First post. Can’t get E2 under control, starting to worry

[AMPS]

Hey guys.

34 years old been on TRT for 6 years.

Not entirely sure what to do here. About 3 months ago my e2 came back at 240 pmol/L. My protocol at that time was

60mg test
.5mg arimidex
500iu HCG

Twice per week for a total of 120 / 1 / 1000

I was pretty inconsistent with my dosing and after talking to the group realized my HCG was probably too high.

So I did 3 months at

60mg test
250iu HCG
.5mg arimidex

Twice per week for a total of 120 / 1 / 500iu

I dropped my HCG by half and was consistent with making sure my arimidex was taken every week at the same time as my test and HCG injection

Just got labs done this morning and my e2 came back at 275!!!?? Even higher than last time. I can’t figure it out I’ve always ran decently high on e2 but never this high

I don’t have high estrogen sides at all. I feel great. All the rest of my labs came back great including blood count and lipids

Not sure what else to do aside from taking another .5mg arimidex mid week?

Please help

It could be testing error, have it redone by another lab and compare results .

 

[AMPS]

It could be testing error, have it redone by another lab and compare results .

 

[RobRoy]

Glad to see a voice of reason in the endless wars of estradiol levels

Ignorance of the medical literature and data is not a voice of reason

 

[RobRoy]

I respectfully disagree with my colleagues. You're in uncharted territory with such high estradiol. Nobody can give you complete assurance that this is going to be benign in the long run, particularly when estradiol is also relatively high as a fraction of testosterone.

Here's one potential negative:

A paradoxical decline in semen parameters in men treated with clomiphene citrate​

...​

Elevated estradiol levels result in vacuolization and increased glycoprotein production impairing Sertoli cell function. It also disturbs communication with germ cells, increases collagen synthesis and fatty degeneration in the testicular connective tissue. All these actions collectively result in the induction of germ cell death (Leavy et al., 2017). Oestradiol also plays a critical role in round spermatid chromatin reorganization during spermiogenesis through its action on Estrogen Receptor Alpha (ERα) present on Sertoli cells (Cacciola et al., 2013). Overexposure to estrogens reduces the expression of ERα on Sertoli cells, impacting this critical action. Moreover, it has been recognized that supraphysiological concentrations of estrogen act as powerful apoptotic triggers that induce germ cell apoptosis (Correia et al., 2015).​

[R]​

This isn't to say that forcing estradiol lower with aromatase inhibitors is necessarily any better. There are plenty of unknowns here as well.

If you have access to a testosterone nasal gel, such as Natesto, then it's worth looking into as an alternative to traditional TRT. This form of treatment keeps your hormones in a more natural state, and preserves fertility. I suspect this short-acting testosterone would not give you nearly as much trouble with elevated estrogen.

