Great T-levels (1298) but high E-levels (93.7) in follow-up BW

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brokendownbro

New Member
First of all, I feel great. TRT has been doing everything I expected. Bloodwork was taken last week on Tuesday before my Wednesday injection (160mg). I have been on TRT since the beginning of August. The doctor hasn't put me on HCG or an AI yet; but with an estradiol at 93.7, I am assuming that he will be doing so shortly. Any thoughts?
 

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brokendownbro

New Member
REPOSTED HERE FROM EXCEL MALE FACEBOOK PAGE

Nelson Vergel, Gene Devine, Jasen Bruce...Would you consider this a sound practice? I know that it is bad for estradiol to be high? There is no question about that. However, if a patient feels good on a dose of testosterone (160mg) and they aren't on any aromatase inhibitors, wouldn't you try prescribing the aromatase inhibitors before drastically cutting the dosage back down to 100mg? The doctor speaks of a 1290 ng/dl level as though it is going to kill me. SMH. I felt so-so when on 100mg; I feel awesome on 160mg. He says that my levels are now kickstarted, so I don't need the higher dosage anyway. Some of the stuff he says puzzles me. He also says that the inclusion of an AI at this point will drive my levels up anyway; so if he lowers the dose to 100mg and adds half a tablet of Arimidex twice per week, my net testosterone level will be about the same and my estradiol will be lower. I pay a lot of money for this "conceirge medicine". Would I be better off just packing my bags and moving over to DefyMedical? What would be your approach to this? Is my current doctor on the right path, or is he doing more harm than good?
 

brokendownbro

New Member
REPOSTED HERE FROM EXCEL MALE FACEBOOK PAGE

Would you consider this a sound practice? I know that it is bad for estradiol to be high? There is no question about that. However, if a patient feels good on a dose of testosterone (160mg) and they aren't on any aromatase inhibitors, wouldn't you try prescribing the aromatase inhibitors before drastically cutting the dosage back down to 100mg? The doctor speaks of a 1290 ng/dl level as though it is going to kill me. SMH. I felt so-so when on 100mg; I feel awesome on 160mg. He says that my levels are now kickstarted, so I don't need the higher dosage anyway. Some of the stuff he says puzzles me. He also says that the inclusion of an AI at this point will drive my levels up anyway; so if he lowers the dose to 100mg and adds half a tablet of Arimidex twice per week, my net testosterone level will be about the same and my estradiol will be lower. I pay a lot of money for this "conceirge medicine". Would I be better off just packing my bags and moving over to DefyMedical? What would be your approach to this? Is my current doctor on the right path, or is he doing more harm than good?
 

Hydranted

New Member
A total T of 1300 6 days after your injection is very high, most would say too high.

Both your T and E2 are going to be significantly higher earlier in the week. You may want to consider decreasing your dose as well as splitting your injections to twice weekly.
 

Vettester Chris

Super Moderator
That doesn't even appear to be a sensitive assay. I can only imagine where it might be at with a Labcorp sensitive?

For the short-term, I'm sure that serum level will have you on cloud nine. However, for the life long marathon of maintaining a successful HRT campaign, I anticipate it will be hard to sustain this sensation of well being at that serum level. I could be wrong, although the E2 lab is usually a good marker with letting you know that there could be an imbalance. Do you by chance have your free/bio available test lab, and/or SHBG?

Again, no disputes on how you feel, that should always be factored, but other variables will start taking their toll when one variable is either elevated or is deficient. The E2 subject is just one of those variables. Here's my .02 on where you're at ... I think you're tapping into something good with how you feel, and obviously you want to sustain that. I think if you will put a little more emphasis upstream; meaning supplement some Pregnenolone, DHEA (you could easily increase 200 ug on your value), make sure your thyroid activity is optimal, and supplement with adequate Vitamin C, D, E, B Complex, Selenium, Gaba, etc., you will see even better results.

