E2 at 51, to anastrozole or not to anastrozole

[crazyhaha]

I’ve been on TRT for over 1 year now and things are really going well...life is looking much better from this side it just took a while. A million thanks for the people on this site and if you are beginning TRT give it time. I have been injecting every other day 0.25 ml testosterone cypionate , and 0.5 ml HCG. My latest labs are posted in a reply below but here are the most important ones:

Total T: 1069
Free T: 34.7
Estradiol: 50.9
SHBG: 13.4.

TSH: 3.5
T4 free: 1.00
T4: 5.2
T3: 110

My latest labs showed elevated estradiol (E2) at 50 pg/ml. My doc (Dr. Melograna, Maryland), said I can consider anastrozole but that he would cut back a bit on the Testosterone and see what it looks like in 6 months. He also suggested taking some zinc and DIM (Diindolylmethane). I’m going to take the zinc, because I don’t see a big downside, but it seems not many find DIM useful.

As far as symptoms, the most important is that I feel more irritable and get angry more quickly which is a bit of a problem with the kids. I feel like I have always had a bit of gynecomastia but I don’t think I look any different and I don’t have any nipple sensitivity.

Current Plan
So, I am slowly backing down to 0.20 ml test. Cyp. and 0.40 HCG every other day. Will add zinc. I am definitely building muscle, which is awesome, but I need to lose some abdominal fat which may contribute to the E2.

Questions:
In Nelson’s talk, there was a lot of discussion about T:E2. So my E2 is about 5% of total T. Seems a bit high. Should I be considering anastrozole or is this still seem ok as long as symptoms are ok.

How much of a factor is fat? My body composition is improving but I still have too much around the middle.

I probably don’t have gynecomastia, just extra fat on top of my chest muscles. Any advice on exercises to work on that area without enhancing the effect.

 

[crazyhaha]

Thyroxine (T4) Free, Direct, S
[FONT=&quot]Thyroxine (T4)[/FONT]

5.2NORMAL




​

​

Reference Range: 4.5-12.0 ug/dL​

Thyroxine (T4) Free, Direct, S
[FONT=&quot]T4,Free(Direct)[/FONT]

1.00NORMAL




​

​

Reference Range: 0.82-1.77 ng/dL​

Triiodothyronine (T3)
[FONT=&quot]Triiodothyronine (T3)[/FONT]

110NORMAL




​

​

Reference Range: 71-180 ng/dL​

DHEA-Sulfate
[FONT=&quot]DHEA-Sulfate[/FONT]

258.1NORMAL




​

​

Reference Range: 102.6-416.3 ug/dL​

TSH
[FONT=&quot]TSH[/FONT]

3.510NORMAL




​

​

Reference Range: 0.450-4.500 uIU/mL​

Thyroid Antibodies
[FONT=&quot]WBC[/FONT]

5.8NORMAL




​

​

Reference Range: 3.4-10.8 x10E3/uL​

[FONT=&quot]RBC[/FONT]

5.92HIGH


​

​

Reference Range: 4.14-5.80 x10E6/uL​

[FONT=&quot]Hemoglobin[/FONT]

14.6NORMAL




​

​

Reference Range: 13.0-17.7 g/dL​

[FONT=&quot]Hematocrit[/FONT]

46.2NORMAL




​

​

Reference Range: 37.5-51.0 %​

[FONT=&quot]MCV[/FONT]

78LOW





​

​

Reference Range: 79-97 fL​

[FONT=&quot]MCH[/FONT]

24.7LOW





​

​

Reference Range: 26.6-33.0 pg​

[FONT=&quot]MCHC[/FONT]

31.6NORMAL




​

​

Reference Range: 31.5-35.7 g/dL​

[FONT=&quot]Neutrophils[/FONT]

66NORMAL




​

​

Reference Range: Not Estab. %​

[FONT=&quot]Immature Granulocytes[/FONT]

0NORMAL




​

​

Reference Range: Not Estab. %​

[FONT=&quot]Lymphs[/FONT]

21NORMAL




​

​

Reference Range: Not Estab. %​

[FONT=&quot]Monocytes[/FONT]

10NORMAL




​

​

Reference Range: Not Estab. %​

[FONT=&quot]Eos[/FONT]

2NORMAL




​

​

Reference Range: Not Estab. %​

[FONT=&quot]Basos[/FONT]

1NORMAL




​

​

Reference Range: Not Estab. %​

[FONT=&quot]Platelets[/FONT]

