Low testosterone / low'ish estrogen

[Fr8man]

Hi all! First time poster looking for some expertise.

37 / m / 248 lb / 6'4 / %26 bf

Total T: 216 (286 - 802) ng/dL

Estrogen: 15 (11 - 44) pg/mL

I don't get it. What does it mean that estrogen is at the lower end when testosterone is also low?

I expected my estrogen to be high since I have ALL the symptoms - muscle mass is shot to oblivion, gut, carrying most of the fat on thighs, buttocks, belly and hips, depression, low tolerance to stress, no libido.

Should I ask them to repeat the test?

Thoughts?

EDIT: 2 years ago my estrogen was 32.6 (7.6 - 43.0) pg/mL...at the higher end of the reference rage.
And my testosterone was (and had been for a long time) smilar to now.
Nothing else changed in my lifestyle or diet. So why is Estrogen suddenly much lower?

 

[swoops36]

This seems right. Low T can mean low E, since there isn’t enough conversion. Symptoms seem like low T and low E to me

 

[DragonBits]

Total T: 216 (286 - 802) ng/dL

Estrogen: 15 (11 - 44) pg/mL

I don't get it. What does it mean?

I expected my estrogen to be high since I have ALL the symptoms - muscle mass is shot to oblivion, gut, carrying most of the fat on thighs, buttocks, belly and hips, depression, low tolerance to stress, no libido. Granted these symptoms could also be attributed to low t. But 2 years ago my estrogen was 34.17 (34.51 - 107.78) pg/mL...low.

Should I ask them to repeat the test?

Thoughts?

I am not sure why the dramatically different range for estrogen 2 years ago, and what was your total T two years ago, and are both of those the estrogen sensitive test?

But going on the ranges, your estrogen was below the bottom of the range two years ago, now it is ABOVE the bottom of the range, so it's actually higher now.

Your total T at Total T: 216 (286 - 802) ng/d is very low, lower than mine has ever been, and at a estrogen of 11 your E2 is higher than mine (< 5 (7.6 - 42.6) even though total T was 390.

It seems obvious your total T is the problem and your estrogen is normal to high considering your total T is only 216 pg/ml.

Fix your total T and then worry about everything else.

 

[DragonBits]

Thanks for your input. Weird. How did E get so low like this after being so high? If it's because of no conversion, then shouldn't that have been the case too in the past?

The past test was also done after years of being in the same state. So it's not like it had just happened and the e there was from previous excess t...I'd been on low t for a while.

It seems like the tests were done at two different labs, the ranges are dramatically different, so you can't compare the totals between labs without consideration of the range.

 

[Fr8man]

... are both of those the estrogen sensitive test?

Good question! The current result says Estrogen / Estradiol (CMIA). Not sure what the previous test was but I'm pretty sure it was estrogen.

Estrogen sensitive? What exactly is that and is it different than Estrogen / Estradiol?

But going on the ranges, your estrogen was below the bottom of the range two years ago, now it is ABOVE the bottom of the range, so it's actually higher now.

WOW! I can't believe I missed that. I don't know how I misread it. For some reason my brain was reading the previous test as being high estrogen. I guess I was really expecting my estrogen to be high and when I got the result back I was very surprised and made the previous test high estrogen in my head smh. Thanks for pointing it out. I would have probably never noticed. Makes sense now, sorta.

EDIT: Actually, it wasn't. Sorry I posted the wrong number. I just fixed it. It was at the higher end of the reference range.

Your total T at Total T: 216 (286 - 802) ng/d is very low, lower than mine has ever been, and at a estrogen of 11 your E2 is higher than mine (< 5 (7.6 - 42.6) even though total T was 390.

15 actually. Reference range 11-44.
So your e2 was below the reference range? And t was at the lower end of the reference range (normal)?

It seems obvious your total T is the problem and your estrogen is normal to high considering your total T is only 216 pg/ml.

So are you saying considering the level of my testosterone, my estrogen is actually high, even though it's at the lower end of the reference range?

Fix your total T and then worry about everything else.

If I were to exhaust every treatment out there to get my body to start producing by itself before starting TRT, what would the options be considering I'm secondary?

Appreciate your input!

 

[Vince Carter]

Note use of the wrong test for Estrogen, your past numbers in comparison don't matter, now.
And I'll second Dragonbits on the different labs and different lab ranges.

Youre just chasing your tail with this.

 

[Fr8man]

Note use of the wrong test for Estrogen.

Sorry. Not sure I understand. What do you mean by wrong test for estrogen?

