High estradiol even on anastrazole

Jamarisa

New Member
I'm on a morphine pump for chronic back pain and my testosterone dropped to 190. For two years I've been on 1 mg of testosterone cypionate weekly (ships from Empower Pharmacy) and donate blood regularly to keep my hematocrit/hemoglobin levels in check. Last year my estradiol levels were rising. My doctor wants a 30-1 ratio of T/E so he put me on a weekly anastrazole pill. My levels dropped to 14 so he adjusted to half a pill. About that time of the dose adjustment, I started having trouble keeping a firm erection, my orgasms aren't satisfying and my ejaculation is almost non existent. The doctor prescribed a round of HCG, .5 ml twice a week for three months. No improvement. I feel like crap so I went in for blood work; did the draw on my injection day prior to getting my shot. My T is 1410 and my estradiol is 72.1 What gives? Should I consider another form of testosterone injection, stop or increase the anastrazole, try more HCG? Yesterday, my wife bought calcium-d glucarate, DIM, pumpkin seed oil and indole-3 to naturally lower my E levels as she's noticing a difference in me and our sex life. My doctor is having health issues, his practice is rapidly expanding and he doesn't seem to be as involved as before. My wife uses Defy Medical for her HRT and I'm wondering if they might be able to get me balanced. Thanks for any direction or advice you can offer!
 

Cataceous

Well-Known Member
You are another casualty of excessive dosing. With reasonable dosing you'd be much less likely to have issues with estradiol or blood counts—meaning no AI and no blood donations needed. If you're measuring 1,410 ng/dL T at trough then it's possible your peak is well over 3,000. You should cut your dose to a third the current rate and switch to EOD or at least twice-weekly injections. This will be about 70-80 mg/week, assuming you're currently on 200 mg/week. I recommend using Defy, but be proactive about wanting sane dosing. At 200 mg/week you're taking triple the average testosterone production of healthy young men. If you reduce the dose you can expect that the transition won't be nice and will take some months. But chances are you'll feel better in the long run. References:
 

Jamarisa

New Member
You are another casualty of excessive dosing. With reasonable dosing you'd be much less likely to have issues with estradiol or blood counts—meaning no AI and no blood donations needed. If you're measuring 1,410 ng/dL T at trough then it's possible your peak is well over 3,000. You should cut your dose to a third the current rate and switch to EOD or at least twice-weekly injections. This will be about 70-80 mg/week, assuming you're currently on 200 mg/week. I recommend using Defy, but be proactive about wanting sane dosing. At 200 mg/week you're taking triple the average testosterone production of healthy young men. If you reduce the dose you can expect that the transition won't be nice and will take some months. But chances are you'll feel better in the long run. References:
This is really interesting info; I'll read the links- thanks for posting them!
What you really need is a new doctor. Defy uses Empower which can compound anastrozole into .125, .250 mg doses.
I did not know that was an option for dosing - thank you!
 

Jamarisa

New Member
You are another casualty of excessive dosing. With reasonable dosing you'd be much less likely to have issues with estradiol or blood counts—meaning no AI and no blood donations needed. If you're measuring 1,410 ng/dL T at trough then it's possible your peak is well over 3,000. You should cut your dose to a third the current rate and switch to EOD or at least twice-weekly injections. This will be about 70-80 mg/week, assuming you're currently on 200 mg/week. I recommend using Defy, but be proactive about wanting sane dosing. At 200 mg/week you're taking triple the average testosterone production of healthy young men. If you reduce the dose you can expect that the transition won't be nice and will take some months. But chances are you'll feel better in the long run. References:
So I read your info and it's making some sense; forgive me for the following stupid questions but I'm really new getting hands on with my healthcare.
I am at 200mg and what's interesting to me was that last fall I was at .5 T instead of 1mg weekly. My T level was 700 and my E was 40. I felt great at those levels but it concerned my doctor that the T/E ratio wasn't 30-1. (I'd love to know how to do the conversion math myself)
He increased my T and the anastrazole. That's when things started going south. E fell to 14, T was in the 900's so we adjusted to the half pill and left the T at 1 ml. Now both are high and I'm miserable.
You think it's attributed more to the high T? I've never researched the symptoms for that
Realizing you aren't a doctor, would you suggest keeping the anastrazole at half and lowering the T injections?
Lastly, why do you recommend changing the T dose to twice weekly?
 

CKO

New Member
I would guess much of your misery is due to elevated e2 levels. 200mg of T per week is at the top end of TRT. HCG converts to estrogen at a high rate for some people (myself included). AI's do not stop this conversion (HCG).

