1. #1

    Recent labs: HIGH Estradiol. Causing sleep issues?

    These are labs from mid Week 7:

    • Total T: 957 ng/dL (264-916 range)
    • Free T: 25.6 pg/mL (8.7-25.1)
    • E2 Sensitive: 60.6 pg/mL (8.0-35.0)
    • SHBG: 27.1 nmol/L (16.5-55.9)

    This is really high, right?

    I've also ordered a complete follow-up panel but because of Defy's scheduling quirks, I had to wait until these tests were done to do rest of the batch. The above is what I have for now. I have a mini-consult with a nurse-practioner on Friday to discuss switching to a daily protocol and elevated E2 management.

    I really need some advice before my Friday consult.

    I'm feeling good overall, much better than pre-treatment, with a few bad areas or areas that could use improvement:
    • really bad sleep quality (worst problem during treatment, so far)
    • low penile sensitivity (present pre-treatment, improved during first 4 weeks, worsened after)
    • difficulty achieving orgasm
    • inconsistent erection quality (again, worsened after around week 4)
    • possible water retention


    Sleep issues:
    • night sweats (I sleep with the A/C set to 63F to cope)
    • waking up multiple times at night (for no apparent reason)
    • difficulty falling asleep sometimes
    • high alert state after waking up in the middle of night


    I have a LOT of experience with insomnia, so I practice sleep hygiene and am quite well-informed on this area. This kind of insomnia is different and I haven't been able to find an answer.

    My main question is: Is it possible the elevated E2 could be a factor in my sleep issues?

    I don't feel any of the other subjective symptoms of high E2, I don't think, and I'm very weary of going on an AI. I'm at around 22-25% body fat, but it's possible some of it is water retention. I gained about 5-6lbs since I started treatment, some of it very fast. I want to get closer to 15% and I know this will help lower aromatase. I barely drink alcohol but I use marijuana almost daily (often the only way I can fall asleep). I'm working on reducing that as well.

    The purpose of the consult was to discuss switching to a daily injection protocol, which should lower E2 conversion a bit, if I'm not mistaken.

    Current protocol:

    • T-Cyp 50mg MWF (150mg/week)
    • HCG 300IU MWF (900IU/week)
    • No AI


    Weekly log

    Any help would be appreciated. Thank you.
    Last edited by Reason; 04-16-2018 at 05:09 PM. Reason: Added SHBG

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  3. #2
    Do you have your SHBG? You have A LOT of very similar complaints and my E is too high, for me. I have my furnace set @ 61 and a fan going and can wake up overly warm/hot/sweaty.

  4. #3
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    Quote Originally Posted by Vince Carter View Post
    Do you have your SHBG? You have A LOT of very similar complaints and my E is too high, for me. I have my furnace set @ 61 and a fan going and can wake up overly warm/hot/sweaty.
    I forgot to add it! SHBG included in the OP now.

  5. #4
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    If it helps at all, my pre-TRT numbers:

    • Total T: 366 ng/dL (264-916)
    • Free T: 7.5 pg/mL (8.7-25.1)
    • E2, sensitive: 16 pg/mL (8-35)
    • SHBG: 34.3 nmol/L (16.5-55.9)

  6. #5
    Your SHBG isn't that low but given how high your E is Id bet you have a good bit of unbound or Free Estrogen. Also given your Free T is right at the upper range I'm not sure if you'd want to cut your Cyp dose a little bit or a low dose AI, say .25mg twice per week to see how you do though Defy seems to like to give .125mg AI dosing which would also be good to try. IT may just be that you do need an AI...nothing wrong with that at all.

    Maybe 40mg Cyp EOD, too, which might help the E but probably not that much in a realistic sense. I'd pick one strategy and go with it versus tossing too many things at it.

  7. #6
    Are you using DHEA?

  8. #7
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    Only 5mg/day.

    Defy originally prescribed 15mg with 15mg Pregnenolone but I decided to stop for a few weeks to eliminate them as cause of the sleep issues. Nothing changed, so I'm re-introducing DHEA first, 5mg at a time, and wanted to try the Preg after.

