Exhaustion / Poor Sleep with High E2 and Gyno

Current State: Hi, I am new here, a 30 year-old male with gyno (surgically removed) struggling with severe mental exhaustion / reduced brain cognition. No matter how much I sleep, I almost never wake up feeling rested. I wake up feeling like I haven't slept at all, or like I haven't slept in 2 or 3 days! This is my current state.

Quick history: I've been struggling with sleep issues for 10 years. It first started at 20 years old. I could fall asleep with no problem, but I would wake up too early and feel dead tired and would not be able to get back to sleep. All the while I had gyno, but did not know initially that this could've been a sign that something was off in my body (pretty obvious, huh?). It's since been surgically removed.

Fast forward 7 years (3 years ago), I still demonstrated all the same symptoms, but I started on Xanax because of an episodal bout of severe anxiety / severe OCD. Xanax helped me to sleep through this rough period, and also helped me to sleep a little bit better in general. I went on to gain 40 pounds as well (I'm currently back at my original weight - 5'11", 160 lbs). The anxiety and OCD subsided after getting married, although I continued on the Xanax and am still on it currently. Shortly after, in May 2015, I sought out a BHRT doc because of continued poor sleep. The test results were as follows:

TSH - 1.25
T4, Free - 1
T3, Free - 2.8
T, Total - 525
T, Free - 76.8
T, Bioavail. - 161.2
SHBG - 30
Estradiol LC/MS/MS - 41
LH, Pediatrics - 4.2
Prolactin - 9.7
DHEA-S - 353
Dihydrotestosterone LC/MS/MS - 37

I was put on Nature Thyroid and Anastrozole, and eventually Chlomid, all 3 at the same time at one point. The doctor was incompetent and was totally playing guessing games with my health. I educated myself further and sought out help from Defy. My lab results as of 2 weeks ago (Dec. 1st, 2016) were:

TSH - 1.33
T, Total - 713
T, Free - 86.3
Estradiol LC/MS/MS - 37
LH - 6.7
DHEA-S - 240
Progesterone - 0.5

I am just assuming that my estradiol is too high based on the gyno as well as the number, 41 and now 37. I know that a lot of people don't feel well until their T3 is in the upper 1/3 of the range.

Xanax works pretty well for me in that I take it after sleeping 5-6 hours of typical sleep (I usually wake up unexplained). I feel like a new man when I wake up after taking Xanax and only sleeping 1 additional hour (intentionally waking up while the Xanax is still "in my body"). However, it's obviously not the answer and only increases estrogen. Additionally, I believe it's greatly affected my natural sleep cycle when I'm not on it (when not in my body), as my sleep quality has continued to get worse and worse over the last 3 years.

I am currently weening off of the Xanax. I can sleep 12 hours and will still feel the crippling mental exhaustion. It's as if my body clock is just off and I never wake up when I'm supposed to / at the end of a sleep cycle. Something, perhaps estradiol or cortisol, seems to be acting as a stimulant. I wonder if I should be testing my thyroid and adrenal function right now. I apparently got a slim package from Defy, although they seem EXTREMELY competent.

Any thoughts would be greatly, greatly appreciated! Thank you! (I think I'm allowed to mention Defy, right?)

Welcome to ExcelMale. We're glad you joined us and hope you'll be an active member.

Would you you clarify some points? You are a Defy patient, are you on exogenous testosterone, a TRT protocol, at the present time? You aren't on Clomid any longer? Perhaps I missed it, but that point eluded me. Are the test results you posted in anticipation of a consultation with Defy, or have your already discussed them with Defy's medical staff? Was a cortisol study discussed? Has sleep apnea been eliminated?

You're right - Defy is extremely skilled. You are in good hands.

One point - when posting labs, it helps if you include ranges. Labs report differently, the ranges are important. Thanks!

Hi, thank you for the welcome! I am currently only on Xanax (2.5mg / day) at the moment. I stopped seeing the doctor who prescribed the Anastrozole, Clomid, and Nature Thyroid. I didn't feel comfortable with her after continuing to educate myself. I was "prescribed" SAMe, Evening Primrose Oil, as well as a compounded multi-vitamin from a different MD as a result of a diagnosis of undermethylation and high copper (increased copper levels have been associated with increased estrogen levels).

The test results I posted are in anticipation of a consultation with Defy Medical. A cortisol study has not been discussed. Sleep apnea has in fact been eliminated.

I will post the ranges as soon as I get home. All labs were done through Quest. Thank you so much for your response. The amount of good doctors who are actually out there is very scary!

Frusciante0386 said:

Hi, thank you for the welcome! I am currently only on Xanax (2.5mg / day) at the moment. I stopped seeing the doctor who prescribed the Anastrozole, Clomid, and Nature Thyroid. I didn't feel comfortable with her after continuing to educate myself. I was "prescribed" SAMe, Evening Primrose Oil, as well as a compounded multi-vitamin from a different MD as a result of a diagnosis of undermethylation and high copper (increased copper levels have been associated with increased estrogen levels).

