E2 test

[Zooulie12]

My biggest fear is that at some point my libido and lack of erections will be a constant thing. But I don’t want to believe that because like I stated there are times where all systems are go.

 

[OMI100]

Do a search here for "sensitive e2 vs standard e2" or similar. You should find a number of post where folks did BOTH at the same time and you can see how the difference varies...
Just remember every one is different BUT I think it can be fair to say that the standard will read higher than the sensitive and if an AI is given based on the STANDARD E2 test there is a good chance you will drive your E2 way too low.
Do a search for "Low E2" or "crashed E2" or similar and see the mess that brings.

 

[Zooulie12]

Do a search here for "sensitive e2 vs standard e2" or similar. You should find a number of post where folks did BOTH at the same time and you can see how the difference varies...
Just remember every one is different BUT I think it can be fair to say that the standard will read higher than the sensitive and if an AI is given based on the STANDARD E2 test there is a good chance you will drive your E2 way too low.
Do a search for "Low E2" or "crashed E2" or similar and see the mess that brings.

Oh trust me, I have done ALOT of research. It just seems people kind of go back n forth on what they believe. Obviously everyone is different. I just wanted to ask myself and see what others thoughts were. Because people on this board seem incredibly knowledgeable. From what I have read, it seems like it’s better to be on the high side of e2 then the low side. In your opinion is that true? Thank you!

 

[Zooulie12]

To be honest I think it’s kind of ridiculous I have to go to a forum to get answers. I am super greatful there are forums out here for guys who are on trt and who have knowledge. It just frustrates me that my doctor who claims “high knowledge of trt” doesn’t have the answers at times. Or just doesn’t want to answer them. And I really don’t bother him at all. Even if there is an issue I don’t bother him with it. Another question, are they checking for enough when they do labs. All they check is T, E2, SGHB, hemocrit, free T and PSA. My doctor says those are the most important one for libido/erections.

 

[CoastWatcher]

To be honest I think it's kind of ridiculous I have to go to a forum to get answers. I am super greatful there are forums out here for guys who are on trt and who have knowledge. It just frustrates me that my doctor who claims “high knowledge of trt” doesn't have the answers at times. Or just doesn't want to answer them. And I really don't bother him at all. Even if there is an issue I don't bother him with it. Another question, are they checking for enough when they do labs. All they check is T, E2, SGHB, hemocrit, free T and PSA. My doctor says those are the most important one for libido/erections.

You aren't the first, and, sadly, won't be the last to discover your doctor is not able to play the androgen management game very well. There are good doctors who practice in this area and work with your insurance...maybe; they are few and far between. A vast number of us had to work with a number of different physicians before we landed with someone who could serve as a true partner and help us manage this problem successfully. In many cases, if they lived in the States, it means seeking fee-for-service care outside of insurance.

 

[1Draw]

Only way to know for sure where your Estradiol Sensitive stands is to test it.
https://www.discountedlabs.com/estradiol-sensitive-lc-ms-ms

The results can then dictate what to do about your AI instead of guessing.

 

[Gman86]

My biggest fear is that at some point my libido and lack of erections will be a constant thing. But I don't want to believe that because like I stated there are times where all systems are go.

Nah don't worry about you never getting all that back. I've read multiple times on forums about 60-70 year old guys getting erections, libido and orgasm quality back after not having any of that for 20-30 years. I'd say theres like a 99% chance that once you find your sweet spot of free T and sens E2, you'll get all that back. Just got to keep fine tuning and checking labs.

You definitely want E2 a little too high than a little too low though. E2 is extremely important for a number of things in males, sexual function absolutely being one of them.

Have you had your free testosterone level checked?

 

[MarkM]

I did labs and my e2 came back at 30 (mind you this is the normal test as I have stated not the sensitive one) the PA at the clinic said my e2 was getting a little too high and I need to immediately get back on my AI. I just want to know, because from reading forum after forum it seems like the people on forums ‘this one included' know wayyy more then the doctors. But what I am real curious about is if they are really pushing using the AI too much. Like the PA was legitimately worried when my e2 was 30

Typically an E2 on the non-sensitive test, Roche ECLIA, coming in at 30 could easily mean you would come in low on the Estradiol Sensitive test, LC/MS/MS assay. Not always, but probably 95% of the time. There are individuals, including a few on this forum, that have had their non-sensitive E2 come back higher than their Estradiol Sensitive. In your case, a result of 30 on either test would not generally be considered high under any circumstance I can think of.

In my last blood work in May, my non-sensitive E2 come in at 91.0 pg/ml on a range of 7.6 - 42.6 pg/ml and my Estradiol Sensitive came in at 35.3 pg/ml on a range of 8.0 - 35.0 pg/ml. If I allowed a doctor to treat me based off the non-sensitive E2 test and result of 91.0 pg/ml I would have been prescribed 1mg or anastrozole two to three times a week.

