1. #1

    Lab Results - Discussion of Free Estradiol

    Below are my recent lab results which I'm pleased with. I'm happy to see my latest whole blood donation (27 March) brought down my RBC and I'm not sure if this helps, but I've started drinking a LOT of water and working out (dropped ~13lbs in the past couple months). I'm guessing the latter has minimal effect.

    My E2 is down at a good level as well. Back in January Defy started me on .125mg Anastrazole twice a week when I take my Test E and HCG.

    My protocols is:
    Test E - M/Thr (.3ml)
    HCG - M/Thr (.5ml)
    Anastrazole - M/Thr (.125mg)
    DHEA - Daily (25mg)
    Calcium D-Glucarate - Daily (400mg)
    D3 - Daily (5000ui)

    The lab work was completed before my Monday (~09:00) injection and fasting for 12 hours.


    CBC With Platelet And Differential Reference Range 4/18/2017 1/3/2017
    WBC 3.8-12.8 4.4 6.1
    Red Blood Cell Count (RBC) 4.20-5.70 5.44 6.03
    Hemoglobin (Hgb) 14.0-18.0 15.1 18.4
    Hematocrit (HCT) 42.2-53.8 47.6 54.7
    MCV 81.0-102.0 87.5 90.7
    MCH 26.9-35.0 27.8 30.5
    MCHC 30.4-34.8 31.7 33.6
    RDW 38.2-53.0 45.7 44.7
    Platelet Count 137-397 270 240
    Neutrophils Automated 41.0-77.0 66 69.7
    Lymphocytes Automated 14.0-48.0 22.5 20.8
    Monocytes Automated 4.0-13.0 8.3 7
    Eosinophils Automated 1.0-8.0 2.5 1.5
    Basophils Automated 0.0-1.5 0.7 0.7
    Immature Granulocyte Automated 0.0-1.0 0 0.3


    Estradol, Free LC/MS/MS


    Reference Range


    4/10/2017


    1/25/2017
    Estradiol Free < or =0.45 0.52 0.86
    Estradiol < or = 29 24 39


    PSA


    Reference Range


    4/10/2017


    1/3/2017
    PSA 0.00-4.00 0.74 0.52


    Testosterone


    Reference Range


    4/10/2017


    1/3/2017
    Testosterone 205.00-781.00 873.59 787.36


    Testosterone, Calc. Free/Bioavail (Adult Male 14+)


    Reference Range


    4/10/2017


    1/3/2017
    Free Testosterone, Percent 1.60-2.90 1.76 2.18
    Free Testosterone (calculation) 33-227 154 168
    Testosterone Bioavailable 131-682 361 395
    Sex Hormone Binding Globulin 11-71 51.0

  2. # ADS
    Purchase From Our Affiliates
    Join Date
    Always
    Location
    Houston, TX
    Posts
    51
    Help Excelmale

    Defy
     

  3. #2
    Can you remind me how long you've been on TRT?
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

  4. #3
    Junior Member stevep's Avatar
    Join Date
    Jun 2016
    Location
    Tennessee
    Posts
    110
    This summer will be 3 years. The first 2+ years were with doctors that no clue on what they were doing. My RBC has been high the entire time. No other doctor brought it up as an issue. I had 4 different doctors during that time.

    When I started with Defy several months ago they made the following changes.

    First appointment (~Oct 2016) Changed to twice a week Test E. Added HCG, D3, DHEA.

    Somewhere around Dec/Jan I posted on here about ED coming back and thought it was due to high E2. Dr. Saya replied and suggested I take DIM and the Calcium D-Glucarate until I could get my follow up. Which helped.

    Second appointment (Jan 2017). Defy added the AI and I dropped the DIM. I think / know the Calcium helps me. If I miss a dose I can tell.

    This lab work will be for my third appointment with Defy.

  5. #4
    Good looking results stevep and great job with the RBC/HgB/HCT.

    Your E2 levels look great and is interesting for everyone to see the free E2 level (even with an SHBG of 51). One can easily see the impact of LOWER SHBG levels on free E2.
    Lead Physician & Medical Director
    www.defymedical.com

    NOTE: Comments on this forum are NOT medical advice and are no substitute for individualized patient care. Comments on this forum do not constitute or establish a physician-patient relationship. Please consult your personal physician prior to initiating or changing ANY treatment regimen.

  6. #5
    Quote Originally Posted by Dr Justin Saya, MD View Post
    Good looking results stevep and great job with the RBC/HgB/HCT.

    Your E2 levels look great and is interesting for everyone to see the free E2 level (even with an SHBG of 51). One can easily see the impact of LOWER SHBG levels on free E2.
    Some discussion of this point earlier in the week, in the abstract, here on the Forum. Fascinating to see a clinical example.
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

  7. #6
    Quote Originally Posted by CoastWatcher View Post
    Some discussion of this point earlier in the week, in the abstract, here on the Forum. Fascinating to see a clinical example.
    I've seen many...just wish the estradiol with free estradiol test was at a better price point so as to be more commonly ordered (I use it as a more specialized test currently).