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    https://www.excelmale.com/showthread.php?14288-Are-you-HYPOTHROID-Answer-these-questions-and-see

    Excellent post by Orrin.... Your symptoms are NOT testosterone related. I would order full thyroid panel especially reverse T3. Hopefully Defy will include this in all their pre and post Trt testing. Took me a long time to figure out.

    Also, another excellent source since symptoms of low T and Hypothyroidism are the same....https://www.restartmed.com/thyroid-symptoms-men/
    Last edited by 1Draw; 04-16-2018 at 05:59 PM.

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    Are you saying that the sleep symptoms are not T or E2 related? The posts you shared have seemingly every single possible symptom low-t, most of which I do not have anymore since treatment, and therefore I'm not sure I've gained much from reading them.

    Quote Originally Posted by 1Draw View Post
    https://www.excelmale.com/showthread.php?14288-Are-you-HYPOTHROID-Answer-these-questions-and-see

    Excellent post by Orrin.... Your symptoms are NOT testosterone related. I would order full thyroid panel especially reverse T3. Hopefully Defy will include this in all their pre and post Trt testing. Took me a long time to figure out.

    Also, another excellent source since symptoms of low T and Hypothyroidism are the same....https://www.restartmed.com/thyroid-symptoms-men/

  11. #10
    I noticed you're using 900IU HCG per week. Have you considered reducing that amount, or perhaps eliminating HCG altogether to see what effect that might have on your E2 levels?

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    I will discuss this in my consult. I am 37 and although I know HCG doesn't totally preserve fertility on TRT, I like the insurance.

    Quote Originally Posted by S1W View Post
    I noticed you're using 900IU HCG per week. Have you considered reducing that amount, or perhaps eliminating HCG altogether to see what effect that might have on your E2 levels?

  13. #12
    Estrogen is the sleep hormone, when my estrogen is high I sleep too much. Perhaps it has more to do with having a higher free T is what's keeping you wired and awake. My bet is on the HCG though.

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    Reason I did find this link to high estradiol and sleep -

    http://www.peaktestosterone.com/High_Estradiol_Symptoms.aspx

    However no mention of night sweats. All your symptoms MAYBE thyroid related. I definitely know poor sleep is a symptom. Have you ever had a complete thyroid panel? May be worth your while to have it ran and be sure to test Reverse T3.

    Iím a patient of Defy and my RT3 was 28.1 due to low iron/ferritin caused by frequent blood donations. Range should be less than 15 and lower. Tested in Feb.

    Had a bad sinus infection in Jan. Now on T3 cytomel and s l o w l y feeling better. Dr Caukins suggested the thyroid test once I described my symptoms.

    As usual Defy was on top of the cause and - it wasnít testosterone related. That was my point in posting Orrinís post. There are excellent websites that gives you a ton of info. Low T and Hypothroidism have almost identical symptoms.

  15. #14
    Quote Originally Posted by 1Draw View Post
    Reason I did find this link to high estradiol and sleep -http://www.peaktestosterone.com/High_Estradiol_Symptoms.aspx

    However no mention of night sweats. All your symptoms MAYBE thyroid related. I definitely know poor sleep is a symptom. Have you ever had a complete thyroid panel? May be worth your while to have it ran and be sure to test Reverse T3.

    I’m a patient of Defy and my RT3 was 28.1 due to low iron/ferritin caused by frequent blood donations. Range should be less than 15 and lower. Tested in Feb.

    Had a bad sinus infection in Jan. Now on T3 cytomel and s l o w l y feeling better. Dr Caukins suggested the thyroid test once I described my symptoms.

    As usual Defy was on top of the cause and - it wasn’t testosterone related. That was my point in posting Orrin’s post. There are excellent websites that gives you a ton of info. Low T and Hypothroidism have almost identical symptoms.
    Everytime I start a new protocol I get night sweats and know to get the towel to place on top on my pillow.

    I like this one better -> https://dosagemayvary.com/high-estro...ptoms-for-men/

    For thyroid -> https://hypothyroidmom.com/300-hypot...many-you-have/

  16. #15
    Quote Originally Posted by Systemlord View Post
    Everytime I start a new protocol I get night sweats and know to get the towel to place on top on my pillow.
    x2. I also noticed I got night sweats when first I began TRT, and still get them with protocol changes.

