T Nation

Need Advice for High E2

I could really use some advice. I’m 37 and have been on TRT for a year now. Throughout that year, I have read posts on this forum up and down as well as several other forums to educate myself and to have more informed conversations with my urologist. I think I’m pretty fortunate that he is actually aware of a lot of the topics on these TRT forums and has been open and receptive to my suggestions and info based on them. That said, I think we’re getting to a point where he doesn’t know where to turn and neither do I.
I have primary hypogonadism – my thyroid/FSH/LH, prolactin, cortisol etc. are normal. My comprehensive metabolic panels, lipid profiles, and CBC’s are all normal. I’ve lost 22 pounds over the past year (6’0 and 194 now) and can see quite a lot of lean muscle definition which I’ve never had before in my life. But I currently have high E2 (42.7pg/ml) and it’s just the worst thing ever.

So a little history:

In March 2015, I was started on T Cyp 200mg every 2 weeks which of course sucked. Then 100mg every week by last summer which didn’t seem any better. My T was up to 800, but would drop rather quickly to 125 by the 7th day. That seemed to me to be a pretty fast drop for something that has a half-life of 8 days, but maybe it’s normal. E2 was at 32. By the end of summer, I was telling the doc about what I was reading and how smaller, more frequent injections were supposedly superior. I told him I wanted to try that so he said let’s try 50mg E3D, and I could adjust a little up or down if I wanted. My T went up to 925, but I didn’t feel any better. I eventually went up to 60mg E3D by last fall and man that made all the difference. Throughout November and December, I can say that I felt better than I ever have in my life. And I should have, because my T was 1059.

Then things started to go downhill in January. I now have horrible acne on my back and shoulders and it’s starting to go down my arms. I physically cannot have sex. I’ve tried daily 5mg Cialis, I’ve tried taking 4 of those at once (doc’s suggestion) to get a “normal dose”, and I’ve tried 100mg Viagra. They all literally do nothing now whereas last summer, they worked great. I sometimes get morning wood, but it’s only like 50% I would say.

So to me it’s obvious that the high T has caused E2 to climb so much that it’s now more than I can handle. I’ve tried taking DIM Plus for several weeks in Feb and March, but it just didn’t seem to be strong enough. I pretty much demanded that I wanted an E2 test in mid-March based on my symptoms, and my doc was hesitant, but I got one. That’s how I know it’s 42.7pg/ml. And it’s actually likely higher than that, because that test was done while I was taking the DIM. So my doc finally acknowledges the E2 problem after seeing the rest results. but didn’t want to prescribe and AI even though he has mentioned that it is used in the past. He kept saying that well, it’s an off-label use and there isn’t a prescribed dosage for men. Sort of seemed like he was chickening out when it came down to it. I know all of that and suggested that I try a quarter tablet with each injection to see if it helps. But first he just wanted to lower the injections to 40mg E3D because the other docs that he consulted said my T should be 500-600 and not almost 1100. I just want to feel good and don’t care what number it’s at, but aside from the high E2, I have had no other side-effects from it being that high and all of my bloodwork is well within the normal ranges, so I didn’t see what the problem was. Don’t mess with what is working, and just fix the single E2 problem was my logic.

I’ll get another T and E2 test in about a week. Maybe E2 will be a little but lower, but obviously something is still wrong because I still have the exact same symptoms. If anything, I don’t have as much energy now. Not sure if that’s because of E2 or the lower T Cyp dose.

There isn’t much of a choice around here for switching doctors. It’s a rural area and there just aren’t many urologists. At least this guy has been somewhat open to my suggestions in the past, so I feel as though I’m better off than a lot of other guys based on stories I’ve read. Where can I go from here? Is there somewhere that I can point him to an AI dosage? Is an AI appropriate?

I’ve also read about HCG, and how that helps ED and low libido in some guys for what seems like an unknown reason. It sounds like it is mostly prescribed to keep a guy’s sperm count up, but I had a vasectomy 7 years ago so that’s no concern. And I’ve thought about my testicles shrinking – they have somewhat, but I don’t feel like that bothers me at all.

