Lab Results - Discussion of Free Estradiol

[stevep]

Below are my recent lab results which I'm pleased with. I'm happy to see my latest whole blood donation (27 March) brought down my RBC and I'm not sure if this helps, but I've started drinking a LOT of water and working out (dropped ~13lbs in the past couple months). I'm guessing the latter has minimal effect.

My E2 is down at a good level as well. Back in January Defy started me on .125mg Anastrazole twice a week when I take my Test E and HCG.

My protocols is:
Test E - M/Thr (.3ml)
HCG - M/Thr (.5ml)
Anastrazole - M/Thr (.125mg)
DHEA - Daily (25mg)
Calcium D-Glucarate - Daily (400mg)
D3 - Daily (5000ui)

The lab work was completed before my Monday (~09:00) injection and fasting for 12 hours.


[TABLE="width: 347"]
[TR]
[TD]CBC With Platelet And Differential[/TD]
[TD]Reference Range[/TD]
[TD="align: center"]4/18/2017[/TD]
[TD="align: center"]1/3/2017[/TD]
[/TR]
[TR]
[TD]WBC[/TD]
[TD]3.8-12.8[/TD]
[TD="align: center"]4.4[/TD]
[TD="align: center"]6.1[/TD]
[/TR]
[TR]
[TD]Red Blood Cell Count (RBC)[/TD]
[TD]4.20-5.70[/TD]
[TD="align: center"]5.44[/TD]
[TD="align: center"]6.03[/TD]
[/TR]
[TR]
[TD]Hemoglobin (Hgb)[/TD]
[TD]14.0-18.0[/TD]
[TD="align: center"]15.1[/TD]
[TD="align: center"]18.4[/TD]
[/TR]
[TR]
[TD]Hematocrit (HCT)[/TD]
[TD]42.2-53.8[/TD]
[TD="align: center"]47.6[/TD]
[TD="align: center"]54.7[/TD]
[/TR]
[TR]
[TD]MCV[/TD]
[TD]81.0-102.0[/TD]
[TD="align: center"]87.5[/TD]
[TD="align: center"]90.7[/TD]
[/TR]
[TR]
[TD]MCH[/TD]
[TD]26.9-35.0[/TD]
[TD="align: center"]27.8[/TD]
[TD="align: center"]30.5[/TD]
[/TR]
[TR]
[TD]MCHC[/TD]
[TD]30.4-34.8[/TD]
[TD="align: center"]31.7[/TD]
[TD="align: center"]33.6[/TD]
[/TR]
[TR]
[TD]RDW[/TD]
[TD]38.2-53.0[/TD]
[TD="align: center"]45.7[/TD]
[TD="align: center"]44.7[/TD]
[/TR]
[TR]
[TD]Platelet Count[/TD]
[TD]137-397[/TD]
[TD="align: center"]270[/TD]
[TD="align: center"]240[/TD]
[/TR]
[TR]
[TD]Neutrophils Automated[/TD]
[TD]41.0-77.0[/TD]
[TD="align: center"]66[/TD]
[TD="align: center"]69.7[/TD]
[/TR]
[TR]
[TD]Lymphocytes Automated[/TD]
[TD]14.0-48.0[/TD]
[TD="align: center"]22.5[/TD]
[TD="align: center"]20.8[/TD]
[/TR]
[TR]
[TD]Monocytes Automated[/TD]
[TD]4.0-13.0[/TD]
[TD="align: center"]8.3[/TD]
[TD="align: center"]7[/TD]
[/TR]
[TR]
[TD]Eosinophils Automated[/TD]
[TD]1.0-8.0[/TD]
[TD="align: center"]2.5[/TD]
[TD="align: center"]1.5[/TD]
[/TR]
[TR]
[TD]Basophils Automated[/TD]
[TD]0.0-1.5[/TD]
[TD="align: center"]0.7[/TD]
[TD="align: center"]0.7[/TD]
[/TR]
[TR]
[TD]Immature Granulocyte Automated[/TD]
[TD]0.0-1.0[/TD]
[TD="align: center"]0[/TD]
[TD="align: center"]0.3[/TD]
[/TR]
[TR]
[TD]

