Can't figure out Estradiol extremes

Hi,

I am a 54 y/o doing trt for about 6 months. Dose is 400mg T cyp two times a month. Major issue was depression and lower doses were not that effective but 400mg is effective. The twice monthly schedule is also good; more frequent (one a week) made no difference in mood. Also, re libido, this dose and schedule was optimal. I really like urologist and he insists on shots being done in office- more frequent than current just not practical due work. I see people use his name on other forums as a "go see this this guy...." so don't want to change hoping "grass will be greener...." I live in S. Florida.

Total T is always in the low 800's via Labcorp 347-1197 scale. Nothing has changed with that for the past 4 months.

E is a different story. Highest it had been through Nov. was 40 via Quest < = 39 but in terms of libido, morning wood, etc., everything was perfect. This changed when "I insisted" on taking adex because of what I had read. I took 1mg 3 x week starting about mid January (1/12-1/19) and libido and wood totally disappeared. I only did this for a week- meaning 3 doses. Then I stopped taking it. Since then, my E got really high (see test results 2/8 and 2/12) and I tried the adex again (dose/dates next to 2/8 test results) but now E is too low again (no libido or wood). Results are below. Please, if anyone can offer a dosing schedule to potentially end this see saw effect, I would be very grateful!

2/4 Total T 885 ng/dl 347-1197 L (past 4 months ranged from 830-895)
2/8 Total Estrogens 207 pg/ml 40-115 Labcorp (I paid for extra test and forgot to do just Estradiol but it's still twice normal). (BEGAN taking adex again- 1 mg e3d on 2/10)
2/12 Estradiol 75 pg/ml < = 39 Quest (re-checked it quickly after realizing above was just total estrogen)
2/27 Estradiol 13 pg/ml 7-42 Labcorp (need help with suggestions re what dose of adex to reduce to and how frequently- it needs to climb back up to 20-30 based on what others have written feels best/is safest level- though for me this might be low to mid 30s but not fly by those numbers and be too high again)

Other bloodwork- metabolic and cbc all consistently stay in range. Thanks!

Your protocol is decades out of date and it is no surprise you have E2 issues because of it. Top TRT doctors have their guys injecting every 3.5 days, not every once 2 weeks. The Adex dose of 3mg per week is out of control as well.

I know you don't want to hear it, but if you want to have success with TRT, you need to fire this doctor and get one that is up to speed on TRT. Defy Medical is in Florida and they are one of the best providers in the entire country.

Finallycured said:

Hi,

I am a 54 y/o doing trt for about 6 months. Dose is 400mg T cyp two times a month. Major issue was depression and lower doses were not that effective but 400mg is effective. The twice monthly schedule is also good; more frequent (one a week) made no difference in mood. Also, re libido, this dose and schedule was optimal. I really like urologist and he insists on shots being done in office- more frequent than current just not practical due work. I see people use his name on other forums as a "go see this this guy...." so don't want to change hoping "grass will be greener...." I live in S. Florida.

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Good God. Talk about a textbook example of a clueless doctor using an outdated protocol.

Sorry for being so harsh, but excuse me...2 injections per month, and 3mg of Adex per week? Holy crap, that is an enormous dose of AI. Did your doctor actually suggest that you take that much, or did you decide that by yourself?

You seriously need a doctor that knows what he is doing, because your urologist doesn't, and neither do you. Call Defy Medical, and get the help that you desperately need.

You need a new doctor. You're never going to make progress, in fact, you'll feel worse and worse, by following the protocol you're on. In a nutshell, contemporary TRT practice calls for smaller doses of testosterone injected frequently. Fifty milligrams twice a week (every 3.5 days) is a typical starting dose. There's more that could be said, such as the irresponsible estradiol management your doctor engages in...but the best thing for you to do is find a physician who understands the hypogonadal man.