Assuming sleep, diet and exercise is fine… everything shared suggests conversion to estrogen & DHT.

Have you explored other TRT options with your DR - i.e.; a rub-on gel? You’d likely use those daily in small doses. Maybe your body would adapt better.

The less complicated the better, in my opinion -

Hope the best,


Sleep has been off lately, which I know doesn’t really help things. I read that is also a possible side effect. I’ll wake up in the middle of the night hot as hell and sweating and it will take an hour to fall back asleep. I exercise pretty regularly. Weights 2x a week and rowing 2-3x a week.

My doc did mention gels, but besides being more expensive, I have a wife and 3 little kids. The risk of transference from them touching me is just too much for me personally. I don’t mind the injections. I would even do it EOD if that is better than E3D. I use these tiny 27g needles and inject into my deltoids mostly, so it’s pretty easy going.

Post your labs with ranges, telling us labs are “normal” is insufficient.

Anything would be a guess without the whole story.

When my e2s gets into the high 30’s my libido tanks, I get weepy and emotional. Typical starting dose for arimidex/anastrazole is 1 mg/100 mg’s of test. To make the math easy, if you inject 50 mg’s of test twice per week, you would take 1/2 mg of anastrazole the same day twice per week. If your Dr needs help convincing, just do some research on the negative health consequences of high estrogen in men. I’ve been able to greatly reduce my anastrazole dose by getting quite lean personally since much of T -> E aromatization is based on body fat levels as well as liver clearance rates. I’ve also heard that you can order a liquid form of anastrazole online through a lab and dose accordingly, worse case scenario if your Dr won’t assist you, but I’ve never had to go that route myself.

Labs from Feb/March. My urologist doesn’t really test for a lot.as far as thyroid and other hormones. These are the latest sets of tests. He has been just ordering Total T every 3 months and CBC every 6 months, but I was insistent on adding the metabolic panel and E2 because of the symptoms I’m seeing. Next set of tests in June will include SHBG as well.

E2 (March 2016)
ESTRADIOL: 42.7 pg/mL

GLUCOSE: 80 mg/dL
BUN: 11 mg/dL
CREATININE: 1.10 mg/dL
ALBUMIN: 4.3 g/dL
A/G RATIO: 1.4
CALCIUM: 9.3 mg/dL
TOTAL BILI: 0.7 mg/dL
ALT: 35 U/L
AST: 20 U/L
SODIUM: 143 mmol/L
POTASSIUM: 4.4 mmol/L
CHLORIDE: 105 mmol/L
CO2: 27 mmol/L
ANION GAP: 15 mmol/L
eGFR: >60.0

CBC (Feb 2016)
WBC: 6.20 103
RBC: 5.45 10
MCV: 87 fL
MCH: 28.8 pg
MCHC: 33.2 g/dL
RDW: 13.8 %
PLATELET: 220 10*3

Testosterone, Total: 1059.8 ng/dL

That’s another thing - I’ll be watching TV and some dramatic scene comes on, then all of a sudden I feel all anxious and like on the verge of tears and I’m like WTF.

I’m having another E2 and Total T lab done on Friday. So I probably won’t hear back from the Dr until the end of next week. I think I’m just going to lay it out for him and give him this and other info, then tell him that we can either work together on this, or I’ll do what I need to do in order to make myself feel better. I know where to buy Anastrozole myself if I have to, but I would really rather not do that unless there are no other options. But I need to do something- and fast, because I just can’t deal with this for much longer. He could have already put me on something to fix this, but no. I even wrote an iOS app to record my injections and labs and correlate those to how I’m feeling each day in graphs.

Thanks for the dosage info. It’s really all over the place depending on what you read. Everywhere from 0.25mg per injection no matter what to things like the formula that you gave. Getting E2 right is starting to sound like a slow moving seesaw that you can never balance.

Please post your normal numbers and ranges.

