T Nation

Seeking Advice About Bloodwork, Low E2


-age 24
-height 5’11"
-waist 38"
-weight 225 lbs
-describe body and facial hair slight amount of stomach/chest hair, very little beard, arm and leg hair, no back hair
-describe where you carry fat and how changed mostly waist, lowerback, inside abdomen and chest. Been this way since I was a teenager
-health conditions, symptoms [history] sleep issues since 13-14 years old, nothing else
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever some sleep medication 8-10 years ago, can’t remember the name
-lab results with ranges

Cholesterol 4.20 nmol/l <6.50
AST 39 U/L <50
ALT 37 U/L <50
GGT 18 U/L <60
creatinine 96 μmol/l <124
GFR 88.3 ml/min/1.73m² >60.0

Albumin 47.7g/L 35.0 - 52.0
LH 3.7 IU/L 1.7 - 8.6
FSH 2.3 IU/L 1.5 - 12.4
Testosterone 13.1 nmol/L 8.6 - 29.00
Test. Free 0.291 nmol/L > 0.125
Estradiol 24.2 pmol/L 99.5 - 191.6
SHBG 24.8 nmol/L 18.3 - 54.1

-describe diet consistent clean eating, steak, chicken, eggs, rice, potatoes, 2x veggies etc, 2-3 cheat meals a week. Calories around 3200-3500 depending on rest/training days
-describe training 3x a week upper/lower split, muscles hit twice a week. 2x a week cardio i.e sled work loaded carries or similar
-testes ache, ever, with a fever? nope
-how have morning wood and nocturnal erections changed used to be great, now almost non-existent

Hello guys. I hope some of you could shed some light on my problems. For a few years now I’ve had absolutely terrible libido, a general feeling of apathy (I wouldn’t call it depression, but I lack motivation to do almost anything) and have had trouble with fat gain around/in the waist and chest that I can’t seem to get rid of no matter how lean I get.

Been to three different doctors, none of whom saw fit to do full bloodwork. Getting sick of getting nowhere, I had some bloodwork done on my own dime. The test was nowhere near as comprehensive as I would like, but it’s very expensive to pay out of pocket and I can’t exactly shell out 500 euros for some bloodwork right now.

I don’t know what any of it really means. I showed these results to my doc, was told to contact a clinical chemist at the hospital for more information and he promptly told me that there were zero issues. When I told him about my issues and asked about my (IMO) low levels of test, E2 and FSH, he told me again that I was within range and it doesn’t require intervention (he was agitated about me talking back a little). Apparently a 60 year old and I could have the same testosterone levels and it’d be healthy because it’s “in range”…

I supplement Vitamin D3 5000 IU’s a day, but have only been doing so for about 5 months. I do not supplement with iodine, will start that as soon as I get an iodine supplement. I also supplement zinc, magnesium, vitamin B12, selenium and use a basic multivitamin. I do not know about my temperatures, I’ll get a thermometer and check it tomorrow.

It’s a wall of text, but I hope someone can help me out a little.

EDIT: oh I forgot to mention, I have never used AAS or any other PED.


On TRT with high T levels, E2=80 pmol/L is near optimal.
E2=24.1 pmol/L is not healthy. The brain needs E2 to function properly.

Thanks for your reading and knowing what is needed here.

Were you not using iodized salt?
Where is one expected to get iodine from there? bread? dairy?
Are outer eyebrows sparse?
Feeling cold easier now?

With low T and/or low thyroid function, training can be a stress factor, on top of whatever other stresses in your life, leading to ‘over training’ and adrenal fatigue, rT3 blocking fT3 etc. When I hear you talk about apathy and describe your training, I suspect that you are overcoming fatigue with adrenalin, which is damaging long term.

Your diet may be too clean and total cholesterol too low.
Cholesterol is the foundations for creating many hormones and vitamin D


I use sea salt, nowhere on the package does it say that it is iodized so I’m assuming it is not.
I don’t eat alot of bread, usually some buns on sunday with breakfast but that’s about it.
My outer eyebrows aren’t sparse, I think… I don’t have very prominent eyebrows as it is (blonde, western European)
If it’s not freezing, I’m not cold. I don’t think that this has been any different at any point in my life.

In regards to the fat content of my diet: on a daily basis I consume 1 liter of whole milk, 6 whole eggs, 1 pound of steak (the steak is a pretty lean cut though), 8 ounces of salmon, about 25ml of extra virgin olive oil and maybe a handful of mixed nuts. And then there’s of course the carbs and veggies. It comes to around 130 grams of fat. I would guess that that’s plenty, but increasing my fat intake is something that I consider more of a delight than a punishment.


Okay so I checked the temperatures.

Yesterday I checked at 5:30 am, and it was 35.9 C / 96.6 F
Around 11:30 am it was 36.3 C / 97,3

I sleep in a room with the windows cracked open and it’s well below freezing outside, so that may have had something to do with it.

Today my morning temperature at 8:30 am was 36.2 C / 97.1 F and it hasn’t budged so far.


After having contact with several specialists, I’m pretty sure that I’m going to have to take the DIY route…

If I were to do so, what additional bloodwork would you guys suggest I get? I know that I’ll have to get thyroid hormones checked, but I don’t know if I need to get all of them. I’m guessing TSH, T3 and T4 , fT3, fT4 and rT3? Probably cortisol, prolactin and several others.

EDIT: Oh I got an iodine supplement which is some ‘kelp’ 150 microgram crap, I figured if I throw 20 of these pills down everyday it might have an effect. I just found a place that sells Iodoral 12.5 mg, since you referenced that product in your Thyroid Basics thread I think I’ll buy that and just see what happens.


