High T & estradiol levels on testosterone pellets

[Jay-Jay]

I'm a senior (over 65) that's been on T replacement therapy for 27 months. My therapy is with a urologist and consists of inserting 14 T pellets every 4 months. He also prescribed 1/2 mg anastrozole per week, which he suspends when estradiol is too low. I am extremely pleased with the many positive effects of my increased T but worry about the estradiol always being too high or too low. I have read repeatedly that estradiol should be 20-30.

My labs last week, 1 month after 14 pellets inserted and anastrozole suspended were T = 1137. Estradiol = 60.

The lab 60 days prior, which was 90 days after previous 14 pellet insertion was T = 600, Estradiol = <5. All previous labs done at 30 & 90 days post insertion have T = 600-1300 and E = <5 to 60.

Now that the estradiol is 60, I am back on 1/2 mg anastrozole every week, but I fear that as my T begins to fall that estradiol will be again taken too low. The DR. explained that both T & E are moving targets and he is not concerned unless the estradiol is over 60.

Questions:
Am I expecting too much for my estradiol to be consistently close to the target range of 20-30?

The dose of 14 pellets seems a little high, based on what I've read, although I am ecstatic with the results. Should I ask about reducing pellets, which would also reduce estradiol, making it easier to manage?

 

[Steve Williams]

Hi Jay Jay, I have read (on this forum) that the ratio of T to E can be a better marker than the flat numbers. The target ratio is 20 T to 1 E (if I remember correctly) and that would put you in a pretty good place. Unless you see symptoms of high or low E, I would not necessarily try to correct it. When you E is high, do you have symptoms? What about when your E is low?
Also, make sure he is using the right test for the E, because a normal blood test can read your levels erroneously.

 

[Sean Mosher]

Jay-Jay, are you experiencing any "roller coaster" with pellets only being inserted every 4 months?
It looks like you went from 1137 to around 600.
It seems it would be extremely hard to maintain consistent T levels and then would be very difficult to manage estradiol.....

 

[Steve Williams]

Pellets give you high numbers the first month and a gradual decline over the next four to five months.

 

[CoastWatcher]

Welcome to Excelmale. Frankly, pellets present the devil's own challenge when it comes to managing testosterone and estradiol levels. The reason for that is clear from your own experience - once inserted you can only react to serum level changes, you can't actually manage your protocol. That is the reason that the overwhelming majority of doctors practicing in this area prefer injections of testosterone, injections typically self-administered. Once a dialed-in protocol is in place adjustments can be made simply and directly.

That said, you are right to be concerned about your estradiol level. There is no absolute, fixed value that every patient ,use aim for. An important question: was your estradiol measured via the sensitive (LC, MS/MS) lab test? If it wasn't you present numbers that are of limited, if any value. What is the range on your lab report?

In in all honesty, the complications, on Anastrozole and off it, could probably be eliminated if you and your doctor adopted a contemporary protocol...one not involving pellets. Your doctor's comment that testosterone and estradiol are "moving targets" is a dead giveaway - of course you can't achieve stability with pellets. But you certainly can expect to with another mode of delivery.

 

[Vince Carter]

MY impression with pellets is that you'll have to dose your AI based on symptoms, I doubt testing is going to be of any real value given the four month time frame. If you're not having a problem withe E @60, you needn't do anything. If you're having night sweats/body heat, or acne, two prevailing high E symptoms, you should treat that though it's common here to also state that .5mg of Anastrozole is a very heavy dose. Most of us ever only use .25mg at one-time, if not less.
Im not sure what help we can give this predominantly an injections group that you might find limited value for. As Coasty said, pellets aren't the "thing" to do as far as whats the most current treatment regimen(s).
If it works and you're happy you should absolutely continue the pellets, but when it comes to E2 we typically say to treat a negative symptom and the an AI should not be included "just because".

 

[Jay-Jay]

Thanks Steve. The 20-1 ratio is very helpful. No, I do not feel or see symptoms of the high or low E. But, the T therapy has been a life-changer for me.
I don't know how to tell if it's the right test for E. It is a blood test done in the lab. This time it was only T & E but other times, it is a much larger blood panel, including PSA.

