Crashed E2

[Mitch]

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View attachment 7021

Pics above and lower are current labs


So, here are my labs numbers before trt
Tt-278
E2 standard- 24


Protocol has been 50mg test cyp 2x a week and 1/4mg anastrozle with injection.... i was on trt for close to two years and made the mistake of switching clinics. New clinic didn’t use sensitive testing (I didn’t know the difference) decided to go off trt because I felt so terrible. New clinic gave me a terrible PCT of 500 HCG 3x week and Clomid eod. Now I am back with my old doc but he used most recent labs from a normal endo and again. Non sensitive test.. I have eliminated my AI and upped my test to 60mg 2x a week.. Nelson said it’s going to take a couple months to bounce back.. just looking for reassurance, crashed E2 has been the worst.. and I am a former meth addict.. i would rather go through that again then E2 crash. The anxiety and panic has been unbearable. There was an extended time were trt had me cool as cucumber and I hope to get back to that.

 

[Mitch]

How long should I wait to do labs?? My doc is on jury duty and may not be done for another week. Ha. Also, should I see improvements sooner than two months or do I just have to be patient?

 

[madman]

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How long should I wait to do labs?? My doc is on jury duty and may not be done for another week. Ha. Also, should I see improvements sooner than two months or do I just have to be patient?

How recently did you increase T dose from 50 mg----->60 mg twice weekly (every 3.5 days)?

Seeing as your dose was increased your hormones will be in flux until levels stabilize.....wait 6 weeks on new protocol before follow up labs to see where your TT, FT and e2 levels sit.

What is your SHBG?

 

[Mitch]

How recently did you increase T dose from 50 mg----->60 mg twice weekly (every 3.5 days)?

Seeing as your dose was increased your hormones will be in flux until levels stabilize.....wait 6 weeks on new protocol before follow up labs to see where your TT, FT and e2 levels sit.

What is your SHBG?

Upped it my dose the last 4 injections, so 2 weeks.. I inject every Wednesday and Saturday. anxiety has spiked a bit, tiredness is a pain, but brain fog is better, erections not great, but libido is up.. Shbg was 49 (16-70) 6 weeks ago when I started trt again. Will get my labs ordered from discount labs, what do you recommend I all have tested? TT, FT, DT, DHEA, E2 sensitive and SHBG? Anything else?

 

[Vince Carter]

Your E2 is not crashed, the panic and anxiety are really not hormone related, either. What's you history with anxiety/OCD/ADHD/etc etc

 

[Mitch]

Your E2 is not crashed, the panic and anxiety are really not hormone related, either. What's you history with anxiety/OCD/ADHD/etc etc

I always had some underlying anxiety, guessing the 8.5 is actually up, going off of old protocols my doc was concerned that I would go too high with E2.. it’s unfortunate that I don’t have sensitive e2 labs prior to restart. Just the standard that says I was at a 24. I do have a psychiatrist appt for next month, but didn’t want to start a med while protocol was adjusting, if that makes sense. The best I ever felt was tt at 1000 and E2 at 17 on quest ultra sensitive... crashing my numbers coming off has probably exasperated an underlying anxiety disorder. Just afraid of making the wrong move again because I paid for it last time.

 

[Cataceous]

Assuming SHBG didn't go down from 49 pg/mL, calculated free estradiol is 0.18 pg/mL. That is quite low considering the normal range is more like 0.3-1.5 pg/mL.

If you are seeing large and consistent differences between the standard and sensitive estradiol tests then you might want to measure your C-reactive protein level. Elevated CRP would indicate systemic inflammation, and should be investigated.

 

[Mitch]

Assuming SHBG didn't go down from 49 pg/mL, calculated free estradiol is 0.18 pg/mL. That is quite low considering the normal range is more like 0.3-1.5 pg/mL.

If you are seeing large and consistent differences between the standard and sensitive estradiol tests then you might want to measure your C-reactive protein level. Elevated CRP would indicate systemic inflammation, and should be investigated.

Is that calculation off of the 8.5 estrodiol test? Because I was on an AI... correct me if I am wrong, but that test is for cardiovascular stuff, diabetes etc?

 

[Cataceous]

Is that calculation off of the 8.5 estrodiol test? Because I was on an AI... correct me if I am wrong, but that test is for cardiovascular stuff, diabetes etc?

Yes, the free estradiol calculation is based on E2 of 8.5 pg/mL, TT of 644 ng/dL, and your other numbers.

If you're referring to the CRP test: it's a measure of systemic inflammation that may have any number of causes, including heart disease, autoimmune diseases, cancer, tuberculosis, etc.

I mentioned it because the standard estradiol test can act like a combination E2/CRP test.

 

[Mitch]

Yes, the free estradiol calculation is based on E2 of 8.5 pg/mL, TT of 644 ng/dL, and your other numbers.

If you're referring to the CRP test: it's a measure of systemic inflammation that may have any number of causes, including heart disease, autoimmune diseases, cancer, tuberculosis, etc.

I mentioned it because the standard estradiol test can act like a combination E2/CRP test.

Thanks, I will add that test to my next labs in a few weeks then.. I was also going to to the e2 sensitive and standard at the same time to get a comparison on the same day to see exactly the difference..

 

[Systemlord]

There have been a lot of members who are able to ditch their AI's for more frequent dosing therefore better managing estrogen.

 

[Mitch]

There have been a lot of members who are able to ditch their AI's for more frequent dosing therefore better managing estrogen.

