Low estrogen on TRT

[borat]

FYI - I am new to this forum.

Been on TRT for ~3 yrs. I managed estrogen myself as doc didn't prescribe anything. Generally, things were good until about 6 months ago.

I am a 'over-responder' to AIs. The smallest amount of Arimidex, Letro and Aromasin would crash my e2. So, I would always be in a bit of a rollercoaster with estrogen. But, it was manageable.
In the past 6 months, I have ceased everything that lowers e2 (AIs, Zinc, etc.).

My estro has been low since and I am having low e2/high DHT sides which I never had before including constant hair loss in the past 3-4 months (+ many others). My assumption is e2 is very low and TRT is increasing DHT excessively.

I got blood work done in mid Oct - peak was high test and trough was within range - nothing to worry about. E2 was <19 on both tests, confirming what I thought. Endo suggested adding HCG and lowering T dose from ~130/week to 100. I started the HCG at ~500-1000/week 2 weeks ago and have had no improvement.

I am at a loss. I want to increase test and/or HCG to try to increase e2 but I'm worried more test will just convert to more DHT and make things worse.

ANY help is appreciated. I just added saw palmetto a few days ago and using nizoral every few days. I am debating DHT blockers because nothing is helping

I have always had issues with e2 being on the higher end and now I cant get it up!

 

[CoastWatcher]

Welcome to Excelmale. Let me emphatically suggest you reconsider your use of saw palmetto or any other DHT blocker - it's a significant risk to take with one's endocrine system. If you'd post your most recent lab results it would be a help, opening discussion and soliciting a wide-ranging conversation. In addition to the "regular" lab values (total and free testosterone, SHBG, and so forth), what is your most recent DHT level? What about DHEA? Have you measured it? DHEA supplementation can bump estradiol for many men. Are you delivering your testosterone dose in a weekly injection, or multiple times a week?

 

[borat]

CW - Thanks for the reply.

I added saw palmetto about 5 days ago as nothing else seems to do anything. I figured it was a mild option to try to get things back on track.

I haven't been tested for DHEA or DHT. My endo would only test for the 'normal' things. However, my GP will most likely test for whatever I ask for. So, the info is appreciated and if you can think of anything else (progesterone?, or ?), I will try to get those tested as well.

Weekly shots on Tuesday AM (I was doing bi-weekly but went back to weekly to try to figure out when certain symptoms were hitting me)

Also, important to note that I started supplementing with Zinc at ~25mg per day and ZMA at night which also seemed to have a very strong effect on e2 (I think I am hyper sensitive to anything that lowers e2). This was about 8 months ago maybe?

Recent bloods (mid Oct):

Peak (Friday AM)
E <19
Test 39 (8 - 29)
Free Test 1356 (175 - 700)

*Other tests - Blood count (all normal but Hemoglobin and hematocrit on the very high end), Lipid panel, LH, TSH, PSA, Vit D were all within normal range

Trough (Following Tues AM before shot)
E <19
Test 17.6 (8 - 29)
Free Test 556 (175 - 700)

I am seeing my GP on Friday and will ask for more blood work. Any tips on HCG dose in the meantime? I was planning to drop to 500 iu the day before shot but all my logical decisions are out the window now.]

Random question... - Is it possible to damage the aromatase enzymes/activity from Aromasin or anything else? I didn't think it was but read a couple of things online that suggested it happened to people. Seems farfetched to me...

Thank you.

 

[Vince]

The first thing I'm wondering, did you have the right sensitive test for men? I may have missed it.
A lot of doctors still are using the LabCorp 004515 which may lead to overtreatment with anastrozole.

 

[HealthMan]

Do you have an actual number for your E2? I had low E2 before TRT (single digits) and at low double digits i would not feel bad because of it (everyone is different but that’s my experience). Also what dosage were you using for AI? If i were you I would go back to more frequent injections (your trough number is in the low side) and stop using anything that lowers E2 and keep testing periodically until your E2 goes back to levels that you feel good. If E2 gets out of control again then add very small dosages (you can get tiny doses compounded for you. Sometimes splitting the tiny 1mg tablets you can only split in 4 and 0.25mg maybe a lot for you from what you have said) and go from there.

 

[lowe2sucks]

^he feels bad with low e2 because he crashed his e2 before its different if you have low e2 naturally. I have same thing happen to me.. nothing helped so far and I was feeling only worse and worse as my e2 was going up.

