Getting dialed in? E2 crash

[A]

Greetings fellow forum members.

I am recently dx'ed with hypogonadism. I am having trouble getting "dialed in" while on T therapy. My Urologist is nice enough but he does not test estradiol, he's concerned with the overall T level. That being said I've found out that I am somewhat of a hyper-responder to topical T. The only thing that actually changed between January and March was that I started working the night shift at work and my sleep has been disrupted (Avg 4 - 6 hrs). I have never been on an AI as my urologist thought it wasn't needed. I am actually shocked my T levels are as high as they are.

Are there other causes of E2 crashing outside of using too much of an AI? My sex drive has suffered and I don't know if the disrupted sleep is related or just a side effect of working overnights.

I've attached some blood work below. After reading this forum I've opted to get my own sensitive E2 Test.

All blood tests were taken 24 hours after last topical T dosage prior to reapplying for the day.

Stats:
156lbs
Very low BF (definitely sub 10%)

Workouts:
4x HIIT
Very active outside, hike/bike etc.

Medical History:
Ulcerative Colitis Patient 10+ Years

Current Protocol
RX:
Topical Testosterone 30 mg/1.5 mL x 1 pump daily
Synthyroid 50mcg
Lialda 1.2g/3x

OTC Supplements
Fish Oil
Multi Vitamin
Alpha GPC
Melatonin
Vitamin B Complex
BCAA
Creatine

Thank you in advance.

3/4/2019

2/4/2019

Most recenty TSH/T4 Panel

Initial Follow Up with Urologist 1/8/19

Pre T therapy labs from another Urologist whom I left

 

[Systemlord]

Usually when on thyroid treatment Free T3 and Reverse T3 are used to balance out the thyroid, Free T3 (not TSH or Free T4) increases body temperatures and metabolism, it seems your doctors are stilling doing things old school. Free T3 testing shows what's going on at the cellular level, this test is more closely relate to symptoms, TSH and Free T4 do not.

You won't find many on Tropical T as it's difficult to control levels, I'm not saying it can't work, just find injections is easier to control all your levels. The proven protocols for high SHBG men are injectable T since it keeps levels elevated 24 hours a day, tropicals see large short spikes in levels followed by a fast decline since there are no esters to slow the rate of metabolism.

It doesn't seem whoever is managing you thyroid treatment or TRT aren't using the correct tests and seem to be doing things olds school which tells me they don't continue to reeducate and stay up to date on new more effective treatment protocols.

These doctors of yours are inept to help you manage either your thyroid treatment or TRT and don't even seem interested in re-education, they just want to continue practicing medicine the way it was taught 20 years ago.

 

[Vince Carter]

You're URO leaves alot to be desired but I do see the proper E2 testing so that's a plus, but, absence of Free T and SHBG testing since you started treatment is a problem. Looking at Total T is a horribly flawed, and let's assume your SHBG stayed at preTRT levels...77 is very high and will be a problem. Reason we need to see it now, on treatment, as well as your Free T.
That Total T, yes there's a lot of it, but it's all bound up and unusable to a very high degree. I bet your Free T if measured would be low. The E2 numbers you posted, <15 and 27 would not characterized those numbers as low or being crashed.

 

[A]

I should have clarified that an endocrinologist prescribed the synthyroid. I ask for extra testing and at this point would be willing to run my own to get situated.

From the replies it looks like I should have:

Free T
SHGB
E2
Thyroid panel

Correct?

 

[fifty]

E2 Sensitive LC/MS