Just met with Endo and hesitant to move forward.

Bobsyouruncle · Wednesday at 1:25 PM

I have been reading this great wealth of knowledge for a couple months and its finally time for my first post.

All labs by Quest D 50 years old 6' 225lbs
TT 633
FT Equ Dia 75 range 33-155
SHBG 52 <50
Estradiol sensitive 40 range <29
TH 1.3 range 0.4-4.5 will order autoimmune test next just to make sure
T3 Uptake 35 range 22-35%
Free T4 index 2.7 range 1.4-3.8
T4 7.6 range 4.9 10.5
Aldosterone 3 range <28
Renin 0.76 range 0.25-5.82
DHT 38 range 12-65
DHT free 1.99 range 0.62-3.38
FSH 5.3 range 1.4-12.8
LH 3.2 range 1.5-9.3 (this was 5.1 60 day ago)
Cortisol total 6.3 range morning 4.6-20.6
Cortisol free 0.21 range 0.07-0.93
ACTH 9 range 6-50

Symptoms cut and paste from google - all of these impact me and have slowly increased over the last 5 years or so but I noticed them starting 10-15 years ago. All previous Dr visit ended with, its in your head...take some SSRIs (which I am against specifically for men struggling with ED) and get in shape which I did and cleaned up my diet significantly. All my other labs have corrected to dead normal as a result of the effort...but I am stuck now.,

Lower motivation
Reduced confidence
Irritability
Brain fog
Mild depressive symptoms
Lower libido
Weaker erections
Fewer morning erections
Reduced orgasm intensity
Lower energy
Reduced strength
Increased body fat
Slower recovery
Difficulty building muscle
Gynecomastia unresolved from puberty and still around
I think there is some testicular atrophy - don't have baseline to confirm

Additional symptoms possibly from low cortisol/aldosterone

mild to moderate orthostatic intolerance (most noticeable after standing for 20min)
HR increases upon standing anywhere from 20-40 BPM
light activity doing dishes, vacuuming HR = 130
Salt craving {i'm on 6-10g of salt per day to function)

So I have been prescribed Anastrozole and Fludrocortisone. The latter I understand, but the aromatase inhibitor has me concerned. Studies I have read report increased Ft and lower E2, but no confirmed symptom relief. I am also concerned this off label us is primarily to subdue the masses from "abusing" TRT not maintaining the health and function of men. I think it is utterly irresponsible not to have published Ft guidelines leaving us to shop around for help. I think Ft of 75 at 50yrs old with 10 years of struggling until blue pills no longer work is low. I am highly likely to grab a second opinion from Defy but wondered if the forum had any suggestions until I can meet with them.

My life has come to a halt...as stated to my primary and Endo...I am unable to work professionally in this condition, and my wife is gorgeous and I feel like I am dying a bit every day I am not intimate with her...I can't even sleep in the bed at this point.

I have more labs and details if needed. Opinions appreciated

madman · Wednesday at 7:15 PM

Bobsyouruncle said:
I have been reading this great wealth of knowledge for a couple months and its finally time for my first post.

All labs by Quest D 50 years old 6' 225lbs
TT 633
FT Equ Dia 75 range 33-155
SHBG 52 <50
Estradiol sensitive 40 range <29
TH 1.3 range 0.4-4.5 will order autoimmune test next just to make sure
T3 Uptake 35 range 22-35%
Free T4 index 2.7 range 1.4-3.8
T4 7.6 range 4.9 10.5
Aldosterone 3 range <28
Renin 0.76 range 0.25-5.82
DHT 38 range 12-65
DHT free 1.99 range 0.62-3.38
FSH 5.3 range 1.4-12.8
LH 3.2 range 1.5-9.3 (this was 5.1 60 day ago)
Cortisol total 6.3 range morning 4.6-20.6
Cortisol free 0.21 range 0.07-0.93
ACTH 9 range 6-50

Symptoms cut and paste from google - all of these impact me and have slowly increased over the last 5 years or so but I noticed them starting 10-15 years ago. All previous Dr visit ended with, its in your head...take some SSRIs (which I am against specifically for men struggling with ED) and get in shape which I did and cleaned up my diet significantly. All my other labs have corrected to dead normal as a result of the effort...but I am stuck now.,

Lower motivation

Reduced confidence

Irritability

Brain fog

Mild depressive symptoms

Lower libido

Weaker erections

Fewer morning erections

Reduced orgasm intensity

Lower energy

Reduced strength

Increased body fat

Slower recovery

Difficulty building muscle

Gynecomastia unresolved from puberty and still around

I think there is some testicular atrophy - don't have baseline to confirm

Additional symptoms possibly from low cortisol/aldosterone

mild to moderate orthostatic intolerance (most noticeable after standing for 20min)

HR increases upon standing anywhere from 20-40 BPM

light activity doing dishes, vacuuming HR = 130

Salt craving {i'm on 6-10g of salt per day to function)

So I have been prescribed Anastrozole and Fludrocortisone. The latter I understand, but the aromatase inhibitor has me concerned. Studies I have read report increased Ft and lower E2, but no confirmed symptom relief. I am also concerned this off label us is primarily to subdue the masses from "abusing" TRT not maintaining the health and function of men. I think it is utterly irresponsible not to have published Ft guidelines leaving us to shop around for help. I think Ft of 75 at 50yrs old with 10 years of struggling until blue pills no longer work is low. I am highly likely to grab a second opinion from Defy but wondered if the forum had any suggestions until I can meet with them.

My life has come to a halt...as stated to my primary and Endo...I am unable to work professionally in this condition, and my wife is gorgeous and I feel like I am dying a bit every day I am not intimate with her...I can't even sleep in the bed at this point.

I have more labs and details if needed. Opinions appreciated

Welcome to Nelson's house!

Smart move testing the most critical fraction FT using the most accurate testing method ED.

As you can see although you are hitting a robust TT 633 ng/dL with a high SHBG 52 nmol/L your FT sits on the lower-end what would be called falls in the grey zone 5-9 ng/dL where some men may experience symptoms of low-T.

Any doctor in the know would treat a man with symptoms of hypogonadism and a FT <10 ng/dL.

Need to keep in mind that if you end up jumping on T you are going to have to tread lightly on how you manage the elevated estradiol as your levels with be pushed up much further depending on how high you drive up your FT especially seeing as you have dealt with gyno.

Your endo most likely wanted to take the easy route to try and treat the elevated estradiol and drive up your T which should improve your symptoms but unfortunately in the long run would be detrimental to your bone health if your estradiol is driven too low.

Even then many would not fare well overall when it comes to symptom relief especially libido.

Bobsyouruncle · 2026-03-19T06:40:52-0500

Thanks for your thoughts. I suppose I am going to need stabilize my other issue then drop 40 lbs through keto, intermittent fasting, and HIIT rowing along with some natural aromatase inhibitors and natural testosterone enhancers. Even if the suppliment effects are minor it may help. If I can effectivly reduce estradiol and its symptoms through this I may have options if I still have low Ft symptoms 6-12 months from now.

If Im missing something please let me know. I will read through all the threads here on estradiol but I think most focus on management with TRT which does not look like my best next move.

Thanks to all on the board. This place make me feel not alone and reminds me to stay in the fight when i am frustrated or discouraged.