T Nation

My Fight with Estradiol...Am I Doomed?


#1

I guess by now many TRTers have realized how difficult it is to keep estradiol levels under control.

I am no exception. Estradiol is for me a pending subject. E2 is like poison for me. I just need it to pass 25 pg/ml for all the typical symptoms to show up (burning sensation on face and some areas of arms, feeling crabby/bitchy/exasperated all the time, no libido or morning erections, sleepyâ?¦etc basically same symptoms of low T).

I consider myself an over-aromatizer. This is a huge problem, and AI is not working as intended. From my experience 3 HUGE questions are unanswered and I hope that people in this forum would help me with the answers.

The questions are at the end of this first postâ?¦

This is my case and hopefully it will serve to others and others could help me with their experience and knowledge.

WHO AM I?

I am 37, from a Central America Country. In June 2011 after bumping into a book on Testosterone I decided to test my T levels. They came very low (13.3 pg/ml). I also took my prolactin, PSA, FSH, LH and all were within ranges. Estradiol although within range was high (30).

I suspected low T because my symptoms were similar to what was described in Dr. Morgentalers book testosterone for life. Low weight (130 lbs. and height of 170 cm. or 5´7´´), extremely low energy, sleepness, burning sensation on my face, crabby most of the day, muscle loss and focused fat accumulation (waist, chest) were my symptoms. Surprisingly I had no sexual related issues (libido, ME, was OK) which of course caused it to last so long before an explanation for my symptoms could come up.

Before testing for low T I have had a battery of thyroid tests which came normal (including ultrasound and biopsy).

So, my endo decided to start slow so he put me on Provironâ?¦

STAGE 1: THE PROVIRON.

3 pills a day. Wow, what a change. The first fifteen days was like an overhaul. I gained about 4 pounds of muscle, hungry all the time, high energy. However, after 15 days the party was over. All the symptoms returned. I kept the treatment for 2 months but after that we moved on to T shots.

I didn´t know then but it was the estradiol mounting up that provoked the crash�or so I suspect (although at the time I didn´t have a estradiol test to back me up on this but it is highly likely).

STAGE 2: THE SUSTANON

1 shot (250 mg/ml) every 4 weeks. Not enough. Good for the first couple of weeks and then the effect tapered off. Increased frequency to 1 shot every 20 days. Although not as effective as the first fifteen days on proviron, the sustanon did its job eliminating the ugly symptoms of low T, especially the burning sensation on the face and the crabbiness. I put on some more weight reaching the 140 lbs. But something was lurking insideâ?¦immediately after the shots I used to feel the burning sensation on my face and lack of energy and bitchinessâ?¦It happened that Estradiol was increasing with every shot and it caused me a Thrombosis after a trip to Europe (9 hours sitting). Of this I do have proof. Estradiol was 45 one week after the Thrombosis!!!

STAGE 3: THE REST

Thrombosis was scary. I had to quit TRT for various months. I also change doctor. The new one wanted me to stay 6 full months off of testosterone before trying something new.

STAGE 4: T. ENANTHATE

I started T shots every 4 weeks but a free T test revealed that after two weeks my levels were 10 pg/ml. The shot was not working (too much time between shots). So it was time to come back toâ?¦

STAGE 5: SUSTANON II

1 shot every 2 weeks. Oh my. Estradiol entered scene with full strength. Every shot pushed up my E2 levels to around 65, basically wiping out the testosteroneâ?¦.so it was time to include AI.

STAGE 6: ENTER AROMASIN

After reading a lot I decided for Aromasin. This is legit medicine bought to the official distributor in the country (you don´t need doctor´s prescription here, just the money).

The aromasin seemed to work but with every injection I needed more doses to keep E2 under control. First it was enough with 12.5 mg (half a tablet) EOD 3 times. Second time (next shot) it was same doses. But for the third shot it took 12.5 mg more.

For the fourth shot I decided to take the pill before the shot (a couple of hours). It worked great and E2 did not rise until the 4th day. But it did not work for the fifth shot. Needed more and more Aromasin for keeping E2 under control.

Basically I used to spent 1 week taking aromasing (2-3 25 mg pills) with high estradiol symptoms starting 1 hour after the shot!!! (Symptoms were the same of low T BUT also low libido, and no ME, and stupid things put me angry and exasperated) and 1 week ok.

I knew I had to change things so I turned toâ?¦

STAGE 7: SUBCUTANEOUS HIGH FREQUENCY SHOTS (CURRENT PROTOCOL)

Yes, I read that SQ high frequency shots could be a solution because there is no testosterone peak and absorption is slower.

So I divided the 250 mg of testosterone (using Primoteston depot from Bayer) in 6 doses of 17ml with shots on M, W, F. So far the symptoms of Estradiol have been present with every shot and I have needed Aromasin pills in each of the two weeks I have used the procedure. It seems I need less Aromasin so far (1 pill per week) but I donâ??t know if my body is going to adapt to it and I am going to need more and more as before.

So the protocol is not working in terms of Estradiol control. Besides, so far (1 and half weeks) the libido is low with mild MEâ?¦however some SQ users say that it takes at least 2 weeks for the protocol to really work so I will wait patiently.

However I am worried that even small amounts of testosterone provoke such aromatization forcing me to make use of a potent AI such as Aromasin.

So far my greatest worries and questions are:

  1. Why do I aromatize more and so fast (just 1 hour after the T shot symptoms come in)
  2. Why my body has been adapting to aromasin, needing more and more?
  3. What are the long term effects of taking AI (afraid of arthritis and bone porosity)?

What do you think?


#2

Please CAREFULLY read these stickies:
- advice for new guys
- protocol for injections

You should be injecting 100mg T ester per week. I cannot tell what you are doing from your description. Your high E2 may be from too much T. E2 can be high from liver issues, need lab work ALT/AST

E2 will not cause thrombosis. That is a risk to anyone who does not move around in their seat. Your low body weight may make blood vessels more vulnerable.

AI drugs do not cause the side effects that you are concerned with; low E does that. Properly dosed - no problem.

Aromasin does not work for everyone. Anastrozole is more effective and you only introduce 1mg/week of a drug into your body.

How do you know what you are doing with Aromasin without lab work? With your T injections, T levels are slowly increasing for a while, E2 levels are increasing. You are not steady state.


