T Nation

T Increasing, E2 Decreasing on TRT, No AI. Why?


#1

Male 42, young teenage voice, no visible adams apple, patchy facial hair, no male hair on arms. T varied between 155-190 from 2013-2016. E2 was 20 in 2013. Prolactin 15, increased to 25 after starting thyroxine, decreased to 4-14 after increasing salt intake. I struggled with thyroxine to get a grip on TSH (TSH 15, T4 8.5 in 2013, no goitre ever, clean USG, AMA,ATG >600, ATG decreased on thyroxine) but to no avail. Went to the doctor and he’s suspecting Kallmann, but that is impossible as I have a very strong sense of smell (like an addisons patient, and cortisol is also repeatedly near 12 at 8am). Doc prescribed sustanon recently after I had already started it. I will be doing the MRI though, just to be sure, but at a government hospital as it’s cheaper, so will have to wait in queue (I’m in India). Anyway, in 2017 I decided to do something about the testosterone. Ran some experiments:

Baseline: T 189, LH 5.72, FSH 2.51 in June 2016; T 196, LH 3.33, FSH 2.08, PRL 14.36, cortisol 15.08 in Dec 2016 (yeah, I’m an idiot for not having a E2 baseline here. It was 20 in 2013)
HCG 625 IU/day for 3 weeks: T 424, E2 71, PRL 11.6, Cort 13.42
HCG 312 IU/day for 2 weeks: T 216, E2 33
clomiphene 12.5mg/day for 2 weeks: T 388, E2 24.5, LH 6.53, FSH 4.73, PRL 12.09
Letrozole 1.25mg/day for 2 weeks: T 408, E2 <11.8, LH 10.96, FSH 7.03, PRL 12.36
Sustanon 50mg/week for 2 weeks: calcium 8.64, sodium 143
Sustanon 50mg/week for 2 more weeks: T 452, E2 16.21, LH 3.53, FSH 2.64, PRL 17.2, Cort 12.7, Calcium 8.75, albumin 4.4, sodium 143, magnesium 2.05. 24Hr urine: calcium 116mg, Phos 499mg. (2 weeks later: sodium 145, potassium 4.5)

So now 2 questions (first one really important):
If I assume the E2 baseline for me is 20, how did it drop to 16 on sustanon, even though T doubled? Did this ever happen to anybody? Seems like all my E2 is intratesticular in origin from the HCG results, so will probably have to add HCG. Did this happen to anybody? I did feel splendid on HCG despite the high E2, just that all my lymph nodes started swelling up. (they also swelled up on hydrocortisone and clomiphene, no fever, so I’m not sure what the problem is… and yes I did go to a doctor who gave me a tablet for gas).

Secondly, I started having severe muscle cramps, twitching, tingling etc on sustanon. Apparently, internet says this happens to some people. My doc (MRCP endocrinologist) has never seen this, nor the hypocalcemia, and doubts it is hypocalcemia. I disagree, the prolactin shot up, probably to correct the calcium. Me and my paternal family has a history of muscle cramps (usually leg). On sustanon it was 10x bad. Can this happen if E2 decreases? Has anybody seen this happen? It maybe theoretically possible as E2 does regulate calcium intake, bone and PTH, but actual evidence anyone? The cramps did not happen much on letrozole though. I didn’t feel good on sustanon though (actually felt horrible due to the aches), but it did cure my headaches (probably due to sodium retention? resting BP increased to 120/80). Interestingly, nicotine gum relieves the cramps (had some gum lying around, I don’t smoke).

Also, any questions and answers I have missed, please ask or answer :slight_smile:


#2

I was asked about the nutty protocol on another site. It’s a valid objection, so I’ll just paste my reply to that, here:

I agree, time was short between therapies (gap was 1 week between them). However the differences were clearly perceptible. Side effects changed from one to the other. Besides, doses are low, co changeover time could be reduced. And then, as for the low dosage… well, I do not want to repeat my mistake of taking thyroxine for 4 years and praying for a miracle. If things are to improve, I will likely notice in the first couple of days itself. Only side effects take longer to show up. I need to see results before debating if I want to live with the side effects. Also, I have to be taking thyroxine through all this anyway, so I can’t really remove all cross reactions. Besides, some effects also change seasonally (yes, I have a diary for last 4 years), or with diet etc, so I just wanted to get it over with quickly. Running the experiment over 6 months would have come with it’s own problems, and maybe would be even more difficult to interpret.

As for the nutty 50mg sustanon, it did raise T from 175 or so to 450. Surely I should at least see my fatigue improve? That did not happen. And I cannot see why E2 should still be low after more than a month of stopping letrozole during which time T almost tripled on sustanon. Makes no sense.

I have to admit the 50mg sustanon looks low, that is what the doc had also prescribed, and after 6 weeks may have reached a healthy 500 (I’m not a bodybuilder, just trying to survive). But here I am a month after my last dose, and balls still shrinking (am on clomiphene now). So 50mg is scary enough for me. And anybody wanting me to raise it to 100-125mg, needs to be here to take care of my muscle cramps, or worse (yeah, I was scared my heart would cramp).