 

[Cataceous]

Estradiol is made from testosterone. Testosterone is low, leading to low estradiol. It's that simple. Often overlooked is that low estradiol is associated with increased fat. Estradiol is not always the bogeyman that it's made out to be. It's also important for libido.

Don't worry about which estradiol test you used. It's low regardless.

 

[Vince]

You should have gave you the one for men. Sensitive estrogen LC/MS/MS.

I agree with the others, as your testosterone increases your estrogen will increase.

 

[Systemlord]

Total T: 216 (286 - 802) ng/dL

Estrogen: 15 (11 - 44) pg/mL

These numbers are really low, but some tests are missing. SHBG is another important one and should dictate a plan of action when it's time to start TRT. If you were to start TRT with an infrequent dosing schedule, estrogen would likely become a problem because of your high body fat percentage.

The Roche ECLIA methodology estrogen testing is not sensitive enough and picks up on other steroids and falsely elevates estrogen, the sensitive method (LC/MS/MS) doesn't have these limitations.

Your estrogen is on the low side, I had low estrogen when I was diagnosed with low testosterone, but that soon changed when I went on an inappropriate protocol and now estrogen was at 70, double the reference ranges and my high body fat had a lot to do with it.

I want to add that if SHBG is really low, an estrogen of 15 may not be as bad as it looks on paper because having low SHBG usually means a high free estrogen which allows you to get away with a lower estrogen value.

 

[Cataceous]

This excessive attention to the type of estradiol test is not helpful to @Fr8man at this time. It's not so important if these immunoassay tests are overstating the results a bit, given that they are already low.

What matters is that OP is very hypogonadal, even if SHBG were low, and has symptoms probably related both to low testosterone and to low estradiol. More complete testing should be done to rule out potentially causative factors, e.g. high prolactin, hypothyroidism, extreme vitamin D deficiency, etc. If nothing is found then some form of HRT/TRT is likely going to be needed. Weight loss may help some, but it would be rare to recover fully from such low numbers.
Testosterone Tests

 

[DragonBits]

Good question! The current result says Estrogen / Estradiol (CMIA). Not sure what the previous test was but I'm pretty sure it was estrogen.

Estrogen sensitive? What exactly is that and is it different than Estrogen / Estradiol?



WOW! I can't believe I missed that. I don't know how I misread it. For some reason my brain was reading the previous test as being high estrogen. I guess I was really expecting my estrogen to be high and when I got the result back I was very surprised and made the previous test high estrogen in my head smh. Thanks for pointing it out. I would have probably never noticed. Makes sense now, sorta.



15 actually. Reference range 11-44.
So your e2 was below the reference range? And t was at the lower end of the reference range (normal)?




So are you saying considering the level of my testosterone, my estrogen is actually high, even though it's at the lower end of the reference range?



If I were to exhaust every treatment out there to get my body to start producing by itself before starting TRT, what would the options be considering I'm secondary?

Appreciate your input!

I am not saying your E2 is HIGH in an absolute sense, only that the conversion of E2 from testosterone is high. If my total T was 216, my E2 would likely be 3-4, and when I was NOT on TRT my E2 was often too low to measure, which meant below 5 pg/ml.

If you are in the USA and have health insurance, my advice would be to go to a urologist or endocrinologist, they will investigate if there are any physical reasons for your low testosterone. But if they don't find any causes, they would very likely recommend TRT for you.

You could go to Defy Medical, but then you would need to private pay.

A doctor should do a standard battery of blood tests, Defy medical would recommend the following.

1. Comprehensive Metabolic Panel
2. CBC
3. Lipid Panel
4. Testosterone Free and Total
5. Estradiol Sensitive
6. DHEA-S
7. TSH
8. PSA
9. LH
10. Sex Hormone Binding Globulin
11. IGF-1

You could read this forum, read Nelson's free book on TRT, educate yourself, but with a total T that low nearly any doctor would put you on TRT. As to what protocol they recommend, that is why you might want to educate yourself as a check on what a doctor tells you to do.

My last Estrogen sensitive test I was at 25.5 pg/ml (8.0-35.0) , middle range, not high nor low.

Estrogen is derived in men from testosterone. I typically convert 1.9% - 2.45% of my T to E2. You are converting almost 7% of your T to E2, that is high.

A E2 of 15 is NOT high in an absolute sense, but that is a high percentage to convert, unless maybe you are also taking a lot of dhea or clomid.

If the percentage of conversion stayed the same, you would have very high E2 IF YOU TOOK TRT AND the percentage stayed the same.