The test results I posted are in anticipation of a consultation with Defy Medical. A cortisol study has not been discussed. Sleep apnea has in fact been eliminated.

I will post the ranges as soon as I get home. All labs were done through Quest. Thank you so much for your response. The amount of good doctors who are actually out there is very scary!

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The Clomid did have some effect, I would say - your total testosterone level did rise? No SHBG results, and the issue of sleep apnea- has it been eliminated as the reason for your exhaustion?

It is strange that my Testosterone rose so much. I was a lot heavier at the time of my first blood draw (200 lbs vs. 160 now), and I was also on a larger dose of Xanax at the time (a dangerous 6mg / day vs. 2.5mg / day now). I'm wondering if that had anything to do with it.

Can Clomid really have a permanent affect where increased T levels stay increased after the Clomid is stopped? I just remembered that the doctor also put me on HisSyngery at the time, a supplement thought to help with T production. I apologize, as the doctor was just throwing a lot of things at the wall at once to see what stuck. Unfortunately, the medications and supplements were not introduced individually, but rather all in a cluster. Therefore, it's a little more difficult to say which was effective / what the issue actually is.

Sleep apnea was in fact eliminated as the reason for my exhaustion. Thank you!!

Frusciante0386 said:

It is strange that my Testosterone rose so much. I was a lot heavier at the time of my first blood draw (200 lbs vs. 160 now), and I was also on a larger dose of Xanax at the time (a dangerous 6mg / day vs. 2.5mg / day now). I'm wondering if that had anything to do with it.

Can Clomid really have a permanent affect where increased T levels stay increased after the Clomid is stopped? I just remembered that the doctor also put me on HisSyngery at the time, a supplement thought to help with T production. I apologize, as the doctor was just throwing a lot of things at the wall at once to see what stuck. Unfortunately, the medications and supplements were not introduced individually, but rather all in a cluster. Therefore, it's a little more difficult to say which was effective / what the issue actually is.

Sleep apnea was in fact eliminated as the reason for my exhaustion. Thank you!!

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Yes, Clomid can certainly result in a permanent increase in testosterone levels. This discursive thread, initiated by Dr. Saya, explores Clomid success stories. https://www.excelmale.com/forum/sho...rns-or-do-they-really-exist&highlight=Unicorn

You aren't the first man to discover that far too many doctors are utterly at sea when it comes to male andrology. In fact, your protocol, fast and loose as it was, is hardly the worst we've heard about here. Take comfort in the fact that your going to be treated in the future by one if the leading physicians in this field.

Thank you! That is very comforting to know. I will check out the article by Dr. Saya on Clomid. Thank you very much. Perhaps I should call and have my SHBG as well as my adrenal function checked out. Are you aware if Defy has recommended tests for adrenal function themselves? Lastly, I should have a full thyroid panel done includin T4, T3, and reverse T3. I've already tested for thyroid antibodies and those came back negative, I guess ruling out Hasimoto's or Grave's? I have heard that estrogen can negatively impact thyroid binding hormone (TBH)?

I just really believe I may be particularly sensitive to estradiol. Perhaps I personally may not feel well until my estradiol is say, 18. In that case, my current estradiol level of 37 would be double what it should be! Plus, I can't forget that I had a fairly extreme case of gynecomastia, and that the conditions within my body that gave rise to that have never really been rectified. I mean, had I not had it surgically removed, I would still be walking around with a VERY large left breast. My right breast was completely fine.

Thank you!!

Frusciante0386 said:

Thank you! That is very comforting to know. I will check out the article by Dr. Saya on Clomid. Thank you very much. Perhaps I should call and have my SHBG as well as my adrenal function checked out. Are you aware if Defy has recommended tests for adrenal function themselves? Lastly, I should have a full thyroid panel done includin T4, T3, and reverse T3. I've already tested for thyroid antibodies and those came back negative, I guess ruling out Hasimoto's or Grave's? I have heard that estrogen can negatively impact thyroid binding hormone (TBH)?

I just really believe I may be particularly sensitive to estradiol. Perhaps I personally may not feel well until my estradiol is say, 18. In that case, my current estradiol level of 37 would be double what it should be! Plus, I can't forget that I had a fairly extreme case of gynecomastia, and that the conditions within my body that gave rise to that have never really been rectified. I mean, had I not had it surgically removed, I would still be walking around with a VERY large left breast. My right breast was completely fine.

Thank you!!

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I would contact Defy and discuss your concerns, particularly the thyroid, adrenal/cortisol questions. They can test, and treat, for any of those issues. It's what they do.

So so many men come to EM terrified of estradiol; many overreacting. You, on the other hand, have a history that explains why you zero in on your e2 level with such intensity. I'll just note that estradiol levels can be very easily suppressed. When that happens, and it can happen very quickly if too liberal a dose of anastrozole is prescribed, it's a miserable place for a man to be. Immsure you'll avoid both extremes since you are a patient of Dr. Saya.