#3

Hi KSMan,

Thanks, I definitively will read and carefully...

Just for adding more information regarding your points underscored I also include the following:

  1. I am currently injecting 125 mg of enanthate per week (3 SQ shots M, W, F, 42 mg each which, given the concentration is about 17 ml/shot). It is an ampule of Primoteston depot from Bayer that I distribute among 6 SQ syringes 1/2 inches long and 29 gauge).

  2. I am very careful measuring E2. I have taken like one every 1 or 2 weeks for the past 3 months and definitively my E2 has never been low. The lowest was 16 and that is after I have taken enough aromasin and about 1 week after the shot.

I can tell you that when I was in my previous protocol (1 shot of sustanon every two weeks or 250 mg IM at once) my E2 used to take off immediately. I used to take tests two days after the shot and it was around 65. That is why I started aromasin. It has helped but not as much as I would like, and it seems with diminishing returns (took me around 1 week to stabilize the E2 and take it to 20). Trying to stabilize the levels and slow down the release is why I adopted the SQ protocol.

  1. The thrombosis was a combination of elements of which being seated too long was the main factor, I agree. But, there is evidence that high levels of estrogen predispose the body to a thrombo. My thrombosis occurred two days after the shot, which is, according to my E2 pattern, when the E2 is peaking.

  2. I also have lipids problems. low HDL (around 38) and high LDL (160, but it was 177 9 months ago...just because of exercises) and triglicerids (91 it was 120 a year ago...exercises again). My diet is clean and I do a lot of exercise (cardio + weights). I am now 150 pounds, not shredded but I would say good shape. What I am saying is that I have read about the potential impact of arimidex on lipids. I think that someone said on this forum that as long as the anastrozole does not reduce E too much then it would not mess with your lipids...I guess I am going to find this information on the readins right?

But of course, I am going to read...Thanks (and I mean it, thank you...you are helping a lot of people for free here)


#4

OK, this is an update,

Recently (june 3 2013) got lab results and there is something that is worrying me a lot: CHOLESTEROL.

But before the other results:

Estradiol: 26.3 less than 54...it means with SQ and 40 mg per shot I am more or less controlling estradiol...but it seems at a high
price (see cholesterol problem below). However, currently my libido is nonexistent and feel lethargic and sleepy, so
it seems that my testosterone is low (I didnt take the testosterone test, but I knew that if my estradiol was under
control it would only mean that testosterone was low. So it seems that 125 mg a week of testosterone is too little for
me. I think I am going to increase it a bit (After a couple of years in this you learn to listen to your body and I knew
my current symptoms were from low testosterone as opposed to high estradiol).

TSH: 2.4 (0.27-4.2)

AST: 18 (10-42) KSMan requested this to check liver.
ALT: 38 (20-65) Same as above

Leukocyte: 4.8 (4.5-10.8)
Erythrocit: 5.38 (4.2-6.3)
Hemoglobin: 16.8 (13.5-18)
Hematocrit: 50.4 (40-52)
MCV: 93.8 (78-100)
MCH: 31.2 (25-35)
MCHC: 33.3 (32-36)
Platelet: 195 (150-450)
segmented: 37 (40-70) This one and the one below have been out of the range since I have been measuring blood (2007)...
lymphocyte: 60 (20-45) ...Why do you think? I think I am going to visit an hemathologist for this...
monocyte: 2 (0-10)
eosinophil: 1 (0-6)
basophil: 0 (0-3)
cel en banda: 0 (0-6)

Ok, now the new problem (well, not that estradiol is completely under control, but this one is worrisome)

Total Cholesterol: 250
HDL: 44
LDL: 182
Triglicerids: 118
Lipid Ratio: 5.7

The problem was that 5 months earlier (January 12) the levels were:

Total Cholesterol: 215 less than 200
HDL: 37 more than 50
LDL: 160 less than 130
Triglicerids: 91 30-175
Lipid Ratio: 5.8 4.8-5.9

And 10 months earlier (august 12), same ranges:

Total Cholesterol: 231
HDL: 37
LDL: 170
Triglicerids: 121
Lipid Ratio: 6.2

And 14 months earlier (april 12):

Total Cholesterol: 243
HDL: 42
LDL: 177
Triglycerides: 119
Lipid Ratio: 5.8

So, you can see that LDL, triglycerids and cholesterol were in a downward trend. However something happened from January 2013 to the present. In that period (5 months) for example, triglycerides increased by 30 percent !!!

My diet is not perfect but clean (skim milk, no sweets or cookies or desserts, mostly chicken but not necessarily the breast). The only changes introduced in that period were:

1) Three daily teaspoons of grounded flax seed (morning, lunch, dinner)
2) Testosterone 250 mg IM every two weeks (sustanon). Before it was enanthate every 4 weeks. And the two weeks before the blood test 3 SQ shots of Primoteston depot a week (40mg each small shot)
3) Aromasin to manage estradiol

My best guess is that the aromasin messed up my lipids. I therefore, would be very nervous to adopt the protocol presented in the forum since Arimidex (the recommended AI) is theoretically even worse on the lipids. I know that the argument is that as long as estradiol is around 22 there should not be an effect of Arimidex on Lipids, but theoretically also Aromasin should not have messed up the lipids and it seems it did (although I am open to alternate hypothesis).

Add to that that my estradiol has been either high or under control but never low (during the 5 month period Jan-Jun 2013 at least):

Estradiol (range less than 54, but above 25 is poison for me)

11 Jun 11: 30 (On proviron 3 pills a day)
28 sep 11: 37 (On sustanon 250 1 shot every four weeks)
18 oct 11: 41 (same as above)
24 nov 11: 34 (One week earlier I had thrombosis, had to stop TRT for almost a year)

18 april 12: 14 (not on TRT yet)
28 aug 12: 14 (started TRT but one shot of test. enanthate 250 mg / 3 ml every 4 weeks, this is at the fourth week)

05 march 13: 62 (two days after the sustanon shot)
14 march 13: 16.4 (after three days of aromasin)
22 march 13: 20 (day before the T shot)
26 march 13: 56 (again two days after T shot)
02 april 13: 20 (after aromasin control)
24 april 13: 44 (two days after T shot with aromasin the same day of shot)
2 may 13: 35
3 june 13: 26 (With SQ shots and aromasin control around 1 1/2 pills a week)

I am all ears...thanks


#5

Are you also on HCG? If so drop it for four weeks. Stick with your T dose and 12.5mg of Aromasin a day.


