Help Decipher Labs - Very Low E2

[Nate]

1/2017
Triglycerides - 67 (<150 MG/DL)
Cholesterol - 172 (<200 MG/DL)
LDL/HDL Ratio - 1.33 (<3.55 Ratio)
Hemoglobin A1c - 5.1 (4.0-5.6 %)
Albumin - 4.9 (3.5-5.2 G/DL)
Calcium - 9.9 (8.5-10.5 MG/DL)
Chloride - 104 (97-110 MEQ/L)
Creatine - 0.82 (0.8-1.4 MG/DL)
Glucose - 88 (70-99 MG/DL)
Potassium - 4.5 (3.5-5.3 MEQ/L)
Protein, Total - 7.0 (6.1-8.3 G/DL)
Sodium - 146 (133-146 MEQ/L)
Alkaline Phosphatase - 42 (46-118 U/L) LOW

5/2017
Testosterone - 310 NG/DL (300-1080)

6/2017
WBC - 8.0 (3.4-10.8x10e3/uL)
RBC - 4.88 (4.14 - 5.80 x 10e6/uL)
Hemoglobin - 15.3 (12.6-17.7 g/dL)
Hemocrit - 44.8 (37.5-51%)

TSH - 1.150 (0.450-4.500 uIU/mL)
Thyroxine (T4) - 7.8 (4.5-12 ug/dL)
T3 Uptake - 28 (24-39%)
Free Thyroxine Index - 2.2 (1.2-4.9)

Estradiol - <5.0 L (7.6-42.6 pg/mL) LOW

LH - 8.6 (1.7-8.6 mIU/mL)
FSH - 4.4 (1.5-12.4 mIU/mL)

Testoterone, Serum - 552 (348-1197 ng/dL)
Free Testosterone(Direct) - 12.3 (8.7-25.1 pg/mL)

PSA Serum 1.3 (0.0-4.0 ng/mL)

7/2017
Prolactin - 7.8 NG/ML (4.0-15.2)
TSH - 0.734 UIU/ML (0.4-4.1)

What can be deduced? The estradiol test was NOT sensitive. Am I primary? Is estradiol the only problem or inconclusive? Is thyroid good?

I started TRT this week. First shot, 200mg, 3 days ago. Just not sure if I needed it or not. My doctors are junk. Plan on 50mg e3.5d, self administered. First shot was at Dr office; the Rx is 200mg e2wks. Have no AI or HCG Rx. May get it underground.

Thanks,
Nate

 

[johndoesmith]

1/2017
Triglycerides - 67 (<150 MG/DL)
Cholesterol - 172 (<200 MG/DL)
LDL/HDL Ratio - 1.33 (<3.55 Ratio)
Hemoglobin A1c - 5.1 (4.0-5.6 %)
Albumin - 4.9 (3.5-5.2 G/DL)
Calcium - 9.9 (8.5-10.5 MG/DL)
Chloride - 104 (97-110 MEQ/L)
Creatine - 0.82 (0.8-1.4 MG/DL)
Glucose - 88 (70-99 MG/DL)
Potassium - 4.5 (3.5-5.3 MEQ/L)
Protein, Total - 7.0 (6.1-8.3 G/DL)
Sodium - 146 (133-146 MEQ/L)
Alkaline Phosphatase - 42 (46-118 U/L) LOW

5/2017
Testosterone - 310 NG/DL (300-1080)

6/2017
WBC - 8.0 (3.4-10.8x10e3/uL)
RBC - 4.88 (4.14 - 5.80 x 10e6/uL)
Hemoglobin - 15.3 (12.6-17.7 g/dL)
Hemocrit - 44.8 (37.5-51%)

TSH - 1.150 (0.450-4.500 uIU/mL)
Thyroxine (T4) - 7.8 (4.5-12 ug/dL)
T3 Uptake - 28 (24-39%)
Free Thyroxine Index - 2.2 (1.2-4.9)

Estradiol - <5.0 L (7.6-42.6 pg/mL) LOW

LH - 8.6 (1.7-8.6 mIU/mL)
FSH - 4.4 (1.5-12.4 mIU/mL)

Testoterone, Serum - 552 (348-1197 ng/dL)
Free Testosterone(Direct) - 12.3 (8.7-25.1 pg/mL)

PSA Serum 1.3 (0.0-4.0 ng/mL)

7/2017
Prolactin - 7.8 NG/ML (4.0-15.2)
TSH - 0.734 UIU/ML (0.4-4.1)

What can be deduced? The estradiol test was NOT sensitive. Am I primary? Is estradiol the only problem or inconclusive? Is thyroid good?

