Help needed for overseas patients

[Appassionato]

Hi everyone,
I'm a guy living in Cyprus and, as most of the people in Europe, I have troubles to find a medical centre providing the estradiol sensitive blood test.
I have been on TRT since 1 years and 2 months and until now I didn't manage to get my estradiol dialed in. I either go too low or too high and it's like walking in the dark when you don't have the appropriate test.

I spoke with Dr. Crisler through phone and he confirmed me that the regular estradiol test is pointless, especially if someone is on AI, as it reads any AI like actual estradiol.
Also I'm an anastrazole over-responder, which makes things even more complicated.
My doctor here in Cyprus doesn't know much about TRT, but he realized that I've done my homework and he prescribes me what I ask him.
Through Dr. Crisler I've nailed down the protocol as 17.5mg of T enanthate 3 times a week, along with 100 IU of HCG at the same time, 3 time a week again.

I managed to crash my estradiol 8 weeks ago, adding just 0.125mg of anastrazole everytime I was injecting both test and HCG and I feel even worse since then. So I got another blood test done now (without taking any AI for 2 months) for the 3 values that usually changes with the protocol changing, and that's the result. The blood sample has been taken few hours before the injections:

Total Testosterone 1464.27 ng/dL (241 - 827)
Estradiol (Standard) 104.17 pg/mL (<40)
Prolactin 21.31 ng/mL (2.1 - 17.7)

I haven't checked free testosterone, SHBG and DHT this time because they are always stable around:

Free T = 31.5 pg/mL (8.5-27.9 pg/mL)
DHT = 1179 pg/mL (300 - 1200)
SHBG = 26 nmol/L (13 - 71)

So as you can see, the wrong unreliable standard estradiol test came out really high, even if I have zero symptoms of high estrogens, along with a high prolactin, because I have suspended taking Dostinex when I crashed my estradiol 2 months ago.
Also, only with 52.5 mg of T enanthate and 300 IU of HCG per week I'm getting quite high level of total T and free T. I don't if this depends on the fact that I'm doing heavy weights lifting or because my HPA axis is still quite awake at an age of 31 years.

This makes absolutely no sense to me because I am still having some of the low estrogens symptoms: I pee frequently, dry skin, wedding ring is coming out of my finger really easily (while when estrogens were high was complicated to take it out) and soft stools. I also feel always nervous, anxious and easily irritable, but this could be associated to high estrogens as well.

I bought some vodka to dissolve anastrazole in and take a minimal dose, but I didn't have the gut yet, because the crashed estradiol experience has been pretty nasty.

Anyway, all of this to ask your opinion and if you can point me to some doctors possibly in London, having access to sensitive estradiol test. I know doctor Robert Stevens is offering it, but I've tried to contact him with no success and it's quite a trip from Cyprus to get into Poole. It would be easier to get a plane from here to get in London or any other major city in the UK.
Apologies for the long post and I hope you will be able to help me.
Thanks.

 

[Vince Carter]

It would be extremely unlikely that you crashed your E on .125mg (I see you misplaced the decimal in your post), just 3x per week.

 

[Appassionato]

Hi Vince, yeah sorry I misplaced the decimal (fixed now). Unfortunately, as said before, I'm an AI over-responder, so I had terrible joint pain, excessive peeing and liquid stool for weeks until one day, after another dose of 0.125mg of Anastrazole I felt like I was having a terrible flu. I felt terribly cold, even if it was quite warm here in Cyprus, got into bed covered by several throws and I didn't have the strength to do anything.
I know how it feels to have high estrogen, as I have been on TRT for months prior to touch any AI, but I never experienced anything like that before.
Unfortunately I can't prove it, not having access to the sensible estradiol test, and I know it's something unknown in medical literature, but there are several guys who are AI over responders.

 

[Vince Carter]

The only overseas country that comes to mind is Canada now has a sensitive test. Typical advice for you guys is just use what you have available as you have almost no other choice. Try cutting your dose back a little bit to let your Free T down to the lab range. Getting on a plane and traveling like that for a blood test seems extreme at this point.

 

[Appassionato]

I was thinking to cut the HCG dose in half, as it seems I'm really sensible to it as well.
With 75 mg of T enanthate per week on its own, my total T was at 851 ng/dL.
What do you think?

 

[Vince Carter]

Cutting HCG could help reduce E, too, worth a try just reducing dosing over taking an AI.

 

[Appassionato]

Yeah, I'm trying to leave an AI as a last resource as it seems I don't have any high estrogen side effect at the moment. Hopefully anxiety and the tiredness feeling after the injections will fade away.

 

[Appassionato]

I would like to post an update here, as my suspect of being an AI over-responder has been confirmed and maybe this could contribute to the new trend of going completely off any AI, which I don't agree with, despite the fact I've tanked my E2 once.

So I've re-tested after cutting on half the HCG dose and being on 17.5 mg of T enanthate and 50 IU of HCG 3 x week , and these are the results:

Total T = 1386.8 ng/dL (241 – 827 ng/dL)
Free T = 25.2 pg/mL (8.5 - 30.4 pg/mL)
Estradiol = 102.14 pg/mL (10 – 40 pg/mL)
Prolactin = 26.91 ng/mL (2.1 – 17.7 ng/mL)
TSH = 2.075 uUI/mL (0.35 – 5.5 uUI/mL)
Free T3 = 3.1 pg/mL (2.3 – 4.2 pg/mL)
Free T4 = 0.89 ng/dL (0.89 – 1.76 ng/dL)
SHBG = 23 nmol/L (10 – 80 nmol/L)
Cortisol = 16.69 ug/dL (AM: 4.3 - 22.4 ug/dL)
IGF-1 = 136.0 ng/mL (Age 31-35: 88-246 ng/mL)
DHEA-S = 209.3 ug/dL (35 – 550 ug/dL)
Pregnenolone= 211.5 ng/dL (38 – 248 ng/dL)

As you can see, despite the fact of lifting heavy 4 times x week (200 kg 6 reps of squat, 140 kg 6 reps of bench press, 170 kg 6 reps of deadlifts, 75 kg 6 resp of overhead press) and being quite muscular (180 cm, 91 kg, 11% body fat), I aromatize like a crazy and I have all the above mentioned symptoms of high E2.
I’ve booked in a phone consultation with Dr. Saya, who advised me to introduce 0.1 mg of anastrazole in the mix, along with DHEA and pregnenolone to control my anxiety (I didn’t touch pregnenolone yet, because my serum levels are already in the mid-top range).
I started conservatively and took just 0.05 mg out of a vodka solution with anastrazole, and tested E2 2 weeks after, with just one dose taken the night before the blood test.
Well, my E2 went to 46.3 pg/mL, more than halved with a single dose of 0.05 mg! I started having some libido again, the gynecomastia went completely away, my memory and focus improved, my anxiety decreased substantially and I almost stopped sweating at night.
Probably my gene expression has changed with Finasteride (as Dr. Crisler was claiming), but with people like me, with such heavy aromatization, despite having a dialed in diet and heavy workout routine, I think a really small dose of anastrazole could be a game changer.
Unfortunately, some sides, like mild joints pain and liquid stools, have popped out again though.
I will test again my E2 an DHEA in 3 weeks and see how throwing in anastrazole and DHEA in the mix will change how I feel and the numbers.
I’m curious to know if someone else had a similar experience.