85 years of using testosterone in men with decades of that use without labs before the 1970s. In all of those decades and in every study showing benefits of testosterone in men none of them blocked or controlled estrogen. Testosterone is a prohormone in many tissues. It hss to be converted into it's active metabolites in order to exert its beneficial effects.
The rates of conversion of testosterone to DHT and estra- diol vary among people due to polymorphisms of genes that encode the steroid 5α reductases and the aromatase enzyme as well as other host-specific factors that affect the activity of these enzymes
Everyone thinks testosterone acts as testosterone in all tissues but that is completely false. It acts through it's active metabolites and predominantly estradiol. When you block or control those active metabolites then you block or control the benefits of testosterone. What you are measuring with regard to estradiol is simply what is converted peripherally and there's no way an indicator of levels in the tissues. No matter how accurately think you can measure it in the serum it is not an accurate measurement of the tissues. But when you use an aromatase inhibitor to lower serum levels he will then lower it in the tissues such as the brain, the bones, the heart, the blood vessels, the sexual organs etc... And by doing so you block the beneficial effects of testosterone in those tissues. There are not any unknowns that you mention. There are knowns and the knowns are the negative effects of blocking estradiol. When men were young and in their teens and early 20s and had excellent levels of testosterone they also had excellent levels of testosterones active metabolites which are DHT and estradiol. Did anybody want to take an aromatase inhibitor when they were in high school with excellent testosterone levels? When testosterone therapy is done correctly there's absolutely no need for an aromatase inhibitor. We have 85 years of proof with using testosterone in men and raising estradiol in all of these men when we gave them testosterone. There is no such thing as pro AI and anti AI but there is such a thing as non-evidence based medicine and evidence based medicine. The use of an aromatase inhibitor is not evidence based and was started in the bodybuilding world. I think it food for thought when you look at some of the great bodybuilders such as Arnold Schwarzenegger, Lee Haney, Frank Zane and others back in the 70s and 80s. They could not take an aromatase inhibitor because they weren't developed until the 1990s. So all these great bodybuilders do I think I better physiques the bodybuilders today or taking excessive doses of testosterone but yet they couldn't use an aromatase inhibitor. So you're going to tell me that a man taking a relatively low dose of testosterone or even a moderate dose of testosterone does need an aromatase inhibitor? Men should stop measuring something that they're not going to control that just causes them anxiety and you're measuring something that is not an accurate measure in the first place.
In healthy men and in studies of medically castrated men undergoing graded testosterone add-back, serum levels of E2 reflect the total E2 that has diffused into the blood from all tissues having been synthesized by aromatase and escaped local tissue metabolism. These blood levels, no matter how accurately measured, are an indirect reflection of total estrogen signalling which is further locally modulated by sulphoconjugation and deconjugation of estrogens
In 85 years there's still not a study where we gave testosterone to men and blocked estradiol and it gave them benefit.

 

[Charliebizz]

Hey guys.

34 years old been on TRT for 6 years.

Not entirely sure what to do here. About 3 months ago my e2 came back at 240 pmol/L. My protocol at that time was

60mg test
.5mg arimidex
500iu HCG

Twice per week for a total of 120 / 1 / 1000

I was pretty inconsistent with my dosing and after talking to the group realized my HCG was probably too high.

So I did 3 months at

60mg test
250iu HCG
.5mg arimidex

Twice per week for a total of 120 / 1 / 500iu

I dropped my HCG by half and was consistent with making sure my arimidex was taken every week at the same time as my test and HCG injection

Just got labs done this morning and my e2 came back at 275!!!?? Even higher than last time. I can’t figure it out I’ve always ran decently high on e2 but never this high

I don’t have high estrogen sides at all. I feel great. All the rest of my labs came back great including blood count and lipids

Not sure what else to do aside from taking another .5mg arimidex mid week?

Please help

I would personally drop the a.i and forget about the e2 number. But im sure I’ll get flamed for that. I love my e2 on trt.

 

[Cataceous]

85 years of using testosterone in men with decades of that use without labs before the 1970s. In all of those decades and in every study showing benefits of testosterone in men none of them blocked or controlled estrogen. Testosterone is a prohormone in many tissues. It hss to be converted into it's active metabolites in order to exert its beneficial effects.
...

Many words, but no scientific evidence that supra-physiological estradiol is safe in the long run. What is clear in the literature is that high and low levels of hormones have negative associations over time. You can argue against causality, but that's just speculation. Healthy young men have physiological testosterone and estradiol, around 600-700 ng/dL and 30 pg/mL respectively. It's a straw-man argument to say that anyone is advocating AI use at these levels. You also skipped the part where I said that AI use is likely also problematic. For most men on TRT there's a simple solution to high estradiol: lose the more-is-better mentality and cut the dose.

There are a few men who seem to aromatize at an unusually high rate. We could debate whether AI use is appropriate for them in the presence of symptoms and normal or low-normal testosterone. However, you can't reasonably argue that estradiol has only local action. The HPTA itself is regulated by systemic estradiol, and this estradiol does influence various other tissues and organs, including the brain.