As said, he wanted me to get shots every week. Coming in that often was a problem. I can actually make that work, though. So, I will go to every week. Yes, the adex and dose were my idea. I'm posting this because I'm hopeful someone (an experienced patient) will look objectively at my situation and give me some ideas re an adex dose that might work. I'm lucky that I have great health insurance that covers everything except extra blood tests I order and unlucky that it is low paying so a service that doesn't bill insurance just isn't an option.

Question- if he agrees to let me do shots myself I can certainly try every 3.5 days. Correct that these can still be IM and don't need to be Sub Q?

They can be either IM or Sub-Q. Use an insulin syringe and its dead easy either way. Remember too that your E2 is going nuts because of the ridicules protocol you are on. When you switch to twice weekly injections instead of twice monthly injections, you may not need an AI at all. The way to find out is to start twice weekly shots, stay with it for 4-6 weeks with no other changes and the measure with the right E2 test (sensitive assay)

Your doc is not doing you any favors so why the reluctance to switch? If you brought your car to a mechanic and he fixed it incorrectly every time, would you stay with him?

Finallycured said:

As said, he wanted me to get shots every week. Coming in that often was a problem. I can actually make that work, though. So, I will go to every week. Yes, the adex and dose were my idea. I'm posting this because I'm hopeful someone (an experienced patient) will look objectively at my situation and give me some ideas re an adex dose that might work. I'm lucky that I have great health insurance that covers everything except extra blood tests I order and unlucky that it is low paying so a service that doesn't bill insurance just isn't an option.

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Jesus...where do I start? First off, let's address the Adex that you're taking. You just decided to start taking it based on what? Did you have symptoms of high E2? You said that you felt good, and that everything was "perfect." Doesn't sound like you had any symptoms of high E2 to me.

If you were basing this decision on lab work, what lab work? Were all your E2 labs based on the sensitive assay? If not, all your lab work for E2 is pretty much worthless. You were basing a medical decision to take an extremely powerful AI drug based on invalid information, ignoring how you actually feel, and without any input from your doctor. Is that correct?

Ok, so now you're taking a huge...and I mean huge dose of Adex, and you tank your E2...big surprise. Then you go on this on again, off again protocol based on more invalid "estrogen" labs. I'm going to go ahead and assume that you felt lousy every time you started eating 3mg of Adex a week...right?

You know what you need to do? Stop taking the Adex, and see how you feel. Then in a couple of weeks, get another set of labs, and use the sensitive E2 test for checking your estradiol level. If your sensitive E2 level is a little above 40, don't freak out. With your total Test level at 885, your TE ratio is just above 20...not bad at all. The bottom line factor in all of this is how do you feel?

If you actually do have symptoms of high E2 (sensitive nipples, etc), then take a very small dose of Adex...I'm talking .15mg BIW. I would do this only after consulting my doctor (one that knows what he's doing). I'm not sure if your doctor meets that requirement.

I'm not saying any of this to be a jerk or to put you down, but it's pretty obvious to me and many here on the forum that you really don't know what you're doing. Trust me, you're not the only one. We see guys on this forum every single day with outdated protocols, and borderline incompetent doctors managing their TRT. It's pretty frustrating, and we feel for you, but you really need to listen to what people are telling you here.

I can't stress enough the importance of having a doctor that knows what the heck he is doing with regard to TRT. If there was anyone that was in desperate need of a consult with Defy Medical, it's you. Please seek professional, competent medical help.

Finallycured said:

Question- if he agrees to let me do shots myself I can certainly try every 3.5 days. Correct that these can still be IM and don't need to be Sub Q?

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You can do them either way. SubQ or shallow IM is very easy to do, and pretty much painless. No need to pin yourself with a 1" needle in the quad or glute.

It should not be a question of obtaining permission to self-inject. It's the common method doctors who understand TRT use with their patients. If you get any pushback that should be the last straw - find another doctor. Frankly, I feel you should do that any way; you are not getting good care.

