Question about T and Estradiol levels on Compounded Cream

Pharma / TRT Testosterone Replacement
1

Hello everyone -

Cleaning up my post-

Age: 30
Height: 6’3"
Weight: 200
BF: Not sure - def not in shape
Issues: 9 prior surgeries, chronic pain, currently feel down, reduced libido, low temp

Using compounded cream. Takes very little for me (seem to be very sensitive to supplments), I do 1/2 or 1 pump of 2 recommended.

T: 731
Estradiol: 39.6
LH: 3.6
Prolactin: 9.8
PSA: 0.7
TSH: 2.3
T4, Free: 1.31

Have CBC if relevant, all in range except EOS (absolute) 0.5 x10E3/uL - I have a lot of allergies, and was diagnosed with eosinophilic esophagitis in Feb - EOS level has been elevated slightly for 6+ years.

Metabolic panel and electrolytes in range.

History:

I have been on and off TRT for about 2 years. I use a compounded cream. Without the cream my level is in the 300-350 range. I have 6 clamps on my left gonadal vein from where a hernia mesh caused variosceles, and my left testicle is small.

I had to go off cream earlier this year because I had to have my gallbladder removed - not sure if TRT/estrogen contributed to this.

On the cream my last tested total T level was 731. My estradiol level was 40. Doctor insisted this was fine but I am reading otherwise.

For me, in the past, when I was not on the cream and I took a lot of fish oil it seemed to kill my sex drive. I can not find much hard conclusive info if fish oil actually depletes estrogen. Now I am thinking maybe it would be smart to take more of it to try to lower my estradiol level a bit?

My LH and FSH seem to be about the same on or off the cream and I have no testicular atrophy. Not sure if this is a concern?

My temperature is also low - high 96s in the morning, 97s in the afternoon. My blood pressure is typically 110-115/65-70 and my resting heart rate is 60-65. Not sure if these are points of concern, I don’t remember either being low when I was younger. I am starting iodine replacement/selenium. I can not have a pituitary MRI because of implanted metal. Between 24-28 I had above said hernia mesh rotting and was in severe chronic pain. Plus more surgeries. My thoughts are that I probably have adrenal fatigue (or extreme adrenal fatigue based on how tired and down I feel) and that is contributing to the hypothyroidism and temperature.

Also last question - I have chronic gerd/reflux (but no heartburn) and TRT makes this worse. I have read about people getting bad heartburn on actual gear. Is there anything I can do about this?

2

There are a few stickies that you need to read:

  • advice for new guys – note first paragraph
  • fining a TRT doc
  • thyroid basics

Your thyroid function is a real problem. fT3 is used to regulate your body temperature and thus your bodies metabolic rate. With lower body temperatures, T levels can be low, energy levels and libido low. Many here have low T and thyroid/iodine issues. You need to not be iodine deficient and if not using iodized salt - long term - that is a major problem.

VA has criteria for lab levels that are stupid and you may be caught in that. Can you afford $$ to do this out-of-pocket if needed?

Your LH/FSH levels should be near zero on TRT. So TRT may not be effective or pituitary is running its own show.

Need ranges on lab work.

Please list fasting cholesterol, glucose as well as hematocrit.

Labs: really need to see free testosterone [FT]

With your medical history, adrenals may be fatigued. See adrenal fatigue, rT3, Wilson’s book in thyroid basics sticky.

Thyroid labs:
TSH
fT3 <<<<<<
fT4
rT3 <<<<<

I don’t see a heartburn TRT issue. You may have a hiatal hernia and that will improve with loss of abdominal fat. Low thyroid function promotes weight gain. Some weight training might create pressures that move stomach contents up if the valving is incompetent.

Transdermal T has the highest potential for T–>E2 conversion. Injected T the lowest and also least cost.

Transdermal T absorption can be very poor with low thyroid function. Injecting bypasses that problem.

Your FT may be low because you have a lot of T+SHBG that can create exaggerated TT levels. Your high E2 will increase SHBG levels.

Summary:
Your labs are very odd with higher TT and still having interesting levels of LH/FSH. Your are hypothyroid based on TSH and body temperatures. Management of E2 is critical. Injected T will bypass some of the T–>E2 that is happening in your skin. Your status is incomplete without FT and rT3. Restored thyroid function will promote weight loss; possibly needing meds, otherwise maybe iodine. E2 management is also critical for wellbeing and weight loss; as well as prostate health.

3

KSMAN I really appreciate the help, and the help you give everyone in this forum.

TSH 2.330 uIU/mL (0.450-4.500 )
T4,Free(Direct) 1.31 ng/dL (0.82-1.77 )
Hematocrit 44.8 % (37.5-51.0 )
Estradiol 39.6 pg/mL (7.6-42.6 )
LH 3.6 mIU/mL (1.7-8.6 )

I do not have cholesterol in the blood work I can find, but last I got it checked I remember both types being in the middle of tested ranges (for whatever that is worth).

Should I just stop using the cream at this point? Is it doing me more harm than good?