That’s what i read, i know 8.5 is in range, but that may be too low for me to feel good. Seems like most members find their sweet spot higher.

 

[Cataceous]

... I was also going to to the e2 sensitive and standard at the same time to get a comparison on the same day to see exactly the difference..

This is an excellent thing to do. The sensitive, mass spectrometry-based tests are more accurate when they are done right, but they are easy to mess up, and thus occasionally give very wrong numbers.

 

[Mitch]

This is an excellent thing to do. The sensitive, mass spectrometry-based tests are more accurate when they are done right, but they are easy to mess up, and thus occasionally give very wrong numbers.

Really? I thought Everyone here said that was the most accurate.. how often have people had issues where they’re wrong?

 

[Cataceous]

Really? I thought Everyone here said that was the most accurate.. how often have people had issues where they’re wrong?

In my case two out of six have been completely wrong, in one case leading to a dubious treatment recommendation from the doctor. There is additional anecdotal evidence in this thread where @Gman86 posted a lot of test results, and it turned out that the standard estradiol tests were producing better numbers than the sensitive tests.

It's important to be aware that if you personally have significant amounts of substances other than estradiol that the standard tests pick up then you cannot rely on these tests for accurate absolute numbers. However, they are still useful for relative measurements, as they are very reliable, basically idiot-proof. In my case the standard tests are consistently around 10% higher than the sensitive tests. Therefore, if I use the standard test and subtract ~10% I will be more likely to have a good measurement than with the sensitive test, which has been over 50% low on those two occasions.

 

[Mitch]

In my case two out of six have been completely wrong, in one case leading to a dubious treatment recommendation from the doctor. There is additional anecdotal evidence in this thread where @Gman86 posted a lot of test results, and it turned out that the standard estradiol tests were producing better numbers than the sensitive tests.

It's important to be aware that if you personally have significant amounts of substances other than estradiol that the standard tests pick up then you cannot rely on these tests for accurate absolute numbers. However, they are still useful for relative measurements, as they are very reliable, basically idiot-proof. In my case the standard tests are consistently around 10% higher than the sensitive tests. Therefore, if I use the standard test and subtract ~10% I will be more likely to have a good measurement than with the sensitive test, which has been over 50% low on those two occasions.

And now I am 2nd guessing my labs. Lol

 

[Cataceous]

And now I am 2nd guessing my labs. Lol

I always say we should be careful about relying too much on any one measurement. If it's not information overload you can read LEF's defense of the standard testing here. They quote the Endocrine Society on MS testing:

It needs to be noted that mass spectrometry assays are highly complex and require both a high degree of manual adjustments and controlling of operational conditions. Therefore, a high level of skill and knowledge is required to properly set up and operate these methods. Inappropriately operated mass spectrometry methods can lead to profoundly incorrect and inconsistent results. ...

 

[Gman86]

Here’s a bunch of my E2 results to show the differences between the standard E2, and sensitive E2 tests, that I’ve seen while using Quest.

8-15-17
E2 Sensitive - 8
E2 NOT Sensitive - 13
E2 Free - 0.28 (0.2-1.5)
SHBG 51 (10-50)
Albumin - 4.6g/dL (3.6-5.1)

12-13-17
E2 Sensitive - 9
E2 NOT Sensitive - 13
E2 Free - 0.28 (0.2-1.5)
SHBG 36 (10-50)
Albumin - 4.4g/dL (3.6-5.1)

7-9-18
E2 Sensitive - 46
E2 NOT Sensitive - 27
E2 Free - 0.58 (0.2-1.5)
SHBG 47 (10-50)
Albumin - 4.6g/dL (3.6-5.1)

8-24-18
E2 Sensitive - 57
E2 NOT Sensitive - 56
E2 Free - 1.35 (0.2-1.5)
SHBG 41 (10-50)
Albumin - 4.3g/dL (3.6-5.1)

10-23-18
E2 Sensitive - 58
E2 NOT Sensitive - 68
E2 Free - 1.48 (0.2-1.5)
SHBG 44 (10-50)
Albumin - 4.6g/dL (3.6-5.1)

12-6-18
E2 Sensitive - 10
E2 NOT Sensitive - 15
E2 Free - 0.33 (0.2-1.5)
SHBG 45 (10-50)
Albumin - 4.7g/dL (3.6-5.1)

1-25-19
E2 Sensitive - 29
E2 NOT Sensitive - 27
E2 Free - 0.67 (0.2-1.5)
SHBG 40 (10-50)
Albumin - 4.5g/dL (3.6-5.1)

2-20-19
E2 Sensitive - 28
E2 NOT Sensitive - 32
E2 Free - 0.76 (0.2-1.5)
SHBG 44 (10-50)
Albumin - 4.6 (3.6-5.1)

 

[Systemlord]

That’s what i read, i know 8.5 is in range, but that may be too low for me to feel good. Seems like most members find their sweet spot higher.

Most find their sweat spot more than double that number, rarely do we see men feeling normal this low. More often than not, you've got to have low testosterone to have these low E2 numbers.

 

[Cataceous]

Here’s a bunch of my E2 results to show the differences between the standard E2, and sensitive E2 tests, that I’ve seen while using Quest.
...

The important thing about your data is that when calculated free estradiol was compared to measured values, the immunoassay tests had excellent correlations, but the sensitive tests weren't nearly as good. The one thing that's a little problematic is that the measured free estradiol tests are based on mass spectrometry. But I'm guessing that because it was such a complicated and expensive test they took a lot more care to get it right.