Ero, you are obviously really sharp and I'm confident you picked up my saying "depression" was major issue; libido, etc. was second. So I owe you the balance details- He wanted to see me once a week for shots (I refused as I noted) because for people with MDD and taking ADs, moods can go in a really bad direction fast. Also, once it was confirmed it "seemed to be working" confirmation was (well, still is) being determined by tapering off the ADs. I am a difficult patient medically and I am very stubborn. True, he may or may not be the "best" at TRT but his concern for my safety, conservative way of practicing medicine etc., makes him ideal for me now. Yes, later, when it's clear no need for ADs ever again, I may find someone else.

I had appointment today at 12:30. He is fine with twice weekly provided I come in once a month (no co pay for a shot) so one of the nurses can confirm I am doing ok. and he can go over blood work with me during months it is there so I stop trying to micromanage this. I agreed. BW after 4 weeks, then at six week intervals.... (regardless, I will still do my own E2 periodically because I want to Anyway, I have an RN to give me shots (she will teach me) as he knows. What I didn't tell him is she doesn't about details about best syringes/best injection sites, etc. So, what size needle gauge/length? For an insulin syringe, won't I need a larger needle to first fill it? I can reach my glutes easily but wouldn't quads be easiest? Don't want Sub Q (for some reason it grosses me out).

Thanks again!

CoastWatcher, I hear you. I provided some details in response to Ero that should better explain my situation. As you are a moderator- great forum; Ero and some of the stickies gave me enough info/confidence to ask about the twice weekly. Granted, he obviously knew but I had no way to predict that. So, thank you.

Finallycured said:

Ero, you are obviously really sharp and I'm confident you picked up my saying "depression" was major issue; libido, etc. was second. So I owe you the balance details- He wanted to see me once a week for shots (I refused as I noted) because for people with MDD and taking ADs, moods can go in a really bad direction fast. Also, once it was confirmed it "seemed to be working" confirmation was (well, still is) being determined by tapering off the ADs. I am a difficult patient medically and I am very stubborn. True, he may or may not be the "best" at TRT but his concern for my safety, conservative way of practicing medicine etc., makes him ideal for me now. Yes, later, when it's clear no need for ADs ever again, I may find someone else.

I had appointment today at 12:30. He is fine with twice weekly provided I come in once a month (no co pay for a shot) so one of the nurses can confirm I am doing ok. and he can go over blood work with me during months it is there so I stop trying to micromanage this. I agreed. BW after 4 weeks, then at six week intervals.... (regardless, I will still do my own E2 periodically because I want to Anyway, I have an RN to give me shots (she will teach me) as he knows. What I didn't tell him is she doesn't about details about best syringes/best injection sites, etc. So, what size needle gauge/length? For an insulin syringe, won't I need a larger needle to first fill it? I can reach my glutes easily but wouldn't quads be easiest? Don't want Sub Q (for some reason it grosses me out).

Thanks again!

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It sounds like you have had a very productive conversation with your Dr and it is great that he is agreeable to both twice weekly injections and letting you do them yourself after the RN shows you. Good on you for having what can be a difficult conversation and getting him to be more of a partner in your care!

Yes, it is easiest to "backfill" an insulin syringe with a standard 20 gauge (or thereabouts) syringe. You can get insulin syringes here very cheaply and your RN maybe able to get you a few larger ones for filling purposes. Just about any insulin syringe will do so don't worry too much about size. Many of us use a 29 gauge 5/8" but a 31 gauge 1/2" works just as well. With Sub-Q you can inject anywhere - stomach area, shoulders, front of your thighs, etc...Don't worry too much about where, as long as you can easily reach, you are fine.

Bear in mind that your should have FAR less E2 issues (or no E2 issues) with a twice weekly regimen vs. what you have been doing, so I would recommend starting your 50 mg every 3.5 days (twice a week - say Monday morning and Thursday evening as an example) routine and wait 4-6 weeks before blood work. Change nothing during this time and don't use any AI either, as it is far less likely that you will need any. Then, test Free and Total T and E2 (sensitive assay).

I am confident that you will feel a lot better with the more stable levels this protocol will provide. It may take a few weeks to notice, or you may notice sooner - everybody is different on how soon they feel a change.

