T Nation

New to TRT, E2 is Very Low. Should I Take an AI?


#1

Hello, I am new to TRT. I am a 25 year old man and I have probably been suffering from low T since puberty. I have always struggled with depression and lethargy. I suspected that this might be due to low T. After lurking on this site for a while and reading threads by people like Ksman, I finally decided to get tested.

I got tested for LH, FSH, TT, FT and E2.

My results are as follows:

LH - 8.72 mIU/ml {Range : 2.00 - 12.00}
FSH - 5.39 mIU/ml {Range : 1.50 - 12.40}
TT - 2.96 ng/ml {Range : 2.49 - 8.36}
FT - 20.87 pg/ml {3.84 - 34.17}
E2 - 5.00 pg/ml {Range : 25.8 - 60.7}

I was initially planning on following Ksman’s suggested protocol of T+AI+HCG. Please help me with the following doubts I have. I am very confused.

  1. Shall I forgo Anastrozole for the time being, as my E2 is already too low? Would it be more appropriate to wait for signs of high E2 before taking Anastrozole?

  2. I just shot from a 100mg ampoule of Testosterone Enanthate for the first time. It was a Testoviron Depot branded amp from India. The packaging states that 1ml contains 100mg/ml of Testoviron Depot. In smaller font below it says that it contains 110mg of Test E and 25 mg of Test P. So do I rely on 100mg or 135 mg as the number according to which I should adjust my dosage?

  3. Are 31 gauge insulin syringes with a 1/3 inch needle fine to shoot with?


#2

Your T is low and sometimes as a result E2 is also low. My E2 was lower than yours in relation to my TT levels and been on TRT for 8 months and only when I went above 800 ng/dL did I experience high E2 symptoms. Reduced my dosage yesterday and already feeling better, erections seem fuller, warmer and ache is subsiding.

I’ve never touched an AI and don’t plan to be because it’s a drug and some guys have side effects with AI’s. Usually you want to hold off on AI’s until there’s evidence you even experiencing high E2 symptoms. If using HCG and AI will likely be necessary as you will convert more T -> E2, fine tuning will take time. I’m not on HCG and feel great, might give it a try at a later date. Most doctors will not prescribe HCG do to lack of knowledge, if no then you know doctor is behind the times and not up to date.

You’re also missing the most important test, SHBG which is the foundation for activating and regulating sex hormones. Doctor use SHBG levels to determine how often you should be inject T, my doctor ran SHBG then put me on one weekly injection. Low SHBG guys require more frequent shots for the fact that we low SHBG guys tend to excrete most of our T into our urine, it goes into the blood straight to your urine. More frequent shots raises FT in order to compensate for this which most doctor miss.

Two injections per week is what I recommend for those with no SHBG testing and will work perfectly as long as your SHBG isn’t crazy high, which is where one large weekly injection works best for the patient. I use EasyTouch 27 gauge insulin syringes for easy loading and inject into shoulders since fat is thinnest there.


#3

Thank you for your insights SystemLord. I was planning on injecting twice a week. You said you feel great without HCG, that is good to know. I feel I should not be putting any drug or substance into my body until the time that I actually need it. My concern however is that not taking HCG will shrink my testicles. Have you suffered from this problem? And I was just curious to know how much your TRT dosage is.

Also, even if not taking an AI does not cause any side effects or high E2 symptoms, it might still cause above average E2 levels. And above average E2 levels increase your chances of getting cancer.


#4

In the beginning TRT shrunk my testes, but once my body reached a balance the started hanging again 20% less than before I became low T. It did take me longer than most to reach that balance, I seemed to reach that balance after I started injecting 50mg twice weekly, only then did testes start hanging again.

Then I tried injecting 25mg EOD (100mg total weekly) and 3 weeks later started having high E2 symptoms, testes shrunk. Only just lowered my weekly dose to 80mg yesterday (20mg EOD) and now erections returning and all E2 symptoms vanishing. Some guys don’t tolerate HCG well, not everyone needs it amd some guys that don’t do well on it will use it only to get the wife pregnant.

I’m willing to bet having your estrogen too low is far more dangerous given the fact that low estrogen causes more misery. Just ask anyone who has had both high and low estrogen. Only now can I claim to have experience both. As long as you keep your estrogen within ranges you’ll be fine.


#5

Bump


#6

@systemlord When you inject T EOD does that mean You T injections are not on the same days every week?

So do you still prefer EOD over twice weekly because I have low SHBG which is 15nmol and Im trying to get my self prepared to talk to doctor next week. Do you think that EOD is gonna cause my E@ to go up even higher if I switch to that??
On top of me being on HCG as well??