202NORMAL




​

​

Reference Range: 150-379 x10E3/uL​

[FONT=&quot]Neutrophils (Absolute)[/FONT]

3.8NORMAL




​

​

Reference Range: 1.4-7.0 x10E3/uL​

[FONT=&quot]Immature Grans (Abs)[/FONT]

0.0NORMAL




​

​

Reference Range: 0.0-0.1 x10E3/uL​

[FONT=&quot]Lymphs (Absolute)[/FONT]

1.2NORMAL




​

​

Reference Range: 0.7-3.1 x10E3/uL​

[FONT=&quot]Monocytes(Absolute)[/FONT]

0.6NORMAL




​

​

Reference Range: 0.1-0.9 x10E3/uL​

[FONT=&quot]Eos (Absolute)[/FONT]

0.1NORMAL




​

​

Reference Range: 0.0-0.4 x10E3/uL​

[FONT=&quot]Baso (Absolute)[/FONT]

0.0NORMAL




​

​

Reference Range: 0.0-0.2 x10E3/uL​

[FONT=&quot]RDW[/FONT]

15.3NORMAL




​

​

Reference Range: 12.3-15.4 %​

Triiodothyronine,Free,Serum
[FONT=&quot]Thyroid Peroxidase (TPO) Ab[/FONT]

7NORMAL




​

​

Reference Range: 0-34 IU/mL​

[FONT=&quot]Thyroglobulin Antibody[/FONT]

<1.0​

​

Reference Range: 0.0-0.9 ​

Thyroglobulin Antibody measured by Beckman Coulter Methodology






Triiodothyronine,Free,Serum
[FONT=&quot]Triiodothyronine,Free,Serum[/FONT]

3.6NORMAL




​

​

Reference Range: 2.0-4.4 pg/mL​

Sex Horm Binding Glob, Serum
[FONT=&quot]Sex Horm Binding Glob, Serum[/FONT]

13.4LOW





​

​

Reference Range: 16.5-55.9 nmol/L​

Estradiol, Sensitive
[FONT=&quot]Testosterone, Serum[/FONT]

1069HIGH


​

​

Reference Range: 264-916 ng/dL​

Adult male reference interval is based on a population of healthy nonobese males (BMI <30) between 19 and 39 years old. Travison, et.al. JCEM 2017,102;1161-1173. PMID: 28324103.



[FONT=&quot]Free Testosterone(Direct)[/FONT]

34.7HIGH


​

​

Reference Range: 6.8-21.5 pg/mL​

Estradiol, Sensitive
[FONT=&quot]Estradiol, Sensitive[/FONT]

50.9HIGH


​

​

Reference Range: 8.0-35.0 pg/mL​

This test was developed and its performance characteristics determined by LabCorp. It has not been cleared by the Food and Drug Administration. Methodology: Liquid chromatography tandem mass spectrometry(LC/MS/MS)






Comp. Metabolic Panel (14)
[FONT=&quot]Cholesterol, Total[/FONT]

143NORMAL




​

​

Reference Range: 100-199 mg/dL​

[FONT=&quot]Triglycerides[/FONT]

179HIGH


​

​

Reference Range: 0-149 mg/dL​

[FONT=&quot]HDL Cholesterol[/FONT]

22LOW





​

​

Reference Range: >39 mg/dL​

[FONT=&quot]LDL/HDL Ratio[/FONT]

3.9HIGH


​

​

Reference Range: 0.0-3.6 ratio units​

[FONT=&quot]VLDL Cholesterol Cal[/FONT]

36NORMAL




​

​

Reference Range: 5-40 mg/dL​

[FONT=&quot]LDL Cholesterol Calc[/FONT]

85NORMAL




​

​

Reference Range: 0-99 mg/dL​

PSA (Reflex To Free) (Serial)
[FONT=&quot]Calcium, Serum[/FONT]

9.2NORMAL




​

​

Reference Range: 8.7-10.2 mg/dL​

[FONT=&quot]Glucose, Serum[/FONT]

83NORMAL




​

​

Reference Range: 65-99 mg/dL​

[FONT=&quot]BUN[/FONT]

13NORMAL




​

​

Reference Range: 6-24 mg/dL​

[FONT=&quot]Protein, Total, Serum[/FONT]

6.7NORMAL




​

​

Reference Range: 6.0-8.5 g/dL​

[FONT=&quot]Albumin, Serum[/FONT]

