Apparently E2 is way out but I'm feeling good

[TestOneTwo]

Gents,

Here my journey so far.

Baseline

BP 120/72
TT 275 (264-916)
FT 12.5 (6.8-21.5)
E2, SENSITIVE 10.6 (8-35)
SHBG 25.7 (16.5-55.9)
HCT 45.1 (37.5-51)
TRIGLYCERIDES 117 (0-149)
HDL 35 (39- ?)
LDL 116 (0-99)

All the common low T symptoms I don't want to bore you with.

3 months in, T cyp only (70mg E3.5D, total 140mg/week)

BP 123/71
TT 622 (264-916)
FT 25.1 (6.8-21.5)
E2, SENSITIVE 24.4 (8-35)
SHBG 15.4 (16.5-55.9)
HCT 51.7 (37.5-51)
TRIGLYCERIDES 175 (0-149)
HDL 37 (39- ?)
LDL 117 (0-99)

Better but still not great. SHBG went south. Provider insists all is great even though I made clear it’s really not yet. I said I’d rather try the 800 area so I had to suggest myself maybe to go EOD in order to increase my trough. No decrease in dose has been recommended for that which I found odd.

Now, 6 month later, T cyp only (40mg EOD, total 140mg/week)

BP 124/73
TT 1180 (264-916)
FT 35.5 (6.8-21.5)
E2, SENSITIVE 48.5 (8-35)
SHBG 32.5 (16.5-55.9)
HCT 54.4 (37.5-51)
TRIGLYCERIDES 90 (0-149)
HDL 42 (39- ?)
LDL 156 (0-99)

Feeling best so far. I realize I have to lower my HCT by donation/phlebotomy soonish and by lowering the T dose by say 10% and see how it goes. I don’t mind my E2 though. I don’t suffer under any high E2 symptoms yet my provider strongly insists that my E2 of 48.5 is way too high for a man and is not listening to me at all. I suggested I can go down to 0.36mg (total 126mg/week) and see how it goes. Nope. They insisted I had to go 34mg at least, better 30mg - apparently not because of HCT but because of E2 and all its side effects I don’t have. It’s all nice and well but other than my increased HCT I need to sort out, aren’t we at a point now where how you feel counts for something? I even had to justify why my TT was so high in these results, even though we had agreed me going EOD on our last meeting which would obviously increase my trough. Why didn’t they know that? The amazing fact that my SHBG had doubled has been completely ignored also. Should I choose another contact at my provider or is this normal and I best just go with the flow? I really want someone who is willing to work with me rather than going strictly by textbook and treating me like an infant. I just want to feel good and have the freedom to experiment a little, within reason, of course.

 

[Cataceous]

Estradiol follows testosterone, and that's what we see in your results; the level of estradiol is normal for the amount of testosterone, or maybe even a little low. The issue is that your testosterone is nearly double that of the average man in his prime, which is contributing to side effects like high HCT and subpar lipids. I would cut the testosterone dose by 20-40%. I've tried a similar reduction (-40+%), and feel better overall—also have better lipids. Only athleticism took a minor hit, which is a worthwhile tradeoff unless you're competing. Dr. Saya believes that high HGB/HCT may be a risk due to long-term stress on the vasculature. That's a good reason to bring them down.

I agree that an informed patient should have a strong role in directing his treatment, including some experimentation within reason. But you must factor in the silent risks that exist even when you feel good.

That recovery of SHBG with more frequent injecting is an interesting result. I wonder if it's due to the reduction in peak testosterone?

 

[Walker DC APRN]

Gents,

Here my journey so far.

Baseline

BP 120/72
TT 275 (264-916)
FT 12.5 (6.8-21.5)
E2, SENSITIVE 10.6 (8-35)
SHBG 25.7 (16.5-55.9)
HCT 45.1 (37.5-51)
TRIGLYCERIDES 117 (0-149)
HDL 35 (39- ?)
LDL 116 (0-99)

All the common low T symptoms I don't want to bore you with.

3 months in, T cyp only (70mg E3.5D, total 140mg/week)

BP 123/71
TT 622 (264-916)
FT 25.1 (6.8-21.5)
E2, SENSITIVE 24.4 (8-35)
SHBG 15.4 (16.5-55.9)
HCT 51.7 (37.5-51)
TRIGLYCERIDES 175 (0-149)
HDL 37 (39- ?)
LDL 117 (0-99)

Better but still not great. SHBG went south. Provider insists all is great even though I made clear it’s really not yet. I said I’d rather try the 800 area so I had to suggest myself maybe to go EOD in order to increase my trough. No decrease in dose has been recommended for that which I found odd.

