is low, iron is strong but unreliable as its level is driven by recent meals.

Ferritin should be at e least 80 as it is known that lower levels are associated with impaired fT4–>fT3. We are not concerned that fT3 is low in your case but concerned that lower levels of ferritin can be interfering with some basic processes in the body.

Need RBC and hematocrit.

Males typically do not need additional dietary iron and when iron is low, a GI bleed blood loss needs to be considered and one screens for that via an occult blood test. Are you a vegetarian? Lower RBC and hematocrit [HTC] suggest a GI bleed as well. Both are increased with good T levels so should be quite robust now.

Thyroid: fT3 is well above mid-range. Your body temperatures should be good or warm. Do you feel overheated or jittery? Please post your oral body temperatures so we can see what is going on. Your low TSH is expected with your higher fT3, which is a good sign.

Both your T and fT3 should be driving weight/fat loss.

HbA1c indicates that you do not have diabetes, so your low SHBG is not driven by that. Some just have low SHBG.

Your TT is very strong. FT was not tested but with low SHBG, non-bioavailable SHBG+T is relatively low and TT=943 is under estimating your T status.

Your feeling down is not been driven by low thyroid function [still need body temps] or by elevated E2.