4.0NORMAL




​

​

Reference Range: 3.5-5.5 g/dL​

[FONT=&quot]Bilirubin, Total[/FONT]

0.5NORMAL




​

​

Reference Range: 0.0-1.2 mg/dL​

[FONT=&quot]Alkaline Phosphatase, S[/FONT]

60NORMAL




​

​

Reference Range: 39-117 IU/L​

[FONT=&quot]AST (SGOT)[/FONT]

18NORMAL




​

​

Reference Range: 0-40 IU/L​

[FONT=&quot]Potassium, Serum[/FONT]

4.1NORMAL




​

​

Reference Range: 3.5-5.2 mmol/L​

[FONT=&quot]Sodium, Serum[/FONT]

139NORMAL




​

​

Reference Range: 134-144 mmol/L​

[FONT=&quot]Chloride, Serum[/FONT]

98NORMAL




​

​

Reference Range: 96-106 mmol/L​

[FONT=&quot]Creatinine, Serum[/FONT]

1.05NORMAL




​

​

Reference Range: 0.76-1.27 mg/dL​

[FONT=&quot]ALT (SGPT)[/FONT]

16NORMAL




​

​

Reference Range: 0-44 IU/L​

[FONT=&quot]Carbon Dioxide, Total[/FONT]

27NORMAL




​

​

Reference Range: 18-29 mmol/L​

[FONT=&quot]BUN/Creatinine Ratio[/FONT]

12NORMAL




​

​

Reference Range: 9-20 ​

[FONT=&quot]Globulin, Total[/FONT]

2.7NORMAL




​

​

Reference Range: 1.5-4.5 g/dL​

[FONT=&quot]A/G Ratio[/FONT]

1.5NORMAL




​

​

Reference Range: 1.2-2.2 ​

[FONT=&quot]eGFR If NonAfricn Am[/FONT]

87NORMAL




​

​

Reference Range: >59 mL/min/1.73​

[FONT=&quot]eGFR If Africn Am[/FONT]

101NORMAL




​

​

Reference Range: >59 mL/min/1.73​

PSA (Reflex To Free) (Serial)
[FONT=&quot]Prostate Specific Ag, Serum[/FONT]
[FONT=&quot]

0.4NORMAL




​

​

[/FONT]
[FONT=&quot][/FONT]
[FONT=&quot]

Reference Range: 0.0-4.0 ng/mL​

[/FONT]
[FONT=&quot]
[/FONT]

 

[madman]

I would definitely try lowering your overall weekly testosterone dose to help bring down e2 before adding an aromatase inhibitor.

Even though e2 is flagged as high for estradiol (sensitive assay) if you feel good overall and are not experiencing any issues such as gyno/extreme water bloat/ed and lower libido/high blood pressure avoid adding an a.i. to your protocol.

Highly doubtful adding zinc will lower your e2!

Your total/free t numbers are good although on the higher end and could be contributing you feeling more irritable/angry as this is not always related to elevated e2 as many seem to think.

High t levels should improve ones overall mood/well being but can also amp some people up too much and contribute to short temper especially if one normally gets wound up too easily.

If ones total/free t numbers are on the higher end some will feel better with slightly higher e2.

I think lowering your weekly dose slightly would be a good move as your lipids also need to be improved...........low hdl/high ldl and your triglycerides are high.

How is your diet?

Macros/calorie levels will be the key players regarding your fat loss as no specific exercise will target fat loss as you need to lower your body fat levels by manipulating your diet (macros/calories).

As you stated nipple/chest may look puffy due to layer of fat.

 

[Vince Carter]

I would take a smaller stab at lowering the T dose if that's the route you want to travel, Id lower it by 5mg vs 10mg and see how things shake out...small changes you can titrate than a larger swing that might take you too far.

 

[nurselyfe]

I would forget the zinc and DIM for now and keep the HCG the same to ensure optimal testicle function (and mood/libido) but lower the T dosage. Your levels are on the high side, dropping the dosage can be more congruent with your age. Make small changes every 8 weeks and see how things pan out. Get bloods again when your doctor will allow.

I see that your RBC's are high but MCV is low. How's your diet? This could indicate microcytic anemia caused by iron deficiency. Might be something to bring up to your provider.

 

[Vince]

I wouldn't change your protocol, your E2 is not too high. Zinc is a good supplement to take, I take Jarrow Zinc balance it give you the right balance of zinc and copper. We all gain weight in different parts of our body, you may need a better diet.