Do you know what lab did the hormone work? The total T range does not look familiar. Ask for the original lab reports from the lab if a local medical office transcribes these things. They need to tell you the range.
Most here deal with serum E2 0-53 labs. Total estrogen is not used often and causes confusion. You can control E2 production with arimidex. Total E includes the metabolites of E2, other estrogens. If E2 is high and you reduce it, then the other estrogens should follow.
LabCorp lists total estrogen 40-115 for adult males.
Your 90 puts you at about 75% of the range. For serum E2 (0-53) guys do well at 40-50% of the range. Optimal E2 is often thought to be around 17-20 from a libido point of view.
I think that you simply have the wrong test. You want to get E2 controlled and if you do that and still have persistent E type symptoms, you might have unusual E2 metabolic products… but that is rare and you should not need to be concerned with that and deal with E2 levels and see if that improves life.
Your TT and FT levels are not high. You do not seem to be good at absorbing TDs (transdermals). TD’s do push up E more than injectables. Your T levels might be good for you, but with higher amounts of E, that T can be blunted by the E.
There is a great variability in how guys react to TDs and some simply do not absorb well… and some do initially, but hormone changes alter the skin properties then they later fail to absorb. Some simply feel worse on TDs. Some react well. Note that there is a well known association of a lack of TRT TD response among those with hypothyroidism (diagnosed or not).
While TDs can lead to worse E2 outcomes than injectables, E2 problems are very common or the norm with TDs and injectables.
You can ask for a serum E2 test with arimidex to take your E down to 40-50% of range. If your doc refuses to do that, go on your own. You can get E2 serum from LabCorp via LEF.org. You can do one first if you want to have the justification on file, or you can start the adex and then let your first E2 test be used for any dose alteration needed.
If you an get your doctor to cooperate, you can get the script in hand then keep that at home and use a research chem. This will save major money if not covered by insurance and will also be a lot cheaper than co-pays. The liquid adex allows great flexibility in dosing that cannot be achieved by breaking up 1mg tablets.
If you get a script and go the research chem route, remember to always get new script in hand when you visit your doc. You don’t want the office trying to phone in renewals or dose changes.
A typical starting dose of adex is 1mg/wk in divided doses.
You have not talked about how you feel. Just as a doctor should not be treating your lab work in isolation from your symptoms, you should not either.
Even with very high T numbers, elevated E can leave you feeling like crap. Your doc might be happy that your TD has you in the middle of normal range, but that is certainly not an optimal response.
If you lower E, then SHBG will [should] go down and FT will increase. Less T will aromatize to E, so TT will increase. What FT and Bio-T that you then have will also be more effective as there will be less interference of E at the E receptors. And less activation of E receptors will change the way that your brain and body work.
Typically the first thing that you notice when T is up and you lower elevated E with an AI is an increase in libido and often a return of morning erections. Libido is a good fast acting barometer for how TRT is improving one’s well-being. If you have any libido issues, probably E related and you have to make this known to your doc. If he does not understand or care, he is not one of the best.
Many guys have doctors who do not understand the E connection as a success factor for TRT.
What are your testes doing? Shrinking? Scrotum pulled up tight. If so, that is to be expected with TRT that is working right. You can inject HCG to restore and maintain your testes, but that then sort of makes the needle avoidance of TDs look silly.
If your testes seem normal and hang down freely, most would see that as a sign that your TD TRT is not working fully… which would seem unexpected for your TT and FT levels.
-optimal T and FT
-injected VS TD
-HCG(injected)250iu SQ EOD for health testes and mood improvement
-appropriate E test should be E2
-goal for E2 lab work numbers
-E symptoms, libido and persistence or return of classic hypogonadism symptoms, fat patterns and gain/loss
-arimidex to reduce E2
-prescribed arimidex or on your own
-insurance coverage of arimidex and co-pay costs
-libido as a measure of how TRT is working
KSman, excellent post as always!