 

[borat]

Lowe2 (haha, great name...)

That's correct. On 100mg / wk of test, my estrogen is usually on the higher end. Over the years, I have crashed my estrogen with AIs and it has bounced back as it should. The biggest difference in the past 6 months has been the supplementation of Zinc. It seems crazy that it could be that, but the timing all makes sense. I was only taking ~25-50 max of elemental zinc and only on days I 'felt high'.

Also, wanted to hear more thoughts on Saw Palmetto. I understand the risks with the Duta/Fina but was under the impression that SP was mild and safe. Any experiences?

I have been on 750-1000 HCG / wk. I have bloods scheduled for Tuesday and will see. Don't feel any better so we will see.

 

[CoastWatcher]

Lowe2 (haha, great name...)

That's correct. On 100mg / wk of test, my estrogen is usually on the higher end. Over the years, I have crashed my estrogen with AIs and it has bounced back as it should. The biggest difference in the past 6 months has been the supplementation of Zinc. It seems crazy that it could be that, but the timing all makes sense. I was only taking ~25-50 max of elemental zinc and only on days I 'felt high'.

Also, wanted to hear more thoughts on Saw Palmetto. I understand the risks with the Duta/Fina but was under the impression that SP was mild and safe. Any experiences?

I have been on 750-1000 HCG / wk. I have bloods scheduled for Tuesday and will see. Don't feel any better so we will see.

Saw Palmetto is, as you noted, milder than finasteride or dutasteride, but it seems to be associated with many of the same issues identified as the post-finasteride syndrome. Multiple references on the sites dedicated to p-fs recovery. My own urologist has told me he warns patients to avoid it because it can do a number on the male endocrine system. So, less potent and possibly less explosive than fin and dut...but the risk seems to be there.

​

 

[nurselyfe]

Saw Palmetto is, as you noted, milder than finasteride or dutasteride, but it seems to be associated with many of the same issues identified as the post-finasteride syndrome. Multiple references on the sites dedicated to p-fs recovery. My own urologist has told me he warns patients to avoid it because it can do a number on the male endocrine system. So, less potent and possibly less explosive than fin and dut...but the risk seems to be there.

​

Yeah you couldn't pay me any amount of money to touch a 5AR inhibitor even if it's just a 'natural herb'

Some of the worse PFS stories I've heard are from Saw Palmetto.

 

[Vince Carter]

I'll pile on with everyone about any kind of 5AR inhibitor, they're spot on correct. And I'll add that you're talking about things you haven't even been tested for, and you're getting the wrong test for E. lastly hair shedding is a rather natural thing, hair loss though is when the follicle shrinks and stop growing, which is FAR more genetic than DHT (or any other factor) I think you've been sold something about DHT being bad when it absolutely is not. It's a vital Androgen that you need. I do hear good things about Nizoral though.

 

[Vitamin_C]

Yeah you couldn't pay me any amount of money to touch a 5AR inhibitor even if it's just a 'natural herb'

Some of the worse PFS stories I've heard are from Saw Palmetto.

Which is weird because the ancients used it as an aphrodisiac and for male health, and some guys say it actually helps with libido/erections, some guys say it makes it worse, who knows? I've taken it in the past, I didn't have any issues, it seems to be user dependent.

An excerpt from one study:

"One of the more convincing is a study that followed 69 men who suffered from an enlarged prostate. Over the period of eight weeks all were given saw palmetto as a supplement to help with their enlarged prostates; of the 69 participants 64% of the men had improved erections and 54 % had improved sex drives."

From prostate.net

"In this new study, 82 men with moderate to severe symptoms of BPH plus sexual problems (e.g., erectile dysfunction or loss of libido) were assigned to take 320 mg daily of saw palmetto extract daily for eight weeks. At the end of the eight weeks, the International Prostate Symptom Score (IPSS) was significantly reduced by 51% and erectile dysfunction, libido, and other sexual functions had improved by an average of nearly 40%.


According to Dr. Eugen Riedi, MD, a urologist in Switzerland and the study's lead researcher, “This is one of the first therapies ever to show an improvement of BPH symptoms and of sexual dysfunctions at the same time.” Saw palmetto also was well tolerated and patient compliance was “excellent.”

The mechanism for SP to treat ED may be this

http://www.sciencedirect.com/science/article/pii/S0090429513001696