Now, 6 month later, T cyp only (40mg EOD, total 140mg/week)

BP 124/73
TT 1180 (264-916)
FT 35.5 (6.8-21.5)
E2, SENSITIVE 48.5 (8-35)
SHBG 32.5 (16.5-55.9)
HCT 54.4 (37.5-51)
TRIGLYCERIDES 90 (0-149)
HDL 42 (39- ?)
LDL 156 (0-99)

Feeling best so far. I realize I have to lower my HCT by donation/phlebotomy soonish and by lowering the T dose by say 10% and see how it goes. I don’t mind my E2 though. I don’t suffer under any high E2 symptoms yet my provider strongly insists that my E2 of 48.5 is way too high for a man and is not listening to me at all. I suggested I can go down to 0.36mg (total 126mg/week) and see how it goes. Nope. They insisted I had to go 34mg at least, better 30mg - apparently not because of HCT but because of E2 and all its side effects I don’t have. It’s all nice and well but other than my increased HCT I need to sort out, aren’t we at a point now where how you feel counts for something? I even had to justify why my TT was so high in these results, even though we had agreed me going EOD on our last meeting which would obviously increase my trough. Why didn’t they know that? The amazing fact that my SHBG had doubled has been completely ignored also. Should I choose another contact at my provider or is this normal and I best just go with the flow? I really want someone who is willing to work with me rather than going strictly by textbook and treating me like an infant. I just want to feel good and have the freedom to experiment a little, within reason, of course.

I function best with higher testosterone levels. Every one is different - that is what "optimization" is all about. Estradiol is your own personal journey. In "general" most men seem to do well with an E2 between 20-50. Some like it higher. For some guys if their E2 goes above 30 it will just shut them down with fatigue, etc. for others they can get in a real bad mood and will come rip your car door off if you get in a fender bender with them. It is all about you and how you feel and what makes you function at your best. Also, just curious what was your hemoglobin levels for all 3 visits?

 

[TestOneTwo]

Estradiol follows testosterone, and that's what we see in your results; the level of estradiol is normal for the amount of testosterone, or maybe even a little low. The issue is that your testosterone is nearly double that of the average man in his prime, which is contributing to side effects like high HCT and subpar lipids. I would cut the testosterone dose by 20-40%. I've tried a similar reduction (-40+%), and feel better overall—also have better lipids. Only athleticism took a minor hit, which is a worthwhile tradeoff unless you're competing. Dr. Saya believes that high HGB/HCT may be a risk due to long-term stress on the vasculature. That's a good reason to bring them down.

I agree that an informed patient should have a strong role in directing his treatment, including some experimentation within reason. But you must factor in the silent risks that exist even when you feel good.

That recovery of SHBG with more frequent injecting is an interesting result. I wonder if it's due to the reduction in peak testosterone?

Thanks for your input! The SHBG likely went up because I had lost a around 25 lbs of fat. I utilized the more controllable nature of the COVID lockdown situation and increased my workout load and went on a calorie deficit. That’s also why my lipids actually got better, especially triglycerides. I’m actually not surprised about either the total cholesterol and even HCT - I went low carb and ate a lot of red meat. Regarding athleticism, for some reason TRT doesn’t seem to have the slightest effect on my muscle growth and even less on my strength. I almost feel strength took a hit instead. Where it does seem to help somewhat is maintaining muscle during fat loss.

 

[TestOneTwo]

I function best with higher testosterone levels. Every one is different - that is what "optimization" is all about. Estradiol is your own personal journey. In "general" most men seem to do well with an E2 between 20-50. Some like it higher. For some guys if their E2 goes above 30 it will just shut them down with fatigue, etc. for others they can get in a real bad mood and will come rip your car door off if you get in a fender bender with them. It is all about you and how you feel and what makes you function at your best. Also, just curious what was your hemoglobin levels for all 3 visits?

Thanks for your comments. My hemoglobin levels were as follows:

Baseline: 14.8
3 months: 14.8
Now: 16.9

 

[TestOneTwo]

Oh and for future fellow members searching this forum for info on how to reduce HCT - I can attest that grapefruit seed extract does NOTHING. I had taken 500mg for over 4 months only to see my HCT increasing. I will now start taking Bromlein more regularly as well as Ashwagandha which seems to have beneficial effects on HCT and hemoglobin. Fishoil I’m taking anyway to keep things nice and slippery.