By taking a broader approach with this, my guess is that you will achieve a well being better than what you are currently experiencing, it will be multi -dimensional, and the balance (homeostasis) will be much more attainable. Additionally, your program will be structured for the long haul!
 

brokendownbro

New Member
Thanks Chris. This is follow-up bloodwork, so they didn't do the full panel. My DHEA is 158.4. Do you think I need to supplement with DHEA? I thought DHEA contributes to higher estrogen. My thyroid appears to be working correctly, however Nelson Vergel asked if I was on thyroid medication; I'm not sure why. I eat pretty clean, and I supplement with the LifeExtension Mix of vitamins. Are you familiar with them?
 

Vettester Chris

Super Moderator
Yeah, E2 converts downstream, BUT, right now you're seeing some hyper-converting primarily from your test serum. If you're right at 1,300ng/dl after 6 days, it's much higher at 2 to 3 days, which is when you will see the peak value. Administering an AI at/around 24 hours after injecting would be the best strategy, but consult that with your physician.

Your doctor did a good thing with splitting the dose 2x and reducing your dosage. This will help keep the serum level stable without hitting all those spikes, causing a surge in E2 conversion. Depending on where your free/bio test sits, you might not even need that much, but that's also factoring if you include HCG at some point.

Anyhow, once you find that "zone", your body will be in a better place. Implementing DHEA won't be so bad "IF" you get the test subject under control. Again, it's about balance ... Implementing 25mg or 50mg of DHEA micro can be a wonderful compliment to add balance, but that's permitting you have the test serum under control.

In my case, I do the 2x/week via sub Q, plus HCG admin sub Q. With a little topical DHEA, I can barely keep my E2 in the 20's on a Labcorp 3-70 scale. I keep my serum level in the high 600's, low 700's (give or take), but I am also over 3% on free test (pretty low SHBG).

I add in some of the supplements that were mentioned, run some regular labs, and things aren't too bad. Don't get me wrong, it's a continuous learning curve, and once you think you have it down you get thrown a monkey wrench. Other variables like RBC's & Hematocrit come into play, etc.

However, it's been much more beneficial to me with spreading the focus throughout the endocrine system, as opposed to just completely focusing on some of the primary areas that always get talked about. Trust me, if your adrenals are shot, or your Reverse T3 is elevated out of proportion, more testosterone will just be detrimental. Just my .02 and perspective.
 

Vettester Chris

Super Moderator
... My bad, I see your free testosterone. I overlooked it before. It's at 1.7%. There might be a little room to improve that into the 2% to 3% range, but still get the total serum reduced. Free/Bio is what actually is available to be used by the body. Most of it is strongly bound by SHBG. We can discuss this down the road ... For now I agree with you getting adjusted to your new protocol, and get a plan in place to get your E2 under control.
 

brokendownbro

New Member
I mentioned the sensitive test to my TRT doctor, and he said that I got the appropriate estradiol test. SMH. I don't know about this dude. He's like 32 years old; and even though he says his specialty is hormone regulation/endocrinology, I have serious doubts about him. When he saw my test results, he wanted me to get off of TRT altogether.
 
My dr will order whatever test I suggest....I have a good relationship with him. I challenge him based on what I read here. He's pretty cool. My consultations with him scientific based...with trend charts and all that. Try to take a different approach. He works for you! Not the other way around.
 

Nelson Vergel

Founder, ExcelMale.com
Just show him this study.



Comparisons of Immunoassay and Mass Spectrometry Measurements of Serum Estradiol Levels and Their Influence on Clinical Association Studies in Men



"In conclusion, our findings suggest interference in the standard immunoassay-based E2 analyses, possibly by CRP or a CRP-associated factor. Although this interference does not seem to affect association studies between immunoassay E2 levels and skeletal parameters, we propose a reevaluation of previous association studies between immunoassay-based E2 levels and inflammation-related outcomes. In addition, MS-based assays are to be preferred for the quantification of E2 levels in men."
 

Vettester Chris

Super Moderator
Really??? What does the size of the needle have to do with aromatization control? Interesting.

It's not applicable to the size of the needle, but more so with injecting Sub Q in an adipose section, opposed to intramuscular. The size of the needle is just a bonus feature, which makes the injection process a little more convenient.
 

brokendownbro

New Member
So does the standard estradiol test underestimate or overestimate E2 when compared with the sensitive assay? If the standard estradiol says my E2 is 93.7, would it register more or less by the sensitive assay? If so, by how much. What is the percent error rate?
 
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