Please do not forego getting selenium as I recommend with all iodine supplementation.

Read the thyroid basics sticky.


I’ve read the sticky already. I’ve been checking my temperatures throughout the week and they’re coming in really low on a very consistent basis. The highest I’ve been was 97.1 F, but it’s usually mid 96’s. Two times I was even in the high 95’s…

I expect the 12.5mg iodine supplement to come in the mail tomorrow, I hope that it helps.

Supplementing with selenium is something I’ve been doing for over two years now, but how much of a dose would you suggest on maintainance as well as during the iodine-supplementing phase? I’m usually on 300 micrograms per day, as it is in my multivitamin.


300 mcg is more than enough selenium


I got the Iodoral in the mail today, I’m gonna start taking 4 x 12.5mg daily and see how both my temperatures and mood progress over the coming weeks.

I’ve been reading a little bit into this, and some people suggest to use a whole list of minerals and vitamins to supplement with, like celtic salt, magnesium (which one seems to vary, I have no knowledge about the differences), vitamin C, B2 and B3 and a bunch of others.

Is all that necessary in your opinion?


If you get leg or foot cramps, you are magnesium deficient. Consider Bio-test ZMA sold at the store here.

I do not like celtic salt, pink salt etc as there are no useful amounts of iodine and guys have messed up on that.

If iodine gives you intestinal discomfort, because the bacterial are not working, cut dose in half and extend the time.

Most multi-vits cover the trace elements that you need.


You seem to be the only one replying, so I wanted to thank you for taking the time and responding to my questions so far.

I’ve been looking into my estrogen and testosterone situation. Even though my temperatures are low and maybe my thyroid isn’t working as well as it should, do you think that if it were functioning properly that my hormone levels would go back to their proper respective ranges? Because I’m looking into this whole low-E2 deal and I can’t really find anything on how to raise or manage it.

EDIT: Okay after learning more about this, it seems that a favorable drug to use for something like a HPTA restart is either Nolvadex, Clomid or hCG. I read in the HPTA restart thread that you discourage the use of Clomid and instead recommend Nolvadex or HCG for various reasons. You also suggested that one keep something like anastrozole on hand. My problem being mainly very low E2, even if something like Nolvadex would raise T->E2 would that be a bad thing? Of course I don’t want it going too high, and Anastrozole is dirt cheap so if necessary I’ll just get it too.

Also, since Nolvadex seems to do the same job as Clomid at a much lower dose, wouldn’t your suggested dose of 20mg EOD be on the high end? On every forum I read about guys having terrible high E2 symptoms and sides from Clomid doses like 50 or even 25mg ED, and I read about Nolvadex having the same effect as Clomid at maybe 1/4 of the doses.


Okay this is getting stupid.

I measured 94,6 orally this morning, and I thought to myself this is bullshit. Measured under the armpit, it was 96,6. Stuck the thermometer up my butt and it was 98,0.


I have not see that Nolvadex dosing needs to be less than Clomid. Can’t help with that.

Any developments?


I’ve been supplementing with Iodoral 12.5mg for about 15 days now, averaging 40mg or so a day (felt kinda crap on 50mg, for some reason 37.5mg didn’t make me feel weird). So far, my temperatures haven’t changed much. In the evening, I might hit 98-98.5 F, but in the mornings it’s still really low at 96-96.5 F usually.

I’ve been reading around alot and I’m going to start TRT through self-medication. Getting it through a doctor is going to be hard and it will take months, not to mention it will be much more expensive.

Test E 125mg a week divided over 2 doses, HCG 250iu EOD and I’ll keep Anastrozole on hand. I don’t know if I need it right away with my E2 being so incredibly low at 6.6 pg/ml… I’d like to see it triple at least.

I can get the HCG as Pregnyl as an injectable and my ‘friend’ told me there’s orals aswell? Seems like a bunch of nonsense to me, I can’t find anything on it. I have some questions on the pins and injecting itself, I’ll see about posting them in the TRT injection protocol sticky.



So over the last couple of weeks my temperature has slowly started to go up a bit. I’m getting readings of low to mid 97’s now first thing in the morning, and usually by noon it’s in the mid 98’s. It’s been getting better since lowering my dose to 25mg a week.

I’ve also started my own TRT with test E injections, and I should be getting the HCG today. I have a question about the injections, and I hope you might have an answer.

I inject SC 0.25ml 2x a week with 29g 1/2" insulin pins (Test E). I’ve pinned 3 times now and all 3 times I’ve gotten a very small nodule that a little tender to the touch. It’s not an actual bump, it’s not red and it’s not hot or very painful. Just a very small hard lump about the size of a pea inside the fat.

First two injections I did at an angle, and figured that I probably wasn’t injecting deep enough. So the last one I did at 90 degrees and then massaged it a little. I take my time for the injection, it’s usually around 45-60 seconds. This last one is also a little tender, no nodules yet but it was yesterday so we’ll see.

Some say it’s the oil, some say it’s not deep enough, some say the needle causes too much pressure and it damages the tissue… It’s not terrible, doesn’t bother me unless I touch the spots but it’s not something I’d like to have after every shot… Any ideas?


I inject SC on upper leg, avoiding veins that I can see. I pinch up a fold of skin and inject into the end of the fold, needle parallel to muscles underneath. There is a bulge/lump from the injected fluid. Speed of injection does not seem to matter for me, but with #23 1/2" 0.5ml insulin syringes, it is rather slow anyways, even with a lot of pressure.

If needle hurts and pain is diffuse, not locate, that is a vein, remove needle and try again.