 

[slicktop]

Oh and for future fellow members searching this forum for info on how to reduce HCT - I can attest that grapefruit seed extract does NOTHING. I had taken 500mg for over 4 months only to see my HCT increasing. I will now start taking Bromlein more regularly as well as Ashwagandha which seems to have beneficial effects on HCT and hemoglobin. Fishoil I’m taking anyway to keep things nice and slippery.

you mean, "grapefruit seed extract did nothing for ME", right? ;-)

 

[TestOneTwo]

you mean, "grapefruit seed extract did nothing for ME", right? ;-)

Yeah that would be a fair addition I suppose. Wait, does it work for you?

 

[Walker DC APRN]

Thanks for your comments. My hemoglobin levels were as follows:

Baseline: 14.8
3 months: 14.8
Now: 16.9

Estimated Hematocrit is Hemoglobin x 3. 16.9 x 3 = 50.7.
The difference between the estimated Hematocrit 50.7 and the HCT 54.4 - is that it looks like you were dehydrated.
An ideal goal is to stay under HCT 50. Thus HCT 50.7 is not too bad.
With elevated HCT just look for signs of shortness of breath, dizziness, headaches, etc.
I find aerobic workouts tend to lower my Hematocrit.

 

[Walker DC APRN]

you mean, "grapefruit seed extract did nothing for ME", right? ;-)

Oh and for future fellow members searching this forum for info on how to reduce HCT - I can attest that grapefruit seed extract does NOTHING. I had taken 500mg for over 4 months only to see my HCT increasing. I will now start taking Bromlein more regularly as well as Ashwagandha which seems to have beneficial effects on HCT and hemoglobin. Fishoil I’m taking anyway to keep things nice and slippery.

I use a lot of Naringin for health benefits. Seems to lower my HCT, too.
Research Study: "Naringin supplementation lowers plasma lipids and enhances erythrocyte antioxidant enzyme activities in hypercholesterolemic subjects".

https://www.sciencedirect.com/science/article/abs/pii/S0261561403000591

Naringin at a dose of approximately 100 mg/kg/day. This dose corresponds to ~1 g/day naringin in a 70 kg (154 #) human based on scaling equations. 1 Tablespoon = 14 g. 4 Tablespoons = 56 g. Peaks at 4 hours. Take BID.

Naringin Bulk Supplements 500g bag one tablespoon = 5.5 grams (equals 500 mg capsules x 11).

 

[TestOneTwo]

I use a lot of Naringin for health benefits. Seems to lower my HCT, too.
Research Study: "Naringin supplementation lowers plasma lipids and enhances erythrocyte antioxidant enzyme activities in hypercholesterolemic subjects".

https://www.sciencedirect.com/science/article/abs/pii/S0261561403000591

Naringin at a dose of approximately 100 mg/kg/day. This dose corresponds to ~1 g/day naringin in a 70 kg (154 #) human based on scaling equations. 1 Tablespoon = 14 g. 4 Tablespoons = 56 g. Peaks at 4 hours. Take BID.

Naringin Bulk Supplements 500g bag one tablespoon = 5.5 grams (equals 500 mg capsules x 11).

I’ve heard about Naringin in combination with grapefruit seed extract. I will give it a shot on its own. Thanks for the tip! Regarding dehydration I wished that’s what it is. Unfortunately, I have been drinking a lot of water lately - if it’s dehydration I wouldn’t even know what else to do about it.

 

[TestOneTwo]

I use a lot of Naringin for health benefits. Seems to lower my HCT, too.
Research Study: "Naringin supplementation lowers plasma lipids and enhances erythrocyte antioxidant enzyme activities in hypercholesterolemic subjects".

https://www.sciencedirect.com/science/article/abs/pii/S0261561403000591

Naringin at a dose of approximately 100 mg/kg/day. This dose corresponds to ~1 g/day naringin in a 70 kg (154 #) human based on scaling equations. 1 Tablespoon = 14 g. 4 Tablespoons = 56 g. Peaks at 4 hours. Take BID.

Naringin Bulk Supplements 500g bag one tablespoon = 5.5 grams (equals 500 mg capsules x 11).

The recommended dosages I can find seem to vary wildly. At the highest end and with my BW of 105kg I’d be looking at over 10g/day. That’s seems to be an awful lot. However, on the lower end it’s just 1g/day or less - similar to the amount of GSE I’m taking that has no effect. Are you saying I’m probably just not taking a high enough dose?