Thanks for the reassurance.

 

[Jay-Jay]

Sean, normally, I don't feel a huge variation. But, one time it was 4 months & 18 days. The extra 18 days made a big difference.e I think mt T was very low and I felt like I was getting over the flu. If the keep it very close to 4 mos., I seem to be OK at around 600. My initial pre-therapy level was 325, so 600 feels OK.

I'm an Aggie fan even though my kids are Longhorns.

 

[Jay-Jay]

Thank you for the welcome and excellent input. I will discuss the alternatives with my doctor. Here is all I see on the lab report.

Order: Estradiol
Name Date Value Units Range Source
Estradiol 4/4/2016 <5.00 52.90&#8208;63.30 USMD Health System
Notes:
Postmenopausal females 51.6&#8208;314
Non&#8208;pregnant Females
Mid&#8208;follicular phase 173&#8208;315
Mid&#8208;luteal phase 294&#8208;752
Ovulation phase 317&#8208;525
Updated Reference Range 6/11/2015

 

[Jay-Jay]

Thank you. The doctor is very good about responding to questions. I'll ask him about the Anastrozole dose and the his thought on going to self administered injections. But, he has given me the impression that injections are a fall-back mode if there are problems with the pellets.

 

[CoastWatcher]

Thank you for the welcome and excellent input. I will discuss the alternatives with my doctor. Here is all I see on the lab report.

Order: Estradiol
Name Date Value Units Range Source
Estradiol 4/4/2016 <5.00 52.90&#8208;63.30 USMD Health System
Notes:
Postmenopausal females 51.6&#8208;314
Non&#8208;pregnant Females
Mid&#8208;follicular phase 173&#8208;315
Mid&#8208;luteal phase 294&#8208;752
Ovulation phase 317&#8208;525
Updated Reference Range 6/11/2015

Your estradiol level was measured using the standard test - a reliable instrument if you're a woman, of little, or no, value if you are a man. The standard test over-reports estradiol in men; you can't rely on it. Ask for doctor for the sensitive test - Liquid Chromatography, Dual Mass Spec.

 

[Jay-Jay]

I'm very grateful for the this important information. Since my earlier post, I spoke with my caregiver about the E2 being 60. He said to relax, take .5 mg of Anastrozole, repeat weekly, come for a re-test in 6 weeks. I'm feeling over-medicated.[/COLOR]

I've also read the thread on why men should only be given the sensitive E2 test. Very convincing!

The knowledge about the E2 sensitive tests and that self administered injections are the preferred protocols puts me in a good position as a more informed patient. But as a layperson, I'm in the uncomfortable dilemma of how do I tell the doctor that I'd prefer to change the mode of T replacement, after 2+ years of pellet therapy that has changed my life. And I also wish to be re-tested with a E2 sensitive test. It's a contradiction to his treatment plan. As a Medicare Advantage patient, my physician choices are limited, but it must be done. Any suggestions?

 

[Zxy]

My E was 60. I take 1/4 tablet of a 1MG Anastozole twice a week. Now I am at 20 or slightly higher. How's the DHT doing.

 

[Zxy]

Oops...
Y
ou mitten consider going to 1/4 tablet and see if that keeps you in range. Or possible 1/4 twice a week the first month or two and reducing the final 2 months...?

 

[Jay-Jay]

I don't see DHT anywhere in my labs, but I googled it. Is this something that should be watched?

 

[CoastWatcher]

I'm very grateful for the this important information. Since my earlier post, I spoke with my caregiver about the E2 being 60. He said to relax, take .5 mg of Anastrozole, repeat weekly, come for a re-test in 6 weeks. I'm feeling over-medicated.[/COLOR]

I've also read the thread on why men should only be given the sensitive E2 test. Very convincing!

The knowledge about the E2 sensitive tests and that self administered injections are the preferred protocols puts me in a good position as a more informed patient. But as a layperson, I'm in the uncomfortable dilemma of how do I tell the doctor that I'd prefer to change the mode of T replacement, after 2+ years of pellet therapy that has changed my life. And I also wish to be re-tested with a E2 sensitive test. It's a contradiction to his treatment plan. As a Medicare Advantage patient, my physician choices are limited, but it must be done. Any suggestions?