#6

brentf

No, I am not on HCG. I would prefer to learn to control my estradiol and my cholesterol before adding something else to the equation.

ah, and by the way I really think that I need to push up the dose of testosterone. Since I started to SQ (about 2 1/2 weeks) I have lost 3 pounds... this is worrisome for me because I am just 150.5 (well, was, I am now 147.8). That is another symptom of low testosterone...moreover when I started TRT I was just 130 pounds (a walking skeleton, since I am 1.69 mts high).

So it seems that I can increase my testosterone with the shots but need to control estradiol with AI, but then my system replies with increasing my cholesterol...a dead end!!

By the way, I think that I am going to switch back to sustanon 250 and drop the primoteston depot (enanthate bayer) because of costs. The first is about $7 and the second is $15. I live in Central America and for me cost is an issue.


#7

"But, there is evidence that high levels of estrogen predispose the body to a thrombo."
- if you mean with women on oral birth control, that does not apply. That problem is from two effects, progestins [fake progesterone] and estrogens that both reduce HPOA activity resulting in less progesterone production in the ovaries. They end up with progesterone shut down and progestins in there systems. Estrogens cause endothelial dysfunction [google that] when estrogens are not balanced by progesterone.

Progestins are not cardio protective like progesterone. Otherwise normal women have way more estrogens than you and they do not have the problems that you are thinking about. You need to be able to properly read and eval info that you find and need to understand context. So stop spinning that story that others may read.

There are guys who naturally have E2 levels in the range that we are seeking and they do not have cholesterol problems. I think that the answer lies elsewhere. Anastrozole does not create such issues, only low E2 levels. Cholesterol is made in the liver, there may be some connection there. Your liver markers are OK.

Cost: Can you get T in 10mg multi dose vials instead of ampules? Talk to pharmacists to find out about options.

More T: Watch your hematocrit, you really do not want to be much beyond current levels. 52% is cut off in USA.

Elevated Lymphocyte: http://en.wikipedia.org/wiki/Lymphocyte#High
This is not something for a hematologist! Your body is simply reacting to something like a low grade viral infection or challenge and it doing its job. Have you felt ill recently before the lab work?


#8

Hi KSMan,

thanks for the reply.

1) Yes, I noticed the hematocrits...damn, I think I am going to stop the shots before I evaluate what to do...at least for today. I havent bought the testosterone yet but I wont do it until I clear my mind. Phlebotomy maybe an answer? there is even an equation to calculate how much blood to get extracted to reduce red cells...not sure if the procedure is performed here in my country...

2) There are only three brands of testosterones available here:

Sustanon 250 (prefilled syringe) about $7
Lento Martone (test. enanthate 250mg/3ml, ampoule) about $5.5
Primoteston depot (test. enanthate 250mg/1ml, ampoule) about $15

The problem with Lento Martone is the concentration...it would require a lot of ml to be injected into my fat (using SQ shots right now). Dr Cresler mentions that it is not recommendable more than 40ml per shot ... opinions are more than welcome.

I open the ampoule, extract the medicine and prefill SQ syringes and keep them away. So far I just injected 6 doses.

3) About elevated lymphocytes, I know that that is a response of the body to a virus...but the problem is that lymphocytes have been elevated for ... forever!!! I started measuring them in 2007 and they were already out of range... same with the segmented ones...only low... I am of course afraid that something is lurking behind those out of range numbers for so long.

4) About high Cholesterol: Something hapenned between january and may that increased abnormally my bad lipids (and good ones). That was not natural; I mean my lipids were not OK, but the trend was downward thanks to the aerobics mostly and good diet. I am also trying to figure out the culprits and for that I came up with what new entered in my system in that time.

It comes down to:

a) Aromasin
b) Testosterone IM
c) Testosterone SQ
d) Ground flax seed
e) Creatine (about 5 gr. on training days)
d) Glutamine (about 5 gr. on training days)

See? If you have to pick out one, which one would be? I am not a tenth as knowleadgable as KSMan, but my bet is the Aromasin... I know I could be wrong, I am not trying to spin a story, that is why I am in this forum to learn how to live a quality live.

I dont want to be dramatic, but I really, really would love to see my kids all grown up ... and I dont see that happens, at least that is how I feel right now:

-If I keep on with the TRT and AI either my Cholesterol (medium term) or a polycythemia (short term) is going to kill me
-If I quit then well a prostate cancer or heart is going to pull the trigger.

5) About the estradiol and thrombosis: Again, I am not trying to misinform anyone, not trying to spin a story, and if it seemed like that I apologize. I had in my mind the research of Dr. glueck that goes like this (and I did not mention that a genetic anomally was required for the argument to work, so my argument was flawed...KSMan came with an argument that, well will take most of the rest of the week for me to research and understand if maybe):

"When men are given testosterone, either by application of an androgen gel or by injection, some of that testosterone is coverted by the body (aromatized) to the female hormone, estradiol. If men have an underlying inherited trait which increases their risk of blood clotting, particularly the Factor V Leiden mutation, the Prothrombin gene mutation, high Factor VIII, high homocysteine, or the lupus anticoagulant, then the estradiol can interact with the underlying clotting trait to produce blood clots in the legs, the lungs, the eyes, the brain, and the bones"

I dont know if I can post external websites, so I wont do it ... if anyone knows it is correct then I can attach them later...

Maybe I have one of those genetic mutations...


#9

So, summarizing the previous post my questions are:

1) High hematocrits...should I do a phlebotomy? and if not possible here in my country should I stop TRT?

2) Could the testosterone concentration (mg/ml) be a factor in the rise of estradiol? if that is the case I could use a 250mg/3ml instead of the 250mg/1ml that I am using right now

3) How many ml per shot is the ceiling for subcutaneous?

4) Lymphocytes high and segmented low (both out of range) for years? What should I do? could be off topic or not, maybe related ...

5) Cholesterol, LDL, and triglycerids increased a lot ... if not aromasin what could it be? what should I think or research?

Thanks for reading the previous posts and giving your best answering these questions... I am right now feeling down in the dumps and not (yet) because of low testosterone, but because I dont see a way to go...