Estradol, Free LC/MS/MS[/TD]
[TD]

Reference Range[/TD]
[TD]

4/10/2017​

[/TD]
[TD="align: center"]

1/25/2017[/TD]
[/TR]
[TR]
[TD]Estradiol Free[/TD]
[TD]< or =0.45[/TD]
[TD="align: center"]0.52[/TD]
[TD="align: center"]0.86[/TD]
[/TR]
[TR]
[TD]Estradiol[/TD]
[TD]< or = 29[/TD]
[TD="align: center"]24[/TD]
[TD="align: center"]39[/TD]
[/TR]
[TR]
[TD]

PSA[/TD]
[TD]

Reference Range[/TD]
[TD]

4/10/2017​

[/TD]
[TD="align: center"]

1/3/2017[/TD]
[/TR]
[TR]
[TD]PSA[/TD]
[TD]0.00-4.00[/TD]
[TD="align: center"]0.74[/TD]
[TD="align: center"]0.52[/TD]
[/TR]
[TR]
[TD]

Testosterone[/TD]
[TD]

Reference Range[/TD]
[TD]

4/10/2017​

[/TD]
[TD="align: center"]

1/3/2017[/TD]
[/TR]
[TR]
[TD]Testosterone[/TD]
[TD]205.00-781.00[/TD]
[TD="align: center"]873.59[/TD]
[TD="align: center"]787.36[/TD]
[/TR]
[TR]
[TD]

Testosterone, Calc. Free/Bioavail (Adult Male 14+)[/TD]
[TD]

Reference Range[/TD]
[TD]

4/10/2017​

[/TD]
[TD="align: center"]

1/3/2017[/TD]
[/TR]
[TR]
[TD]Free Testosterone, Percent[/TD]
[TD]1.60-2.90[/TD]
[TD="align: center"]1.76[/TD]
[TD="align: center"]2.18[/TD]
[/TR]
[TR]
[TD]Free Testosterone (calculation)[/TD]
[TD]33-227[/TD]
[TD="align: center"]154[/TD]
[TD="align: center"]168[/TD]
[/TR]
[TR]
[TD]Testosterone Bioavailable[/TD]
[TD]131-682[/TD]
[TD="align: center"]361[/TD]
[TD="align: center"]395[/TD]
[/TR]
[TR]
[TD]Sex Hormone Binding Globulin[/TD]
[TD]11-71[/TD]
[TD="align: center"]51.0[/TD]
[TD][/TD]
[/TR]
[/TABLE]

 

[CoastWatcher]

Can you remind me how long you've been on TRT?

 

[stevep]

This summer will be 3 years. The first 2+ years were with doctors that no clue on what they were doing. My RBC has been high the entire time. No other doctor brought it up as an issue. I had 4 different doctors during that time.

When I started with Defy several months ago they made the following changes.

First appointment (~Oct 2016) Changed to twice a week Test E. Added HCG, D3, DHEA.

Somewhere around Dec/Jan I posted on here about ED coming back and thought it was due to high E2. Dr. Saya replied and suggested I take DIM and the Calcium D-Glucarate until I could get my follow up. Which helped.

Second appointment (Jan 2017). Defy added the AI and I dropped the DIM. I think / know the Calcium helps me. If I miss a dose I can tell.

This lab work will be for my third appointment with Defy.

 

[Dr Justin Saya MD]

Good looking results stevep and great job with the RBC/HgB/HCT.

Your E2 levels look great and is interesting for everyone to see the free E2 level (even with an SHBG of 51). One can easily see the impact of LOWER SHBG levels on free E2.

 

[CoastWatcher]

Good looking results stevep and great job with the RBC/HgB/HCT.

Your E2 levels look great and is interesting for everyone to see the free E2 level (even with an SHBG of 51). One can easily see the impact of LOWER SHBG levels on free E2.

Some discussion of this point earlier in the week, in the abstract, here on the Forum. Fascinating to see a clinical example.

 

[Dr Justin Saya MD]

Some discussion of this point earlier in the week, in the abstract, here on the Forum. Fascinating to see a clinical example.