Here’s what the medications cure for me (and they all show evil sides as well):
thyroxine : depression
hydrocortisone : fatigue
HCG : mood
clomiphene : fatigue
letrozole : no benefit really
sustanon : headache

[no knowledgeable TRT docs here, and no doc here has more than a few minutes… so that chapter is closed. Thankfully tests and medicines are mostly readily available]


#3

Sust has less T than T cypionate or enanthate, so 120mg/week in two divided doses would be good. You can also then use those other forms of T at 100mg/week.

What is your long term history of using iodized salt?
Are you a vegetarian? If so, probably B12 and folate deficient and possible essential amino acid deficiencies.

Are you near any of the alluvial deposits from the mountains that cause high cyanide levels in well water?

You may have more than single causes.

Magnesium deficiency causes muscle cramps, more often foot or legs.

T4 will not work if T4–>T3 conversion is poor or impaired. Low ferritin could do that, typically an iron issue which would be unusual for a male unless there is a GI bleed or blood loss. If reverse T3. rT3 is elevated, it blocks some of the actions of fT3 which is the active hormone. Please see last paragraph in this post.

Adrenal fatigue can lower cortisol, hydrocortisone is dangerous if used long term, can be very catabolic and body shape can change, tendons have been known to break, T levels drop. This suggests adrenals, maybe adrenal fatigue.

You have primary hypogonadism. Have your testes been checked by a doctor? Any aches?

Please see all of the following and then come back with some questions based on what you have read.

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
  • Thyroid Basics
  • 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.


#5

I’ve tried everything to do with the thyroid (iodated salt, non iodated salt, lugol iodine, dessicated thyroid… TSH is never stable, it has a mind of it’s own). It’s not a thyroid issue, even though antibodies are high. B12, and folate are in range (after correction; I am non-veg), didn’t change anything. I have axillary temp data for last 3.5 years (mean and median 36.0, mode is 36.2) It really doesn’t change on thyroxine dose etc. Neither does my pulse rate (~64), nor respiratory rate (~8). Doesn’t matter if TSH is 0.01 or if it’s 17. But obviously the thyroxine works, since a bunch of problems go away, including depression and insomnia.

Water comes from a state of the art purification plant that was set up to remove arsenic, so it’s clean. I also send it through an RO unit. No magnesium deficiency, I take it, and blood levels are on the higher side. Ferritin is fine, around 125 usually, never below 75.

Obviously I can’t raise test injections without fixing the muscle cramps. My doc looked strangely at me when I said it could be primary. He thinks it’s Kallmann (wants olfactory bulb MRI). I think it may be a little of both (not Kallmann though). Doc checked TV at 15ml. My measurements put it below 12ml (major axis 38mm, minor axis 18mm, and it’s an ellipsoid, so really impossible to be 15ml). No pains.

Strange thing about the cortisol. Symptoms mostly resolve on 2.5mg, but not completely. Also it causes tolerance, raised blood counts, swollen lymph nodes, and of course I start putting on weight that does not come off easily on stopping cortisol. Anyways, I’ve stopped it.

There is another strange thing. I have symptoms of hypocalcemia if I take calcium, drink milk everyday, or take vitamin D, or even if I’m in the sun too long few days in a row. Increasing vitamin D does not increase calcium levels. calcitriol and alfacalcidol decreased my urine volume so I did not experiment with them. My blood test for calcium did come a bit low at 8.8 when I took too much calcium in 2015. But this time it decreased just with sustanon. Since all of these hormones (T, E2, cort, PRL, TSH) are closely linked to calcium metabolism, I’m wondering if there is a problem with that itself. I cannot rely on the PTH results I have as they used clotted blood (came 27 and 20 when calcium was 8.8). Sodium, potassium, magnesium are all fine mostly. Sodium goes down if I reduce intake, but it stayed at 143+ on sustanon, even with reduced intake. I’m wondering if the T is low because of the calcium, and not the other way around.

However, right now, the thing that confuses me is how E2 can go down when T increased on sustanon. I’m 65kg and 62" tall, so I should have enough aromatase in my fat, right? For some reason, all my E2 is probably coming from the testis. I wonder if this has something to do with the weird calcium phenomenon. I’ve read up over 8 K papers in the last 4 years, and some books, but haven’t found anything that explains these. My doc too is at a loss (and he sees maybe a hundred patients a day). So I thought someone on the forums may have come across these things. Apparently, muscle cramps on testosterone is not rare, many forums have guys complaining, even after years. Interestingly, nearly all are on TRT, not just supplementing for muscle gains.

I should say that many of the problems have been there from ever, like age 4 or so, from my earliest memories. Although I rapidly started deteriorating from around age 9 or so. So, difficult to say if T is the real culprit here.