I started TRT this week. First shot, 200mg, 3 days ago. Just not sure if I needed it or not. My doctors are junk. Plan on 50mg e3.5d, self administered. First shot was at Dr office; the Rx is 200mg e2wks. Have no AI or HCG Rx. May get it underground.

Thanks,
Nate

Wow, that is one LOW aromatization rate, holy crap. 550 with completely crashed E2.

I don't know where you got the idea that you'd ever need an AI, but seriously, do not take one.

Based on low E2 and high LH, I'd conclude you're primary, but there's no way your E2 should be THAT low with a pretty decent total testosterone level.

BTW I think a lot of guys are going to come in here and see the 550 and say not to take TRT, that you're fine, but to ignore an E2 that low, would be ridiculous.

 

[CoastWatcher]

Please heed the words of johndoesmith and avoid the use of an AI. His observations on your estradiol were on the mark. Introducing one at this point would be a ticket to hormone hell.

 

[Nate]

Think I'm already in hormone hell.

Anyone seen this before? Could the lab work be wrong because it wasn't a sensitive E2 test?

Was more concerned about getting HCG to ward off shrinkage. I guess the extra estrogen from that wouldn't hurt either.

Anyway to increase E2 without TRT? I already smoke and drink. Haha

Thanks for the replys.

Here is more background info before I found this site:
https://forums.t-nation.com/t/do-i-need-trt-e2-low/231858

 

[johndoesmith]

Think I'm already in hormone hell.

Anyone seen this before? Could the lab work be wrong because it wasn't a sensitive E2 test?

Was more concerned about getting HCG to ward off shrinkage. I guess the extra estrogen from that wouldn't hurt either.

Anyway to increase E2 without TRT? I already smoke and drink. Haha

Thanks for the replys.

Here is more background info before I found this site:
https://forums.t-nation.com/t/do-i-need-trt-e2-low/231858

You smoke cigarettes? How much?

 

[Nate]

Pack a day, why?

 

[Vettester Chris]

You had asked if the thyroid was "good"? The labs they gave you are outdated and pretty much useless for giving any assessment of how the thyroid is working. Anything noted "uptake" and "index" is junk!

What you need is: Free T3, Free T4, Reverse T3, TSH (You got), and antibodies (TPO and TgAb). Let's see your Iron Serum and Ferritin as well, plus electrolytes and vitamin D3.

 

[johndoesmith]

Pack a day, why?

Nicotine is an aromatase inhibitor. I suspect most guys who post super low T/E2 ratios are smokers but aren't willing to admit it.

 

[Nate]

Interesting; I did not know smoking caused low E2. I quit every year during lent. This year I didn't start smoking again until this month. All the labs except for the lastest, prolactin and second TSH, were taken without having touched a cigarette since January. Any idea how long nicotine's aromatase suppression lasts after quitting? Been smoking for over 20 years--perhaps a permanent change in T/E2 ratios has been created.

I was worried my tests were incorrect. Guess I'll have to get labs myself. Not surprised that my doctor ordered outdated tests. I have looked into the online lab work used here often; it would require a 3hr round trip to nearest city for testing. I will look through the test results for electrolytes, vitD and iron and post what I have.

Appreciate the time here guys.

 

[Nate]

OK, I have NO Iron Serum, Ferritin or vitD3 tests.

I can add to the 6/2017 test some:
MCV - 92 (79-97 fL)
MCH - 31.4 (26.6-33.0 pg)
MCHC - 34.2 (31.5-35.7 g/dL)
RDW - 13.4 (12.3-15.4%)
Does this, along with Hemoglobin and Hematocrit previously posted, add any info regarding iron? I am a meat eater.

Electrolytes: Sodium, Calcium, Chloride and Potassium are in the previously posted results. Bicarbonate was NOT tested.

VitD3: I have no test results for that. I should say that I work outside for a living. I also drink vitD fortified milk daily.

Thought I should also add that I deal with herbicides and pesticides several times per year for livestock and field crops. Wanted to mention it because of the affect smoking may have had on my E2.

