Looking for help

[Hai Bodong]

Hello

First of all, if this is wrong section, apologies.

For the past three years I have been experiencing low energy, low motivation, brain fog, memory shortness, super low libido and as of last year, ED. The libido is almost at the bottom now. I am not on TRT and I have never used hormones in the past.

When I check this forum and a lot of other forums and Facebook groups, I see that every symptom I have, falls under the low oestrogen symptoms. Both for TRT users and supraphysiological users. Additionally, almost all the people that post their labs in those groups, have around twice the level of e2 that I have.

I had an appointment with Leger clinic, which ended in them prescribing me tadalafil. I have been using for 5 days now and I saw some activity but from the second day I started having aches all over the body. Moreover, it has AI effects which will be terrible for my low E2. Maybe the aches started because my E2 dropped already. Essentially I am disappointed not because I was not prescribed TRT, but I gained no solution or at least knowledge. Lastly, the doctor did not mention anything about my E2 levels being that low. I would assume if my FT was proportionally low, there would be talks about it.

My TT was at 15.6nmol/l in 2020 on a let's get checked test and my prolactin a bit higher than the highest normal.

What do the experienced members think? How can I raise my E2 to test whether the problem is there?

 

[Systemlord]

How can I raise my E2 to test whether the problem is there?

You need two things to increase estrogen, one is more testosterone, two is adequate aromatase enzymes in the body. You may even have an aromatase deficiency which would explain why E2 is 12.5 pg/mL and FT midrange.

There may even be genetic testing for an aromatase deficiency. This low level of estrogen will likely cause osteoporosis as well as other diseases!

Sex hormones is a blind spot for a lot of doctors with little or no training in medical school.

HCG, TRT will increase testosterone and therefore estrogen.

Estrogen is essential for maintaining nigrostriatal dopamine neurons in primates: implications for Parkinson's disease and memory - PubMed

Estrogen deficiency and the pathogenesis of osteoporosis

Estrogen deficiency is a pivotal cause of postmenopausal bone loss and contributes to age-related bone loss in both sexes. At the cellular level, estr…

www.sciencedirect.com

 

[Systemlord]

How can I raise my E2 to test whether the problem is there?

Beer, alcohol increases estrogen, so if you were to drink a couple of beers and felt better for the next 24 hours...

As for the tadalafil, yeah, that's a bad move on your doctors part.

 

[Hai Bodong]

You need two things to increase estrogen, one is more testosterone, two is adequate aromatase enzymes in the body. You may even have an aromatase deficiency which would explain why E2 is 12.5 pg/mL and FT midrange.

This low level of estrogen will likely cause osteoporosis as well as other disease!

HCG, TRT will increase testosterone and therefore estrogen.

Estrogen is essential for maintaining nigrostriatal dopamine neurons in primates: implications for Parkinson's disease and memory - PubMed

Estrogen deficiency and the pathogenesis of osteoporosis

Estrogen deficiency is a pivotal cause of postmenopausal bone loss and contributes to age-related bone loss in both sexes. At the cellular level, estr…

www.sciencedirect.com

Thank you friend for your input.

In your experience, could this level of oestrogen be the source of my blight?

Regarding memory, last year and this year have been terrible. I work and within minutes i forgot where the tools are. If you ask me something to do and I do not do it instantly, it is gone from my brain. If I have to do something and something else interrupts me, I have forgotten the original thing super fast.

 

[Hai Bodong]

Beer, alcohol increases estrogen, so if you were to drink a couple of beers and felt better for the next 24 hours...

As for the tadalafil, yeah, that's a bad move on your doctors part.

In general I do not drink a lot and as time goes by, I drink less and less. In my youth I used to drink copious amounts of beer and I wonder whether that affected my hormones one way or another.

I am very disappointed by the doctor. That's a lot of money I paid and I am at square one. She did not even say a thing about my oestrogen. If my FT was 12, I would have been prescribed most likely.

Some more info: I am 35 yo, 1.8m tall, 100kg and muscular. But I am not vascular or in general with cuts and veins.

 

[Systemlord]

In your experience, could this level of oestrogen be the source of my blight?

Absolutely, 99.9995% certain!

Regarding memory, last year and this year have been terrible. I work and within minutes i forgot where the tools are. If you ask me something to do and I do not do it instantly, it is gone from my brain. If I have to do something and something else interrupts me, I have forgotten the original thing super fast.