This is why it is so important to make sure we have our estradiol tested on the Sensitive, LC/MS/MS assay. It is much more accurate for men. The Roche ECLIA is designed for women and can way overestimate the estradiol in men, as my non-sensitive test result shows. Imagine if I was really 91.0? My "little buddy" would probably turn himself inside out and I would be lactating. By the way, I take no AI.

Your question of "are they really pushing the AI too much. Like the PA not legitimately worried when my e2 was 30." I just don't think the PA had a clue what they are managing.

 

[Zooulie12]

Typically an E2 on the non-sensitive test, Roche ECLIA, coming in at 30 could easily mean you would come in low on the Estradiol Sensitive test, LC/MS/MS assay. Not always, but probably 95% of the time. There are individuals, including a few on this forum, that have had their non-sensitive E2 come back higher than their Estradiol Sensitive. In your case, a result of 30 on either test would not generally be considered high under any circumstance I can think of.

In my last blood work in May, my non-sensitive E2 come in at 91.0 pg/ml on a range of 7.6 - 42.6 pg/ml and my Estradiol Sensitive came in at 35.3 pg/ml on a range of 8.0 - 35.0 pg/ml. If I allowed a doctor to treat me based off the non-sensitive E2 test and result of 91.0 pg/ml I would have been prescribed 1mg or anastrozole two to three times a week.

This is why it is so important to make sure we have our estradiol tested on the Sensitive, LC/MS/MS assay. It is much more accurate for men. The Roche ECLIA is designed for women and can way overestimate the estradiol in men, as my non-sensitive test result shows. Imagine if I was really 91.0? My "little buddy" would probably turn himself inside out and I would be lactating. By the way, I take no AI.

Your question of "are they really pushing the AI too much. Like the PA not legitimately worried when my e2 was 30." I just don't think the PA had a clue what they are managing.

Wow thanks for all the insight there. Honestly it seems like this entire time I have been keeping e2 below the normal range. Because my labs are always coming back in the mid to low 20s (unless I take a week off the AI) and like I said that’s the standard test. Also I got my labs back for Monday for my 90 day panel, e2 was at 21 and the PA said stick with the routine. I told him maybe I don’t have to be on an AI, he thought that wasn’t the best idea. So Friday of last week (2 days ago) I took my .25 and I just feel like death. Super down, sluggish, depressed, libido obviously non existent. I keep telling the PA and my doctor maybe I can do TRT without an AI. But they both think no, but look you said you don’t even take an AI at all. Honestly are they really necessary. Like I get high e2 is bad. But low e2 seems and feels like it’s probably worse: I haven’t ever experienced my e2 slightly high. The minute they saw my e2 on the standard test go above 45, I was put on anastrolze: that was literally almost 2 months after I started TRT. I wasn’t splitting doses back then either. Now I do my injections on Monday and Thursday.

 

[MarkM]

I would try to do without the AI. Your E2 numbers just don't warrant an AI. You don;t want to drive your E2 down any farther. You always have some handy if you absolutely need it. Neither high nor low E2 is something you want but for most people, it is easier to bring it down quickly if it gets high verses trying to bring it up once it gets too low.

I am going to really simply this ......if your E2 gets high you might cry a little bit at things you normally wouldn't because your emotions are jacked up. Example, you see the ASPCA commercial on TV about abused animals and you start crying because it is so sad. One the other hand, if your E2 gets to low you might also cry, but not because your being sensitive, but because you are miserable and can't stand life or yourself. I'd rather cry at the sad commercial. Now, this is just a simple example but I think you might understand.

 

[Zooulie12]

I would try to do without the AI. Your E2 numbers just don't warrant an AI. You don;t want to drive your E2 down any farther. You always have some handy if you absolutely need it. Neither high nor low E2 is something you want but for most people, it is easier to bring it down quickly if it gets high verses trying to bring it up once it gets too low.

I am going to really simply this ......if your E2 gets high you might cry a little bit at things you normally wouldn't because your emotions are jacked up. Example, you see the ASPCA commercial on TV about abused animals and you start crying because it is so sad. One the other hand, if your E2 gets to low you might also cry, but not because your being sensitive, but because you are miserable and can't stand life or yourself. I'd rather cry at the sad commercial. Now, this is just a simple example but I think you might understand.

That makes perfect sense. You see I really always thought If your e2 was low you wouldn’t cry. But yeah crying because you feel miserable makes sense lol. I have also read OCD in people who have it can be increased when there e2 drops, you ever heard of anything like that?