#10

1) Can you donate blood. If you have a chronic virus that is screened by the blood bank service, then that will be discovered.
2) The lower amount of injected oil/fat is probably better
3) Not known, probably more of a comfort thing
4) What kinds of virus can be lurking for years?
5) Anastrozole would load the liver with a much lower mass of chemical.

More:
2) Increased E2 can also be an indication of impaired liver clearance of estrogens.
4) https://www.google.com/search?q=virus+infection+liver+wiki Look for possibilities that can also affect cholesterol levels. The TRT may not be causing the elevated cholesterol, but could be creating processing loads of a normal viral male on the liver that disclose a problem that was masked by your low testosterone levels. Note that liver markers are also not high, so subtile in that regard.

Creatine, synthesized in the liver and kidney. I briefly looked to see if creatine imposed any loads on the liver and did not see anything. You have hints of a viral load and changed liver function for cholesterol production. The immune issue predates TRT and is a background problem. Some things might be making some existing effects apparent and are not the prime cause. Note that TRT often decreases elevated cholesterol levels. So your case represents a cholesterol gain as shown by your labs plus the lost cholesterol decrease. There is also the possibility that you were destined to higher cholesterol levels, but you had some metabolic issues that impeded your liver's ability to make cholesterol. Then TRT has restored your livers ability to make cholesterol. Those are logical possibilities, not necessary correct.

I missed this: Before testing for low T I have had a battery of thyroid tests which came normal (including ultrasound and biopsy).
TSH=2.4 may be statistically normal in 95% of the population, but is is typically abnormal function and your doc must have done the biopsies because of enlargement and lumps. Please post: TSH, fT3, fT4, T3, T4 rT3 if available. Read the thyroid basis sticky. Post your history of iodine intake from iodized salt or from vitamins that list iodine. Post your waking and mid afternoon [not mid day] oral body temperatures. Please report in F degrees, show C as well if measured that way.

Get thyroid info above and ping me again.


#11

Thanks KSMan,

THYROID ISSUES:

I read the thyroid sticky and learned the importance of body temperature. Today I measured mine and these are the results:

Wake-up temperature: 36.4 C (97.52 F)
Mid-afternoon temperature: 36.55 C (97.79 F)

These are the available test results related to thyroid:

T3: 95.83 ng/dl (84-172) May 2011
T4: 9.41 ug/dl (4.5-12.5) May 2011
fT3: 3.5 pg/ml (2.1-4.7) June 2011
fT4: 1.21 (may 2011) 1.5 (June 2011) 1.58 (October 2011) (0.9-1.70)
TSH: 2.66 (may 11) 1.3 (june 11) 1.0 (oct. 11) 2.1 (april 12) 2.4 (june 13) (0.4-4.2) uUI/ml
Anti-thyroglobulin: 39 UI/ml (less than 120) June 11
Anti-microsomal: 53 UI/ml (less than 65) June 11
rT3: Not available

ADRENAL GLANDS:

Cortisol AM: 6.8 mcg/dl (5-25) april 2012
Cortisol PM: 6.8 mcg/dl (2-12) april 2012

Androstenediona:
0.4 (april 2012) out of TRT for 5 months because of thrombosis
1.6 (aug. 2012) on T enanthate 250mg every 4 weeks
0.4 (jan. 2013) on T enanthate 250mg every 3 weeks

Glucose fasting: 95 (oct 2007) 89 (aug. 2009) 92.6 (jun. 2011) (70-110) mg/dl
Glucose 2-hours: 100.8 (jun. 2011) (70-155) mg/dl

THYROID ULTRASOUND:
Thyroid of normal size and outline, its ecogenecity subtlety and diffusely enlarged with a bare enlargement of perivascular connective tissue. There are not solid nodules. No calcifications
right lobe: 3.5 x 1.2 x 1.4 cms
left lobe: 3.6 x 1 x 1.3 cms
there are some cervical and maxillary nodes (ganglion?) of reactive inflammatory type, of no clinical importance

Remember that my first endo told me that the size was not totally OK, especially for males, and the touching was somewhat painful (although he pressed strongly...I told him this and he said I should not respond with pain for such pressure).

Thyroid byopsy:
In favor of minor chronic lynphocytic thyroiditis

The endo put me on levotiroxin (eutirox) 25mgs 1/2 pill everyday. I had this treatment for some months (started on august 2011), but with the thrombosis I had to stop...actually I dont really remember if I stopped because of the the thrombosis (november 2011) or because my new endo told me so (march 2012). To be honest I did not feel anything new while on eutirox. It was like taking a placebo.

IODINE INTAKE:
Well, I dont take any iodine supplement. My iodine intake should come from salt which is iodized. I dont know if this is enough, but body temp. seems to imply no problem (that is what I got from the sticky...)

LIVER IMPORTANT INFO:

  1. I had hepatitis when I was a kid (1984: remember perfectly because when back from the doctor I was put to extreme rest and to eat sugars like crazy and watch the Los Angeles Olympic Games on TV). Do not know what type.

  2. I had one more old test for the liver biomarkers AST ALT:
    AST: 15.1 (aug. 2010) 18.1 (june 2013) (0.01-38)
    ALT: 15.8 (aug. 2010) 38 (june 2013) (0.01-41)

So the ALT although within range, has increased a lot...although I dont know if steroids or AI influence the results.

Clotting function Liver
Prothrombin time (day I started warfarine, but before first dose): 13.4 (10-16) 21 Nov 2011
INR: 1.05 (0.7-1.3) 21 Nov. 2011

Creatinine: 0.78 (oct 2007) 0.7 (aug. 2010) (0.6-1.2)

Abdominal Ultrasound: Liver Apparently Normal 2011

PLUS: REVISTING BLOOD ABNORMAL RESULTS: PLAYING SOME ROLE? Lymphoc. and segmented out of range always!!!

Lymphocytes: 62(oct 07) 47.9 (aug 10) 59.6 (jun 11) 52.6 (nov 11) 63.1 (29 nov 11) 57 (aug 12) 56 (jan 13) 60 (jun 13) (20-45)
segmented: 31(oct 07) 42.5 (aug 10) 33.3 (jun 11) 37.5 (nov 11) 27.6 (29 nov 11) 38 (aug 12) 38 (jan 13) 37 (jun 13) (40-70)

Summarizing:

  1. I will donate blood this week...is it OK even if one is/was on TRT? had hepatitis?
  2. A week without TRT because of high hematocrits plus high cholesterol plus high estradiol...