I've seen many...just wish the estradiol with free estradiol test was at a better price point so as to be more commonly ordered (I use it as a more specialized test currently).

 

[CoastWatcher]

I've seen many...just wish the estradiol with free estradiol test was at a better price point so as to be more commonly ordered (I use it as a more specialized test currently).

What are the variables that result in your ordering it? If you don't mind...

 

[Dr Justin Saya MD]

What are the variables that result in your ordering it? If you don't mind...

Typically for challenging cases of suspected E2 involvement. Occasionally when symptoms point one way, but the total estradiol level (via LC/MS) is neutral or points the other way...and so on. Just another tool in the arsenal.

 

[johndoesmith]

Typically for challenging cases of suspected E2 involvement. Occasionally when symptoms point one way, but the total estradiol level (via LC/MS) is neutral or points the other way...and so on. Just another tool in the arsenal.

Well, then I was incorrect about free hormones not ruling all. I always was of the opinion that it's more complex than free vs total(not referring to this case) essentially the free hormone hypothesis vs the free hormone transport hypothesis.

Is the free E2 test subject to the same fluctuations in reliability as the free testosterone assays?

 

[stevep]

I was told something went wrong with the CBC vial and needed to have additional blood drawn to get that lab work completed. So I went back on the 18th (Tue) which is the day after I inject. For whatever reason they re-ran the testosterone labs as well. Just to show the difference between lab work in trough vs. after an injection:

[TABLE="width: 351"]
[TR]
[TD]Testosterone[/TD]
[TD]Reference Range[/TD]
[TD="align: center"]4/10/2017 Trough[/TD]
[TD="align: center"][/TD]
[TD="align: center"]4/18/2017[/TD]
[/TR]
[TR]
[TD]Testosterone[/TD]
[TD]205.00-781.00[/TD]
[TD="align: center"]873.59[/TD]
[TD="align: center"][/TD]
[TD="align: center"]1056.85[/TD]
[/TR]
[TR]
[TD]Testosterone, Calc. Free/Bioavailable (Adult Male 14+)[/TD]
[TD]Reference Range[/TD]
[TD="align: center"]4/10/2017 Trough[/TD]
[TD="align: center"][/TD]
[TD="align: center"]4/18/2017[/TD]
[/TR]
[TR]
[TD]Free Testosterone, Percent[/TD]
[TD]1.60-2.90[/TD]
[TD="align: center"]1.76[/TD]
[TD="align: center"][/TD]
[TD="align: center"]1.84[/TD]
[/TR]
[TR]
[TD]Free Testosterone (calculation)[/TD]
[TD]33-227[/TD]
[TD="align: center"]154[/TD]
[TD="align: center"][/TD]
[TD="align: center"]194[/TD]
[/TR]
[TR]
[TD]Testosterone Bioavailable[/TD]
[TD]131-682[/TD]
[TD="align: center"]361[/TD]
[TD="align: center"][/TD]
[TD="align: center"]455[/TD]
[/TR]
[TR]
[TD]Sex Hormone Binding Globulin[/TD]
[TD]11-71[/TD]
[TD="align: center"]51.0[/TD]
[TD][/TD]
[TD][/TD]
[/TR]
[/TABLE]

 

[Dr Justin Saya MD]

Well, then I was incorrect about free hormones not ruling all. I always was of the opinion that it's more complex than free vs total(not referring to this case) essentially the free hormone hypothesis vs the free hormone transport hypothesis.

Is the free E2 test subject to the same fluctuations in reliability as the free testosterone assays?

In general the more VARIABLES that are involved in impacting any given test, the more variability you will see with measurements. In other words, independent variables (albumin, SHBG) impact the test variable (free testosterone, free estradiol, etc). Similar to how the RIA shows much more variability (both up and down) than the LC/MS due to cross-reactivity (i.e. other variables).

As a general note, looking at Steve's January labs I can envision many stating his estradiol of 39 would be a perfectly fine level (which it is for *some*)...but the free estradiol starts to paint a different picture. One could also say that there isn't data to support any "goal" or "optimal" range for free estradiol, which there isn't (keep in mind there isn't much data for sensitive estradiol LC/MS levels just yet either, he vast majority of data is still utilizing RIA). This is where the trained clinician must piece together the ENTIRE picture, both objective and subjective, to arrive at a conclusion in each individual case.