 

[Charliebizz]

If we could keep this debate civil for once, that would be great.

while I agree with parts of what both of you guys say. Nothing is truly clear cut answer in this game. Even simple as the reason why all of us are on trt. We are overriding the bodys defense mechanism to a point no ? Something is going wrong in our body’s that causing us to produce less t no ? Same as how much a humans thyroid will slow down when it’s depleted of nutrition. And then we just ramp it up with hormones to fix it ! Can that not be detrimental to some degree ?

 

[RobRoy]

Many words, but no scientific evidence that supra-physiological estradiol is safe in the long run. What is clear in the literature is that high and low levels of hormones have negative associations over time. You can argue against causality, but that's just speculation. Healthy young men have physiological testosterone and estradiol, around 600-700 ng/dL and 30 pg/mL respectively. It's a straw-man argument to say that anyone is advocating AI use at these levels. You also skipped the part where I said that AI use is likely also problematic. For most men on TRT there's a simple solution to high estradiol: lose the more-is-better mentality and cut the dose.

There are a few men who seem to aromatize at an unusually high rate. We could debate whether AI use is appropriate for them in the presence of symptoms and normal or low-normal testosterone. However, you can't reasonably argue that estradiol has only local action. The HPTA itself is regulated by systemic estradiol, and this estradiol does influence various other tissues and organs, including the brain.

You speak of supraphysiologic but you don't even know where the normal estradiol range came from. I do. What is it men on testosterone? Was it from a study? Where did it come from and what population of men? You take those numbers as gospel and that's a mistake. Do you realize how many men have had documented aromatase excess syndromes? It is actually extremely rare. The HPTA system is no longer regulated by estradiol when you're on testosterone. You can't base baseline observations and physiology on what happens when we give testosterone. It becomes problematic when men like you want to give advice when you have no true knowledge of physiology, bio chemistry, anatomy, and most importantly medicine. What part do you not understand about measuring estradiol and that it does not reflect what is at the tissue level? Which study lowering estradiol in men that you say "aromatize at eight unusually high rate" provided them with benefit? Point is like many others is that you should not be giving advice based on what you've already written. We do know what supraphysiological estradiol does even in men. See that's where a knowledge of medicine comes in quite handy. We treat men with estradiol that have severe dyslipidemia and their levels are in the hundreds and it only improves their health and their lipids and provides them with cardiovascular protection. No harm ever. We take me in that is undergoing androgen deprivation therapy and we give them back estradiol to treat the severe symptoms related to the deprivation. Levels are also in the hundreds and it only provides them with protective affects and reverses many of the deleterious effects of the androgen deprivation because once again it's not all about testosterone. When we castrate men they lose testosterone but most importantly they lose estradiol because that's the main active metabolite of testosterone. The word supraphysiologic has been hijacked to imply harm but yet there is no harm with supraphysiologic levels of testosterone as well as estradiol within reason. What is that reason? Well we don't use it for bodybuilding purposes. But being outside the normal range let's just say with a testosterone level of 1 to 2000 doesn't harm anyone and never has and that means that the estradiol will be outside the normal range and therefore supraphysiologic. When we treat men with testosterone we are giving them the end result of what is a complex physiologic process when they make it themselves. Yes if we could all make a healthy level ourselves of seven or eight maybe even 900 we would probably all be fine. But when we give testosterone we bypass our own steroidogenesis and all of the intermediate hormones involved which certainly do play a role in testosterone actions. From a clinical standpoint we need more than we could produce naturally to get the same effect. We see this over and over again for a clinical standpoint and it is now documented in clinical studies by physicians such as Rebecca Glaser and others. The recommendation that men betrayed it to the mid normal range is not based on any medical data. It is purely an opinion. The opinion that we should stay within the normal range when men undergo treatment with testosterone is also not based on any medical data or literature but once again an opinion. We aim for a physiologic number such as 450 to 700 but that is not based on medical data. Be careful how you use the word super physiologic and imply that it is somehow harmful because it is not. We see more harm done with men only get a little bit of testosterone and that is shown over and over again in multiple studies. We can provide you with dozens of studies that show testosterone doesn't work and then everyone of those studies they only raise testosterone levels a little bit usually to the mid normal range.