So, this is the puzzle we have:

  1. Counterintuitive reaction of my body to TRT+AI in terms of Lipids
  2. Counterintuitive reaction of my body to TRT+AI in terms of E2 (not tried yet anastrozole, but afraid because of 1.)
  3. High hematocrits (blood donation seems the answer)
  4. Abnormal lymphocytes+segmented for long time (related somehow??)
  5. New info related to thyroid+liver not yet analyzed..

Could it be the liver (but biomarkers and clotting time OK...although ALT increasing...could it be because of steroids or we have a real clue here)? thyroid? (but eutirox didnt bring out any change) something before liver or thyroid (adrenals? but cortisol OK) else?

Before starting TRT I already had high cholesterol (could be that I was genetically predetermined to have high cholesterol), but I attributed it to low T. Then I started T but due to lack of knowledge I was injecting every 4 weeks and it did not bring any change to my lipids. I attributed it to lack of regulation of T therapy. It was until I started injecting every two weeks or SQ EOD or using Aromasin that my lipids crashed and interrupted a downward trend brought about by the introduction of cardio to my routine.

What should I do next?

What do you think KSMan? Other guys in the forum?

Thanks for your time...


#12

There is something chronic going on and your immune system seems to indicate viral activity. Your situation is very confusing.

Body temps seem low. Have you repeated measurements?

Blood donations: do not know if past hep would disqualify.

"Hashimoto?s thyroiditis is also known as lymphocytic thyroiditis"

"of no clinical importance " <-- not enough to warrant treatment, does not mean things are OK.
"cervical and maxillary nodes (ganglion?) of reactive inflammatory type" <-- indication that immune system is active
"Thyroid of normal size" Normal is a statistical range, does not imply normal health


#13

Body temps:

-assuming your measurements are good. Do not be talking, eating, drinking or exercising for 30 minutes prior.

Your fT3 should be creating better body temperatures. When this does not occur, one needs to suspect that rT3 is interfering with fT3.


#14

Hi everyone,

I have collected new information regarding my case, which, nothwistanding is not helping in explaining neither why I have not responded well to the TRT nor what should I do about it.

First what have I done since my last post (1 year).

  1. Stop T shots because:
    a) high hematocrits
    b) lost control of estradiol
    c) lipid profile deteriorated

  2. Discovered I had two major problems:

a) Gene defect: homozygous MTHFR C677T...So my body is not processing very well Vitamins B (6, 12, Folic Acid).

b) Low Vitamin D (22.7 ng/ml range 30-100)

I have to add that staying out of T has had an impact in my weight loosing 15 pounds (I was 150 and now 135 lbs looking emaciated with 5'7''

SEE BELOW FOR BLOODWORK JULY 2013 A COUPLE OF MONTHS AFTER I STOPPED TRT

So, I started taking Vitamin D supplements (first 50,000 I.U per week and later on after stabilization 15,000 a week). Now my level is 64, which is OK. This has helped me a lot in terms of inmune system. Basically, almost a year without a major cold whereas I used to have 4-6 really bad colds every year.

Also, started taking Vitamin Bs, a supplement called homocystex Plus...

My doc told me that because of the homozygous defect it would too dangerous to restart TRT...although finally we agreed that the real danger lies on getting estradiol too high. See, high estradiol interacts with the thrombophilia (i.e. elements that can trigger a thrombosis...such as being homozygous...other are Factor V Leiden etc...). This is of importance to me because I suffered thrombosis while on TRT back in november 2011 and high estradiol interacting with my homozygouscity was the probable culprit.

Other than that I suspect I have insulin resistance. My glucose was 100 and it was 89 in 2010. My insulin was 6.4 uIU/mL in July 2013 (lowered to 5.6 in April 2014). I suspect this is caused by low T, so it makes me keep trying to start TRT again. Remember that I am lean and my diet is OK (not perfect maybe but I dont eat bad carbs or drink alcohol...well, maybe a couple of beer every two months).

Ok, so I decided to restart TRT 2 weeks ago. To do that I had a bloodwork that could serve as a baseline:

PSA 0.5 (<4)
Estradiol 26.7 (<54)(It was 7 in July 2013...started vitamin D in september and in november 2013 estradiol was 19.4. Above 30 for me is poison
Vitamin D 64ng/ml (30-60)
C-reactive protein 1.6mg/L (0.1-3) according to LEF it should be <1
total cholesterol 192 (<200) Hurra! it was 227 in jul. 2013 maybe Vit. D?
LDL 135 (it was 161 in july 2013)
HDL 37 (it was 44 in july 2013)
triglicerids 101 (it was 108 in july 2013)
Insulin 5.4 (it was 6.4 in july 2013)
glucose 104 (it was 100 in july 2013)
hematocrits 43.6
hemoglobin 15
FSH 4.9 (0.7-11.5)
LH 3.8 (0.6-7.4)

I wanted to be very cautious so decided to do it in really small quantities to avoid aromatization and avoid also the use of AI (doc told me that AI are thrombophilic too and even if this is not true my experience with aromasin was not pleasant - it destroyed my lipid profile increasing LDL and lowering HDL).

I chose SQ shots of about 10 mg of testosterone (primoteston depot from bayer). I planned to do it daily. Got first shot saturday May 3.

Around 20 hours later I started to feel the symptoms of aromatization...hot flashes on the left side of my face. Up until today I still feel the symptoms of high estradiol (irritability, hot flashes on arms and face).

I only could get one shot, so with only 10 mg of testosterone my body started to aromatize excessively. So, I decided to stop and look for what to do about this.

It is the same result: Excess aromatization....let´s review the events that make me claim that:

  1. In mid 2011 started proviron 3 pills a day...first 15 days were the most incredible days of the last 10 years...but it all ended after that, with symptoms of high estradiol (did not know about estradiol back them, but the Free T test showed it was around 8 when "normal" started at 11. Now I know or I hypothesize that my body adapted to the increase in T elevating E2.