I'm a Defy patient and dealt with similar E2 challenges. Defy medical recommended I reduce my HCG from 500 IU X2 a week to 300 IU X2 per week. this resolved much of my e2 symptoms in a couple weeks. They also recommended DIM, which I have found somewhat helpful. I'm on 140mg T per week.
 
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Cataceous

Well-Known Member
Let's clarify the units for your testosterone. You should be discussing your dose of testosterone cypionate in terms of its weight in milligrams (mg). When you mention numbers like 0.5 and 1.0 you're presumably referring to the total volume injected in milliliters, which includes the carrier oil along with the testosterone. The problem is that testosterone cypionate concentrations can vary. Most common, at least in the U.S., is 200 mg per milliliter of volume. So 0.5 mL and 1.0 mL provide 100 and 200 mg of testosterone cypionate respectively, if this concentration applies to your product.

The dose of 100 mg per week is more reasonable by far than 200 mg. But when it's administered once weekly it has the potential to cause large swings in testosterone over the course of the week. A trough value of 700 ng/dL for total testosterone could mean you'd be pushing 2,000 ng/dL at peak. If the dose is divided into two injections a week then the difference between peaks and troughs is smaller. Typically peaks could be 50% higher than troughs with this pattern. Every other day dosing smooths out serum levels even more.

Regarding estradiol, there's nothing special about a T/E2 ratio of 30-1. I prefer to think about E2/T by weight. The 30-1 figure translates to about 0.3%, which I'd consider to be at the bottom of the normal aromatization range of 0.3-0.6%. Your value was a little under 0.6%, at the high end of normal, but nothing to fret about in the absence of symptoms.

The anecdotes I provided show than high T has the potential to create misery. Low estradiol can also cause some problems. In the other direction, higher estradiol is more likely to cause obvious misery when the aromatization rate is also high, meaning estradiol is relatively high compared to testosterone. This would not apply to your recent measurements, in which the aromatization rate is about 0.5%. However, estradiol over 70 pg/mL greatly exceeds what's expected in normal male physiology, so I don't recommend it either unless you're planning to be part of an experiment on the long-term safety of high levels.

My suggestion is that under Defy's supervision you cut back your testosterone cypionate dose to 70-90 mg cypionate split into at least two weekly doses with no AI. Give it some months to get through the transition. Only if your aromatization rate is high and you're having symptoms would I consider using the AI.
 

Jamarisa

New Member
I would guess much of your misery is due to elevated e2 levels. 200mg of T per week is at the top end of TRT. HCG converts to estrogen at a high rate for some people (myself included). AI's do not stop this conversion (HCG).

I'm a Defy patient and dealt with similar E2 challenges. Defy medical recommended I reduce my HCG from 500 IU X2 a week to 300 IU X2 per week. this resolved much of my e2 symptoms in a couple weeks. They also recommended DIM, which I have found somewhat helpful. I'm on 140mg T per week.
More and more I’m thinking my wife’s care with Defy outranks what I’m getting. (I just don’t want to admit to her she was right) The HCG was added because of my shrinking testicles and low sperm volume. It’s probably exasperating rather than correcting the issue
 

Jamarisa

New Member
Let's clarify the units for your testosterone. You should be discussing your dose of testosterone cypionate in terms of its weight in milligrams (mg). When you mention numbers like 0.5 and 1.0 you're presumably referring to the total volume injected in milliliters, which includes the carrier oil along with the testosterone. The problem is that testosterone cypionate concentrations can vary. Most common, at least in the U.S., is 200 mg per milliliter of volume. So 0.5 mL and 1.0 mL provide 100 and 200 mg of testosterone cypionate respectively, if this concentration applies to your product.

The dose of 100 mg per week is more reasonable by far than 200 mg. But when it's administered once weekly it has the potential to cause large swings in testosterone over the course of the week. A trough value of 700 ng/dL for total testosterone could mean you'd be pushing 2,000 ng/dL at peak. If the dose is divided into two injections a week then the difference between peaks and troughs is smaller. Typically peaks could be 50% higher than troughs with this pattern. Every other day dosing smooths out serum levels even more.

Regarding estradiol, there's nothing special about a T/E2 ratio of 30-1. I prefer to think about E2/T by weight. The 30-1 figure translates to about 0.3%, which I'd consider to be at the bottom of the normal aromatization range of 0.3-0.6%. Your value was a little under 0.6%, at the high end of normal, but nothing to fret about in the absence of symptoms.

The anecdotes I provided show than high T has the potential to create misery. Low estradiol can also cause some problems. In the other direction, higher estradiol is more likely to cause obvious misery when the aromatization rate is also high, meaning estradiol is relatively high compared to testosterone. This would not apply to your recent measurements, in which the aromatization rate is about 0.5%. However, estradiol over 70 pg/mL greatly exceeds what's expected in normal male physiology, so I don't recommend it either unless you're planning to be part of an experiment on the long-term safety of high levels.