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    If you have had a Full thyroid panel done with RT3 testing and everything is good to go it maybe a reaction to the oils used. Conflicting advise from websites.

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    Interesting. Thanks for the info everyone.

    I just drew follow-up labs but the only thyroid items in the order were TSH and RT3. TSH was normal pre-treament, but I know this is incomplete info. I'll see when I get results back if they'll tell me anything and consider a full thyroid panel.

    Even if there is an underlying thyroid issue, the E2 as high as it is worries me. Nelson himself, who advocates restraint with managing E2, often mentions E2 > 50 as an issue. I'm 37 and I don't want the higher cancer risk and others from years of elevated E2. Switching to a daily regimen could help, it seems, and I've dropped the DHEA completely. I might also discuss lowering my T dose during my mini-consult on Friday.

    One thing to note:
    I had gynecomastia when I was younger, hit during puberty and never went away, and surgically removed it in my mid-20s. I know causes of gyno are more complicated than estrogen, but I think this is important and leads me to think I have a propensity to aromatize T more than most. I have a bit of remaining glandular tissue on the right side and none on the left, so I'm guessing this won't be a problem again (crosses fingers).

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    Whom ever you consult at Defy can give you a good path to follow. Full thyroid panel will help you a lot IMHO.

  20. #19
    Quote Originally Posted by Reason View Post
    Interesting. Thanks for the info everyone.

    I just drew follow-up labs but the only thyroid items in the order were TSH and RT3. TSH was normal pre-treament, but I know this is incomplete info. I'll see when I get results back if they'll tell me anything and consider a full thyroid panel.

    Even if there is an underlying thyroid issue, the E2 as high as it is worries me. Nelson himself, who advocates restraint with managing E2, often mentions E2 > 50 as an issue. I'm 37 and I don't want the higher cancer risk and others from years of elevated E2. Switching to a daily regimen could help, it seems, and I've dropped the DHEA completely. I might also discuss lowering my T dose during my mini-consult on Friday.

    One thing to note:
    I had gynecomastia when I was younger, hit during puberty and never went away, and surgically removed it in my mid-20s. I know causes of gyno are more complicated than estrogen, but I think this is important and leads me to think I have a propensity to aromatize T more than most. I have a bit of remaining glandular tissue on the right side and none on the left, so I'm guessing this won't be a problem again (crosses fingers).
    Man, your pre-TRT numbers and background are very similar to mine. Same experience with gyno as a teen...removed surgically. I've always been lean and athletic, but seem to have a propensity to aromatize T as well. My thyroid is totally fine FWIW.

    I was recently on a 64mg T. Cyp. E3.5D with 350IU HCG E3.5D protocol. I don't have my labs in front of me but peak reading was around 750TT with E2 55. SHBG was a few points lower than yours, FT a bit high out of range, age 40. I didn't really feel bad per se, but didn't feel great either compared to pre-TRT. In terms of high E2 symptoms, I felt an abnormal tingling/burning/pain in my breasts with those E2 numbers, and a few other minor symptoms. Some guys will tell you that nipple tingling is normal with hormonal changes - this was more than that and was consistent and uncomfortable. I was also concerned about long-term effects of high E2 and I'm very reluctant to start on an AI until I have absolutely exhausted every other option.

    So with my doc, we decided to try changing the T dose to 60mg E3.5D and drop the HCG altogether. I'm only a few weeks into that protocol and will not draw labs for a while. But I can say that the breast discomfort is gone. Zombie dong is back though (I've noticed that when I'm on T only, penile sensitivity decreases for some reason). But overall, feel better SO FAR without the HCG. I'm going to ride this out for a bit and see how I feel and what labs look like once stable levels have been reached, however unless I feel like a million bucks I'm planning to add HCG back at a lower dose. The idea with all of this would be that with baseline labs from a T. Cyp. only protocol, I would be able to accurately see what effect, if any, HCG is having on my numbers once it is added back in.

