T Nation

Normal Everything but HIGH Estradiol Level & ED is Ruining My Life


#1

Hi all,

I’m a 30yo male who has been suffering from low libido and ED for years but I got so used to it I never really tried to solve it. I hadn’t had sex without Cialis for 2 years straight but now got in a stable relationship and it’s getting too much for me.

I finally had blood work done and the result seems to explain things.

TESTO 453ng/dl (175-781)
E2 87pg/ml (20-47)
PROG 0.46ng/ml (0.14-2.06)
PRL 8.36ng/ml (2.64-13.13)
FSH 6.88mIU/ml (1.27-19.26)
LH 3.73mIU/ml (1.24-8.63)

The endo suggested I take weekly 250mg/wk of Testosterone Undecanoate for 4 weeks combined with HCG (I think it’s 4000iu but am not sure). He claimed this would help restore the T/E ratio and balance things out. I had my first shots yesterday.

I spoke about this with some bodybuilding contacts and they said that didn’t make any sense. I’ve heard from several people that this approach would only solve the problem temporarily by raising testosterone, and also that it would aromatize and actually increase E2 even more. On top of that, my hormonal balance would supposedly crash again as soon as I stop using the injections. They suggest I don’t use any exogenous testosterone but simply take an AI for a while and all would be fine.

Another hobbyist health specialist friend of mine said that I should simply use Clomid to balance things out and also increase my slightly low LH levels. I went back to the hospital and asked to prescribe me some Clomid which they did, although the endo did not suggest I take any as according to him my situation is not that bad and does not warrant something this extreme. I have no idea about his credentials. For what it’s worth, I did a blood test 3 years back and my E2 was 17pg/ml.

I tried searching for solutions but I can not find a similar case anywhere online. The closest I came was on this forum where KSman wrote some very interesting things. Hoping some wisdom will come this way.

I have no idea what to do now!

Here is some valuable info:
-age: 30 years old
-height: 6ft3 (1m92)
-waist: 34-36"
-weight: 209lbs (95kg)
-body and facial hair: bald spot and receding hairline, some hair on chest, belly and upper back but nothing like a carpet, decent beard, plenty of leg hair
-describe where you carry fat and how changed: my bf is probably around 17%, I carry fat extremely well on a lanky frame, I would say it’s spread evenly and don’t have any problem areas. One thing I think is worth noting is that I do have some fat buildup around my nipples (which I’ve had since I was 16), but since I started lifting weights around that age my chest looks very “bodybuildy” and others consider it my best body part. Although when I flex my chest I can feel there is actually a lot of fat that shapes them like that. I carry around plenty of muscle and strength, and people consider me a big athletic guy.
-health conditions, symptoms: No history of any particular illness or condition other than ED which has been getting worse over the last 3 years. At 25 my libido was crazy and I masturbated at least 10 times per week. Nowadays I have virtually NO libido and I masturbate once or twice a month if I remember to force myself to do it. Even then erections are very weak and inconsistent. My sleep is sublime, I feel energetic, happy and don’t get mood swings.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever:
(1) I did my first Dianabol only cycle about 4 years ago at 30mg/day spread evenly. No PCT.
(2) Two years ago did 500mg/wk of test-e only for 10-12 weeks with a minimum of anastrozole on/off which I eventually quit taking. I took Tamoxifen/Nolvadex for a few weeks as PCT.
(3) Last year I was on 250mg/wk of test-e for about 8 months straight with no AI/SERM. No PCT.
(4) For the last two years I haven’t had sex without some sort of dick pill. Started with GNC Yohimbe 451 (bark), then Cialis 20mg, then oral Phentolamine Mesylate 40mg. Since I started a relationship 8 months ago I’ve been taking Cialis 5-10mg almost every single day.
(5) ZMA, fish oil, multi-vitamin, creatine
(6) Took half a year of Fluconazole 200mg/wk to remove nail fungus immediately after (3).
-describe diet: My diet consists almost entirely of whole foods. I live in China and now my girlfriend cooks so it’s a ton of rice and veggies, lots of oil, lots of pork, lots of animal fat, lots of spices and peppers, some almonds, some fruit, 3-4 protein shakes a day
-describe training: I’ve been training seriously for about 4 years and not so seriously for maybe 14. Currently train about 4 times a week focusing on olympic lifts, lots of squats and pulls. I still make strength gains very slowly without PEDs. I also do about 30miles on my bike at a pretty high pace.
-testes ache, ever, with a fever: no
-how have morning wood and nocturnal erections changed: Without Cialis I get virtually zero morning wood. When I use 5mg daily my morning wood is still weak and inconsistent, and I almost have no libido to speak of. I almost never get erections throughout the day and I don’t even remember what sex drive feels like. That being said, I have been able to perform on/off with the use of Cialis (5mg) with a semi hard one. I recently quit Cialis entirely and I do still get erections if we get the mood just right, but I can not maintain them during sex.