#7

My SHBG was 18 nmol/L at the 4th week check up after starting TRT. Do to an EOD protocol I set reminders in my phone, example Monday/Wednesday/Friday/Sunday, next week Tuesday/Thursday/Saturday/Monday. Whether or not you’ll have E2 problems injecting EOD will be unique to you, if you reach the point where you start to have E2 build up in your system and your liver clearance reaches it’s limit, then you would just back down the dosage 10-20mg to bring it below that limit. It’s going to be tougher to find that point at which E2 becomes a problem if you go on a large dose and shoot way past that limit.

I will never go back to twice weekly injections as I will never be able to achieve the same FT level on twice weekly injections. I will always end up dumping a most of it and want to always provide plenty of FT to my body. The only way I would ever consider twice weekly injections again is if I was somehow able to significantly raise my SHBG near 30 nmol/L after losing 70 pounds and reversing my type 2 diabetes. HCG will definitely cause more E2 conversion, but at this point you don’t even know if you’ll feel anything using it or if you’ll be able to tolerate it.


#8

It’s going to take 4-6 weeks for your blood to stabilize after a protocol change, dose increase or decrease and longer to feel if the change yields improvements in how you feel. Be aware what you are describing sounds like the honeymoon phase most guys experience 2-3 weeks after starting TRT. Your pituitary gland regulates your T and when your pituitary gland senses plenty of T circulating in the blood it shuts down, your testes no longer are being told to produce testosterone and you feel like pure crap, this is normal and is expected.

Some guys once they start using HCG report feeling great for a while, but later feel nothing or even feel worse on it. Some automatically believe that because you have low SHBG that TRT won’t work, this isn’t always true. It is believed that everyone is unique and the efficiency of SHBG greatly varies from person to person, but it can be true that a low SHBG guy can take longer than average to reach full TRT effectiveness as I’m finding out myself.


#9

OP: At your age, hCG 250iu subq EOD is needed to prevent a real risk of infertility.

E2 is from FT/Bio-T --> E2. Low E2 means that FT is low.

TT and FT provides most of the SHBG status by inference.

Please edit original post to add lab ranges. Look for pencil icon below post.

Most young men who come here with low-T also have low thyroid function which can explain a lot of low energy and lethargy. Often caused by iodine deficiency caused by not using iodize salt. Please see ‘oral body temperatures’ below.


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.

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.


#10

Thank you for your guidance Ksman. I have added the reference ranges .

I have been eating iodised salt since I was born except for a cumulative five year period between 2010 and 2017. Since this year I have replaced iodised salt with Himalayan pink salt in one of the two salted meals that I eat.

I had a few questions for you.

  1. Shall I forgo Anastrozole for the time being, as my E2 is already too low? Would it be more appropriate to wait for signs of high E2 before taking Anastrozole?

  2. I had shot from a 100mg ampoule of Testosterone Enanthate for the first time. It was a Testoviron Depot branded amp from India. The packaging states that 1ml contains 100mg/ml of Testoviron Depot. In smaller font below it says that it contains 110mg of Test E and 25 mg of Test P. So do I rely on 100mg or 135 mg as the number according to which I should adjust my dosage?

  3. Are 31 gauge insulin syringes with a 1/3 inch needle fine to shoot with subcutaneously or are they too small? I am getting coin sized bumps from them that are made from the Test E oil accumulating there. These accumulations of oil make the skin sore but go away after I rub the area for a few days. I was worried this was happening because the needle length was too small.

Oh and I just took a 250IU shot of HCG for the first time and I intend to take it EOD as per your suggested protocol.


#11

Have seen this disturbing range before, most ranges top out at 39 pg/ml

Himalayan pink salt does not have any useful amounts of iodine, this is a problem. Many guys here have been in that trap.

Waiting to see your free T results. You may still need anastrozole when you get youthful T levels from TRT. The signs of high E2 are not pleasant at all. If high means >60.7 you would be in big trouble. Guy start to have problems with E2 in lower 30’s - but your E2 lab range may make everything a mess is that company produces inflated E2 results.

Roche’s labs ranges capture 97.5% of sample as normal that then included more extremes from the sample population. You should see if you can get labs from Labcorp or Quest.

You can try the #31 5/16th needle, but not recommended by me.

T=135 mg, labwork later will provide further guidance.


#12

Thank you for replying. I got my free T results, surprisingly it is in range. It is 20.87 pg/ml. I am living in Asia at least for the next few months and I am not from the US so I can’t get labs from Labcorp or Quest.