    Bringing it back to you, I think your doses of both T. Cyp. and HCG are too high. And if those labs when you drew 957 TT and 60 E2 were taken at your trough (low point just before your next injection, on your protocol likely first thing Monday morning), it looks like everything, not just E2, is high.

    Blind leading the blind here - I'm far from a guru and not completely dialed in myself. But given our very similar backgrounds and numbers, I figured I'd chime in with a few more details. Best of luck and please update your post with your progress.
    Last edited by S1W; 04-19-2018 at 03:24 PM.

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    @S1W: This is great perspective and I really appreciate it. Sorry you had to deal with gyno... it was awful for me and once I got it removed my life changed.

    Labs were drawn on trough, literally right before my next shot. I agree, Iím probably on a too high dosage, but we were shooting for close to 1000 TT and close to 25 FT to start, and we hit those numbers. It just may be that this is too much for me, specially since Iíve probably never had so much T EVER in my body. And it does seem we both aromatize T a lot.

    Good luck with your stuff too!

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    Had my consult and got more labs back. Here's an update.

    Spoke with a NP who recommended:

    - Start .125 Anastrozole 2x week, increase to 3x week if necessary
    - If the AI does not ameliorate symptoms, remove HCG and re-evaluate
    - If symptoms subside, add HCG back slowly to find ideal dose

    This is if I want to maintain my current T/FT levels, which are right on the money (T~950, FT~25) for where we wanted them to be during my initial consult: T ~1000, FT 18-30. And I was feeling really good before week 6.

    I will also switch to a daily injection schedule @ 20mg/day which will put me at 140mg/week.

    If all of this goes well, I will consider re-introducing Pregnenolone and then DHEA one at a time and slowly.

    New labs:

    Highlights:
    - FT3: 3.9pg/mL (2.0-4.4)
    - TSH: 4.130 uIU/mL (0.450-4.500), up from 2.190 pre-treatment
    - IGF-1 333ng/mL (83-233), included for free, never tested before (HIGH)

    HCT went up slightly, 43.5 -> 46.4
    PSA went up slightly, 0.7 -> 0.8

    Everything else looks good and stable.

    Although this isn't a full thyroid panel, I'm not seeing much reason for worry here. Still thinking my symptoms are either the E2 or the T.

    Questions:

    How do I inject HCG on a daily schedule? Can I just do HCG MWF in the morning?

    Should I be worried about the elevation in TSH and the elevated IGF-1?

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    Although your E2 is elevated a bit, your TSH went from 2.190 pre treatment to 4.130 last lab test. You definitely have something going on with your thyroid that needs further blood test to identify the problem. Low T and Hypothroidism symptoms are like twins.... Good link here:

    https://www.restartmed.com/thyroid-symptoms-men/

    I would at least run a Reverse T3 and Iron/Ferritin blood test and go from there. Surprised your NP at Defy didn't comment on the rise in TSH which is a clear indicator of a thyroid problem. Optimal levels are at a minimum less than 2.

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    I know you keep banging on the hypothyroidism drum but I didnít experience many of the classic hypothyroidism symptoms pre-TRT. Hypogonadism fit better and was confirmed through blood tests. Pre-treatment my T and FT levels were the only anomalies on my labs. My E2 is almost double where it should be. Fits better for the current symptoms.

    And another option is: TSH is a pituitary-produced hormone and that combined with optimum FT3 levels plus my hypognadism likely being secondary could indicate a pituitary issue. TRT messes with the HPTA axis.

    Or the pituitary is fine and has to pump out more TSH for a now broken thyroid (because of TRT???) to produce normal levels of hormones? Seems strange.

    To check into this Iím going to have to go through my regular doctor and the Kaiser bureaucracy because I donít have the means to pay out of pocket for 2 hormonal treatments with all the associated tests.

    Hopefully theyíll work with me without trying to mess with my TRT. My doctor was VERY against me going into TRT citing all the myths to back up her concerns...

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    Quick update:

    After adding an AI, issues improved a lot but sleep still bad.

    Just got labs back and my TSH, FT3/FT4 levels are either at or near optimal.

    T, FT, and E2 are still high so I'm planning on reducing my dose slightly.

    I've a follow-up consult on 07/05, we'll see what they say then.

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