 

[Zooulie12]

I would try to do without the AI. Your E2 numbers just don't warrant an AI. You don;t want to drive your E2 down any farther. You always have some handy if you absolutely need it. Neither high nor low E2 is something you want but for most people, it is easier to bring it down quickly if it gets high verses trying to bring it up once it gets too low.

I am going to really simply this ......if your E2 gets high you might cry a little bit at things you normally wouldn't because your emotions are jacked up. Example, you see the ASPCA commercial on TV about abused animals and you start crying because it is so sad. One the other hand, if your E2 gets to low you might also cry, but not because your being sensitive, but because you are miserable and can't stand life or yourself. I'd rather cry at the sad commercial. Now, this is just a simple example but I think you might understand.

So your saying with only doing 140mg a week, doing split doses. I dose on Monday and Thursday. There isn’t a need for an AI you think? Also I work out extremely hard for 40 minutes a day. Idk if that helps lower estrogen naturally: thanks a lot for the advice and help!

 

[MarkM]

So your saying with only doing 140mg a week, doing split doses. I dose on Monday and Thursday. There isn’t a need for an AI you think? Also I work out extremely hard for 40 minutes a day. Idk if that helps lower estrogen naturally: thanks a lot for the advice and help!

I don't think you need an AI. I think if you keep taking it you could crash your E2 which you don't want to do. I inject Monday and Thursday too. Monday am and Thursday pm; every 3.5 days. I'm on 160 mg total a week. My last blood work in May was:

Total T 1055 ng/dl Range of 264 - 916 ng/dl
Free T 30.1 pg/ml Range of 7.2 - 24.0 pg/ml
Estradiol Sensitive 35.3 pg/ml Range of 8.0 - 35.0 pg/ml
SHBG 30.0 nmol/l Range of 19.3 - 76.4 nmol/l
No use of an AI.

 

[Zooulie12]

So just an update I asked my doctor in depth about the difference between the sensitive test and the normal test. And he said it’s only 10 percent. From all the responses I have got on here it obviously isn’t 10 percent. So I am starting to think my doctor knows nothing. Secondly I am pretty sure I dropped my e2 when my took my AI on Friday. 3 days ago. How long for it to rebound?

 

[Zooulie12]

I don't think you need an AI. I think if you keep taking it you could crash your E2 which you don't want to do. I inject Monday and Thursday too. Monday am and Thursday pm; every 3.5 days. I'm on 160 mg total a week. My last blood work in May was:

Total T 1055 ng/dl Range of 264 - 916 ng/dl
Free T 30.1 pg/ml Range of 7.2 - 24.0 pg/ml
Estradiol Sensitive 35.3 pg/ml Range of 8.0 - 35.0 pg/ml
SHBG 30.0 nmol/l Range of 19.3 - 76.4 nmol/l
No use of an AI.

Just started your routine of injecting Monday morning. Going to inject Thursday night. I assume it’s important to do rotate it like morning and night? Not just doing any time on Monday and Thursday? Also from your experience, does e2 that is low (like real low) is that worse for you libido then if it’s on the higher side? Because your sensitive is 35 and I imagine your doing alright with your libido???

 

[MarkM]

Just started your routine of injecting Monday morning. Going to inject Thursday night. I assume it’s important to do rotate it like morning and night? Not just doing any time on Monday and Thursday? Also from your experience, does e2 that is low (like real low) is that worse for you libido then if it’s on the higher side? Because your sensitive is 35 and I imagine your doing alright with your libido???

Yes, you should try to be as consistent as you can in the time you give your injections on your injection days but sometimes life gets in the way and I miss my normal injection time. I try to stick with with Monday at 5am and then Thursday at 7pm. As far as E2 and libido, real low libido is probably much worse than high E2 on libido but both have drawbacks. Everyone has their sweet spot. I am good with my E2 at 35 although some might find that on the high side. I feel good and have good libido and don't have any type of ED issues.

 

[CoastWatcher]

You wrote that you test "three days after injections." For clarity, you do know that it is standard to test just prior to an injection, to capture trough testosterone/free testosterone values (and grab the estradiol value - E follows T) somewhere near a high water mark?

 

[Zooulie12]

You wrote that you test "three days after injections." For clarity, you do know that it is standard to test just prior to an injection, to capture trough testosterone/free testosterone values (and grab the estradiol value - E follows T) somewhere near a high water mark?

So wait when is the best time to get you’re levels tested? Right after you inject? Like same day?

 

[Zooulie12]

You wrote that you test "three days after injections." For clarity, you do know that it is standard to test just prior to an injection, to capture trough testosterone/free testosterone values (and grab the estradiol value - E follows T) somewhere near a high water mark?

Because I do split injections. So I inject on Monday and Thursday and get my blood work done on Monday then after my blood work is done I do my injection.