Have you looked at this? About the T Replacement Category

Most guys need around 1mg anastrozole per week when TT levels are 900-1000. But some are anastrozole over-responders who need 1/4th of the expected dose. You adjust the dose to get near E2=22pgml. This is E2 modulation, not elimination.

There is nothing wrong with TT=1000 when E2 is properly managed and hematocrit is OK.

Transdermals lead to more E2 than injections.

Google liquid anastrozole.

Some guys are testosterone hyper metabolizers and half-life is reduced. More T is needed and more often to get steady T levels. You will need steady T levels for anastrozole to work properly.

I don’t have the other test results on-hand, sorry. That was only checked once in March 2015 when I also got a second Total T test to make sure I was low. I didn’t know then what I know now, or I would have insisted on getting copies and periodic re-tests. I do remember that the Dr specifically said he was doing LH/FSH to determine it I had primary or secondary. Cortisol and Prolactin were also checked, and I don’t recall the numbers, but they were both within the given ranges on the higher side. So the Dr determined that I had primary hypogonadism.

That’s interesting that you say that one can be a hyper metabolizer of T. I was on 100mg /week last year, and my Dr agreed to 50mg E3D after I told him about what I read on this forum and others and smaller, more frequent doses. But the thing is that even with that dosage I still felt like I was just injecting plain oil and Total T was at 850 then. I was not quite as tired and felt a little more upbeat about things, but felt none of the benefits that others write about (realize everyone is different). Jumping to 60mg E3D made all the difference for me until the E2 crept up. So I’m partly angry at the Dr for not just giving me an AI, and partly angry at myself for not posting sooner, then getting Anastrozle myself and keeping quiet about it. Now I’m back down to 40mg E3D, and if 50 wasn’t enough to feel good then 40 won’t be (hasn’t been) either.

So I’ll bring up metabolism as well. I’ve always been skinny with almost no muscle tone my while life. The past few years before going on TRT, I started putting on weight and having other problems. I just chalked it up to being almost 40 and 3 kids, etc.

What you said and what I’ve read about Total T also make sense in that it’s not really the indicator that should be looked at. So I’m going to demand a test for Free T as well. Having 1100 is of no use if it can’t be bound to androgen receptors and be used.

Even with the recent problems with this Dr, he seems a lot more informed than most in the stories and posts that I’ve been reading about over the past year. I think when it came down to fixing this problem - it’s serious, he got scared off because he said he talked to several of his colleagues and my T was way too high. So who knows what they told him. I sort of don’t blame them for being conservative about this. You really don’t want to just mess with someone’s hormones or they are doing to die. But for crying out loud, they need to get better informed. These forums have been around for many years. They are filled with non-medical advice, yes. But no one is going to ask for help and give advice for a decade on them if everyone is just making shit up and dispensing bro-science.

So I’m going to compile the info that I feel is relevant to me and make my case. If he is not receptive, then I’m going to have to strike out on my own. Which is unfortunate because I have really good insurance that pays for almost everything. My life is likely only half over at 37. And I’m not spending the second half like this.

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Check here first: https://www.labcorp.com/wps/portal/findalab

and http://www.lifeextension.com/Vitamins-Supplements/Blood-Tests/FAQ

Tests came back.

Been on 40mg E3D for 3 weeks (down from 60mg E3D)

E2 is 27.5 which is much better

Total T is 540. That’s half of what is was when I was on 60mg. So now I feel tired and weak and like my arms weigh 100lbs each. Morning erections are coming back, but still no sex drive.

I’ll try to get this Dr. to agree to the suggested TRT protocol - at least then I would be in the 800-850 range since that’s what my labs were at when I was on 50mg E3D last year.

I got in to see my Dr on Monday. Any suggestions for tests that I should be asking for? I was already going to ask for Free T and SHBG. I would like to be able to look for indicators of a problem elsewhere.

When I think about it more, these latest results just don’t make sense to me. Why do I need 60mg E3D and 1050 Total T to start feeling the benefits of TRT? This sort of feels like having to constantly pour a lot of water into a bucket to keep it full because there is a big hole in the bottom and it empties too fast.