 

[Fr8man]

You should have gave you the one for men. Sensitive estrogen LC/MS/MS.

I agree with the others, as your testosterone increases your estrogen will increase.

Could you have a look at the OP edit please? Why the change? If thats the case, then why was estrogen high before when test was very low?

 

[Fr8man]

These numbers are really low, but some tests are missing. SHBG is another important one and should dictate a plan of action when it's time to start TRT. If you were to start TRT with an infrequent dosing schedule, estrogen would likely become a problem because of your high body fat percentage.

The Roche ECLIA methodology estrogen testing is not sensitive enough and picks up on other steroids and falsely elevates estrogen, the sensitive method (LC/MS/MS) doesn't have these limitations.

Your estrogen is on the low side, I had low estrogen when I was diagnosed with low testosterone, but that soon changed when I went on an inappropriate protocol and now estrogen was at 70, double the reference ranges and my high body fat had a lot to do with it.

I want to add that if SHBG is really low, an estrogen of 15 may not be as bad as it looks on paper because having low SHBG usually means a high free estrogen which allows you to get away with a lower estrogen value.

This excessive attention to the type of estradiol test is not helpful to @Fr8man at this time. It's not so important if these immunoassay tests are overstating the results a bit, given that they are already low.

What matters is that OP is very hypogonadal, even if SHBG were low, and has symptoms probably related both to low testosterone and to low estradiol. More complete testing should be done to rule out potentially causative factors, e.g. high prolactin, hypothyroidism, extreme vitamin D deficiency, etc. If nothing is found then some form of HRT/TRT is likely going to be needed. Weight loss may help some, but it would be rare to recover fully from such low numbers.
Testosterone Tests

I am not saying your E2 is HIGH in an absolute sense, only that the conversion of E2 from testosterone is high. If my total T was 216, my E2 would likely be 3-4, and when I was NOT on TRT my E2 was often too low to measure, which meant below 5 pg/ml.

If you are in the USA and have health insurance, my advice would be to go to a urologist or endocrinologist, they will investigate if there are any physical reasons for your low testosterone. But if they don't find any causes, they would very likely recommend TRT for you.

You could go to Defy Medical, but then you would need to private pay.

A doctor should do a standard battery of blood tests, Defy medical would recommend the following.

1. Comprehensive Metabolic Panel
2. CBC
3. Lipid Panel
4. Testosterone Free and Total
5. Estradiol Sensitive
6. DHEA-S
7. TSH
8. PSA
9. LH
10. Sex Hormone Binding Globulin
11. IGF-1

You could read this forum, read Nelson's free book on TRT, educate yourself, but with a total T that low nearly any doctor would put you on TRT. As to what protocol they recommend, that is why you might want to educate yourself as a check on what a doctor tells you to do.

My last Estrogen sensitive test I was at 25.5 pg/ml (8.0-35.0) , middle range, not high nor low.

Estrogen is derived in men from testosterone. I typically convert 1.9% - 2.45% of my T to E2. You are converting almost 7% of your T to E2, that is high.

A E2 of 15 is NOT high in an absolute sense, but that is a high percentage to convert, unless maybe you are also taking a lot of dhea or clomid.

If the percentage of conversion stayed the same, you would have very high E2 IF YOU TOOK TRT AND the percentage stayed the same.

These were my results a couple of years ago.