 

[RobRoy]

If we could keep this debate civil for once, that would be great.

while I agree with parts of what both of you guys say. Nothing is truly clear cut answer in this game. Even simple as the reason why all of us are on trt. We are overriding the bodys defense mechanism to a point no ? Something is going wrong in our body’s that causing us to produce less t no ? Same as how much a humans thyroid will slow down when it’s depleted of nutrition. And then we just ramp it up with hormones to fix it ! Can that not be detrimental to some degree ?

This was not a current 50 years ago. We didn't see what we see now even 20 or 30 years ago. You can look no further than the toxic environment that we live in. Testosterone and sperm go hand-in-hand. You have to have adequate intro testicular testosterone levels in order to produce sperm. The sperm count has decreased by over 50% and testosterone has decreased significantly over the last couple of decades. There is not a day that goes by now that there's not a new article out on endocrine disrupting chemicals and their deleterious effects on the endocrine system and other organs.
So when men like cataceous speak of supraphysiologic estradiol let's just think about the decades that testosterone was used without any laboratory studies. So we're talking about literally over three decades without any testosterone or estradiol labs. Men were given high doses of testosterone and when that happens it's going to raise estradiol and DHT as well. Certainly in those 3 to 4 decades or more they were plenty of so-called over aromatizers. So when was the harm? We have no documented instances of harm. Certainly if giving high doses to men, and some had to be over aromatizers, for several decades we should've seen some harm somewhere and in someone. But we didn't.
This whole narrative of high estradiol is not based on any medical data and the leading urologists in the country and androgen researchers strongly recommend against aromatase inhibitors. We are all still waiting on the one study that shows using an aromatase inhibitor is beneficial went on testosterone. We have plenty of studies showing harm but no studies showing benefit. Talk about a strawman argument
What is very clear cut is that when we treat men with testosterone deficiency we're treating symptoms of a deficiency. It is so simple to simply raise testosterone levels to overcome the symptoms of the deficiency. Once you have raised testosterone to an adequate level then any symptoms that do not improve are not related to testosterone. Problem is men want every problem to be cured with testosterone. Not all of their problems or hormone related. Once those symptoms are not improving after raising testosterone the other hormones to an optimal level then of course it has to be the fact that it's not a good "protocol ". It has nothing to do with a protocol. You simply provide men with a bio identical hormone and raise levels to overcome the symptoms of a deficiency. So very simple but men want to make it complicated. I don't care how much testosterone you give someone it's not going to improve a symptom that's not related to it. Some men can never accept this fact.

 

[Charliebizz]

This was not a current 50 years ago. We didn't see what we see now even 20 or 30 years ago. You can look no further than the toxic environment that we live in. Testosterone and sperm go hand-in-hand. You have to have adequate intro testicular testosterone levels in order to produce sperm. The sperm count has decreased by over 50% and testosterone has decreased significantly over the last couple of decades. There is not a day that goes by now that there's not a new article out on endocrine disrupting chemicals and their deleterious effects on the endocrine system and other organs.
So when men like cataceous speak of supraphysiologic estradiol let's just think about the decades that testosterone was used without any laboratory studies. So we're talking about literally over three decades without any testosterone or estradiol labs. Men were given high doses of testosterone and when that happens it's going to raise estradiol and DHT as well. Certainly in those 3 to 4 decades or more they were plenty of so-called over aromatizers. So when was the harm? We have no documented instances of harm. Certainly if giving high doses to men, and some had to be over aromatizers, for several decades we should've seen some harm somewhere and in someone. But we didn't.
This whole narrative of high estradiol is not based on any medical data and the leading urologists in the country and androgen researchers strongly recommend against aromatase inhibitors. We are all still waiting on the one study that shows using an aromatase inhibitor is beneficial went on testosterone. We have plenty of studies showing harm but no studies showing benefit. Talk about a strawman argument
What is very clear cut is that when we treat men with testosterone deficiency we're treating symptoms of a deficiency. It is so simple to simply raise testosterone levels to overcome the symptoms of the deficiency. Once you have raised testosterone to an adequate level then any symptoms that do not improve are not related to testosterone. Problem is men want every problem to be cured with testosterone. Not all of their problems or hormone related. Once those symptoms are not improving after raising testosterone the other hormones to an optimal level then of course it has to be the fact that it's not a good "protocol ". It has nothing to do with a protocol. You simply provide men with a bio identical hormone and raise levels to overcome the symptoms of a deficiency. So very simple but men want to make it complicated. I don't care how much testosterone you give someone it's not going to improve a symptom that's not related to it. Some men can never accept this fact.