I don’t feel good and I’ve developed huge love handles that hang on my sides despite not being that overweight anywhere else. Is my estradiol high enough to warrant something like Arimidex or close enough to be lowered with natural things? I get the impression its probably been high ever since puberty based on symptoms though.

Also is it wise to start IR without scans? Or is any guess a crap shoot? I’ve read the stickies and that’s the impression I get.

4

You would do IR if you have not been using iodized salt.

Don’t stop the cream until you have an alternative in hand. You will not get E2 controlled without Arimidex/anastrozole. Injections will also help. You still need FT to see what is going on; but I forgot, with transdermals, FT is not steady and any given lab is a snapshot of changing levels, so SHBG might be better. If you are injecting twice a week or more often, FT levels are steadier and FT labs are then meaningful.

Please read those stickies and post what comes to mind.

Transdermal absorption can be poor with thyroid problems and we have seen TT elevated by high T–>E2 in the skin. So we do not have a good situation and don’t have FT or SHBG data to see what your true T status is.

5

I went and got a script for arimidex today. I am planning on .5mg every other day to start. Will continue cream.

I am on day 5 of IR. Taking 25mg without sides so far. I do not use iodized salt, or really salt period, ever. I also do not eat any wheat (celiac) and from what I understand wheat products can contain some iodine/selenium. I am not sure if this is possible but my acid/GERD seems to be reduced while taking iodine - googling this says its possible but I dont know.

I am going this week to get the other labs run, including all of the thyroid levels that I can get, and then I will post back.

My 28 year old brother has almost all the same symptoms. We are both going to be tested for klinefelter as well - even though that seems extreme.

Thanks again for your help

6

Bread in North America has not used iodine as a dough conditioner for decades.

You will need to do something to obtain a lifelong identifiable source of iodine. Some vitamins contain RDA.

Does your brother also avoid iodized salt and low body temperatures?

7

[quote]

Does your brother also avoid iodized salt and low body temperatures?[/quote]

Yes and yes. We are both going to retest all the recommended items in the stickies this week. Thanks for all the info

8

KSMAN,

Do you have any input temperatures DECLINING on IR?

I’ve been taking 25 mgs a day for over a week. Only showing 97.1 in the afternoon today.

In the process of getting cortisol tested

9

Very odd. Do you feel any different?

Your technique is OK?

10

I believe I was doing something as stupid as just not holding the thermometer in far enough. Sunday night I tried going to 3 Iodoral (~37mg), felt very ill Monday and Tuesday - nausea, anxiety, tingling in left arm. Skipped Monday night, resumed with half an Iodoral last night.

So far doing IR I have improved from an afternoon temp of ~97.5 to 98.0 (assuming non-moron technique). When I first started my temp was also very unstable. GERD/Acid reflux is greatly reduced - maybe the best its been in 10 years. So if this works it is a lifesaver.

11

I just got as complete blood work as I could done, except for a few individual tests which LabCorp reported insufficient samples so we had to draw more.

The only things that stand out to me are my total protein is in the lower end of the scale - going to try to add some more every day.

My LDH is 122 on a 121-224 scale

Thyroid

When I got this blood work done I was 5-600mg into Iodine replacement and had started to feel super tired. I am not sure if this much iodine forced my thyroid hypo because my tsh is up to 2.89 in this test.

T4: 8.7 (4.5-12)
T3 update 28 (24-39)
fT3 2.4 (1.2-4.9)
fT4: 1.31 (.82-1.77)
Thyroid Peroxidase: 12 (0-34)
Antithyroglobulin: <1 (0-0.9)

Hematocrit 44.3

At this point I was a week and a half into Arimidex. I am using 10% compounded cream, recommended 2 pumps - only using 1/2 of 1 pump.

Total T: 1289 (!)
Free T: they needed more blood
DHT: needed more blood
Estradiol: 27 (down from 39 which is good I think)
LH: 7.1 (1.7-8.6)
FSH: 5.2 (1.5-12.4)

Vitamin B12: 628 (211-946)

Vitamin D: 31.9 (30-100) - going to add more of this each night

The doctor I work with says he does not see LH/FSH shut down on creams, only on shots. So not sure what to think. I am also only using 1/4 the recommended dose. I know from being me all my life that I am extremely sensitive to supplements/what I eat.

One I stopped IR (I now just take a small dose each day) that last 2-3 weeks have been the best I’ve felt in years, especially my mental outlook.

KSMan, any thoughts on all this? Much appreciated.

12

Your LH/FSH indicate that absorbed T dose not effective.
TT may be inflated by high SHBG and/or poor liver clearance of T+SHBG

FT on transdermals can be hard to work with as levels swing by large amounts and signal is dominated by lab timing artifacts.
With transdermals, SHBG or SHBG+FT might be more useful that FT alone.

“last 2-3 weeks have been the best I’ve felt in years, especially my mental outlook” is really good news.
Labs should be post IR, allowing for a steady state.
Increased TSH on IR is just that, not hypo thyroidism.

13

I already lost my gallbladder, and I doing more damage to my liver with total T levels that high?