Hormones

testosterone, total
220 (286 - 802) ng/dL

Testosterone, free
34.17 (34.51 - 107.78) pg/mL

Testosterone, bioavailable
138 (138 - 430) ng/dL

SHBG
16.0 (14.5 - 48.4) nmol/L

E2 (Estrogen)
32.6 (7.6 - 43.0) pg/mL

LH
4.0 (1.7 - 8.6) mIU/mL

FSH
3.5 (1.5 - 12.4) mIU/mL

prolactin
16.7 (3.46 - 19.4) ng/mL

Cortisol (AM)
8.30 (3.7 - 19.4) ug/dL

igf-1
160.3 (150 - 350) ng/mL

Thyroid Panel

TSH
4.54 (0.27 - 4.20) uIU/mL

t3, free
3.6 (2.0 - 4.4) pg/mL

T4, free
1.24 (0.93 - 1.70) ng/dL

Lipid panel

Cholesterol
216.1 mg/dL
Desirable: <200
Borderline: 200 - 239
High risk: >240

HDL
32.7 mg/dL
Low: <130
High: >60

LDL
139.5 (<130) mg/dL

VLDL
27.90 (<40.0) mg/dL

Tg (Triglyceride)
219.5 (<200) mg/dL

CBC

HB (Hemoglobin)
12.5 (14 - 18) g/dL

Hematocrit
45.1 (42 - 50) %

RBC
4.79 (4.5 - 6.2) x10*6/uL

WBC
5.60 (5.0 - 10.0) x10*3/uL

WBC & diff / Lymphocyte
40.6 (20 - 40) %

MCH
26.0 (27 - 31) pg

MCHC
29.5 (32 - 36) g/dL

MCV
94.2 (80 - 95) fL

RDW
10.1 (2 - 20) %

Platelet count
250.0 (150 - 400) x10_3/uL

ESR
(up to 10) mm/hr

Clotting time
(2 - 6) mins

Bleeding time
(1 - 6) mins

CMP

-General

Glucose (fasting)
98 (65 - 99) mg/dL

Calcium
8.60 (8.40 - 10.2) mg/dL

-Liver

ALP
82.0 (40 - 130) U/L

ALT (SGBT)
40.2 (Up to 41) U/L

AST (SGOT)
24.9 (Up to 40) U/L

Bilirubin, total
0.80 (up to 1.1) mg/dL

Bilirubin, direct
0.20 (up to 0.25) mg/dL

Bilirubin, indirect
0.60 (0.1 - 0.75) mg/dL

-Kidney

Urea Nitrogen (BUN)
43.5 (<50) mg/dL

Creatinine
0.862 (<1.1) mg/dL

-Electrolytes

Potassium
4.60 (3.60 - 5.5) mmol/L

Sodium
141.0 (135.0 - 152.0) mmol/L

Chloride
99.0 (98.0 - 110.0) mmol/L

-Proteins

Albumin
4.40 (3.6 - 4.6) g/dL

Protein, total
7.30 (6.4 - 8.3) g/dL

 

[Vince]

I see you have a very high TSH. You may want to dig deeper into your thyroid. I would have your reverse T3 checked it also both antibodies.

 

[Cataceous]

Apparent inconsistencies in lab work are something we have to live with. Here it's made more likely by the long elapsed time between tests and the use of different labs. It may never be explained, but going forward I would retest estradiol, and if you do that then throw in testosterone, SHBG and the additional thyroid tests Vince suggests.

Your Tru-T calculated free testosterone from two years ago is 7 ng/dL. This is abysmal, considering the healthy range is 16-31. I had similarly low free testosterone before I started TRT, and I was miserable. Don't wait another two years to take action and improve your situation.

 

[DragonBits]

These were my results a couple of years ago.