You aren't the only member of Excelmale to be faced with challenges with their physicians in TRT-related matters. It is an all too common problem. In regards to the matter of testing your estradiol, it should be a fairly easy request - select the sensitive test rather than the standard one. The issue, of course, is that it reveals your doctor isn't on top of matters. You, his patient, on this point, are better informed than he is. You have the option of self-testing through Discountedlabs.com (www.discountedlabs.com). For a reasonable fee you can have the estradiol sensitive test run and the results emailed to you. Many of us use that service regularly. Should your E2 turn out to be at a reasonable level all is well; if elevated, you can then discuss it with your doctor.

You're right, this community is very injection-oriented. Injections are cheaper than pellet therapy and far easier to manage. Most leading TRT physicians refuse to prescribe pellets as they cost a lot of money and pose real challenges in terms of dialing things in. But, if it works for you...

There are other choices in terms of medical providers. Defy Medical, a national practice, is used by many here. Check their website, they are a sponsor of this site, or call them. They may not be as expensive as you fear.

 

[Zxy]

T turns into Estrodiol and DHT. It's a matter of balance. For E, Anastrozol, for DHT I take Saw Palmetto - good for prostate anyway. For DHT a scrip for it would be Avodart.

To balance this takes patience and a few blood tests.

 

[Fireproof]

I started TRT on pellets. Yes - they helped. BUT I found that I only felt "great" the first month to month and a half after insertion of the pellets. They led me to believe that the absorption is pretty linear over the 4-5 months. It's not. I had a huge spike the first month or so. Then month 2 I felt "okay". Then month 3 and 4 i felt like it was a waste of money because I was feeling symptoms of low-T again.

Not only that - the spike in T led to spikes in estrogen like you are experiencing. So every time I get my insertion - I had to prepare for bloating, tender nipples, and extreme acne outbreak. We tried to manage it with DIM alone - didn't help. Then we tried Anastrozole. But they didn't have me taper it - they just told me to stay on it. So the first month after insertion the anastrozole finally helped keep e2 in check. But then I think it crashed my e2 in months 3 and 4 as my T levels dropped.

Anyway - after 2 years of that - I researched myself and found pellets are NOT the ideal TRT method (far from it).

The problem was - I was using an HRT clinic that only specialized in Pellet therapy. They didn't offer injections or prescribe for self-injection. (In reality - they were just interested in selling their pellet-therapy, not treating the patient in the best manner possible). So I quit going and searched for other solutions.

Highly recommend you figure out a plan to get off of pellets. Fast forward to today, after being with Defy, not only do they effectively manage my T and E levels, but also other important things like DHEA, Thyroid, etc. I'm feeling the best I've felt in 15 years (at 47 years old), my T levels are consistently at the high-end of the range where I feel best, sex drive is up, depression and lethargy are GONE, and acne is minimal to nonexistent.

Like others I inject T-Cyp every 3.5 days along with HCG and am convinced of the value of frequent injections for steady hormone levels.

Good luck.

 

[Vince Carter]

T turns into Estrodiol and DHT. It's a matter of balance. For E, Anastrozol, for DHT I take Saw Palmetto - good for prostate anyway. For DHT a scrip for it would be Avodart.

To balance this takes patience and a few blood tests.

Saw Palmetto is known Androgen, blocker.

https://www.anabolicmen.com/saw-palmetto-testosterone/

 

[Jay-Jay]

Thank you for this extremely valuable insight. Yes, it is a little discomforting to see that my doctor is not up to date. The first step is, I will do a self-test with discountedlabs.com and see where my E2 really is and possibly reduce or eliminate the Anastozole until the next scheduled lab, in about 6 weeks. I'll ask that the lab in 6 weeks be sensitive E2. I am also leaning heavily toward asking to transition from pellets to self injection. It sounds like the transition could be accomplished without interrupting the excellent benefits I have with the increased T, and, that E2 is more easily managed with injections.

I'll definitely also look at Defy Medical and know that I have an option, depending on how my requested changes to sensitive E2 and injections are received.