  8. #7
    Quote Originally Posted by Dr Justin Saya, MD View Post
    I've seen many...just wish the estradiol with free estradiol test was at a better price point so as to be more commonly ordered (I use it as a more specialized test currently).
    What are the variables that result in your ordering it? If you don't mind...
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

  9. #8
    Quote Originally Posted by CoastWatcher View Post
    What are the variables that result in your ordering it? If you don't mind...
    Typically for challenging cases of suspected E2 involvement. Occasionally when symptoms point one way, but the total estradiol level (via LC/MS) is neutral or points the other way...and so on. Just another tool in the arsenal.
    Lead Physician & Medical Director
    www.defymedical.com

    NOTE: Comments on this forum are NOT medical advice and are no substitute for individualized patient care. Comments on this forum do not constitute or establish a physician-patient relationship. Please consult your personal physician prior to initiating or changing ANY treatment regimen.

  10. #9
    Quote Originally Posted by Dr Justin Saya, MD View Post
    Typically for challenging cases of suspected E2 involvement. Occasionally when symptoms point one way, but the total estradiol level (via LC/MS) is neutral or points the other way...and so on. Just another tool in the arsenal.
    Well, then I was incorrect about free hormones not ruling all. I always was of the opinion that it's more complex than free vs total(not referring to this case) essentially the free hormone hypothesis vs the free hormone transport hypothesis.

    Is the free E2 test subject to the same fluctuations in reliability as the free testosterone assays?

  11. #10
    Junior Member stevep's Avatar
    Join Date
    Jun 2016
    Location
    Tennessee
    Posts
    110
    I was told something went wrong with the CBC vial and needed to have additional blood drawn to get that lab work completed. So I went back on the 18th (Tue) which is the day after I inject. For whatever reason they re-ran the testosterone labs as well. Just to show the difference between lab work in trough vs. after an injection:

    Testosterone Reference Range 4/10/2017 Trough 4/18/2017
    Testosterone 205.00-781.00 873.59 1056.85
    Testosterone, Calc. Free/Bioavailable (Adult Male 14+) Reference Range 4/10/2017 Trough 4/18/2017
    Free Testosterone, Percent 1.60-2.90 1.76 1.84
    Free Testosterone (calculation) 33-227 154 194
    Testosterone Bioavailable 131-682 361 455
    Sex Hormone Binding Globulin 11-71 51.0

  12. #11
    Quote Originally Posted by johndoesmith View Post
    Well, then I was incorrect about free hormones not ruling all. I always was of the opinion that it's more complex than free vs total(not referring to this case) essentially the free hormone hypothesis vs the free hormone transport hypothesis.

    Is the free E2 test subject to the same fluctuations in reliability as the free testosterone assays?
    In general the more VARIABLES that are involved in impacting any given test, the more variability you will see with measurements. In other words, independent variables (albumin, SHBG) impact the test variable (free testosterone, free estradiol, etc). Similar to how the RIA shows much more variability (both up and down) than the LC/MS due to cross-reactivity (i.e. other variables).

    As a general note, looking at Steve's January labs I can envision many stating his estradiol of 39 would be a perfectly fine level (which it is for *some*)...but the free estradiol starts to paint a different picture. One could also say that there isn't data to support any "goal" or "optimal" range for free estradiol, which there isn't (keep in mind there isn't much data for sensitive estradiol LC/MS levels just yet either, he vast majority of data is still utilizing RIA). This is where the trained clinician must piece together the ENTIRE picture, both objective and subjective, to arrive at a conclusion in each individual case.
    Lead Physician & Medical Director
    www.defymedical.com

    NOTE: Comments on this forum are NOT medical advice and are no substitute for individualized patient care. Comments on this forum do not constitute or establish a physician-patient relationship. Please consult your personal physician prior to initiating or changing ANY treatment regimen.

  13. #12
    Quote Originally Posted by stevep View Post
    I was told something went wrong with the CBC vial and needed to have additional blood drawn to get that lab work completed. So I went back on the 18th (Tue) which is the day after I inject. For whatever reason they re-ran the testosterone labs as well. Just to show the difference between lab work in trough vs. after an injection:

    Testosterone Reference Range 4/10/2017 Trough 4/18/2017
    Testosterone 205.00-781.00 873.59 1056.85
    Testosterone, Calc. Free/Bioavailable (Adult Male 14+) Reference Range 4/10/2017 Trough 4/18/2017
    Free Testosterone, Percent 1.60-2.90 1.76 1.84
    Free Testosterone (calculation) 33-227 154 194
    Testosterone Bioavailable 131-682 361 455
    Sex Hormone Binding Globulin 11-71 51.0
    Yep, looks about right for BIW with your SHBG.
    Lead Physician & Medical Director
    www.defymedical.com

    NOTE: Comments on this forum are NOT medical advice and are no substitute for individualized patient care. Comments on this forum do not constitute or establish a physician-patient relationship. Please consult your personal physician prior to initiating or changing ANY treatment regimen.