So how does intra testicular testosterone correlate to serum testosterone ? I conceived both of my children with ease. With natural serum levels of 250tt on average.

 

[Charliebizz]

When we treat men with testosterone we are giving them the end result of what is a complex physiologic process when they make it themselves. Yes if we could all make a healthy level ourselves of seven or eight maybe even 900 we would probably all be fine. But when we give testosterone we bypass our own steroidogenesis and all of the intermediate hormones involved which certainly do play a role in testosterone actions. From a clinical standpoint we need more than we could produce naturally to get the same effect.

So your saying ramping up t levels way higher then “normal” compensates for the loss of upstream hormones ? Say preg, prog ect…

Don’t you believe in treating most men with pregnenolone ?

 

[BigTex]

This was not a current 50 years ago. We didn't see what we see now even 20 or 30 years ago. You can look no further than the toxic environment that we live in. Testosterone and sperm go hand-in-hand. You have to have adequate intro testicular testosterone levels in order to produce sperm. The sperm count has decreased by over 50% and testosterone has decreased significantly over the last couple of decades. There is not a day that goes by now that there's not a new article out on endocrine disrupting chemicals and their deleterious effects on the endocrine system and other organs.
So when men like cataceous speak of supraphysiologic estradiol let's just think about the decades that testosterone was used without any laboratory studies. So we're talking about literally over three decades without any testosterone or estradiol labs. Men were given high doses of testosterone and when that happens it's going to raise estradiol and DHT as well. Certainly in those 3 to 4 decades or more they were plenty of so-called over aromatizers. So when was the harm? We have no documented instances of harm. Certainly if giving high doses to men, and some had to be over aromatizers, for several decades we should've seen some harm somewhere and in someone. But we didn't.
This whole narrative of high estradiol is not based on any medical data and the leading urologists in the country and androgen researchers strongly recommend against aromatase inhibitors. We are all still waiting on the one study that shows using an aromatase inhibitor is beneficial went on testosterone. We have plenty of studies showing harm but no studies showing benefit. Talk about a strawman argument
What is very clear cut is that when we treat men with testosterone deficiency we're treating symptoms of a deficiency. It is so simple to simply raise testosterone levels to overcome the symptoms of the deficiency. Once you have raised testosterone to an adequate level then any symptoms that do not improve are not related to testosterone. Problem is men want every problem to be cured with testosterone. Not all of their problems or hormone related. Once those symptoms are not improving after raising testosterone the other hormones to an optimal level then of course it has to be the fact that it's not a good "protocol ". It has nothing to do with a protocol. You simply provide men with a bio identical hormone and raise levels to overcome the symptoms of a deficiency. So very simple but men want to make it complicated. I don't care how much testosterone you give someone it's not going to improve a symptom that's not related to it. Some men can never accept this fact.

@RobRoy I have always heard in bodybuilding circles that is the amount of testosterone you use is directly related to how high your E2 can be and not have side effects. So it is a 20:1 ratio of testosterone to E2 and a 2:1 ratio of DHT to E2. So let's say you have a 1000-2000 serum test, you should have no more that 100 DHT and 50 E2. So in order to be in a balanced state you do not want to get the DHT:E2 any more than 2:1. This will help negative prevent side effects. Using AI's and crashing E2 or even other compounds could easily disrupt this balance leading to side effects. So I am going to assume if this is factual that this same concept could apply to TRT?

