Blood Test Low SHBG, High E2

[buda316]

Looking to wrap my head around my numbers. 60 days into TRT using 87 mg/week (Cypionate) total starting dose on 3 days / week frequency (MWF).

My starting numbers were:
Total T 253 ng/dL
Free T (35-155) 60.2 pg/ml
Calculated Free T 6.82 ng/dl
E2 (standard) 47 pg/ml
SHBG 15 nmol/L
Albumin 4.6 g/dL

45 Days In:
Total T 746 ng/dL
Free T (35-155) 192.5 pg/ml
Calculated Free T 22.3 ng/dl
E2 (ultrasensitive) (<30) 60 pg/ml
SHBG 16 nmol/L
Albumin 4.5 g/dL

Calculated free at issam.ch/freetesto.htm

At the 45 day test mood, focus and workouts were great. I am a was concerned with how high Free T is and E2. With SHBG being so low, will I be more susceptible to high E2 issues?

I ended up starting adex at 0.5mg 2x week trying to target 30pg/ml e2, and started dropping lots of water. Sweating crazy amounts during workouts, lost 10lbs in a week. I am a few weeks before my my next blood work, and noticing major issues in the bedroom, tadalafil does nothing. I need some feedback as honestly feel like the wheels have fell off!

I have stopped adex and looking to get my numbers back to the 45 day tests and will retest in a couple weeks but i am still concerned with the low SHBG and its effects on both free test and "free" e2. Any feedback would be appreciated.

 

[Systemlord]

I am a was concerned with how high Free T is and E2.

Your hormone levels are normal and your estrogen levels are normal as well for a person with a total testosterone over 500. The normal ranges for estrogen were derived from men with a total testosterone under 500.

If you’re having side effects from your TRT protocol, simply lower your dose and toss the aromatase inhibitor in the trash!

With SHBG being so low, will I be more susceptible to high E2 issues?

I don’t understand where your anxiety is coming from regarding low SHBG and free E2.

There is 50 times more estrogen within your tissues, which is where estrogen exerts its biological effects and where it’s made.

Serum estrogen is the leftovers not exerting any biological effects at all, unless it enters the target tissues.

You mentioned at day 45 your mood, focus and workouts are great!

What are you trying to fix by using an AI?

I ended up starting adex at 0.5mg 2x week trying to target 30pg/ml e2, and started dropping lots of water. Sweating crazy amounts during workouts, lost 10lbs in a week.

Aromatase inhibitors can act like diuretics, causing you to lose water. You lost 10 pounds of water.

I hate to be the one to tell you this, but you’ll never hit and maintain your target of 30 pg/mL using aromatase inhibitors.

Trying to control estrogen using aromatase inhibitors is futile in the long term!

 

[Systemlord]

I’m a type 2 diabetic and I doubled my SHBG (11->24) by losing weight and achieving a normal A1C and fasting glucose.

 

[buda316]

What are you trying to fix by using an AI?

Thank you for the reply. There is a lot of information and misinformation to sift through out there. Your response is appreciated!

I started to get itchy nipples and was carrying water weight. Weight loss stopped abruptly when starting protocol (expected) but was concerned with the potential of high E2. Needed feedback to ensure wasn't heading down a wrong path.

Ai is definitely out of the regimen, need to figure out how to continue to cut weight and make progress towards goals, down from 290 to 260 since start of year. Stopped loosing weight on TRT but lost the 10lbs of water you mentioned when wrongly taking ai.

 

[buda316]

I’m a type 2 diabetic and I doubled my SHBG (11->24) by losing weight and achieving a normal A1C and fasting glucose.

A1C and fasting glucose were "normal" but i would suspect that this constitutes as elevated.
A1C 5.3
Glucose 87mg/dL

 

[Systemlord]

Thank you for the reply. There is a lot of information and misinformation to sift through out there. Your response is appreciated!

I started to get itchy nipples and was carrying water weight. Weight loss stopped abruptly when starting protocol (expected) but was concerned with the potential of high E2. Needed feedback to ensure wasn't heading down a wrong path.

Ai is definitely out of the regimen, need to figure out how to continue to cut weight and make progress towards goals, down from 290 to 260 since start of year. Stopped loosing weight on TRT but lost the 10lbs of water you mentioned when wrongly taking ai.

There was a study out of Harvard, where there were three groups of men, one group with low normal testosterone another group with mid range testosterone, and the other group with high testosterone.

They were all given aromatase inhibitors and quickly developed lots of body fat, especially in the midsection. This proves that estrogen is responsible for fat loss when other hormones are in balance.

If you’re having nipple sensitivity issues, that don’t go away after 8 weeks, just lower your dosage.

 

[Systemlord]

A1C and fasting glucose were "normal" but i would suspect that this constitutes as elevated.
A1C 5.3
Glucose 87mg/dL

In the majority of cases, SHBG decreases on TRT, except for those with type two diabetes and metabolic disorders.