  2. Testosterone shots (immediately after proviron failure sept-nov 11). It helped me gaining weight but I could notice hot flashes, irritability and the T test kept indicating low T. Again, high E2. This high E2 along with homocygousity were probably the causes of my thrombosis in Nov. 2011 . Again, my body reacting to high T. although I have to say that were shots of 250mg every 20 days. So one could say that all I needed was an AI...well, I added that to the equation....see below.

  3. It comes the weird thing: I learned about E2 and restarted testosterone along with Aromasin in January 2013. 250mgs shots once a month. First aromasin doses had an effect but subsequent doses had less and less effect on E2 until I was taking 1 pill of aromasin (25mg) everyday. My body circumvented the exemestane and learned to keep producing E2 somehow. Had to stop because of this (did not know what to do) and because hematocrits above 50%.

  4. Without T my estradiol goes down to around 7 (no fuel no fire). Recently started taking Vitamin D and lo and behold, the E2 increased from 7 without T to 27 with Vitamin D. I have read that Vitamin D could increase T, so my best guess is that my higher level of Vit. D tried to increase T, but because my body hyperaromatise it turned all T into E2, increasing it as it occurred.

  5. Recently last attempt was to inject SQ shots of small doses of T (10mg) to see if I could got away with it. Failed. Just the first shot increased E2. Can you imagine it. In less than 24 hours the symptoms are there (irritability, burning sensation in the skin, especially arms and left side of face).

Theories why my E2 increases so much:

  1. Could be that my T receptors are saturated/damaged from prolonged periods of high E2 (dont know how to prove/test it....just from readings around the internet). By the way, it has been 12 days since I injected myself with 10mg of T and still have symptoms of high E2...how long would it take for the body to get rid of excess E2?

  2. Could be an unbalanced of progesterone (not sure whether progesterone imbalance could provoke such reaction as this hyperaromatization).

  3. Insensitivity to AI means the E2 is finding ways to proliferate...dont know how or if this is what is happening.

  4. Liver not cleansing excess estrogen? Mmmm...not sure, liver functions are fine (ast, asp) besides, the estrogen binds to other places besides liver right? (brain, heart, testes, bones), so even if liver is doing its job the excess could be accumulating in some other places.

  5. Insuling insensitivity? My glucose is rising (last year was 100, now is 104 and insulin is 5.6). This is something I consider a result of low T...I guess this is the mechanism by which low T is trying to kill me.

So, what do you think is going on here? What is behind this excess aromatization or hyperaromatization and why? What should I do about it?

As usual, thanks in advance for your help

BLOODWORK JULY 2013

Glucose 100 mg/dl (65-99)
BUN 18mg/dl (6-20)
creatinine 0.79 mg/dl (0.76-1.27)
sodium 139 mmol/L (134-144)
potassium 4.1 mmol/L (3.5-5.2)
Chloride 102mmol/L 134-144
carbon dioxide 21 (19-28)
calcium 9.4 (8.7-10.2)
protein 7.4 (6-8.5)
albumin 4.6 (3.5-5.5)
globulin 2.8 (1.5-4.5)
bilirubin 0.7 (0.0-1.2)
alkaline phosphatase 74 (25-150)
AST (SGOT) 21 (0-40)
ALT (SGPT) 19 (0-44)

Cholesterol 227 (100-199)
Triglycerides 108 (0-149)
HDL 44 >39
LDL 161 (0-99)
VLDL 22 (5-40)
HOMOCYSTEINE 9.2 (0.0-15.0)

TSH 2.4 (0.45-4.5)
T4 7.2 (4.5-12.0)

insulin 6.4 (2.6-24.9)
C-peptide 1.6 (1.1-4.4)

hemoglobin 16.2 (12.6-17.7)
hematocrit 48.4 (37.5-51) Had 3 months since stopped TRT because in part of high hematocrits so that is why they were still relatively high...now are OK

neutrophils 31 (40-74) LOW FOR TEN YEARS IN A ROW NOW ...?????
Lymphs 60 (14-46) HIGH FOR TEN YEARS IN A ROW NOW...?????

Testosterone total 184 ng/dl (348-1197)
testosterone free 4.5 pg/ml (8.7-25.1)
Estradiol 7.5 pg/ml (7.6-42.6) now is 26.7...I argue that it is because higher level of vitamin D tried to increase T and it all converted to E2

Hemoglobin A1C 5.5 (4.8-5.6)
Vitamin D 22.7 (30-100)
methylmalonic acid 100 (73-376)
uric acid 4.8 (3.7-8.6)
PTH Intact 29 (15-65)


#15

"I keep with the same issue of excessive aromatization, that overcomes 1) the use of AI (aromasin) like last year and 2) minimal amounts of testosterone (one shot of 10 mg of testosterone immediately caused the effects of excessive aromatization:
":

I wonder if your body struggles with these ingredients:
Inactive ingredients:

benzyl benzoate
castor oil

Try to avoid the above and see what happens.

Ask if you can get a product that is cotton seed oil based with benzyl alcohol
- these might be found in T cypionate product.

T ethanate used to be sesame oil based and you could also look for that.

T-->E2 will always occur to some degree. In your situation, I suspect that your liver is not able to remove estrogens from your blood stream. This can be from a liver problem or from Rx or OTC meds that load up the same enzyme pathways that also process estrogens. Do you have any RECENT liver ALT/AST lab work with ranges?

"low neutrophils high Lymphs ":
- have you been screened for chronic viral diseases, auto immune diseases etc
- any exposure to tropical diseases

" feel the symptoms of aromatization" or something else like a sensitivity to the inactive ingredients

C-reactive protein: this is general inflammatory marker, probably related to the cause of "neutrophils high Lymphs"

FSH 4.9 (0.7-11.5)
LH 3.8 (0.6-7.4)
- indicated that the top end of your HPTA is trying to work.

AI - anastrozole never has any effect on the arteries. When the dose is too high and E2 is very low, the low E2 can have adverse effects on the arteries and lipid profiles. And estrogens need to be balanced. In women, estrogens are balance with progesterone and DHEA [but not with progestins]. In males, estrogens are balances by DHEA and testosterone. DHEA declines with age as do progesterone in women and testosterone in males. So you need E2 near 22pg/ml and high normal TT and FT for your arterial health.