 

[Dr Justin Saya MD]

I was told something went wrong with the CBC vial and needed to have additional blood drawn to get that lab work completed. So I went back on the 18th (Tue) which is the day after I inject. For whatever reason they re-ran the testosterone labs as well. Just to show the difference between lab work in trough vs. after an injection:

[TABLE="width: 351"]
[TR]
[TD]Testosterone[/TD]
[TD]Reference Range[/TD]
[TD="align: center"]4/10/2017 Trough[/TD]
[TD="align: center"][/TD]
[TD="align: center"]4/18/2017[/TD]
[/TR]
[TR]
[TD]Testosterone[/TD]
[TD]205.00-781.00[/TD]
[TD="align: center"]873.59[/TD]
[TD="align: center"][/TD]
[TD="align: center"]1056.85[/TD]
[/TR]
[TR]
[TD]Testosterone, Calc. Free/Bioavailable (Adult Male 14+)[/TD]
[TD]Reference Range[/TD]
[TD="align: center"]4/10/2017 Trough[/TD]
[TD="align: center"][/TD]
[TD="align: center"]4/18/2017[/TD]
[/TR]
[TR]
[TD]Free Testosterone, Percent[/TD]
[TD]1.60-2.90[/TD]
[TD="align: center"]1.76[/TD]
[TD="align: center"][/TD]
[TD="align: center"]1.84[/TD]
[/TR]
[TR]
[TD]Free Testosterone (calculation)[/TD]
[TD]33-227[/TD]
[TD="align: center"]154[/TD]
[TD="align: center"][/TD]
[TD="align: center"]194[/TD]
[/TR]
[TR]
[TD]Testosterone Bioavailable[/TD]
[TD]131-682[/TD]
[TD="align: center"]361[/TD]
[TD="align: center"][/TD]
[TD="align: center"]455[/TD]
[/TR]
[TR]
[TD]Sex Hormone Binding Globulin[/TD]
[TD]11-71[/TD]
[TD="align: center"]51.0[/TD]
[TD][/TD]
[TD][/TD]
[/TR]
[/TABLE]

Yep, looks about right for BIW with your SHBG.

 

[CoastWatcher]

I was told something went wrong with the CBC vial and needed to have additional blood drawn to get that lab work completed. So I went back on the 18th (Tue) which is the day after I inject. For whatever reason they re-ran the testosterone labs as well. Just to show the difference between lab work in trough vs. after an injection:

[TABLE="width: 351"]
[TR]
[TD]Testosterone[/TD]
[TD]Reference Range[/TD]
[TD="align: center"]4/10/2017 Trough[/TD]
[TD="align: center"][/TD]
[TD="align: center"]4/18/2017[/TD]
[/TR]
[TR]
[TD]Testosterone[/TD]
[TD]205.00-781.00[/TD]
[TD="align: center"]873.59[/TD]
[TD="align: center"][/TD]
[TD="align: center"]1056.85[/TD]
[/TR]
[TR]
[TD]Testosterone, Calc. Free/Bioavailable (Adult Male 14+)[/TD]
[TD]Reference Range[/TD]
[TD="align: center"]4/10/2017 Trough[/TD]
[TD="align: center"][/TD]
[TD="align: center"]4/18/2017[/TD]
[/TR]
[TR]
[TD]Free Testosterone, Percent[/TD]
[TD]1.60-2.90[/TD]
[TD="align: center"]1.76[/TD]
[TD="align: center"][/TD]
[TD="align: center"]1.84[/TD]
[/TR]
[TR]
[TD]Free Testosterone (calculation)[/TD]
[TD]33-227[/TD]
[TD="align: center"]154[/TD]
[TD="align: center"][/TD]
[TD="align: center"]194[/TD]
[/TR]
[TR]
[TD]Testosterone Bioavailable[/TD]
[TD]131-682[/TD]
[TD="align: center"]361[/TD]
[TD="align: center"][/TD]
[TD="align: center"]455[/TD]
[/TR]
[TR]
[TD]Sex Hormone Binding Globulin[/TD]
[TD]11-71[/TD]
[TD="align: center"]51.0[/TD]
[TD][/TD]
[TD][/TD]
[/TR]
[/TABLE]

Another supporting lab account of trough/peak fluctuations. Thank you for posting.