My suggestion is that under Defy's supervision you cut back your testosterone cypionate dose to 70-90 mg cypionate split into at least two weekly doses with no AI. Give it some months to get through the transition. Only if your aromatization rate is high and you're having symptoms would I consider using the AI.
Wow. Thank you for taking the time to explain all of this so thoroughly. I now understand how to correctly reference the dosage so currently I’m at 200mg injected once weekly.
As suggested by someone else, I guess the HCG could be further exasperating the issue.
I understand what you’re saying with lessening peaks by injecting more frequently and agree that my T has to be lowered.
Following your lead, I’ve been reading other posts on the subject today. There’s way more to consider than jacking up T levels and prescribing AI and/or HCG to address the subset of problems that high T creates.
Seems like I’ve got three months between each change to feel a true difference so this is a long haul thing. I’ll be calling Defy and continue educating myself on this site.
 

Wolverine

Member
I would guess much of your misery is due to elevated e2 levels. 200mg of T per week is at the top end of TRT. HCG converts to estrogen at a high rate for some people (myself included). AI's do not stop this conversion (HCG).

I'm a Defy patient and dealt with similar E2 challenges. Defy medical recommended I reduce my HCG from 500 IU X2 a week to 300 IU X2 per week. this resolved much of my e2 symptoms in a couple weeks. They also recommended DIM, which I have found somewhat helpful. I'm on 140mg T per week.
What brand of DIM do you take and what dosage? Tx
 

Vince

Super Moderator
What brand of DIM do you take and what dosage? Tx
I thought this was a cool thread on dim.

 

Mark Saur

Active Member
You can talk about Dim and all others until you are blue in the face but you are so overdosed on T! Get with someone like Defy and get it right! Cataceous is right with about 80mg per week split up. I tried them all and now on T only at 14mg per day! no chasing anything for me! LESS is BETTER!
 

Jamarisa

New Member
You can talk about Dim and all others until you are blue in the face but you are so overdosed on T! Get with someone like Defy and get it right! Cataceous is right with about 80mg per week split up. I tried them all and now on T only at 14mg per day! no chasing anything for me! LESS is BETTER!
Agreed - the high T seems to be the most pressing issue and professional oversight from Defy would be best. Thank you for confirming!
 

Tman

Active Member
So I read your info and it's making some sense; forgive me for the following stupid questions but I'm really new getting hands on with my healthcare.
I am at 200mg and what's interesting to me was that last fall I was at .5 T instead of 1mg weekly. My T level was 700 and my E was 40. I felt great at those levels but it concerned my doctor that the T/E ratio wasn't 30-1. (I'd love to know how to do the conversion math myself)
He increased my T and the anastrazole. That's when things started going south. E fell to 14, T was in the 900's so we adjusted to the half pill and left the T at 1 ml. Now both are high and I'm miserable.
You think it's attributed more to the high T? I've never researched the symptoms for that
Realizing you aren't a doctor, would you suggest keeping the anastrazole at half and lowering the T injections?
Lastly, why do you recommend changing the T dose to twice weekly?
So you felt better at another dose...why not return to that and, if needed, make minor changes only.
 

Jamarisa

New Member
Since my wife started with Defy, she's questioning everything we used to accept. In retrospect, I should've questioned changing doses, levels and adding meds rather than blindly handing it off to my doctor. Thankfully the members on this site are pointing me in the right direction with some common sense and solutions.
My wife wants me to discontinue the anastrazole entirely and start 2-3 weekly injections at 80 or 90 mg total. Probably because her hormones are working great now and she wants me fixed pronto. I'm considering it since I'm going to feel worse for a while regardless of the amount decreased.
Thoughts anyone?
 

CKO

New Member
Short answer, yes. I'm pretty sensitive to having my E2 elevated. I'm not sure it drives down my e2 numbers, but it seems to help me achieve balance with elevated E2 symptoms. My anxiety goes down and my libido goes up. It's very subtle and I actually thought it was all in my head. Until I stopped using it and noticed I felt worse. I like the Now product because it has dim and calcium d-glucarate in it.
 

Wolverine

Member
Since my wife started with Defy, she's questioning everything we used to accept. In retrospect, I should've questioned changing doses, levels and adding meds rather than blindly handing it off to my doctor. Thankfully the members on this site are pointing me in the right direction with some common sense and solutions.
My wife wants me to discontinue the anastrazole entirely and start 2-3 weekly injections at 80 or 90 mg total. Probably because her hormones are working great now and she wants me fixed pronto. I'm considering it since I'm going to feel worse for a while regardless of the amount decreased.
Thoughts anyone?
Your wife is a smart person.
 

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