For your arteries, you also need:
Ubiquinol form of CoQ10, 50 or 100mg [not cheap\
Fish oil, flax seed oil/meal, nuts
High potency B-Complex multi vitamin with trace elements, including selenium and iodine -150-180mcg]
vitamin C
vitamin E natural source
and other antioxidants
80mg aspirin

You have hypothyroidism. No recent fT3. Still suspect rT3
Your chronic cause of "low neutrophils high Lymphs" may be contributing to rT3

You should try a large amount of iodine and see if that helps.

I disagree with many of your assumptions and perceptions about what is going on.

TRT can have bad effects on top of thyroid and/or adrenal problems.

Gene defect: homozygous MTHFR C677T
you have a 35% reduction inMTHFR enzyme.
- increases risk of thyroid problems

I think that you need to resolve your thyroid and body temperature problems and your low temperatures and mid-range fT3 strongly suggests that rT3 is elevated. Please re-read the thyroid basics sticky and look at references to fT3, adrenal, cortisol, stress, chronic infection etc.


#16

KSman,

Thanks my friend...as always your ideas help me to start new searches...

1) About INACTIVE INGREDIENTS....
Well, it is interesting what you say about the inactive ingredients of the testosterone possibly inducing some sort of anaphylaxis...however, I dont think that is the case. Let me explain. I have had about 5 attempts to start TRT and all of them have failed because of high estradiol (measured in a lab, not an assumption) including the first attempt carried out with Proviron. Then it came Sustanon 250, then Lento Martone (national brand, I do not know the inactive ingredients) and Primo teston (bayer). With Proviron the first two weeks were fantastic: increased 5 pounds of muscle weight (hungry all the time), high energy, high libido...nirvana, nothing less....but two weeks later it came the crash: hot flashes, lack of energy, lost of muscle, etc. and high estradiol (Measured in labs). All other episodes: the same (estradiol measured). So in essence, if the ingredients were the culprits why the Proviron increased the estradiol, and more importantly why it always comes with high estradiol (not a symptom of anaphylaxis)...What do you think?
I found a theory about cortisol downregulation quite interesting (a guy called chilln), which I present later, but my labs do not agree with it I guess (see lab results of thyroid and adrenals below)

2) Regarding the AST ALT These are my results:
AST: 15.1 (aug. 2010) 18.1 (june 2013) (0.01-38)
ALT: 15.8 (aug. 2010) 38 (june 2013) (0.01-41)
I guess they are Ok enough to think my liver is working decent enough cleaning toxins...

3) Regarding "low neutrophils high Lymphs ":
- have you been screened for chronic viral diseases, auto immune diseases etc
- any exposure to tropical diseases
I really feared this one, and I have no clue whatsoever...do you have candidates for the chronic or auto immune or tropical which could cause this low neutrophils high Lymphs results? How to proceed here? I can tell you no HIV here (already tested).

4) Regarding Thyroid and Adrenals...
Ok, so in essence I was thinking it may be a thyroid problem or adrenal problem and this is because I read a guy called chilln that says something like this (his theory, not mine, but I have to admit appealing):

WHAT EXACTLY IS CAUSING HORMONES TO GO TOO LOW ? (CHILLN FROM ALLTHINGSMALE, NOT MINE)
The Problem

a) First and foremost, genetic aging causes a relatively large downregulation of our overall metabolsim, specifically by downregulating our cortisol-production-line (includes pregnenolone, progesterone, and cortisol)

b) Even if we manually force maintain our cortisol-production-line at a more youthful throughput, our genes still downregulate our overall metabolic rate by downregulatig our thyroid hormones T4 and T3 to a lesser degree than it would downregulate our cortisol-production-line.

c) If we allow the gradual downregulation of our cortisol-production-line, this feeds back on our liver, which ramps up our LDL cholesterol ! Our liver has the capacity to detect too low pregnenolone (independant to ACTH) and ramps up synthesis of LDL cholesterol in preparation for that LDL cholesterol to be used as raw material to synthesize pregnenolone. But too little of the LDL cholesterol is synthesized into pregnenolone, leaving LDL cholesterol too high.

d) If we allow the downregulation of our cortisol-production-line, this causes too low cortisol, and since we use cortisol as our primary downregulator of our T (testosterone) metabolism, this means T metabolism would be upregulated if the body didn't take evasive action. But our T metabolism is extremely tightly controlled, and this becomes obvious when our body switches from using cortisol to downregulate our T metabolism, to using high levels of E2 to downregulate our T metabolism.

e) High levels of E2 don't provide the optimum neurotransmitter mix from our previously high levels of pregnenolone, and the neurotransmitter mix from high E2 contributes heavily to erectile dysfunction.

f) Even if we force restore our cortisol-production-line, and reduce our E2 back to optimum levels, the number of our testosterone producing leydig cells in our testes are also gradually reducing (not known if this is due to damage or genetic downregulation).
Reduction in leydig cells reduces our pregnenolone, progesterone, DHEA and T but not our E2 (explained above) In order to maintain T metabolism, our body upregulates the synthesis of T into DHT. DHT is more strongly androgenic than T.

g) Gradual downregulation of GH (growth hormone) HERE ENDS CHILLN QUOTING...STARTS ME AGAIN:

So I proceeded to have tests on my thyroid and adrenals (not salivary, not available here):

Thyroid (July 23, 2014)

TSH 2.0 miu/ml (0.4-4.2)
fT4 1.6 ng/dl (0.8-2.0)
fT3 2.9 pg/ml (2.1-4.7)
thyroglobulin antibodies 22 ui/ml (<120)
thyroid peroxidase antibodies 17 ui/ml (<34)

Adrenals and related (July 23, 2014)

Progesterone: 0.5 ng/ml (<0.8)
Cortisol A.M (8:00am) 13.5 mcg/dl (5.0-25.0)
Cortisol P.M (4:00pm) 12.3 mcg/dl (2.0-12.0)
ACTH (8:00am) 78.7 pg/ml (20.0-100.0)
ACTH (4:00pm) 42.4 pg/ml (20.0-100.0)
17-ketosteroids 9.1 mg/dl (12.0-38.0)

Estradiol 17.2 pg/ml (<54)
SHBG 33.0 nmol/l (13.0-71.0)

Besides, I had to monitor my glucose for 10 consecutive days 6 times a day with a glucometer:

Before breakfast: 110, 116, 123, 104, 110, 110, 118, 112, 110, 117
Two hours after breakfast: 123, 112, 110, 102, 109, 111, 118, 103, 121,110
before lunch: 106, 107, 111, 118, 101, 110, 110, 116, 110, 113
Two hours after lunch: 94, 119, 101, 115, 99, 99, 117, 98, 94, 121
before dinner: 97, 97, 118, 103, 108, 112, 108, 110, 105 (missed last day measure)
before going to bed: 133, 108, 125, 126, 103, 117, 129, 142, (missed last day measure)

So in general I dont see anything really, really abnormal about the thyroid or the adrenals that could really validate chilln downregulation of cortisol that could be turning estradiol as the mechanism to upregulate T...which left me again lost in space...what is causing my excessive T--->E2 conversion that is turning my life in hell?