Hormonal Influences on Cognition and Risk for Alzheimer Disease

 

[Hai Bodong]

Absolutely, 99.9995% certain!


Hormonal Influences on Cognition and Risk for Alzheimer Disease

I have been researching on my own and at every turn I see that this is low E2. It is so disappointing the doctor did not even mention this. And i said, ok tadalafil might help there but the focus, libido, motivation issues still exist. £220 pounds for an appointment and the internet has provided more insight.

Has anyone been prescribed TRT for this reason? At this point I am a shadow of my former self and my wife is having a hard time with me.

 

[Hai Bodong]

You need two things to increase estrogen, one is more testosterone, two is adequate aromatase enzymes in the body. You may even have an aromatase deficiency which would explain why E2 is 12.5 pg/mL and FT midrange.

There may even be genetic testing for an aromatase deficiency. This low level of estrogen will likely cause osteoporosis as well as other diseases!

Sex hormones is a blind spot for a lot of doctors with little or no training in medical school.

HCG, TRT will increase testosterone and therefore estrogen.

Estrogen is essential for maintaining nigrostriatal dopamine neurons in primates: implications for Parkinson's disease and memory - PubMed

Estrogen deficiency and the pathogenesis of osteoporosis

Estrogen deficiency is a pivotal cause of postmenopausal bone loss and contributes to age-related bone loss in both sexes. At the cellular level, estr…

www.sciencedirect.com

Why would low aromatase explain the FT midrange?

 

[sammmy]

You can always get a bio-identical estrogen cream, if you think low estrogen is the source of your problem.

Your testosterone seems fine on all tests, including high hemoglobin and hematocrit.

The elephant in the room is that your other tests that are off cannot be explained with "low estrogen":

- your very low neutrophils and lymphocytes suggest an ongoing infection
- high creatinine (can be caused by infection)
- high liver enzymes (can be infection again or a supplement you take)
- high triglycerides (bad diet or something else)

Even of greater concern is your forgetfulness, that may be related to a brain infection or onset of Alzheimer or both.

Do not try to explain everything with hormones or think that TRT will magically fix everything. There are gazillions other factors at play here.

 

[sammmy]

Basically, you need to go to a real doctor. Severe forgetfulness at 35yo is not a common symptom.

 

[Systemlord]

Has anyone been prescribed TRT for this reason?

TRT can be prescribe if there's a medical benefit.

 

[Hai Bodong]

Basically, you need to go to a real doctor. Severe forgetfulness at 35yo is not a common symptom.

This started last year.

I had an ear infection an that is probably why. I have been feeling all these issues since late 2019, early 2020 and I do not think the other numbers are the source to be honest.

I do not have that bad of a diet and I exercise 4 times a week for a decade at least.

Can you expand on the bio-identical oestrogen cream? Will it disrupt my HPTA?

This Friday I am going to the gp although I do not expect much.

 

[Systemlord]

Why would low aromatase explain the FT midrange?

Low aromatase explains the low estrogen, since most of a man's estrogen is converted from testosterone, little to no aromatase, equals low estrogen.

 

[Hai Bodong]

Low aromatase explains the low estrogen, since most of a man's estrogen is converted from testosterone, little to no aromatase, equals low estrogen.

I still do not get how it explains mid FT. In your first post I understood it as if low aromatase has an input in suboptimal FT.

I would assume if my aromatase was proper, my FT would be even lower.

 

[Systemlord]

I still do not get how it explains mid FT. In your first post I understood it as if low aromatase has an input in suboptimal FT.

I would assume if my aromatase was proper, my FT would be even lower.

You misunderstood. Aromatase is responsible for converting testosterone into estrogen, without aromatase a man's estrogen will be very low.

A small fraction of a man's testosterone is made in the testicles. The low estrogen can't be explained by your FT level, that was my point.

Typically the overweight male with low-T has high estrogen and low FT, because the majority of aromatase is in fat tissue, or belly fat.

 

[Hai Bodong]

You misunderstood. Aromatase is responsible for converting testosterone into estrogen, without aromatase a man's estrogen will be very low.

A small fraction of a man's testosterone is made in the testicles. The low estrogen can't be explained by your FT level, that was my point.

