Emotional, ED, high T, and suspiciously low E2

[DaviSh]

Hello, I‘m new here. I’ve read off and on for years, and searched recently through the forum and haven’t found a thread that fits my situation.

First, a brief background: I’ve been on TRT (injections) since summer 2015, with a new “Functional Medicine” DR since mid 2017. She was willing to titrate dosage to maximize well-being, rather than simply max out total testosterone at 500-600 as my PCP and urologist did.

Up until May, my protocol was .20ml daily test cyp (200mg/ml). Numbers in May with a blood draw 5 hours after injection:

total test - 862 ng/dL (300-890)
shbg - 33.3 (16.5-55.9)
calc free test - 200.1 pg/ml (47.0-244.0)
DR never checks estradiol and doesn’t believe it’s necessary.
*I have never taken any AI.

At that time I felt only “OK”, some mild ED, slight libido loss, and occasional emotional/ “weepy” episodes where I struggled to maintain composure in situations in which it should not have been a problem.

DR increased dosage to .25ml test cyp daily. I haven’t felt much better since then, and actually over the last month or so have felt horrible: depression, no morning wood, trouble sleeping all night, and more persistent ED and loss of penile sensitivity.

So on my own this week, I had DiscountedLabs run T and e2 (sensitive). See my attached numbers. The excessively high total and free T is not surprising, but the E2 number is shocking!

Anybody have experience with really high T along with excessively low E2??

I’m grateful for all good advice.

thanks,
ds

 

[Vince]

You said you never used an AI, right? Is there any chance an estrogen blocker is mixed with your testosterone?

 

[DaviSh]

If there is an estrogen blocker, it’s not on the label. I’m not using compounded testosterone cyp, but instead using a standard 10ml vial purchased from a national pharmacy.

 

[DaviSh]

And that is correct, I have never used an AI.

 

[Vince]

And that is correct, I have never used an AI.

Then something is definitely wrong. It could be the labs, or something is added to your testosterone. If you're not having low E2 symptoms, then would think it must be the labs.

 

[DaviSh]

Are any of these low E2 symptoms? — ”over the last month or so I have felt horrible: depression, no morning wood, trouble sleeping all night, and more persistent ED and loss of penile sensitivity.”

I assumed I might have high E2 based on the symptoms, so the lab results were clearly a surprise. I’m trying to sort out what my next steps should be.

If there is no known reason for high T and low E2, perhaps LabCorp has tested erroneously and I have to go and do it all over again.

 

[S1W]

I agree your E2 number seems odd.

However, you're using .25ml/day? As in 50mg per day, 350mg per week?

Because if as you say you have been reading this forum for a while, you know that is considered a pretty high dose for TRT...

Have you ever tried something like .25-30ml (50-60mg) twice per week?

 

[DaviSh]

I agree your E2 number seems odd.

However, you're using .25ml/day? As in 50mg per day, 350mg per week?

Because if as you say you have been reading this forum for a while, you know that is considered a pretty high dose for TRT...

Have you ever tried something like .25-30ml (50-60mg) twice per week?

Yes, you understood correctly (350 mg/wk). I have tried 100-120 mg/wk and couldn’t get my total/free numbers high enough to be optimized. I believe my DR has my dosage way too high now, and the most recent lab results have only further confused me. Clearly total and free T need to come down significantly, but E2 <2.5 is either a serious lab error or I have other serious issues going on.

 

[DaviSh]

Up until May, my protocol was .20ml daily test cyp (200mg/ml). Numbers in May with a blood draw 5 hours after injection:

total test - 862 ng/dL (300-890)
shbg - 33.3 (16.5-55.9)
calc free test - 200.1 pg/ml (47.0-244.0)

Previously, at 280 mg/wk, my total and free levels, along with SHBG, were in normal range. DHEA was 304 ug/dl (44-341) without any supplementation.

Is there something else I need to have tested that would help explain why high TRT dosage appears necessary to reach those levels?

 

[Vvs1]

Definitely retest e2, possibly at a different lab.

Then source another test supplier/pharmacy.

 

[fifty]

Estradiol sensitive sucks. Way too many erroneous results.

Just get regular e2 and realize it may return a value slightly high. But at least it will be consistent and reliable.

 

[DaviSh]

Thank you to those who responded. I’m discouraged and looking to figure out my next steps.

 

[Vince]

Yes, you understood correctly (350 mg/wk). I have tried 100-120 mg/wk and couldn’t get my total/free numbers high enough to be optimized. I believe my DR has my dosage way too high now, and the most recent lab results have only further confused me. Clearly total and free T need to come down significantly, but E2 <2.5 is either a serious lab error or I have other serious issues going on.

Tru T calculator - what is the range?

 

[fifty]

See these posts. I tend to give 1 word answers. Cataceous explains things better than me.

Help with bloodwork, undetectable E2?

Help with bloodwork, undetectable E2?

 

[DaviSh]

Thank you all. This is helpful info.

 

[Systemlord]

I'm wondering have you been taking supplements and/or Cialis lately? If you continue to find yourself with chronically low E2 and none of the above pertain to you, you might consider adding HCG to your TRT protocol which should increase intratesticular estrogen nicely separated from estrogen created through the aromatization process.

 

[Vince Carter]

this is wrong, all wrong:

with a blood draw 5 hours after injection:

Testing is never done this way...always BEFORE your injection.

You guys try to be helpful and then gloss over the obvious.

 

[Cataceous]

...
Testing is never done this way...always BEFORE your injection.
....

Daily cypionate causes very flat hormone levels for the vast majority of guys, meaning test timing is not so important—although it's still good to be consistent.

 

[DaviSh]

Yes, I have been taking Cialis daily.
Supplements: magnesium, omega 3, B-complex, Berbemycin

timing of blood draw is the recommendation by my “functional medicine” hormonal specialist.

 

[trt reznor]

Yes, I have been taking Cialis daily.
Supplements: magnesium, omega 3, B-complex, Berbemycin

timing of blood draw is the recommendation by my “functional medicine” hormonal specialist.

I was just reading earlier how daily regiments of Cialis have been shown to diminish E2 levels. I would try to discontinue the cialis for a couple weeks and see if you start gradually improving. Second, you’re also taking a near-competitive-bodybuilding amount of test every week.

I saw dramatic improvements after getting away from my daily shots and going to bi-weekly. Daily injections have also been shown to lower E2 as well, which is why many go with the daily protocol. Your body may simply be overresponding. Personally I’d try something like two 80mg injections per week, or even a single 160mg dose, and getting off the cialis for awhile.

So you have some possible causes here, and some options. Good luck and post your results no matter what you try!