Thank you. I'll let you know how it is going after the first blood work!

One more question- The time I felt best was back in Nov. when my E2 was 40 with the Quest <=39 scale. It obviously doesn't need to be that high; I'm sure I would be quite content at 30 or over. Since it was 13 end Feb. as posted above (Labcorp 7-42 scale), is it possible I will just sit at a low number due the twice weekly? Meaning, I do want it to go up as at 13 there are the ED, etc. issues..... Just wait it out and test as you suggested?

One more question- The time I felt best was back in Nov. when my E2 was 40 with the Quest <=39 scale. It obviously doesn't need to be that high; I'm sure I would be quite content at 30 or over. Since it was 13 end Feb. as posted above (Labcorp 7-42 scale), is it possible I will just sit at a low number due the twice weekly? Meaning, I do want it to go up as at 13 there are the ED, etc. issues..... Just wait it out and test as you suggested?

Your E2 being at 13 was due to the AI you were taking, so if you stick with your new protocol of no AI, and 50mg of Test every 3.5 days, your E2 will rise from the the low of 13 to a more normal level. That is likely to take a few weeks, plus you need the 4-6 weeks with no changes to get a realistic "baseline" of your new protocol and for your body to adjust to it. Based upon how you feel and the blood work at that time, you may be great to stay as-is, or you may need a slight tweak, but you will have a solid baseline from which to adjust instead of the huge highs and lows you had on your old protocol.

That makes sense. Thanks!

ERO said:

Your E2 being at 13 was due to the AI you were taking, so if you stick with your new protocol of no AI, and 50mg of Test every 3.5 days, your E2 will rise from the the low of 13 to a more normal level. That is likely to take a few weeks, plus you need the 4-6 weeks with no changes to get a realistic "baseline" of your new protocol and for your body to adjust to it. Based upon how you feel and the blood work at that time, you may be great to stay as-is, or you may need a slight tweak, but you will have a solid baseline from which to adjust instead of the huge highs and lows you had on your old protocol.

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Please be patient. Give it at least four, if not six, weeks before any other changes are made. As ERO noted, you should be moving in the right direction.

Libido improved after only two weeks then suddenly ED problems again. Out of curiosity checked E2; it was 48 on the labcorp 7-42 scale. Somehow it went too high for me again; my guess is decent to optimal for me is 30-40 which is a narrow window. Not taking any adex. Any suggestions on a very conservative amount/frequency to try to drop E2 a bit? I am certainly open to doing nothing for another 3 weeks to see where it ends up for a baseline. In short, it seems my body easily/quickly converts to E2. And, I am sensitive to adex (1 mg works like a sledgehammer). Thanks!

A compounding pharmacy can get you capsules with very tiny amounts of Anastrozole. Like 0.15 mg or 0.125 mg. Cutting the 1 mg pills any smaller than 1/4 (0.25mg) is next to impossible, and even 0.25 mg is a potent dose for most guys.

Finallycured said:

Libido improved after only two weeks then suddenly ED problems again. Out of curiosity checked E2; it was 48 on the labcorp 7-42 scale. Somehow it went too high for me again; my guess is decent to optimal for me is 30-40 which is a narrow window. Not taking any adex. Any suggestions on a very conservative amount/frequency to try to drop E2 a bit? I am certainly open to doing nothing for another 3 weeks to see where it ends up for a baseline. In short, it seems my body easily/quickly converts to E2. And, I am sensitive to adex (1 mg works like a sledgehammer). Thanks!

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The scale you indicated, the one that was provided for the estradiol test, is the scale for the standard test. You were checked using the wrong test. You need to be sure you're using the sensitive, LC, MS/MS, protocol. The test you ran overestimates the estradiol in your blood. It was designed for women, works well for them. A bust for men.

If you want a small dose AI:
https://www.excelmale.com/forum/sho...RMACY-CRESTVIEW-FL-compunded-anastrozole-tabs

You can get 0.07mg tabs and dose every day, EOD, E3D. E4D.... What ever you need....