Typically the overweight male with low-T has high estrogen and low FT, because the majority of aromatase is in fat tissue, or belly fat.

So that would mean my aromatase levels are probably very low, hence low converted volume.

Unfortunately I do not have labs with E2 from the past. Some labs from 2014 and 2017 only had TT and FT. If we assume I have been like this with steady decline over the years, could it explain my issues as well as the memory? Maybe for the issues to manifest, this time with low E2 was needed.

I am not trying to justify TRT. I want to understand and find a solution. If the solution is something besides TRT, I am fine with that. I want to fix my libido, fog etc. I don't care about the other things.

 

[sammmy]

Regarding memory, last year and this year have been terrible. I work and within minutes i forgot where the tools are. If you ask me something to do and I do not do it instantly, it is gone from my brain. If I have to do something and something else interrupts me, I have forgotten the original thing super fast.

That's beginning stages of dementia, not "brain fog" or "lack of focus".

Clomiphene will increase your T and probably estradiol but will block estrogen receptors so it is not clear what the overall effect it will have on your brain:

Clomiphene and Estradiol Levels​

Another important consideration is that clomiphene can increase levels of estradiol in some men. The enzyme aromatase converts some of a man’s testosterone to estradiol. If clomiphene is started and testosterone levels increase, then more of this T can be converted to estradiol. Therefore, estradiol levels should be monitored in men on testosterone-enhancing therapies.
Estradiol levels have been documented with the use of clomiphene in men, and this effect seems to increase with longer use of the medication. [Moskovic DJ. BJUI 2012]. In a long term follow-up study on clomiphene use, about 14% of them needed to have anastrazole added onto their regimen due to increases in estradiol levels. [Krzastak SC. JUrol 2019]. This need for using anastrazole also increased with more time on clomiphene, with 37% of men needing the anastrazole if they had been taking the clomiphene for longer than 3 years. These findings show the importance of continued routine follow-up of hormone levels (including estradiol) in men taking clomiphene.

 

[JmarkH]

Clomiphene will increase your T and probably estradiol but will block estrogen receptors so it is not clear what the overall effect it will have on your brain

I can only speak to my experience. I had many of the same symptoms, and the brain fog was worrying me. My labs didn't look that bad, but I noticed the ratios were off. My men's health provider suggested I start with clomiphene and hcg. I was game for just about anything. I had to do something. The first week, the fog began lifting, and stress was less as was anxiety. I can't totally explain it by the labs but this protocol made me human again and feel like a man again. My motivation came back and I started working out. That was last February 2022 when I started this journey. I would never want to go back to the way I was.

 

[Hai Bodong]

That's beginning stages of dementia, not "brain fog" or "lack of focus".

Clomiphene will increase your T and probably estradiol but will block estrogen receptors so it is not clear what the overall effect it will have on your brain:

I do understand that I have come across more extreme than it actually is. But I am not like a goldfish yet.

I can only speak to my experience. I had many of the same symptoms, and the brain fog was worrying me. My labs didn't look that bad, but I noticed the ratios were off. My men's health provider suggested I start with clomiphene and hcg. I was game for just about anything. I had to do something. The first week, the fog began lifting, and stress was less as was anxiety. I can't totally explain it by the labs but this protocol made me human again and feel like a man again. My motivation came back and I started working out. That was last February 2022 when I started this journey. I would never want to go back to the way I was.

Do you have labs before and after? How are you now?

@Systemlord The doc responded this "Essentially he concurred with my treatment plan and didn't feel that your level of oestrogen was the likely cause for your symptoms. Many people tolerate oestrogen on the lower end of the spectrum very well.". The last part is ridiculous to me. If they went by numbers, large swathes of people would not be on TRT. Also, the doc never really addresses what could cause all these symptoms. Not even one suggestion so I can follow another path. Tomorrow I'm visiting the gp but I won't have my hopes up.

Any opinion on this? Icariin from Epimedium brevicornum Maxim promotes the biosynthesis of estrogen by aromatase (CYP19) - PubMed

 

[JmarkH]

Do you have labs before and after? How are you now?

Oh yes. When I signed up with my clinic they ordered labs, then I had a consult. 8 weeks later I had labs and a change in dosage. 8 weeks later another set of labs. That was July and I'll run a new set the first week of March. I'm feeling great and growing stronger in mind and body all the time.