Please could you tell me the following.

1.So should I wait for a couple of weeks for my E2 to go up from TRT and then start Anastrozole?

  1. Do you think I even need TRT seeing that both my FT and TT are ''in range"?

  2. #31 5/16th is the only size available where I live, you said you wouldn’t recommend it. Any reason for not recommending? Is it because oil might leak out from the injection site?


#13

FT - 20.87 pg/ml {3.84 - 34.17}
TT - 2.96 ng/ml {Range : 2.49 - 8.36}

Note that FT is released in pulses and has a short half-life as FT–>SHBG+T, so a lab can catch a high or low level that may not be representative. TT and FT seen together suggests that FT caught a peak level. But this can be distorted if SHBG is very low.

Low TT and higher LH/FSH suggests that your testes are not working properly.

Did you read the ‘things that damage your hormones’ sticky?

You have not provided symptoms or responded to iodine, thyroid and body temperature issues.


#14

I have read the ‘things that damage your hormones’ sticky. I smoked 30 cigarettes and cannabis a day for seven years but I stopped completely in 2015. I used to drink quite a lot of alcohol but since the past two years I only drink a pint of beer or a glass of red wine three times a week.

I also have a varicocele on the left side since the past ten years. Out of the eight symptoms you have listed I have brain fog, dry skin and low energy. But I have always had extremely dry body skin and a very oily T zone.

Please answer the questions I had Ksman. Thank you.


#15

@systemlord Like I said my SHBG is 15 which is even lower then yours I was wondering if you can educate me on the liver clearance and how I can check it.

So I just got more of my results back could you tell me what you think?

FT=291.2 (35-115pg) This is high
TT=994 (250-1100ng)
SHBG=15
E2=64 (<or=29pg)

I have already switched my A.I dosing from .25 2 times a week to .25 three times a week

How do these results look to you from your perspective ??

Rite now my protocol is 100mg of T split into two dosages and 250i.U EOD

I think me and you already agreed that I need EOD injections but what else do you think I could do to prefect my protocol and start feeling better quicker


#16

If your levels are this high now on twice per week injection switching to EOD could send your FT and E2 even higher unless you lower your dose. Like I said I was fine on 50 mg twice weekly, but that same dosage split EOD produced too much FT which then converted more to E2, so I backed off my dose a little and am already rebounding. You’re taking HCG so you’re going to produce more E2. My opinion is your dose is too high.


#17

I have read the ‘things that damage your hormones’ sticky. I smoked 30 cigarettes and cannabis a day for seven years but I stopped completely in 2015. I used to drink quite a lot of alcohol but since the past two years I only drink a pint of beer or a glass of red wine three times a week.

I also have a varicocele on the left side since the past ten years. Out of the eight symptoms you have listed I have brain fog, dry skin and low energy. But I have always had extremely dry body skin and a very oily T zone.

I measured my body temperature three times: on waking up it was 97.2 F, at midday it was 97.7 F and in the evening it was 97.3 F

Please answer these questions I have Ksman. Thank you.

  1. So should I wait for a couple of weeks for my E2 to go up from TRT before taking Anastrozole?

  2. Do you think I even need TRT seeing that both my FT and TT are ''in range"?

  3. #31 5/16th is the only size available where I live, you said you wouldn’t recommend it. Any reason for not recommending? Is it because oil might leak out from the injection site?


KSman is Here
#18

Dry body skin, low energy and brain fog could also be caused by hypothyroidism. These ranges are pure statistical and do a poor job of determining if someone is experiencing low T, that’s why it’s important for doctors to listen to the patients symptoms, simply looking at labs won’t tell you the whole story. You can’t be deciding on taking your AI simply be how you’re feeling this early in the game, that’s a ticket to crashing your E2, labs is going to guide some decisions early on. You wouldn’t be on TRT if you didn’t think you needed it, your at the bottom of the normal range and symptoms are much more likely to be experienced where your numbers are.


#19

Thank you for replying Systemlord. You said that I shouldn’t be deciding on taking an AI based on how I feel or I might crash my E2. What do you mean by that? That I should take an AI or hold off it for the moment?


#20

You’re new to TRT, your expected to feel like crap for awhile, there’s no way you could know for certain what you’re feeling is high E2. I started feeling weird a few weeks ago and it wasn’t until I was able to confirm with labs that I was indeed having elevated E2, it could have been high HCT or a hundred other things that was making me feel strange. Your hormones are all over the place and you’re going to have good and bad days, your hormone are in flux. Run labs to confirm.