After I got 250mg of Undecanoate injected, my morning wood was decent the first day and rock solid the 2nd day.


#2

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

Doctors are the problem.

hCG 250iu SC EOD max
T will increase E2, not decrease.
You need anastrozole to reduce T–>E2.

Labs:
FT
TT
LH/FSH - need to repeat
TSH
AST/ALT

High FSH:LH can be a result of testicular cancer. Had the boys examined?

High E2 can be from impaired E2 clearance in the liver.

You need a new doc, see the sticky on that.


#3

Apologies, I skimmed through the articles before posting but missed the advice one. Will read them all more thoroughly again.

I edited my OP and added lots of info at the bottom.

Some notes:

  • I live in China, HRT does not exist here. It will be virtually impossible to get guidance and/or long term prescriptions for these kind of drugs. The hospital I visited does not have anastrozole or exemestane. I ordered some online which will arrive soon. I did not order any hCG.

  • My hospital does not test FT. I will have to look for a new one.

Some questions:

  1. Is there still is any point in getting my 3 following test+hCG shots or should I drop that immediately?

  2. When the anastrozole arrives, what is my approach? Which dose should I start at, how/when should I reassess, and how often should I get lab work?

  3. High FSH:LH – I did not have my boys examined yet, but they feel normal to me. Should I also get a PSA test?

Thank you so much.


#4

After studying the stickies a bit here is an attempt of answering my own questions in the post above. Please let me know where I go wrong. I also added some new questions.

1. Is there still is any point in getting my 3 following test+hCG shots or should I drop that immediately?

My testosterone level is not the problem. It’s high E2 combined with low FH/FSH. Therefore, increasing testosterone will actually be counterproductive as E2 follows T. Meaning the problem will elevate, even though T will now be high it will be useless as all my androgen receptors will be bound to even higher E2. Therefore, I assume it is a bad idea to go back for more injections.

2. When the anastrozole arrives, what is my approach? Which dose should I start at, how/when should I reassess, and how often should I get lab work?

For mid range T levels, 0.5mg/week in EOD dosing would be a good start with anastrozole. Or should my dosage be higher because of my really high E2?

I’m also still not sure how/when I should reassess. Do I increase/decrease dosage week by week based on how I feel, or do I take the same dosage for 4-6 weeks and then do lab work?

3. High FSH:LH – I did not have my boys examined yet, but they feel normal to me. Should I also get a PSA test?

After self inspection I don’t feel any bumps or lumps on my testicles, should I still have them examined by a health professional?

4. Additional question: Given my really low LH and relatively low T, would it still be helpful to start with a low dose SERM treatment to attempt HPTA restart, given my amateur history with PEDs?

I am aware SERMs will boost LH, resulting in higher T and thus bring E2 up even more in the process (which is not what I want), although at the same time it seems that if I combine or follow up with anastrozole and taper off slowly, the end point might be near?

Or will T & LH also simply increase in itself by lowering my E2 in the first place by only taking the AI?

I feel like both are viable options, with the SERM being the more aggressive approach. Keep in mind I do not have access to hGC unless I buy from an internet-found source.


#5

For Anastrozole, the basic formula for a ballpark figure on dosage is: new dose= old dose x (current e2/optimal e2) The Optimal E2 is around 22.

Start at .2 EOD and retest and adjust based upon the formula.

IMO get the PSA. If its normal, then you have a baseline for later in life.


#6

Thanks for the tip. I found out by now in other threads I should try to keep the dose fairly consistent and I can make small changes every 7 days as it takes time for the body and brain to adapt to the compound. I will take a new blood test 4 weeks from today. I managed to find legit anastrozole in a Chinese pharmacy and said I had a prescription but didn’t have it with me.

I also found out it’s possible to go the SERM way but it’s not advised and it includes more risks. Using anastrozole is in my case presumably the more efficient and risk-adverse way. Using anastrozole and lowering E2 may increase LH/FSH levels.

Please correct me if I’m wrong somewhere.


#7

One very obvious problem is impaired E2 clearance and that means that you have to look at AST/ALT and other possible liver issues.

You should avoid soy. Look at those protein drinks.


#8

I will include AST/ALT in my next lab run.

My protein does have some source of soy, could it really be enough to cause this many issues? All the label just says “Contains milk, egg, peanut and soy derivatives.”