Relation of Testosterone, Dihydrotestosterone, and Estradiol With Changes in Outcomes Measures in the Testosterone Trials

AbstractContext. Many effects of testosterone are mediated through dihydrotestosterone (DHT) and estradiol.Objective. To determine the relative contributio

academic.oup.com

 

[Charliebizz]

@RobRoy I have always heard in bodybuilding circles that is the amount of testosterone you use is directly related to how high your E2 can be and not have side effects. So it is a 20:1 ratio of testosterone to E2 and a 2:1 ratio of DHT to E2. So let's say you have a 1000-2000 serum test, you should have no more that 100 DHT and 50 E2. So in order to be in a balanced state you do not want to get the DHT:E2 any more than 2:1. This will help negative prevent side effects. Using AI's and crashing E2 or even other compounds could easily disrupt this balance leading to side effects. So I am going to assume if this is factual that this same concept could apply to TRT?

Relation of Testosterone, Dihydrotestosterone, and Estradiol With Changes in Outcomes Measures in the Testosterone Trials

AbstractContext. Many effects of testosterone are mediated through dihydrotestosterone (DHT) and estradiol.Objective. To determine the relative contributio

academic.oup.com

most of us cream guys blow that “ratio” out of the water. In respects to dht to testosterone ratio

 

[BigTex]

Seems the most important ratio would be DHT to E2. However, I have never looked at my DHT levels and have no idea how accurate any of this is.

 

[Charliebizz]

Seems the most important ratio would be DHT to E2. However, I have never looked at my DHT levels and have no idea how accurate any of this is.

My last labs looked like this on cream

TT 818
Ft 197 range 35-155
Dht 208 range 12-65
Estradiol ultra sensitive lc/ms 40.

Don’t know if that helps. I feel pretty good trt wise. Great erections, great libido. Energy and moods could use some help but don’t believe it’s trt related

 

[BigTex]

Have any unusual hair loss?

 

[Charliebizz]

Have any unusual hair loss?

Not at all. It’s funny in my late 20s early 30s I started getting some slight thinning. Since I’ve been on trt it hasn’t progressed. I have however gotten a ton more body hair. My father is pretty hairy also. So I’m not sure if I was on this path already, but I’ve had some pretty significant back hair growth over the last few years.

 

[BigTex]

Interesting. No doubt DHT: E2 ratios are very individual. I have never had any real hair loss other than what I believe is genetic.

 

[Stalerigatoni]

This is all fantastic info guys sorry for the late follow up. Appreciate you all. Still trying to figure things out with e2 but will hopefully get there eventually.

 

[RotnGun]

Many words, but no scientific evidence that supra-physiological estradiol is safe in the long run. What is clear in the literature is that high and low levels of hormones have negative associations over time. You can argue against causality, but that's just speculation. Healthy young men have physiological testosterone and estradiol, around 600-700 ng/dL and 30 pg/mL respectively. It's a straw-man argument to say that anyone is advocating AI use at these levels. You also skipped the part where I said that AI use is likely also problematic. For most men on TRT there's a simple solution to high estradiol: lose the more-is-better mentality and cut the dose.

There are a few men who seem to aromatize at an unusually high rate. We could debate whether AI use is appropriate for them in the presence of symptoms and normal or low-normal testosterone. However, you can't reasonably argue that estradiol has only local action. The HPTA itself is regulated by systemic estradiol, and this estradiol does influence various other tissues and organs, including the brain.

I definitely agree with this. Most guys really want to take 150mg to 200mg a week for bodybuilding purposes. I can definitely say that muscle growth effects of a test dosage of 150 to 200mg a week will wear out after 3 months of bodybuilding. It is really wrong to take TRT for bodybuilding purposes because of the eventual lack of bodybuilding returns. To really avoid side effects, it would be best for someone to do a test dosage of 100mg per week or less. And if they wanted to get an extra boost of muscle growth in the gym, then all they have to do is go on a steroid cycle for 3 months at maybe 2 times per year. If I can keep a total test level at 556 ng/dL and estradiol at 23 pg/mL on just 10mg of test a day and not have any problems, then I can't see why anybody else can't achieve the same results