 

[Walker DC APRN]

I’ve heard about Naringin in combination with grapefruit seed extract. I will give it a shot on its own. Thanks for the tip! Regarding dehydration I wished that’s what it is. Unfortunately, I have been drinking a lot of water lately - if it’s dehydration I wouldn’t even know what else to do about it.

If your Estimated Hematocrit is Hemoglobin x 3. 16.9 x 3 = 50.7. Then that is the number you go by.
The HCT 54.4 = a slightly dehydrated state at the moment you had your labs drawn.
Therefore, not a state of alarm to drop your Hematocrit.

 

[Walker DC APRN]

The recommended dosages I can find seem to vary wildly. At the highest end and with my BW of 105kg I’d be looking at over 10g/day. That’s seems to be an awful lot. However, on the lower end it’s just 1g/day or less - similar to the amount of GSE I’m taking that has no effect. Are you saying I’m probably just not taking a high enough dose?

In the beginning I just started out with a tablespoon of the bulk powder, then gradually worked my way up. I use a small cup with the bulk powder and some water. It tastes like mud. I eat half of a grapefruit afterwards. Just doing it for the long term endothelial health benefits of consistent nitric oxide production. Your pump and your erections live or die at the endothelial lining in you blood vessels.

 

[TestOneTwo]

In the beginning I just started out with a tablespoon of the bulk powder, then gradually worked my way up. I use a small cup with the bulk powder and some water. It tastes like mud. I eat half of a grapefruit afterwards. Just doing it for the long term endothelial health benefits of consistent nitric oxide production. Your pump and your erections live or die at the endothelial lining in you blood vessels.

You sir are a scholar and a gentleman. Thanks!

 

[Nelson Vergel]

Total T 1180 ng/dL multiplied by 0.04= 47.2 pg/mL

Your estradiol is where it should be (0.4% of total T)

I have to repeat that the estradiol "normal range" was derived for men who had "normal testosterone". Most guys on ExcelMale have high testosterone and get alarmed when Quest or LabCorp say their estradiol is above "normal".

How to Predict Estradiol and DHT at Different Testosterone Doses

I was able to come up with a table using the predictive model equation derived from data in this study: The Effects of Injected Testosterone Dose and Age on the Conversion of Testosterone to Estradiol and Dihydrotestosterone in Young and Older Men Summary This video discusses a research paper...

www.excelmale.com

 

[TorontoTRT]

Don’t reduce your dosage. It will not lower HCT. IF you don’t have any side effects just leave hct alone and donate a few times a year. Don’t stress over it. And don’t waste time on all these ways to lower it. None of them work. Grapefruit etc. All bullshit. Even though some say it works they don’t really know. Hct fluctuates non stop. A blood test is just a snap shot in time. Hydration only does so much. I tested my hct 3 times in one week. Numbers all over the place. 58 three days later 53. Same hydration and nothing else. It just fluctuates on its own.

 

[slicktop]

@Nelson Vergel yesterday evening I found a post where you mentioned high IGF could cause a conflict with estradiol even if it was "in range" or .4% total T, but now I can't find that. Can you point me to any other information regarding IGF and estradiol? I'm one of those guys that gets symptoms if my estradiol is higher than my SHBG but is within the .4% range, and I have very high IGF. Just looking for some additional info, since this is the first time I've heard of a possible correlation. Thanks!

 

[Nelson Vergel]

This one ?

Gynecomastia Associated with a Combination of High IGF-1 and Estradiol In Adolescents

A Longitudinal Study of Growth, Sex Steroids and Insulin-like Growth Factor I in boys with Physiological Gynecomastia Physiological gynecomastia is common in pubertal boys and appears to be associated with increased levels of insulin like growth factor-1 (IGF-1) and pubertal growth, but not...

www.excelmale.com

 

[slicktop]

This one ?

Gynecomastia Associated with a Combination of High IGF-1 and Estradiol In Adolescents

A Longitudinal Study of Growth, Sex Steroids and Insulin-like Growth Factor I in boys with Physiological Gynecomastia Physiological gynecomastia is common in pubertal boys and appears to be associated with increased levels of insulin like growth factor-1 (IGF-1) and pubertal growth, but not...

www.excelmale.com

I was looking for anything, really. I've never struggled with gyno, but if my estradiol gets above my SHBG, I show other classic symptoms.... hot flashes, moodiness, elevated blood pressure, etc. Thank you for the article!