T Nation

Moob Alert Sounding. Arimidex-Resistant E2 Levels


#1

New to the forum - thank you in advance for your help, suggestions and opinions.

Age 51.

Brief history - went to PCP with complaints of low energy and mood around 10 years ago. T levels were mid-range and libido was fine, though not great. He prescribed Androgel and I was too uneducated about it to question (especially after seeing the ads on the TV). Androgel brought the TT levels up to 700. No E2 testing was done.

Over next five years I would go on to lose my libido, got ED, and had no nocturnal erections. Plus I would get mood swings that would go too negative. I would get emotional easily. I gained about 25 pounds over five years. I was a walking shell of myself 10 years ago. In 2011, I saw an endocrinologist and he told me to consider stop taking Androgel, especially in view of reports of increased cardiac risk in older men. Still no E2 testing done. In any case I listened to him and quit Androgel cold turkey in mid 2011. Three months of horror followed but I survived. However, I settled into a low energy, no libido state. It was at this time I found that my Androgel has shut my HPTA down. yes, ignorance has its consequences. No doctor had previously mentioned this.

My endo told me to wait it out in hope of HPTA getting triggered back again on its own. I brought up the idea of Clomid and he said he had no experience with it and couldn’t help me with it. So I waited while all shriveled up (pun intended). HPTA stayed dead. I had given up on life and had lost all ambition and motivation for anything, including looking for a cure.

In July 2016, I had sunk to emotional and physical lows. Enough to kick my survival instincts back to life. I started looking for a new endo and luckily found one in January of 2017. He immediately put me on Clomid and a month after supplemented with Arimidex. The improvement was almost immediate - libido wasn’t high, but I was getting erections (daytime as well as nocturnal). I felt energetic. All the good stuff T is suppose to bring about.

However, 6 months later, the good stuff started petering out. I still have more energy and better mood. But libido and erections are completely gone. My ambition and motivation is taking hit again and I have started dragging my feet through life again.

And now I think I am getting moobs :frowning: Hence, the cry for help!

Here are my labs from Jan 2017 to now - with my comments. (ranges in some case were missing on the report)

01/09/2017: Before Clomid

Testosterone, Total 208 ng/dl (250 -1100)
Testosterone, Free 52.8 pg/ml (35.0 – 155)
Luteinizing Hormone 1.71 uIU/ml
Prolactin 6.3 ng/ml
PSA 0.51 ng/ml (0.0 – 3.5)

TSH 2.13 uIU/ml (0.35 – 5.50)
Free T4 1.11 ng/dl (0.89 – 1.76)

HGB 13.7 g/dl (13.0 -17.0)
Hematocrit 41.0% (38.8 – 50.0)
H1AC 5.7% (4.8 – 5.6)
Glucose, random (9:30 AM, fasting) 119 mg/dl (70.0 – 99.0)
Vit D 26 ng/ml (20 – 96)

Total Cholesterol 162 mg/dl (0 – 199)
HDL 34 mg/dl (41 – 67)
LDL 94 mg/dl (0 – 129)
Trigycerides 171 mg/dl (0 – 149)

ALT 33 IU/l (9 -33)
AST 22 IU/l (9 -33)

Comments: T confirmed low. Bad lipid profile and possibly prediabetic. I have always had low HDL and high triglycerides as long as I can remember. Total cholesterol and LDL have been kept under control by 10 mg Lipitor ED. Also, take Lisinopril 10 mg ED for mild hypertension. Thyroid seems OK although FT4 is below mid-range (for some reason, FT3 was missed).

01/24/2017: Second Test Before Clomid

H1AC 5.8% (4.8 – 5.6)

Testosterone, Total 196 ng/dl (250 -1100)
Testosterone, Free 38.0 pg/ml (35.0 – 155)
Luteinizing Hormone 3.14 uIU/ml
FSH 4.5 uIU/ml
Dihydrotestosterone 12 ng/dl (16 – 79)
DHEA-S 233.9 ug/dl (34.5 – 568.9)
Estradiol 28.3 pg/ml

AM Cortisol (11:00 AM) 11.4 ug/dl (4.30 -22.4 ug/dl)

Comments: Doc is now comfortable with low T diagnosis. He did not mention it but note the high E2 level (given the T levels are so low). He starts me on 25 mg Clomid MWF to restart HPTA (he is very comfortable with Clomid and prefers “body’s own T over synthetics).”

02/28/2017: w/ 25 mg Clomid MWF since 01/24/2017

Testosterone, Total 502 ng/dl (250 -1100)
Testosterone, Free 92.9 pg/ml (35.0 – 155)
SHBG 22 ZZ(10 – 50)
Luteinizing Hormone 3.15 uIU/ml
FSH 7.0 uIU/ml
Prolactin 3.5 ng/ml
Estradiol 51.6 pg/ml

H1AC 5.8% (4.8 – 5.6)
Ferritin 60.5 ng/dl (22.0 – 322.0)

ALT 22 IU/l (9 -33)
AST 19 IU/l (9 -33)

Comments: T levels have gone up nicely. And I am in my honeymoon period and responding as expected. Also, we now have baseline E2 with Clomid. Endo adds 0.5 mg Arimidex MWF.

04/19/2017: w/ 25 mg Clomid MWF + 0.5 mg Arimidex MWF since 02/28/2017

Estradiol 43.2 pg/ml

Comments: E2 is somewhat lower. Increase Arimidex to 1 mg MWF. The beneficial affects of T are showing some sign of decreasing.