  14. #13
    Quote Originally Posted by stevep View Post
    I was told something went wrong with the CBC vial and needed to have additional blood drawn to get that lab work completed. So I went back on the 18th (Tue) which is the day after I inject. For whatever reason they re-ran the testosterone labs as well. Just to show the difference between lab work in trough vs. after an injection:

    Testosterone Reference Range 4/10/2017 Trough 4/18/2017
    Testosterone 205.00-781.00 873.59 1056.85
    Testosterone, Calc. Free/Bioavailable (Adult Male 14+) Reference Range 4/10/2017 Trough 4/18/2017
    Free Testosterone, Percent 1.60-2.90 1.76 1.84
    Free Testosterone (calculation) 33-227 154 194
    Testosterone Bioavailable 131-682 361 455
    Sex Hormone Binding Globulin 11-71 51.0
    Another supporting lab account of trough/peak fluctuations. Thank you for posting.
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

  15. #14
    Quote Originally Posted by Dr Justin Saya, MD View Post
    In general the more VARIABLES that are involved in impacting any given test, the more variability you will see with measurements. In other words, independent variables (albumin, SHBG) impact the test variable (free testosterone, free estradiol, etc). Similar to how the RIA shows much more variability (both up and down) than the LC/MS due to cross-reactivity (i.e. other variables).

    As a general note, looking at Steve's January labs I can envision many stating his estradiol of 39 would be a perfectly fine level (which it is for *some*)...but the free estradiol starts to paint a different picture. One could also say that there isn't data to support any "goal" or "optimal" range for free estradiol, which there isn't (keep in mind there isn't much data for sensitive estradiol LC/MS levels just yet either, he vast majority of data is still utilizing RIA). This is where the trained clinician must piece together the ENTIRE picture, both objective and subjective, to arrive at a conclusion in each individual case.
    That explains a lot, and I agree with you about Steve's labs, I honestly would have said a 39 E2 level is great, but looking at the difference in free E2 then and now paints a WHOLE different picture.

    I had these taken a while back, and while Labcorp's range is different, plus their total E2 tests can't seem to agree on what my level was at that time, the free E2 test agrees with my clinical picture.

    Name:  e4znarP.jpg
Views: 325
Size:  126.3 KB

    Thanks for the explanation.

    Steve:

    I had nearly the same level of fluctuation with my E3D frequency, if you look through my threads you'll see where I posted labs each day along with graphs.

    IIRC I went from 1013 at peak to 679 at trough, roughly about 300 points. A little bit more than you, but your SHBG is way higher than mine. I was around 22 then whereas you're at 51?

    All in all, I don't feel a single difference on any day. So this is all theoretical. I'm glad you're doing so well on TRT!

  16. #15
    Im very very interested in the Free E aspect, for those of us low SHBG guys as a place to look for so many that have trouble getting in to a sweet spot, this will def be on my next set of labs but I've also felt so good that for at least 6 months I haven't felt any need to test anything. Perhaps we have to run closer to 20 LC/MS/MS to account for the free Estradiol. Low SHBG = high Free T and subsequent (suspected) high Free E. Read this in Dr Crislers book (I think his latest book?)

    I had pretty high E as much as 88 at one point and got on .25mg EOD thanks to Dr Saya, that put me to 17 LC/MS/MS and we adjusted to M/W/F and I think I'm *pretty* good but still bothered with some hot/overly warm in bed and PMSish tough to deal with daily stress, which both are much much better than before the AI.
    Im thinking I may go back to the EOD and in to the teens and see where I'm at.

  17. #16
    It is my understanding that an AI such as Arimidex binds to the receptor sites and blocks the further production of estrogen to a certain percentage based on dosing. So if someone has elevated free E2 levels, would that make the AI useless against the free floating E?

    Can someone elaborate on this?

  18. #17
    Quote Originally Posted by DRay View Post
    It is my understanding that an AI such as Arimidex binds to the receptor sites and blocks the further production of estrogen to a certain percentage based on dosing. So if someone has elevated free E2 levels, would that make the AI useless against the free floating E?

    Can someone elaborate on this?
    ADex/AIs only inhibits the enzyme activity, never heard this about Dex binding to receptors, sounds very suspect, it wouldn't do anything to E that is already in system. I think that that's where a SERM(?) or suicide inhibitor could come in to play.