 

[johndoesmith]

In general the more VARIABLES that are involved in impacting any given test, the more variability you will see with measurements. In other words, independent variables (albumin, SHBG) impact the test variable (free testosterone, free estradiol, etc). Similar to how the RIA shows much more variability (both up and down) than the LC/MS due to cross-reactivity (i.e. other variables).

As a general note, looking at Steve's January labs I can envision many stating his estradiol of 39 would be a perfectly fine level (which it is for *some*)...but the free estradiol starts to paint a different picture. One could also say that there isn't data to support any "goal" or "optimal" range for free estradiol, which there isn't (keep in mind there isn't much data for sensitive estradiol LC/MS levels just yet either, he vast majority of data is still utilizing RIA). This is where the trained clinician must piece together the ENTIRE picture, both objective and subjective, to arrive at a conclusion in each individual case.

That explains a lot, and I agree with you about Steve's labs, I honestly would have said a 39 E2 level is great, but looking at the difference in free E2 then and now paints a WHOLE different picture.

I had these taken a while back, and while Labcorp's range is different, plus their total E2 tests can't seem to agree on what my level was at that time, the free E2 test agrees with my clinical picture.



Thanks for the explanation.

Steve:

I had nearly the same level of fluctuation with my E3D frequency, if you look through my threads you'll see where I posted labs each day along with graphs.

IIRC I went from 1013 at peak to 679 at trough, roughly about 300 points. A little bit more than you, but your SHBG is way higher than mine. I was around 22 then whereas you're at 51?

All in all, I don't feel a single difference on any day. So this is all theoretical. I'm glad you're doing so well on TRT!

 

[Vince Carter]

Im very very interested in the Free E aspect, for those of us low SHBG guys as a place to look for so many that have trouble getting in to a sweet spot, this will def be on my next set of labs but I've also felt so good that for at least 6 months I haven't felt any need to test anything. Perhaps we have to run closer to 20 LC/MS/MS to account for the free Estradiol. Low SHBG = high Free T and subsequent (suspected) high Free E. Read this in Dr Crislers book (I think his latest book?)

I had pretty high E as much as 88 at one point and got on .25mg EOD thanks to Dr Saya, that put me to 17 LC/MS/MS and we adjusted to M/W/F and I think I'm *pretty* good but still bothered with some hot/overly warm in bed and PMSish tough to deal with daily stress, which both are much much better than before the AI.
Im thinking I may go back to the EOD and in to the teens and see where I'm at.

 

[DRay]

It is my understanding that an AI such as Arimidex binds to the receptor sites and blocks the further production of estrogen to a certain percentage based on dosing. So if someone has elevated free E2 levels, would that make the AI useless against the free floating E?

Can someone elaborate on this?

 

[Vince Carter]

It is my understanding that an AI such as Arimidex binds to the receptor sites and blocks the further production of estrogen to a certain percentage based on dosing. So if someone has elevated free E2 levels, would that make the AI useless against the free floating E?

Can someone elaborate on this?

ADex/AIs only inhibits the enzyme activity, never heard this about Dex binding to receptors, sounds very suspect, it wouldn't do anything to E that is already in system. I think that that's where a SERM(?) or suicide inhibitor could come in to play.

 

[DRay]

ADex/AIs only inhibits the enzyme activity, never heard this about Dex binding to receptors, sounds very suspect, it wouldn't do anything to E that is already in system. I think that that's where a SERM(?) or suicide inhibitor could come in to play.

So my question is, would Adex have any affect on the free estrogen floating in the system as a result of high free E levels?

 

[Vince Carter]

You would think that by blunting the conversion to begin with, yes, but once E is converted/produced, an AI would have no effect.

 

[DRay]

You would think that by blunting the conversion to begin with, yes, but once E is converted/produced, an AI would have no effect.

Right. By stopping the conversion it will have an indirect effect by not allowing further E to become free