Hormones

testosterone, total
220 (286 - 802) ng/dL

Testosterone, free
34.17 (34.51 - 107.78) pg/mL

Testosterone, bioavailable
138 (138 - 430) ng/dL

SHBG
16.0 (14.5 - 48.4) nmol/L

E2 (Estrogen)
32.6 (7.6 - 43.0) pg/mL

LH
4.0 (1.7 - 8.6) mIU/mL

FSH
3.5 (1.5 - 12.4) mIU/mL

prolactin
16.7 (3.46 - 19.4) ng/mL

Cortisol (AM)
8.30 (3.7 - 19.4) ug/dL

igf-1
160.3 (150 - 350) ng/mL

Thyroid Panel

TSH
4.54 (0.27 - 4.20) uIU/mL

t3, free
3.6 (2.0 - 4.4) pg/mL

T4, free
1.24 (0.93 - 1.70) ng/dL

Lipid panel

Cholesterol
216.1 mg/dL
Desirable: <200
Borderline: 200 - 239
High risk: >240

HDL
32.7 mg/dL
Low: <130
High: >60

LDL
139.5 (<130) mg/dL

VLDL
27.90 (<40.0) mg/dL

Tg (Triglyceride)
219.5 (<200) mg/dL

CBC

HB (Hemoglobin)
12.5 (14 - 18) g/dL

Hematocrit
45.1 (42 - 50) %

RBC
4.79 (4.5 - 6.2) x10*6/uL

WBC
5.60 (5.0 - 10.0) x10*3/uL

WBC & diff / Lymphocyte
40.6 (20 - 40) %

MCH
26.0 (27 - 31) pg

MCHC
29.5 (32 - 36) g/dL

MCV
94.2 (80 - 95) fL

RDW
10.1 (2 - 20) %

Platelet count
250.0 (150 - 400) x10_3/uL

ESR
(up to 10) mm/hr

Clotting time
(2 - 6) mins

Bleeding time
(1 - 6) mins

CMP

-General

Glucose (fasting)
98 (65 - 99) mg/dL

Calcium
8.60 (8.40 - 10.2) mg/dL

-Liver

ALP
82.0 (40 - 130) U/L

ALT (SGBT)
40.2 (Up to 41) U/L

AST (SGOT)
24.9 (Up to 40) U/L

Bilirubin, total
0.80 (up to 1.1) mg/dL

Bilirubin, direct
0.20 (up to 0.25) mg/dL

Bilirubin, indirect
0.60 (0.1 - 0.75) mg/dL

-Kidney

Urea Nitrogen (BUN)
43.5 (<50) mg/dL

Creatinine
0.862 (<1.1) mg/dL

-Electrolytes

Potassium
4.60 (3.60 - 5.5) mmol/L

Sodium
141.0 (135.0 - 152.0) mmol/L

Chloride
99.0 (98.0 - 110.0) mmol/L

-Proteins

Albumin
4.40 (3.6 - 4.6) g/dL

Protein, total
7.30 (6.4 - 8.3) g/dL

Your results two years ago for E2 (estrogen) and TSH were "odd".

E2 should have been lower, and TSH was too high. No reason I can think of why E2 was in the normal range when it should have been lower. Your recent results for E2 makes senses given your low testosterone.

TSH being high could have been a one time thing, or it could indicate sub-clinical hypothyroidism. You should either recheck just TSH, or do a full thyroid panel that includes

Thyroid antithyroglobulin antibody (ATA)
Thyroid peroxidase antibody (TPO)
rT3

along with the more common TSH, Total Thyroxine (T4) Free Thyroxine (T4), Free Tri-iodothyronine (T3)

Your testosterone has consistently been very low. That sticks out as both consistent and in need of being fixed, so I would focus on those two (T and TSH), with testosterone being the one that needs to be fixed. Though something could have caused a drop in total T, so a doctor would want to investigate any possible reasons.

For me, I know my total T had been on the low side of normal ever since I first measured it 24 years ago, but it was ~350 ng/dl and remained there until I started TRT, which is a lot higher than yours at 220 ng/dl.

I would also add in HS-c-reactive protein to check for general inflammation.

 

[Systemlord]

I never seen a guy feel good with a TSH as high as yours, no rT3 testing which could explain elevated TSH. This TSH score is in hypothyroidism territory.

 

[Fr8man]

Don't wait another two years to take action and improve your situation.

Definitely!

If you are don't mind me asking, how long have you been on TRT? How were you before trt and now on it? Physically and psychologically.

 

[Fr8man]

I see you have a very high TSH. You may want to dig deeper into your thyroid. I would have your reverse T3 checked it also both antibodies.

Apparent inconsistencies in lab work are something we have to live with. Here it's made more likely by the long elapsed time between tests and the use of different labs. It may never be explained, but going forward I would retest estradiol, and if you do that then throw in testosterone, SHBG and the additional thyroid tests Vince suggests.

Your Tru-T calculated free testosterone from two years ago is 7 ng/dL. This is abysmal, considering the healthy range is 16-31. I had similarly low free testosterone before I started TRT, and I was miserable. Don't wait another two years to take action and improve your situation.

Your results two years ago for E2 (estrogen) and TSH were "odd".

E2 should have been lower, and TSH was too high. No reason I can think of why E2 was in the normal range when it should have been lower. Your recent results for E2 makes senses given your low testosterone.

TSH being high could have been a one time thing, or it could indicate sub-clinical hypothyroidism. You should either recheck just TSH, or do a full thyroid panel that includes

Thyroid antithyroglobulin antibody (ATA)
Thyroid peroxidase antibody (TPO)
rT3

along with the more common TSH, Total Thyroxine (T4) Free Thyroxine (T4), Free Tri-iodothyronine (T3)

Your testosterone has consistently been very low. That sticks out as both consistent and in need of being fixed, so I would focus on those two (T and TSH), with testosterone being the one that needs to be fixed. Though something could have caused a drop in total T, so a doctor would want to investigate any possible reasons.

For me, I know my total T had been on the low side of normal ever since I first measured it 24 years ago, but it was ~350 ng/dl and remained there until I started TRT, which is a lot higher than yours at 220 ng/dl.

I would also add in HS-c-reactive protein to check for general inflammation.

Thank you so much for your feedback guys. Here is blood work taken a couple of days ago. I just St got done putting the results together.

I did do thyroid antibodies after the blood work above. I can't find the results but everything was OK there.

Sorry, testosterone is supposed to be pink...