 

[johndoesmith]

Interesting; I did not know smoking caused low E2. I quit every year during lent. This year I didn't start smoking again until this month. All the labs except for the lastest, prolactin and second TSH, were taken without having touched a cigarette since January. Any idea how long nicotine's aromatase suppression lasts after quitting? Been smoking for over 20 years--perhaps a permanent change in T/E2 ratios has been created.

I was worried my tests were incorrect. Guess I'll have to get labs myself. Not surprised that my doctor ordered outdated tests. I have looked into the online lab work used here often; it would require a 3hr round trip to nearest city for testing. I will look through the test results for electrolytes, vitD and iron and post what I have.

Appreciate the time here guys.

So the E2 test was done BEFORE you started smoking?

If so, then nicotine is irrelevant. I also don't know how strong of an AI it is.

It's possible the pesticides have something to do with it, but in reality, you're probably just a really really thin guy.

I'm just perplexed by how low your E2 is.

 

[Nate]

Correct, E2 test done while not smoking.

I am 5'8", 170lbs. I've never been called skinny. Not heavy by any means though.

I'm going to ride out this TRT for two months and get my own blood work done, including:
E2 sensitive,
TT
FT
Serum iron,
Ferritin,
Vit D3,
Free T3,
Free T4,
Reverse T3.

Is there anything else I should add to help me clarify my situation?

 

[johndoesmith]

Correct, E2 test done while not smoking.

I am 5'8", 170lbs. I've never been called skinny. Not heavy by any means though.

I'm going to ride out this TRT for two months and get my own blood work done, including:
E2 sensitive,
TT
FT
Serum iron,
Ferritin,
Vit D3,
Free T3,
Free T4,
Reverse T3.

Is there anything else I should add to help me clarify my situation?

SHBG would be good to have.

 

[Nate]

Is SHBG not derived from TT and FT?

 

[CoastWatcher]

Is SHBG not derived from TT and FT?

No, it is not. It is largely produced by the liver. This provides a quick overview.

https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=167&ContentID=shbg_blood

 

[Nate]

E2 sensitive,
TT
FT
Serum iron,
Ferritin,
Vit D3,
Free T3,
Free T4,
Reverse T3, and
SHBG.

Any others?

 

[Nate]

Lastest bloods are in.

Protocol: 120-125 mg Test Cyp split Monday morning/Thursday night; 666 iu HCG split Wednesday morning/Saturday night. No AI.

Blood drawn 2 hours before next shot.

Hemocrit 48.9 (up)
Cholesterol 176 (up)
Triglycerides 36 (down)
HDL 56 (down)
LDL 113 (up). HIGH

TT 803.4 ng/dL (264-916)
FT 22.6 pg/mL (8.7-25.1)
DHT 57 ng/dL (30-85)
DHEA-Sulfate 271.2 ug/dL (102.6-416.3)
E2 (LC/MS/MS) 12.2 pg/mL (8-35)
SHBG 27.1 nmol/L (16.5-55.9)

TSH 1.090 uIU/mL (0.450-4.500)
FT3 4.3 pg/mL (2.0-4.4)
FT4 1.25 ng/dL (0.82-1.77)

I feel the same as before I started. I guess cigarettes are to blame for low E2. I may try upping Test to see how I feel with higher E2.

 

[Vince Carter]

Why did you omit Reverse T3? Cost? That would show if T3 is pooling, i.e., not making it in the cells. But I think your numbers look fine, I wouldn't speculate on the E2 right now and leave it be and see where you are in at least 4 weeks, how you feel and the labs.
If need be the easiest way for some/most guys to get E to come up, this is an unusual problem, is to use a cheap oral tablet DHEA of maybe no more than 25mg, I'd use less like 5-10 (cut a pill). This could or should spur some aromatase thru the liver. But again I wouldn't treat E right now and just aim for staying steady and consistent for the next month.

I do think your Thyroid numbers as they are look fine but that RT3 would be nice to see, you could still present with Hypo symptoms when these numbers all appear to be OK.

 

[Nate]

Not rich enough for reverse T3 this time. Bloods were $400 this time. Now that I know where SHBG and DHT and DHEA is, I will probably add one test, like RT3, every time I check TT, FT and E2.

I was on TRT consistently for 2 months before getting these bloods.

I don't mind staying on the same protocol to see if E2 gradually increases, but I won't be doing bloods for 4 months; 2 months if I change something.

 

[Vince Carter]

I dont believe RT3 is a stand alone test, sure you can order it singly, and it might still be helpful but I *think* that that one has to be run concurrent to the others.