06/08/2017: w/25 mg Clomid MWF + 1 mg Arimidex MWF since 04/19/2017

Glucose, random (5:27 PM) 99 mg/dl (70.0 – 99.0)
Ferritin 39.3 ng/dl (22.0 – 322.0)

Testosterone, Total 470 ng/dl (250 -1100)
Testosterone, Free 85.5 pg/ml (35.0 – 155)
Estradiol 35.4 pg/ml

Comments: E2 is lower, but I seem to have given more ground on T benefits. ED is back with low libido. Mood is darker and energy levels lower. Increase Arimidex to 1 mg ED.

Ferritin is on the low side.

07/12/2017: w/25 mg Clomid MWF+ 1 mg Arimidex ED since 06/08/2017

Testosterone, Total 469 ng/dl (250 -1100)
Testosterone, Free 73.2 pg/ml (35.0 – 155)
Luteinizing Hormone 5.68 uIU/ml
Estradiol 48.3 pg/ml

TSH 1.73 uIU/ml (0.35 – 5.50)
Free T4 0.96 ng/dl (0.89 – 1.76)
Free T3 3.1 pg/ml (2.3 – 4.2)

Comments: Feeling terrible. I have body aches all over and I have given up 75% of my T benefits. I have gained over 10 pounds mostly on the belly. I feel heavy and lethargic. And I see moobs coming on! I email the endo and suggest I may have crashed my E2 (I had three data points for E2 versus Arimidex dosage, and a simple linear model predicted that my E2 should be around 13. Endo immediately orders new tests . am expecting to see a low E2 print. Instead, it comes back higher! It is as if Arimidex is not working at all.

I request the sensitive test for the E2 and get it.

Also, not too thrilled about my FT3 an FT4 numbers.

07/24/2017: w/25 mg Clomid MWF+ 1 mg Arimidex ED since 06/08/2017

Estradiol (Sensitive, LC/MS/MS, Quest) 47 pg/ml (< or = 29)

Comment: The E2 number from the sensitive test is almost same as the non-sensitive (I presume) one.

09/13/2017: w/25 mg Clomid MWF only since 07/24/2017
HGB 15.1 g/dl (13.0 -17.0)
Hematocrit 44.7%

Comments: Did some iron supplementation. It nicely bumped up my HGB. Need to redo ferritin. hematocrit is slightly elevated compared to pre-Clomid days but in range.

Questions

  1. How to get E2 under control? It seems my body just produces too much of it (see my E2 number with no Clomid and little T).

  2. Why is Arimidex failing?

  3. Why did E2 level go up once Arimidex dosage was increased of 1 mg MWF to 1 mg ED?

Possible future actions:

  1. Zinc supplementation
  2. Progesterone cream
  3. Thyroid hormone
  4. Reduce Clomid dosage
  5. Try Nolvadex or Clomid + Nolvadex

Any comments welcome! Thank you for reading!


#2

Where are you located?

Clomid is causing high T–>E2 inside the testes and anastrozole as a competitive drug cannot work inside the testes. You really need to drop Clomid and self-inject T. Clomid is not working for you.

Please post history of [not]using iodized salt and/or vitamins listing 150mcg iodine.

Check oral body temps as per below. Check wife’s too.

Muscle soreness?
Persistent low level cough?
Probably side effect of the statin drug, most do not have such problems. When problem occurs, it is a statin drug induced CoQ10 deficiency.

Foot/leg cramps? Magnesium deficiency. See “ZMA” in this site’s Biotest store.

HDL:

  • high potency B-complex multi-vit with trace elements including 150mcg iodine AND 150-200 mcg selenium, OK if lists iron.
  • EFA’s: fish oil, nuts, flax seed oil/meal - see Biotest flameout
  • Antioxidants: Vit-C 1000-2000mg, Natural source Vit-E
  • CoQ10 - get the ubiquinol type, note the spelling 50mg
  • Vit-D3 5000iu, tiny oil filled gel caps, 25,000iu first 5 days then 5,000iu

Iron:

  • Ferritin should be ~80 or more to support T4–>T3 conversion
  • Men normally do not need iron. Low iron status is a sign of GI blood loss and you should have an occult blood test and be up to date with colonoscopy exams.

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.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges. a

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


#3

More labs:

AM cortisol: do at 8AM or 1 hour after waking
11AM is not useful

IGF-1 to evaluate GH status


#4

Located in the Southeast US.

I am going to get a complete set of labs soon. Will post then.

I just started monitoring my body temp.

Day # AM temp PM temp
1 97.6 98.1
2 98.1 98.5
3 97.1 98.1

I often get chills and shivers in night (they are internal, blankets don’t help).

Wife has hypothyroidism, but in her case it is Hashimoto’s (her mom’s too). I have tested negative for antibodies.

Use iodized salt.

I just started on:

Vit D 5000 IU ED
Lugol’s 2% iodine 3 drops ED (= 7.5 mg, I think).
Zinc 50 mg
Selenium - either one Brazil nut or Selenium 200 mcg (generally alternate)
Vit C 1000 mg
Apple cider vineger 1 tbs few times a week

My B12 was in low 300s. I took B12 sublingual supplement and it is now 600. Now I take B12 5000 IU once a week.

Eat lots and lots of extra virgin olive oil. Diet in general is healthy but I think I should reduce my carbs more.

I am struggling to understand why Hemoglobin is fine but ferritin is low. I have had stool test for occult blood and it came back fine.

No muscle soreness or other physically felt side effects of lipitor. No foot/leg cramps.