Your SHBG increased one point, indicating a possible metabolic issue.

Chapter 24: Estrogens and Body Weight Regulation in Men

Our understanding of the metabolic roles of sex steroids in men has evolved substantially over recent decades. Whereas testosterone once was believed to contribute to metabolic risk in men, the importance of adequate androgen exposure for the maintenance ...

www.ncbi.nlm.nih.gov

 

[Cataceous]

Your hormone levels are normal and your estrogen levels are normal as well for a person with a total testosterone over 500. The normal ranges for estrogen were derived from men with a total testosterone under 500.

The E2/T ratio appears to be skewed to the high side (0.8% vs 0.3-0.6 typical). Normal estradiol is 30 pg/mL for young men with total testosterone around 600-700 ng/dL.

...
Serum estrogen is the leftovers not exerting any biological effects at all, unless it enters the target tissues.
...

False or else highly misleading. Systemic estradiol regulates the HPTA and produces many other effects. If you don't think so then try injecting 100 mcg a day.

...
I hate to be the one to tell you this, but you’ll never hit and maintain your target of 30 pg/mL using aromatase inhibitors.
...

False. You can achieve fairly precise control of levels with daily microdosing of an AI. However, your next point is more reasonable, in that forcing estradiol down to a particular level may not be a panacea, and could lead to other problems.

 

[buda316]

The E2/T ratio appears to be skewed to the high side (0.8% vs 0.3-0.6 typical). Normal estradiol is 30 pg/mL for young men with total testosterone around 600-700 ng/dL.

I am definitely carrying too much body fat and working to resolve that issue. I am concerned about gyno as I am loosing weight all over and chest is fuller(lack of better term) than usual. I don’t have firm nodules that I can tell, but don’t want it to be an issue. Should e2 be treated or ignored? Prolactin before starting was mildly elevated at 18.5 vs the upper limit of 15.5. No prolactinoma or medications to elevate.

False. You can achieve fairly precise control of levels with daily microdosing of an AI. However, your next point is more reasonable, in that forcing estradiol down to a particular level may not be a panacea, and could lead to other problems.

Been running numbers with Adex 4 day half life and at .25 mg /week I should have a decent blood content to at least reduce aromatization. I was doing .5mg 2x week, which would leave me with a fairly consistent blood content of nearly 1mg.

Is microdosing a thing with adex especially considering the longer half life? How would I do such a thing?

 

[Systemlord]

I am concerned about gyno

Gyno is rare in men with high testosterone.

 

[Systemlord]

Been running numbers with Adex 4 day half life and at .25 mg /week I should have a decent blood content to at least reduce aromatization. I was doing .5mg 2x week, which would leave me with a fairly consistent blood content of nearly 1mg.

Is microdosing a thing with adex especially considering the longer half life? How would I do such a thing?

Stop the AI and just lower your Test dosage.

 

[Cataceous]

... Should e2 be treated or ignored? ...

There's no definitive answer, even though the opposing camps have turned the subject into competing religions. You need to weigh the pros and cons. My take is that direct treatment is a last resort. The first choice, though the hardest, is to lose the body fat. In theory this could have even normalized your original numbers. Otherwise you have to consider side effects. If there are none then in the short run no action is needed. However, long-term maintenance of such levels puts you in uncharted territory. In your case this applies to both the E2/T ratio and the absolute E2. Maintaining such levels must be considered an experiment with uncertain risks.

In some cases elevated prolactin is itself a side effect of high estradiol. If it causes issues then you have to decide whether to attack it directly, e.g. with cabergoline, or indirectly by lowering estradiol.

Long-term AI treatment is not ideal either. Though speculative, it may be that such drugs can create local imbalances in the levels of estradiol.

...Is microdosing a thing with adex especially considering the longer half life? How would I do such a thing?

It is absolutely a thing. At one time I used 30 mcg a day. You can do this by dissolving a 1 mg table in 10 mL of vodka. An oral syringe can be used to measure doses with good precision, 100 mcg per 1 mL.

Anastrozole did ameliorate my symptoms of high estradiol, but the end result was not good enough to maintain the protocol. For me, lowering the dose of testosterone was an important component of improving matters. However, I did not have a lopsided E2/T ratio.

In this case I agree with @Systemlord: The lowest risk path is to lower your dose and try going without the AI. Based on your numbers you would have mid-range T levels for healthy young guys if you drop to 60 mg T cypionate per week in divided (3+) doses. You may have some temporary hypogonadal-type side effects for some weeks or longer during the transition. Be mentally prepared and continue to make fat reduction a priority. Reevaluate in a few months. A lower dose should at least make total estradiol more reasonable. Hopefully fat loss leads to an improvement in E2/T.

Because you started TRT pretty recently let me throw out an alternative: Testosterone nasal gel is less disruptive of other hormones and possibly would improve E2/T on its own. If you're interested then use the forum search function to look for threads on Natesto.