T Nation

Not Feeling Well. Please Help with E2 Levels

Hello. I love this forum and all of the great info and feedback that everyone provides.

I am 41 years old. 5’10" 185 lbs. I started TRT almost a year ago (April 2017).

Originally I was doing 200mg of T a week split into 2 injections per week(100mg per injection). I felt amazing for about the first 6 months. In October of last year, my E2 levels were at 47 and I was not feeling very well. During that same month after reading the stickies here I lowered my dose to about 60mg of T every 4 days and I also started taking 250 IU of HCG EOD for the first time and .5mg of anastrozole on injection days. The first of January my E2 levels were 16.2 7.6-42.6 pg/mL. So in January, I changed the dose of .5MG of anastrozole on injection days to .25mg. My most recent labs taken a few days ago have my E2 at 10.0 7.6-42.6 pg/mL. I would love to hear what someone with more experience has to offer. Should I stop the anastrozole and increase T dosage?

Also my LH is showing 0.1 1.7-8.6 mIU/mL should I be concerned about that.

Here are my most recent labs if you can please let me know what you think or suggest. Also, I typically order the female hormone panel at privatemd labs but I have noticed that some of the levels like free testosterone and SHBG are not included with that panel. Seems like most people here get this bloodwork but is there a better panel test that you recommend for every 6 weeks? I should also note that some of my levels that measure kidney function are very bad because I am in stage 3 with chronic kidney disease. Thanks in advance.


Based on the LabCorp website it looks like you got the female E2 test. You need this one:

Estradiol, Sensitive, LC/MS
TEST: 140244 Test number copied CPT: 82670

That being said how can you be sure you had high E2 which required you to start taking an AI? You posted the same lab twice so may be missing some info.

We see this all the time, men using the female E2 labs and basing their AI dosing off these labs designed for females which overstates a mans E2 levels. This is a ticket to failure.

There’s no need to test LH and FSH while on TRT, suggest doctor is incompetent.

When you lower T dose, you need to also use less anastrozole.
Based on E2=10, you need to reduce anastrozole by 50%. If you get a liquid product, google liquid anastrozole, reduce dose by a factor of 10/22. The goal is E2=22pg/ml.

When on TRT, both LH and FSH should -->zero. When LH–>zero and FSH does not, we are concerned that there might be a FSH secreting testicular cancer and in this case it would be minor in some regards, but you must get testes examined. hCG may increase testicular activity and more FSH could result, but LH will still be ~zero.

What meds are you taking?
Could be why potassium is what it is.

You should be testing TT and FT!

Yes, you might need more T. And if you increase T by 20%, increase calculated anastrozole by 20 percent as well. Take anastrozole at time of injections.

Are you diabetic?

Did you post the same lab set twice instead of most current? If so, comments re E2 and anastrozole dose may be at risk.

Please see below re thyroid function, iodine and oral body temperatures. This can be very important.

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 numbers 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.

NH_Watts, thanks for the feedback. I did accidentally post the same labs twice. Sorry this was my first post in the forums. The lab attachment got placed where I was saying that in October my levels were at 47. I just edited the original post so that it is more clear

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Thanks systemlord! Is there a specific test panel or company that you use at companies like privatemdlabs or LE on a regular basis? I ask because I saw a few posts in this forum where it seemed like most people were using the less expensive “Hormone Panel for Females” on privatemd labs to gauge their levels every few weeks. Just trying find a affordable panel to get tested every few weeks while I am still trying to get my levels dialed in.

Those guys must love gambling because that’s exactly what their doing, those guys will never truly know where their E2 levels are landing. You will consistency crash your E2 levels running those tests, you can’t dial in if you don’t know your E2 level.

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Thank You KSman! I did accidentally post my recent labs twice. I have since re-edited the original post. I started anastrozole because my E2 level was at 47 in October last year.

I am not diabetic but I do have ulcerative colitis and take or have taken medication that weakens my immune system. Currently on a drug called Humira.

Also, I had a vasectomy last year. Would that influence any LH or FSH levels?

I will start testing my FT.

"I am not diabetic but I do have ulcerative colitis and take or have taken medication that weakens my immune system. Currently on a drug called Humira.

Also, I had a vasectomy last year. Would that influence any LH or FSH levels?"

Are you familiar with what leaky gut is and how diet and other environmental factors can effect that condition, specifically how it causes local and systemic inflammation which can then cause changes in gene expression?

What does your diet look like?

Your near zero LH and FSH levels are normal for anyone on trt without a SERM and are caused by testosterone injections. When external T is introduced in our systems, our body’s pituitary gland recognizes high or adequate T levels and believes we don’t need more T. In a healthy individual not on t replacement, when T gets low, their pituitary gland sees that and pulses out LH and FSH which tells the testicles to activate to produce T and begin spermatogenesis. This feedback loop has been shut off in you due to trt.

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Here are my latest Lab results Should I be concerned with the FT high level or the Low DHEA-Sulfate level?

You have the incorrect E2 labs, the Roche ECLIA is the female E2 labs, someone wish to inform the doctor that you are in fact male? We see this all the time, doctors heads in the sand. You need the E2 Sensitive LC/MS/MS method for males. You really need SHBG to determine FT levels.

The results would depend on one thing, how do you feel?