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Testosterone Replacement, Low T, HCG, & Beyond
Blood Test Discussion
High estrogens / SHBG
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<blockquote data-quote="Castaneda" data-source="post: 140112" data-attributes="member: 36807"><p>I've been away for a while researching options. Ultimately, I decided to start testosterone therapy, but it has only made matters worse. Let me explain:</p><p></p><p>I started with IM injections of cypionate, 100mg 2x a week. After frequently hitting nerves in all the recommended injection sites and generally feeling much worse post-injection (lower energy, brain fog, low mood, etc.), I decided to switch to a 200mg liposomal cream.</p><p></p><p>The first few days on the liposomal cream, my dopamine and libido just shot up. I felt great again (finally). That tapered out after a week and gradually changed to lower energy, a complete obliteration of libido, and fairly severe depression. The first 3 weeks, I was using a TopiClick (3 clicks, twice a day on the inner thigh). I discussed the symptoms with the doctor, and his comment was "that's not typical -- but let's give it another 2-3 weeks and test to see where things are at". At that point, he suggested switching from inner thigh application to directly on the scrotum.</p><p></p><p>Fast forward to a week ago, when I had been putting 1 gram of 200mg liposomal cypionate cream on the testes twice a day. I went in for a blood lab about 4-5 hours post morning application. Here is what came out of that:</p><p></p><p>Hemoglobin: 16.2 g/dl (13-17)</p><p>Hematocrit: 45.9% (37-49)</p><p>Platelets: 182 (130-400)</p><p>CBC: Normal except for slightly elevated eosinophils</p><p>Estradiol 39.1 pg/ml (<=60.7)</p><p>Testosterone: 1082 ng/dl (300-890)</p><p>SHBG: 50.4 nmol/l (16.5-55.9)</p><p>Calc Free T: 204.5 pg/ml (47-244)</p><p></p><p>So from a free T point of view, I'm in the zone. SHBG has come down since the last lab (it was 66), and estradiol has come up, over the "optimal" range of 20-30. Before starting therapy, it showed 26.</p><p></p><p>So my symptoms are telling me I am still low T. I feel no energy, limited ability to get an erection or keep it, low libido, and generally depressed. The doc reviewed these labs and responded, "perhaps T therapy is not for you". I'll reserve my lack of enthusiasm for this statement.</p><p></p><p>Where to go from here? The doc keeps pressing me saying this is a high cortisol problem and that cortisol is blocking the androgen receptors-- but if I take one of the cortisol modulating substances (Seriphos, Ashwagandha, Rhodiola, etc.) it makes my energy deficit worse.</p><p></p><p>Has anyone else seen labs like this with subjective feelings of low T? SHBG does seem to be coming down, but isn't that estradiol level a problem? I mentioned it to the doc and he said "estradiol protects against atherosclerosis and cardiovascular disease, similar to women". Terrific. And we now have Jay Cambell et. al. jumping on that bandwagon saying aromatase inhibitors are dangerous and to work on improving insulin sensitivity, reducing adipose tissue, etc. All good recommendations --- as I do have more adipose fat than I need (which is likely the culprit in higher estradiol levels). But I'm in a Catch 22. In order to lose that fat, I need to exercise, and I have hardly enough energy to walk around the block, let alone lift some weights. It's that bad. I feel just awful.</p><p></p><p>The doc ended up giving me .5mg Arimidex, 2x a week as an experiment (for 1 month) to see if the high SHBG could be increasing estrogen's effects. I don't have puffy nipples or emotional ups / downs --- just feeling flat, no energy, and no libido, which (in my opinion, at least), is just as bad, if not worse.</p><p></p><p>The question in my mind is --- how much estrogen is too much estrogen? I have low tolerance for these blanket statements. We can all agree that too little estrogen is bad, but there are ample studies showing too much can lead to prostate cancer and clotting issues. Dr. Crisler recently had a heart attack not a week after he suddenly stopped using Arimidex. I'm not jumping to any conclusions here, but it makes you think --- his first heart attack was due to a blood clot. What did his E2 levels look like? Last I spoke with him, he didn't feel it was necessary to look at PT / PTT in men with stroke risk. This raised a red flag for me --- as does the newly popular rhetoric that we should all ditch the idea of inhibiting aromatase. Too much estrogen is a bad thing, regardless of how many studies prove it prevents atherosclerosis. Just an example:</p><p></p><p><a href="https://www.ncbi.nlm.nih.gov/pubmed/19436016" target="_blank">Circulating estradiol and mortality in men with systolic chronic heart failure. - PubMed - NCBI</a></p><p></p><p>Yes, an observational study, but there are many others.</p><p></p><p>Consider this. 39.1 E2 may not be high enough to produce symptoms, but with high SHBG, we have a changed playing field. SHBG binds to androgens with higher affinity, and when you have a lot of it running around, it's going to hug onto T and DHT much tighter while letting E2 have a free ride. That 39.1 E2, in that circumstance, could behave like much higher E2. At least that's how I'm feeling. This is partly why going on subjective feelings is more important than a lab number.</p><p></p><p>So that's where I'm at. Thanks for listening. I'm going to trial the Arimidex and then test again in 1 month to see where E2 is sitting. Hopefully, during that time, I'll have some change in subjective well-being, similar to the way I felt the first few days of liposomal cream. Then I can get intermittent fasting in gear along with some light weight training --- to turn the tide.</p><p></p><p>In the meantime, if any of you have stories to share or tips, let me know. And yes, I'm looking after my thyroid. I have chronically high RT3 and cannot take NDT (because the T4 in the grains converts almost instantly to RT3). My free T4 and T3 levels look good on labs with a TSH over 3. So I've been flushing out RT3 with straight Cytomel (administered as sublingual drops in a tincture, 3mcg, 4x a day). Speaking of which, off to take my last liothyronine dose of the day.</p><p></p><p>Thanks again for reading.</p></blockquote><p></p>
[QUOTE="Castaneda, post: 140112, member: 36807"] I've been away for a while researching options. Ultimately, I decided to start testosterone therapy, but it has only made matters worse. Let me explain: I started with IM injections of cypionate, 100mg 2x a week. After frequently hitting nerves in all the recommended injection sites and generally feeling much worse post-injection (lower energy, brain fog, low mood, etc.), I decided to switch to a 200mg liposomal cream. The first few days on the liposomal cream, my dopamine and libido just shot up. I felt great again (finally). That tapered out after a week and gradually changed to lower energy, a complete obliteration of libido, and fairly severe depression. The first 3 weeks, I was using a TopiClick (3 clicks, twice a day on the inner thigh). I discussed the symptoms with the doctor, and his comment was "that's not typical -- but let's give it another 2-3 weeks and test to see where things are at". At that point, he suggested switching from inner thigh application to directly on the scrotum. Fast forward to a week ago, when I had been putting 1 gram of 200mg liposomal cypionate cream on the testes twice a day. I went in for a blood lab about 4-5 hours post morning application. Here is what came out of that: Hemoglobin: 16.2 g/dl (13-17) Hematocrit: 45.9% (37-49) Platelets: 182 (130-400) CBC: Normal except for slightly elevated eosinophils Estradiol 39.1 pg/ml (<=60.7) Testosterone: 1082 ng/dl (300-890) SHBG: 50.4 nmol/l (16.5-55.9) Calc Free T: 204.5 pg/ml (47-244) So from a free T point of view, I'm in the zone. SHBG has come down since the last lab (it was 66), and estradiol has come up, over the "optimal" range of 20-30. Before starting therapy, it showed 26. So my symptoms are telling me I am still low T. I feel no energy, limited ability to get an erection or keep it, low libido, and generally depressed. The doc reviewed these labs and responded, "perhaps T therapy is not for you". I'll reserve my lack of enthusiasm for this statement. Where to go from here? The doc keeps pressing me saying this is a high cortisol problem and that cortisol is blocking the androgen receptors-- but if I take one of the cortisol modulating substances (Seriphos, Ashwagandha, Rhodiola, etc.) it makes my energy deficit worse. Has anyone else seen labs like this with subjective feelings of low T? SHBG does seem to be coming down, but isn't that estradiol level a problem? I mentioned it to the doc and he said "estradiol protects against atherosclerosis and cardiovascular disease, similar to women". Terrific. And we now have Jay Cambell et. al. jumping on that bandwagon saying aromatase inhibitors are dangerous and to work on improving insulin sensitivity, reducing adipose tissue, etc. All good recommendations --- as I do have more adipose fat than I need (which is likely the culprit in higher estradiol levels). But I'm in a Catch 22. In order to lose that fat, I need to exercise, and I have hardly enough energy to walk around the block, let alone lift some weights. It's that bad. I feel just awful. The doc ended up giving me .5mg Arimidex, 2x a week as an experiment (for 1 month) to see if the high SHBG could be increasing estrogen's effects. I don't have puffy nipples or emotional ups / downs --- just feeling flat, no energy, and no libido, which (in my opinion, at least), is just as bad, if not worse. The question in my mind is --- how much estrogen is too much estrogen? I have low tolerance for these blanket statements. We can all agree that too little estrogen is bad, but there are ample studies showing too much can lead to prostate cancer and clotting issues. Dr. Crisler recently had a heart attack not a week after he suddenly stopped using Arimidex. I'm not jumping to any conclusions here, but it makes you think --- his first heart attack was due to a blood clot. What did his E2 levels look like? Last I spoke with him, he didn't feel it was necessary to look at PT / PTT in men with stroke risk. This raised a red flag for me --- as does the newly popular rhetoric that we should all ditch the idea of inhibiting aromatase. Too much estrogen is a bad thing, regardless of how many studies prove it prevents atherosclerosis. Just an example: [URL='https://www.ncbi.nlm.nih.gov/pubmed/19436016']Circulating estradiol and mortality in men with systolic chronic heart failure. - PubMed - NCBI[/URL] Yes, an observational study, but there are many others. Consider this. 39.1 E2 may not be high enough to produce symptoms, but with high SHBG, we have a changed playing field. SHBG binds to androgens with higher affinity, and when you have a lot of it running around, it's going to hug onto T and DHT much tighter while letting E2 have a free ride. That 39.1 E2, in that circumstance, could behave like much higher E2. At least that's how I'm feeling. This is partly why going on subjective feelings is more important than a lab number. So that's where I'm at. Thanks for listening. I'm going to trial the Arimidex and then test again in 1 month to see where E2 is sitting. Hopefully, during that time, I'll have some change in subjective well-being, similar to the way I felt the first few days of liposomal cream. Then I can get intermittent fasting in gear along with some light weight training --- to turn the tide. In the meantime, if any of you have stories to share or tips, let me know. And yes, I'm looking after my thyroid. I have chronically high RT3 and cannot take NDT (because the T4 in the grains converts almost instantly to RT3). My free T4 and T3 levels look good on labs with a TSH over 3. So I've been flushing out RT3 with straight Cytomel (administered as sublingual drops in a tincture, 3mcg, 4x a day). Speaking of which, off to take my last liothyronine dose of the day. Thanks again for reading. [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Blood Test Discussion
High estrogens / SHBG
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