I took my first 0.25mg anastrozole yesterday. I don’t know if it was placebo but I had the feeling of sensation “down there” one hour later. Also later that day I felt my libido a little bit while spending time with my girlfriend. Not enough to go all caveman on her, but there was definitely “something” that wasn’t usually there. Is that even possible that fast?

0.25mg EOD actually makes 0.85mg/wk, so I ordered some 20ml vials and a gradual dropper to dose the anastrozole more efficiently.

Morning wood has been fairly consistent since the undecanoate shot. No erections throughout the day, no desire to have sex or masturbate.


#9

After spending hours on this forum I kind of figured out the “hCG 250iu SC EOD max” recommendation is actually to stimulate LH and get the testicles to start working again producing more T. By that, I assume running anastrozole only will not be very effective for an HPTA restart attempt.

Since I do not have access to hCG, and want to avoid ordering generic Chinese hCG from some lab + mess around with bac water + mixing + EOD injections, and the fact I have Clomid from the hospital lying at home, I decided to try the SERM method.

I will be taking 25mg Clomid EOD for a few weeks with the anastrozole, then do blood work. I know I should be careful about T->E2 in the testes and possibly decrease SERM intake if E2 will still be high.

That being said, I took the first dose today and was feeling really dizzy one hour later. Also incredible tiredness all day and dry mouth. I’ll try taking it right before bed next time and sleeping my way through those side effects, if that doesn’t work I will have to order generic tamoxifen and try that.

Let me know if I’m doing something wrong here.


#10

Just wanted to drop in and mention I remembered I also took 200mg Fluconazole for half a year 1x/wk up until 2 months ago to battle toenail fungus. I read The Testosterone System (Eugene Shippen) which was recommended by KSman as a good starting book (apart from the author being very much against injections as the T delivery method) and it was mentioned in there that Fluconazole works as a testosterone receptor inhibitor, increasing estrogen levels.

I feel timing wise this could be very alarming and possibly the reason of my current situation.

Increased zinc intake from 35mg/day to 70mg/day. I know very high doses of zinc can negatively affect other mineral absorption but it should help as an extra estrogen suppressor.

No morning wood today and no sign of libido yet.

@KSman I’m getting really confused whether I actually need a real HPTA restart or if I just need to control my estradiol with the AI? I started 25mg Clomid EOD (+0.25mg anastrozole EOD) yesterday because a very intelligent bodybuilder friend convinced me my LH & test were too low, but range wise they’re actually just right in the middle. Or could both methods work?


#11

I think this is a sound way to go for now. The Clomid will raise your LH which will make your produce more Test and the AI will lower your E2. I would start .5 mg EOD for the AI and see how you feel for a week or two. Once you start getting morning woods again you can drop it to .25 mg E3D. I would keep the Clomid at 25 mg EOD and dose at night to avoid sides. Also, no HCG. May help in the short run but it will only suppress you more. Good luck man!


#12

Thanks for the input jim! Good to hear I’m making at least some sense.

You suggest 0.5mg anastrozole EOD, though I noticed KSman mentioning several times that AI is a competitive compound so that it should be dosed depending on T level. My total T is fairly low, so ~2mg/wk sounds a bit high to start? Or does that not matter anymore all things considered and Clomid presumably raising my T anyway?


#13

Masturbated yesterday with a semi, took Clomid+AI at night and masturbated again today. Erection was a whole lot harder and orgasms getting more intense. I take this is a sign libido is slowly coming back, or at least going in the right direction.


#14

One week later, everything has turned to shit. Morning wood almost completely gone, zero sex drive. I tried increasing the anastrozole but may have overdone it going to 0.5mg EOD. I’m now down to 0.125mg EOD again since today and hope erections will come back. Will not be changing dose for 2 weeks and then do bloods.

I mostly hope it’s not due to SERM induced T>E2 in my testes.

Good news though is that side effects from Clomid almost entirely disappeared. I’m actually pretty sure the side effects were caused by combining it with ZMA. Three days ago I was fine for several hours, then took ZMA and suddenly got dizzy and tired. Yesterday I didn’t take the ZMA and was completely fine. Or it might be in my head and I’m just getting more tolerant to it.


#15

Hey dude just found your thread now. You and I are in similar position except my natural T is more than double yours. But we have similar E2 levels.

My prolactin, and everything else like you is fine.

Why are you taking clomid with the AI? Personally I would have just run the AI standalone and see where that took you, as it would raise your natural test production if you have an working HPTA. Before I crashed my E2 on Arimidex, I saw my SHBG lower, and free test rise.

It sounds like you have crashed your E2. I would completely stop the Arimidex like I did until it bounces back. Of course you should try do labs to reflect this. With me it was a clear line of me coming down into normal E2 where I felt horny as fuck, boners boners then they disappeared when E2 crashed. Also after my experience, I would really be careful with Arimidex. It’s powerful shit man. For me anyway 0.5mg is too much. I’m starting to think I may respond too well to Arimidex. But we will see when I restart at 0.125mg EOD. Seriously, start low and build up, you can always take more, never less.

Also back to the clomid - I don’t have much experience with it (never taken) but I’ve read countless of stories on the internet of people saying they take clomid, test is high due to taking it, yet they have said it doesn’t improve libido. Maybe something to look into.

Also I think you’re reading into stuff too much eg the ZMA comments. Relax, it wouldn’t have that much of an affect. You worrying constantly isn’t going to help your libido either.

So from here I would get new bloods - see where your E2 is at (if it’s crashed wait till it comes back - this can take up to six weeks according to my doctor) if it isn’t crashed you know something else is up. You’ve already started the clomid but I personally would have tried AI monotherapy first before combining it with clomid.

Keep in touch.


#16

Re Clomid: Because I got convinced both my testosterone and LH were on the low end and I felt I was still a decent candidate for the restart method in the sticky. But yes it was mostly me being greedy (wanting results fast) combined with the idea of getting a T boost helping me in the gym. I’m sure anastrozole on its own would have been fine.

I’m not imagining things regarding the Clomid+ZMA. Timing wise it works out every single day. The side effects are not subtle, they come on hard. If it’s not that then it has to be a big coincidence.

But it doesn’t matter anymore. The Clomid made me feel terrible in the gym and I’ve had enough of it. Switched to 20mg Nolvadex EOD just now.

Sticking to the plan for the rest.

Also, some good news, after switching to 0.125mg EOD two days back, erections are hard again since today. Saw tits online and immediately felt like wanking. I know it’s too soon to judge things and I shouldn’t have been messing around with the dosage in the first place, but I got a little sidetracked by jimgainz’s advice. (No worries jim, we’re all in the same boat here.)

Oh, and I noticed I lost almost 5lbs since before, without changing anything to my diet. I assume it’s water weight loss from lowering estrogen.


#17

One week later, feeling FANTASTIC in and out the gym. Tamoxifen feels like a blessing compared to Clomid.

Morning wood has been rock solid almost every day on 0.125mg anastrozole EOD.

Only sad thing is that my libido is still virtually non-existent. Maybe 10% higher. But still never feel like having or needing sex. Damn I want to want to it so bad. It’s ruining my relationship.

Is there anything I can try? Would increasing anastrozole dosage slightly help?


#18

I couldn’t wait and went into the same hospital for some preliminary labs. Unfortunately no FT available here.

FT3 3.2pg/ml (2.5-3.9)
FT4 1.01ng/dl (0.58-1.64)
TSH 1.64uIU/ml (0.35-5.6)

E2 53pg/ml (20-47) --> LOWER than 87!
TT 502nl/dl (175-781) --> SAME as 453

PROG 0.72ng/ml (0.14-2.06)
PRL 6.78ng/ml (2.64-13.13)
FSH 6.49mIU/ml (1.27-19.26)
LH 1.81mIU.ml (1.24-8.62) —> LOWER than 3.73??

The good news is my E2 is going in the right direction. Now I can adjust my dose to 0.125(52/22) = 0.295mg EOD which is exactly 1mg/week.

I am very confused though as my LH is actually HALF of three weeks ago. I started taking the SERM in an attempt to bump up LH but for some reason it dropped down. Meanwhile my TT is not that low, basically unchanged. What can I take from this @KSman ?

One possible explanation that I see is that the testosterone undecanoate shot is still in my system because of the incredibly long ester. Exogenous T could lower LH?

I’m a little bit lost and am not sure what my approach should be right now. Please advise!

Oh, some more good news is that my liver values seem healthy.

ALT 27.8U/L (0-40)
AST 28.5U/L (0-40)

A/G 1.7 (1.2-2.5)
GLO 25.5g/L (25-35)
ALB 44.5g/L (35-55)
TP 70g/L (60-85)
IBIL 2.6umol/L (0-18.2)
DBIL 2.6umol/L (0-6.84)
TIBL 6.2umol/L (0-25)


#19

Nice to see you calc the new anastrozole dose.
Lower E2 will improve LH/FSH

Odd to see LH low VS FSH in two lab reports.
Doctor examined testes?

Cannot test FT. Test SHBG?

With anastrozole, get back to zinc ~25mg/day maximum.


#20

^ Not yet. Will try next time.

Holy cow I’ve lost almost 18lbs since a month ago starting the AI. Is that kind of weight loss usual when lowering E2? I know high E2 causes water retention but it’s pretty damn scary seeing the scale at 192 when you’ve been 209 for years.