  19. #18
    Quote Originally Posted by Vince Carter View Post
    ADex/AIs only inhibits the enzyme activity, never heard this about Dex binding to receptors, sounds very suspect, it wouldn't do anything to E that is already in system. I think that that's where a SERM(?) or suicide inhibitor could come in to play.
    So my question is, would Adex have any affect on the free estrogen floating in the system as a result of high free E levels?

  20. #19
    You would think that by blunting the conversion to begin with, yes, but once E is converted/produced, an AI would have no effect.

  21. #20
    Quote Originally Posted by Vince Carter View Post
    You would think that by blunting the conversion to begin with, yes, but once E is converted/produced, an AI would have no effect.
    Right. By stopping the conversion it will have an indirect effect by not allowing further E to become free

  22. #21
    Junior Member stevep's Avatar
    Join Date
    Jun 2016
    Location
    Tennessee
    Posts
    110
    If you read through this thread I mentioned that my Primary had to draw additional vials for my CBC. For some reason they ran the Test and Estradiol Sensitive labs again. My original draw was at trough and the additional vials were drawn on a Tuesday the day after my injection. In earlier post you can see the difference between Test trough and peak.

    What I find interesting about the Estradiol test I received today which was from the peak draw. Below is a table of the differences. I am surprised that the Anastrazole .125mg dose after my injections (M/Thr) make that big of a difference in my estradiol between trough and peak.


    Testosterone Reference Range 4/10/2017
    Trough
    4/18/2017 Peak

    Testosterone

    205.00-781.00

    873.59

    1056.85

    Testosterone, Calc. Free/Bioavailable (Adult Male 14+)

    Reference Range

    4/10/2017
    Trough

    4/18/2017 Peak

    Free Testosterone, Percent

    1.60-2.90

    1.76

    1.84

    Free Testosterone (calculation)

    33-227

    154

    194

    Testosterone Bioavailable


    Sex Hormone Binding Globulin (SHBG)

    131-682

    361


    51.0

    455

    Estradiol, Free LC/MS/MS


    Estradiol Free



    Estradiol

    Reference Range


    < OR = 0.45 (pg/mL)

    < OR = 29 (pg/mL)

    4/10/2017
    Trough


    .52



    24

    4/18/2017 Peak


    .30



    14

  23. #22
    subjectively, are you at your best in that peak? Specifically with your Free E being down.

  24. #23
    I find this to be very very interesting! It would be cool to have Dr. Saya comment of this too. Is it possible that those of twice weekly anastrozole actually have lower estradiol levels at peak and not trough because the anastrozole is peaking then?? If so would this mean we might be better testing estradiol at peak to get a better indication of the ai dose.

  25. #24
    Junior Member stevep's Avatar
    Join Date
    Jun 2016
    Location
    Tennessee
    Posts
    110
    I know if I have too much estradiol then I don't get the night time erections which is an indicator things are/aren't in sync. When Defy put me an AI last January my free estradiol was .86 and I couldn't buy an erection.

    So at .86 it's too high for me to function properly. My plumbing works at .52 and .30. I can't say I could tell any significant difference between .52 and .30.

  26. #25
    I can usually have overnite erections but it seems like most of those I have to have Cialis in my system, or they're weak/50% erections which is what I have during the day minus the PDE5i

  27. #26
    Very nice thread guys, I just got to realize about the importance of testing Free T for us low SHBG guys, Doc Saya I'm wondering why we haven't done that test before? I'm really starting thinking that most of the trouble encountered after the first 10 months of my TRT were for too much E2 floating around, and for letting blood, that further increase my adrenal fatigue by depleting nutrients

    Adding an AI would squeeze more Testosterone for the less conversion to E2, where would the squeezed T from AI go? would it add to TT and FT or just to TT?

Thread Information

Users Browsing this Thread

There are currently 1 users browsing this thread. (0 members and 1 guests)

Similar Threads

  1. Recent lab results and Total and free T way up
    By buggies100 in forum Blood Test Discussion
    Replies: 4
    Last Post: 02-10-2017, 06:18 AM
  2. Recent lab results and Total and free T way up
    By buggies100 in forum Testosterone Basics & Questions
    Replies: 4
    Last Post: 02-10-2017, 06:18 AM
  3. Lab Results -- T and Free T too high!
    By starda in forum Blood Test Discussion
    Replies: 15
    Last Post: 01-19-2017, 10:56 AM
  4. Lab Results -- T and Free T too high!
    By starda in forum Testosterone Basics & Questions
    Replies: 8
    Last Post: 01-17-2017, 08:32 PM
  5. Latest lab results on 100mg cream T up to 825 fell free to coment
    By roadglide in forum Testosterone Basics & Questions
    Replies: 11
    Last Post: 12-08-2015, 11:29 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •