Is low Estradiol (Naturally) along low free T effectively hypogonadism?

[benaoao]

I was reviewing blood tests from back when I was still natural in 2016. Total T in the 800s, single digit free T (pg/mL), E2 around 10 pg/mL. Then I started using steroids for about 18 months, hopped off. Total T in the 600s, free T and E2 around 12 pg/mL. I’m 10% fat year round. I’ve tried bulking harder, got pre diabetic (6.2% A1c) with sky high cholesterol (LDL 200+) instead. Normalized upon dropping kcals back to normal. Ripped, but no E2. I’m on nandrolone right now but what’s below describes me when I’m off everything.


Symptoms: I don’t know... What’s a libido... Men are supposed to wake up with an erection without drugs? 31yo men don’t all have knees that sound like Rice Krispies whenever they squat and shoulders that pop while doing lateral raises? And that this never seemed to improve even on extremely minimalistic training?

Kidding. ALL the symptoms. It’s clear to me that my total T levels are only decent “thanks” to SHBG. I know SHBG’s importance and studies show that all I’d gain from arbitrarily lowering it is less Test and same low free T and E2.

I haven’t seen many cases like mine. E2 should be high alongside SHBG. If free E2 tests were commonly available I guess mine would be undetectable.

I know that many docs try various therapies when total T is on the low end of the range. What’s their approach when total T is perfectly normal but free T and E2 are trash?

 

[Systemlord]

What’s their approach when total T is perfectly normal but free T and E2 are trash?

Well your free testosterone is getting bound to SHBG and therefore your LH is better indicator of T production. Really what should be happening with a strong properly functioning HPTA is to increase LH which would be the body recognizing the low Free T situation and increasing LH in an attempt to increase Free T, but in your case if LH is unchanged, this would mean your pituitary gland is sluggish.

There are a couple of reasons for high SHBG, liver disease, cutting to get to a lower body fat percentage, in other words starvation. Another possible cause for high SHBG is secondary hypogonadism (low-T) where the body is trying to hold onto what little testosterone you do have.

You'll never be able to increase Total T high enough naturally to have sufficient Free T levels, so your question is the approach to someone with enough knowledge to treat you is TRT. If the doc is not very knowledgeable, he/she will tell you that your levels are normal.

Estrogen is needed for bone strength, it puts minerals in bone and without enough estrogen, osteoporosis is all but guaranteed. Clomid is out of the question because it's known for increasing SHBG and yours is always far too high and would make your Free T situation much worse.

What’s a libido...

Libido is sexual desire where you're attracted to women and thinking about sex. Libido is in the brain, you can't have libido without enough estrogen. Healthy men should be waking up with erections and have them while sleeping.

 

[tarzan92]

Libido is sexual desire where you're attracted to women and thinking about sex. Libido is in the brain, you can't have libido without enough estrogen. Healthy men should be waking up with erections and have them while sleeping.

I'm 28, and hypogonadism. I have been using TRT for almost 2 months, with a dose of 60mg per week, and it was only at the beginning of the treatment that I got my morning erections or during the day. now I'm not having more, would it be time to increase this dose?

 

[Vince]

I'm 28, and hypogonadism. I have been using TRT for almost 2 months, with a dose of 60mg per week, and it was only at the beginning of the treatment that I got my morning erections or during the day. now I'm not having more, would it be time to increase this dose?

It would be better if you started a new thread and posted all of your labs.

 

[Systemlord]

I'm 28, and hypogonadism. I have been using TRT for almost 2 months, with a dose of 60mg per week, and it was only at the beginning of the treatment that I got my morning erections or during the day. now I'm not having more, would it be time to increase this dose?

Your dosage is outside what is acceptable for a weekly TRT dosage, men are on average closer to 100mg weekly. I would start a new thread with labs as Vince has suggested.

 

[Cataceous]

Your dosage is outside what is acceptable for a weekly TRT dosage, ...

Clarification is needed here. If there's only one injection of 60 mg a week then the >50% drop in serum testosterone over the course of the week would cause some men to feel hypogonadal before the next injection. But if the statement is a blanket condemnation of averaging 60 mg a week then it is overly broad. I am taking the equivalent of 53 mg per week and getting better overall results than at higher doses.

 

[benaoao]

Well your free testosterone is getting bound to SHBG and therefore your LH is better indicator of T production. Really what should be happening with a strong properly functioning HPTA is to increase LH which would be the body recognizing the low Free T situation and increasing LH in an attempt to increase Free T, but in your case if LH is unchanged, this would mean your pituitary gland is sluggish.

There are a couple of reasons for high SHBG, liver disease, cutting to get to a lower body fat percentage, in other words starvation. Another possible cause for high SHBG is secondary hypogonadism (low-T) where the body is trying to hold onto what little testosterone you do have.

You'll never be able to increase Total T high enough naturally to have sufficient Free T levels, so your question is the approach to someone with enough knowledge to treat you is TRT. If the doc is not very knowledgeable, he/she will tell you that your levels are normal.

Estrogen is needed for bone strength, it puts minerals in bone and without enough estrogen, osteoporosis is all but guaranteed. Clomid is out of the question because it's known for increasing SHBG and yours is always far too high and would make your Free T situation much worse.


Libido is sexual desire where you're attracted to women and thinking about sex. Libido is in the brain, you can't have libido without enough estrogen. Healthy men should be waking up with erections and have them while sleeping.

Thank you for your message I appreciate it. I was being sarcastic about what’s a libido, meaning I had absolutely no desire ie. “libido?? Me? Haha no”.

yeah Clomid was a massive failure unsurprisingly. Found a bloodwork after 3 weeks on it, total Test was higher but free T was... 2.9pg/mL. So much for e2 barely up to 18 pg/mL anyway. Iirc this was on 50mg EOD. LH&FSH normal always, upper half of the range.

I highlighted the part of your message that’s crucial. I agree that I don’t see how I could pump out so much test that both free T and E2 would be over 20 pg/mL at least. Whenever I move to Toronto I’m out shopping for a capable endocrinologist. Luckily my girlfriend there 1) is supportive of everything I’ve told her 2) is very close friends to a Dermatologist. I guess it won’t be too hard to set me up with someone the Derm knows from med school.

Perhaps there’s a guide for knowledgeable Canadian endos?

 

[Systemlord]

I am taking the equivalent of 53 mg per week and getting better overall results than at higher doses.

I'm doing 12mg every 3 days, 14mg is too much, but my case isn't typical either. Ever since correcting my iron deficiency everything is different, I feel like I'm starting all over again.

Clarification is needed here. If there's only one injection of 60 mg a week then the >50% drop in serum testosterone over the course of the week would cause some men to feel hypogonadal before the next injection.

Agreed, we have many men injecting at different intervals that simply stating I'm on said dosage per week isn't really saying much.

 

[Systemlord]

Whenever I move to Toronto I’m out shopping for a capable endocrinologist.

Perhaps there’s a guide for knowledgeable Canadian endos?

Look up Dr. Lawrence D. Komer Burlington in Ontario, he runs a private men's/women's hormone clinic and he is first rate when it comes to hormones.

We have a few canadian members, perhaps they can make some recommendations as well.

 

[Vvs1]

I was reviewing blood tests from back when I was still natural in 2016. Total T in the 800s, single digit free T (pg/mL), E2 around 10 pg/mL. Then I started using steroids for about 18 months, hopped off. Total T in the 600s, free T and E2 around 12 pg/mL. I’m 10% fat year round. I’ve tried bulking harder, got pre diabetic (6.2% A1c) with sky high cholesterol (LDL 200+) instead. Normalized upon dropping kcals back to normal. Ripped, but no E2. I’m on nandrolone right now but what’s below describes me when I’m off everything.


Symptoms: I don’t know... What’s a libido... Men are supposed to wake up with an erection without drugs? 31yo men don’t all have knees that sound like Rice Krispies whenever they squat and shoulders that pop while doing lateral raises? And that this never seemed to improve even on extremely minimalistic training?

Kidding. ALL the symptoms. It’s clear to me that my total T levels are only decent “thanks” to SHBG. I know SHBG’s importance and studies show that all I’d gain from arbitrarily lowering it is less Test and same low free T and E2.

I haven’t seen many cases like mine. E2 should be high alongside SHBG. If free E2 tests were commonly available I guess mine would be undetectable.

I know that many docs try various therapies when total T is on the low end of the range. What’s their approach when total T is perfectly normal but free T and E2 are trash?

I have lower e2 with high shbg. My e2 is 16-19. Any pde5 inhibitors will lower e2. Plus there are claims of peptides that lower e2(likely the oral ones.) Possibly supps too.

I just received HCG which increases e2, and have been looking into an injectable DHT or T cream applied to the scrotum to decrease shbg. No one has told me whether injectable DHT will hurt fertility, along with HCG.

Have you done a saliva cortisol, or thyroid tests? My saliva cortisol and reverse t3 are low. All other thyroid numbers are normal.

 

[swoops36]

Clarification is needed here. If there's only one injection of 60 mg a week then the >50% drop in serum testosterone over the course of the week would cause some men to feel hypogonadal before the next injection. But if the statement is a blanket condemnation of averaging 60 mg a week then it is overly broad. I am taking the equivalent of 53 mg per week and getting better overall results than at higher doses.

I just saw a video where Danny B pledged $5k to anyone on 50mg weekly with no symptoms & feeling good. Maybe take him up on it?

 

[Cataceous]

I just saw a video where Danny B pledged $5k to anyone on 50mg weekly with no symptoms & feeling good. Maybe take him up on it?

Danny B? Presumably hCG use would be disqualifying because of the potential for endogenous T production. Though in my case that production seems to be negligible. 50 mg of T cypionate is 5 mg of testosterone per day, which is well within the range of 3-9 mg per day produced by normal men. We've had some interesting discussions lately about whether men on TRT really need higher doses and why. I've argued that in some cases the higher doses aren't necessary and may be causing problems. An idea I'd like to see tested is whether some of the good effects of testosterone depend on daily peak levels, while the bad effects depend more on average or trough levels.

 

[benaoao]

I have lower e2 with high shbg. My e2 is 16-19. Any pde5 inhibitors will lower e2. Plus there are claims of peptides that lower e2(likely the oral ones.) Possibly supps too.

I just received HCG which increases e2, and have been looking into an injectable DHT or T cream applied to the scrotum to decrease shbg. No one has told me whether injectable DHT will hurt fertility, along with HCG.

Have you done a saliva cortisol, or thyroid tests? My saliva cortisol and reverse t3 are low. All other thyroid numbers are normal.

Yeah I’ve got quite the list of commonly used products that lower e2. I’m even suspecting red meat to cause issues because of all the zinc (Natural AI?). Might be a bit extreme here I’m not sure. There must be a reason why I don’t enjoy beef as much as chicken, milk, fish ha. I’ve also had multiple blood tests that show borderline low hemoglobin, hematocrit, I’ve had high UIBC and low saturation (11% iirc, normal range 15-55). So perhaps red meat is an issue and I should get iron elsewhere, but I’ve gone meat free many times, low fat high fat whatever, same low E2 issues. I don’t know - which foods have iron but not zinc??

Back to hormones. I have experience with HCG. 500iu e3d. Test 630 E2 35 free T 15. Looking ideal, except that cortisol was very close to being flagged as high. That was last year after a long vacation in the sun training about once a week. I do have high dissatisfaction with my career choices tho and general sense of purpose is low. It would be f*cked if this created an endocrine disorder.

Besides iron, everything else is optimal: fasted glucose in the 80s, single digit prolactin, all micros in check via cronometer, sleep is fine, temp is high, thyroid is good, and so on.

 

[swoops36]

Danny B? Presumably hCG use would be disqualifying because of the potential for endogenous T production. Though in my case that production seems to be negligible. 50 mg of T cypionate is 5 mg of testosterone per day, which is well within the range of 3-9 mg per day produced by normal men. We've had some interesting discussions lately about whether men on TRT really need higher doses and why. I've argued that in some cases the higher doses aren't necessary and may be causing problems. An idea I'd like to see tested is whether some of the good effects of testosterone depend on daily peak levels, while the bad effects depend more on average or trough levels.

I like you’re thinking on this & am curious to see your results.

and I think Danny is much more popular over at T-Nation, however he did a YT video responding to an article about TRT being more a steroid cycle than replacement

 

[Systemlord]

I just saw a video where Danny B pledged $5k to anyone on 50mg weekly with no symptoms & feeling good. Maybe take him up on it?

Time to collect. I'm on 12mg E3D (27.4mg weekly) because 14mg was just too much. I'm still blown away by my low dose, pre-TRT I was at 91 ng/dL and a week ago 277 ng/dL, so its not hard to comprehend why I'm feeling better.

 

[Vvs1]

Yeah I’ve got quite the list of commonly used products that lower e2. I’m even suspecting red meat to cause issues because of all the zinc (Natural AI?). Might be a bit extreme here I’m not sure. There must be a reason why I don’t enjoy beef as much as chicken, milk, fish ha. I’ve also had multiple blood tests that show borderline low hemoglobin, hematocrit, I’ve had high UIBC and low saturation (11% iirc, normal range 15-55). So perhaps red meat is an issue and I should get iron elsewhere, but I’ve gone meat free many times, low fat high fat whatever, same low E2 issues. I don’t know - which foods have iron but not zinc??

Back to hormones. I have experience with HCG. 500iu e3d. Test 630 E2 35 free T 15. Looking ideal, except that cortisol was very close to being flagged as high. That was last year after a long vacation in the sun training about once a week. I do have high dissatisfaction with my career choices tho and general sense of purpose is low. It would be f*cked if this created an endocrine disorder.

Besides iron, everything else is optimal: fasted glucose in the 80s, single digit prolactin, all micros in check via cronometer, sleep is fine, temp is high, thyroid is good, and so on.

Interesting that you brought up iron and zinc. My iron has been on the higher side 58% iron saturation at one time. I went on a low iron diet and felt it lowered my shbg

My RBC copper was very low, and RBC zinc was good. I’ve had issues with taking zinc alone, and mainly supplement with copper now.

Possible that spinach has iron and no zinc. I’d suggest to keep eating meat. I went vegan and it spiked shbg to 88! I’m usually 55ish.

 

[Vvs1]

This is from another forum, regarding shbg

SHBG more important than previously thought - AnabolicMinds.com

Shr 2410 https://superhumanradio.net/shr-2410-rlrx-the-protein-megalin-may-more-important-than-shbg-when-it-comes-to-sex-steroid-uptake-by-tissue From my understanding, this changes the landscape of the free androgen theory.

anabolicminds.com

“Has to do with the gut biome and biliary system driving liver malfunction causing the elevated shbg.
Since working from these 2 angles we have seen lowering of shbg in some cases.
Currently we are in process of using the latest biome testing combined with gene expressions to look at these correlations“