#17

think that you need to resolve your thyroid and body temperature problems and your low temperatures and mid-range fT3 strongly suggests that rT3 is elevated. Please re-read the thyroid basics sticky and look at references to fT3, adrenal, cortisol, stress, chronic infection etc.

Further to that. It is known that some guys crash on TRT when their metabolism cannot keep up with the increased/restored metabolic demands of TRT. This can be functional hypothyroidism or cortisol problems and these two can be intertwined with elevated rT3 So this can explain your negative TRT events.


#18

Ok, let me see if I understand:

I guess you agree with the Chilln reasoning that it is a (thyroid + adrenals + maybe chronic infection) that are behind my excesive aromatization.

Moreover, I understand that you are saying that my thyroid results are OK but my low body temperatures indicates hypothyroidism which would require iodine or T3 supplementation?

By the way, I have temps. measurements for a 12-day stretch (from june 3 to june 13, 2014):

wake-up: 97.4, 97.8, 96.9, 97.3, 97.5, 97, 97.3, 97.3, 97.2, 97.5 (missed just one day)
before lunch: 97.5, 98, 96.9, 96.4, 96.8 (not measured everyday)
before dinner: 97.5, 97.9, 97.3, 97.3, 97.9, 97.9, 97.1 (not measured everyday)

What about adrenals? Last week I tried with Panax Ginseng (adaptogen) and the experiment backfired...experienced same symptoms of high estradiol (hot flashes only on face...not arms as usual, and libido crashed) so after 10 days I stopped and two days after libido better (I have to admit that Vitamin B supplement especial for homozygous MTHFR C677T + Vitamin D seems to help me in this department).

HERE IS WHAT I THINK I MAY DO NEXT (PROPOSED TREATMENT):
T3 supplementation + Progesterone + other adaptogen not estrogenic like rosea or ashwaghanda (read that ginseng is estrogenic) and after X days: SC shots of testosterone (without benzyl benzoate or castor oil, if possible) + Arimidex,

MY QUESTIONS:
1) What do you think of this? My only doubt would be with the progesterone since my bloodwork says that it is 0.5 (optimal <0.8) which seems fine? What would be X in this case?

2) I couldn´t find in the sticky candidates for chronic infections that could be causing "low neutrophils high Lymphs", really please if you could tell me some ideas so that I could investigate and start testing...?

3) Do you think that based on my glucose readouts I need to start metformin?

Thanks,


#19

I don't agree that those issues would create abnormal aromatization rates. I understand that you are trying to find the reason behind that, but that might be making you reach for conclusions that are not valid.

IF you are making a too much rT3 [fT4-->rT3], if you add more T4 you will get more T4-->rT3 and you could then have deeper hyperthyroid symptoms from blocked rT3. When you read about "adrenal fatigue" you will find that one can take more T3 and less or no T4 in the context of taking thyroid hormones. If not taking thyroid hormones, one could just take T3 and that might repress TSH and then less T4 would be produced, T4-->rT3 would drop and rT3 levels would decrease allowing more T3 of the now higher fT3 to get into the cells.

Your bodies odd over-reactions to different things might be related to your functional hypothyroidism. All cells and systems in your body are not functioning properly. There can be odd things with histamine over-reactions. Do you get itchy skin with the hot-flashes? As you can sense, there is a lot of guess work ...

SC testosterone is a slower and smoother delivery and your body may react differently. But you still have the issue of TRT not playing nice with thyroid and/or adrenal problems. Hypothyroidism, low T and estrogen dominance can make that worst.

(1) You are correct with the idea that your progesterone levels may be adequate. But perhaps not if your systems are not working right. You would want some progesterone cream. You can get KAL brand 2% progesterone cream at better health food and vitamin shops or Amazon. Your wife/GF might find that useful as well as many women don't have enough when younger and all are deficient when older.

(2) This can be from a chronic infection and the stickies touch on the effect of that and other stressors on the adrenals leading to elevated rT3. This is "adrenal fatigue" and you will want to read Wilson's book of that title.

(3) This is a problem that indicates insulin resistance: Before breakfast: 110, 116, 123, 104, 110, 110, 118, 112, 110, 117
You may be able to overcome that problem and metformin might be good during this time to protect you from the damage of higher glucose levels. The glucose levels are not severe and your doctor might not see the point, but metformin will not do any harm. When you get the thyroid hormone issue fixed, more fT3 in the cells will up-regulate the mitochondria and your metabolism will increase which will burn fats and glucose in the blood stream. A related issue is how fT3 and insulin work with the cell walls. The issue is cell wall permeability. EFAs [essential fatting acids] are very important for this function. And also related is insulin resistance were the cells start to down reduce insulin receptors and glucose levels rise and insulin levels rise and cells then become more resistant. Metformin can decrease insulin levels and stop that compounding problem. There is a lot of reading that you could do concerning nutrients and cell biology, search at LEF.com.

As suggested before:
Ubiquinol form of CoQ10, 50 or 100mg [not cheap\
Fish oil, flax seed oil/meal, nuts
High potency B-Complex multi vitamin with trace elements, including selenium and iodine -150-180mcg]
vitamin C
vitamin E natural source
and other antioxidants
80mg aspirin

Note that selenium is mission critical for proper thyroid function.


#20

The chronically elevated white blood cells is worrying.

I don't want to scare you but together with your weight loss problems could it be indicative of a blood cancer? Or, as Ksman said, a chronic infection (chronic Hepatitis B, for example)?

If I were you, I would stop messing with hormones now and definitely first see a specialist (hematologist?) to rule out cancer or infection.