New here. Lurking for a while. Pretty sure my E2 is shot. Shitty docs. Here's my history.

[testguy53]

I've been on some sort of protocol for years now, and frankly I don't think it's ever been right. Started just after turning 26. I am now 30. I'll try my best to be short and sweet. I really just want help understanding why I feel so shitty. Also, any insights on why my acne was so bad would be helpful. Major questions in green text.

All Labs to Date, Chronological:

2014, Feb. 14th - Life feels shitty. Lifting weights feels shitty. I am totally not sexual. Had been on SSRIs about a year prior and never felt like I was back to me. So i thought I would investigate my T levels:

• T, Free = 0.91 L (Low)
  • Range = 0.95-4.30 ng/dL
• SHBG = 46
  • Range = 10-50 nmol/L
• Hematocrit = 44.3
  • Range = 38.5-50 %
• After this very first visit at a men's health clinic, they talked about options and I chose Clomid. I remember being a little worried that things were moving too fast. Did I really even need treatment? Would diet/exercise help? I'm only 26, but fairly healthy. Lifted weights. Although the reason I got tested was because my lifting was suffering. Oh well! Listen to the doctor, I said!
• If memory is right, things started getting better. Maybe some slight back acne. Strength returned in the gym.

2014, Apr. 11th:

• T, Free = 191.3 (High)
  • Range = 35.0-155.0 pg/mL
• SHBG = 39
  • Range = 10-50 nmol/L
• Hematocrit = 46.1
  • Range = 38.5-50.0 %
• T, Total = 931
  • Range = 250-1100 ng/dL
• FSH = 2.3
  • Range = 1.6-8.0 mIU/mL
• LH = 4.5
  • Range = 1.5-9.3 mIU/mL
• Estradiol (Quest Ultrasensitive LCMSMS order code 30289) = 36
  • Range: < OR = 39 pg/mL
• At this point they lowered my Clomid dose since it seemed to be working too well.

2014, June. 27th:

• T, Free = 146.5
  • Range = 35.0-155.0 pg/mL
• SHBG = 43
  • Range = 10-50 nmol/L
• Hematocrit = 46.5
  • Range = 38.5-50.0 (%)
• T, Total = 1051
  • Range = 250-1100 ng/dL
• FSH = 1.9
  • Range = 1.6-8.0 mIU/mL
• LH = 3.9
  • Range = 1.5-9.3 mIU/mL
• Estradiol (Quest Ultrasensitive LCMSMS order code 30289) = 51 (High)
  • Range: < OR = 39 pg/mL
• PSA, Total = 1.1
  • Range: < OR = 4.0 ng/mL
• At this point they just kept me on Clomid. Based on my notes nothing was done for my estrogen at this point.

2014, Oct. 3rd (Moved to new city, so new doc. Urologist now who came recommended from previous doc):

• T, Free = 18.8
  • 9.3-26.5 pg/mL
• SHBG = 53.2
  • Range = 16.5-55.9 nmol/L
• Hematocrit = 48.0
  • Range = 37.5-51.0 (%)
• T, Total = 1009
  • Range = 348-1197 ng/dL
• FSH = 2.3
  • Range = 1.5-12.4 mIU/mL
• LH = 7.6
  • Range = 1.7-8.6 mIU/mL
• Estradiol (Roche ECLIA methodology) = 44.8 (High)
  • Range: 7.6-42.6 pg/mL
• At this point they added in arimidex. Again, new doctor, but he seemed knowledgeable. Stayed on Clomid.

OK, typing this all out is taking way too long. I'm going to paste in screenshots for the rest:

2015, Jan. 19th:


2015, Aug. 7th:


2016, Jan. 22:


2016, Jul. 23rd:

• So pretty much up to this point I am getting shit for labs for the past 2 years. Looking back, my mood and strength in the gym were all over the place. But this doctor kept telling me my labs were good so I chalked it all up to work stress etc. It was at this point that I really started doing more of my own research and decided to switch doctors again. I stopped everything for a little while to let myself "cleanse" (feel free to laugh at that).
  
• I also decided I wanted to be on injections. I have had zero sex drive for quite a while at this point and I'm blaming Clomid.
  
• Also acne started getting a bit worse. Mostly on my back. Just tired of Clomid. Read too much bad stuff about it.

2017, Feb. 3rd - First time at new doctor. Another men's clinic/anti-aging place. It felt weird from the start. Lot's of rules about coming in at least once a week. No ability to do injections on my own if I didn't come to the office at least once a week. But they did frequent blood work so I thought it was a win:

• They try to put me on Test-Cyp 150mg per week, and eventually arimidex 0.25mg twice a week. I requested to start lower with 100mg per week and no arimidex to start. Also on 250 IUs HCG to help my balls. We split the dose into 2 injections every 3.5 days or so. I would do one at home and come in for the other.

2017, Feb. 27th

• Sometime around here, insane acne. Cystic all over my back. I try everything until I can't take it. See a derm. Awesome guy. Get on accutane. Best drug ever for me at least.

2017, Apr. 14th


2017, Jun. 19th

• At some point during this timeframe I am feeling a lot better. Injections are way better. We determine that 100mg is a little too high and I actually lower to 80 mg per week. STILL ON ARIMIDEX. Can't always get hard but using cialis. I figure things are fine. Having anxiety, but I've had that my whole life. So whatevs. Too nervous to push back because the Nurse Practitioner who sees me is a little intense.
  
• Acne is clearing. No real issues with Accutane. Just dry. Derm is OK with a low-and-slow regimine. Says it's better for me and skin can adjust more.
  
• Upped my HCG to 500 IUs per week.

2017, Sep. 1st:

• At this point I do more research on how the hell I am getting billed by this clinic. I figure out that Test-Cyp is dirt cheap with insurance and I'm pissed I'm paying this clinic special fees even with insurance. So I go to my Primary Care doc and ask if I can switch everything over to them. They say sure!
• Also, a new nurse at this men's clinic has no clue how to draw blood and stabs me in a tendon. That was the icing on the cake.
• I get my Rxs filled. Start injecting myself 20mg EOD Sub Q. On the alternate days I inject 250 IUs HCG Sub Q. I quit the arimidex and figured I would let myself get used to this new EOD dosing and get labs before I mess with estrogen.
• Acne pretty much gone. Wrapping up accutane to present day.
  
• I also added in a very low (13.5 IU) injection of Foliculin (FSH) along with my HCG. Read it can keep sperm up. Still on it now. It's cheap enough where i get it from figured it can't hurt. Could this be hurting me at all?

2017, Dec. 11th.

• First labs back from my PCP. Up to this point I am feeling the best I have ever felt. Erections. Morning wood. High sex drive. In the gym. Motivated.
  
• He tells me my estrogen came back high. I got back on arimidex .25 twice a week. Things have been getting worse since. Crazy anxiety lately. Obsessive thoughts and constant worry. No gym motivation. Can this caused by low E2?
  
• Finally realized that all this time NO ONE has EVER given me the Estradiol, Sensitive test. Finally got that done today. Want to see what it says. I want to quit Arimidex. I think that's the problem.
  
• Would an extra 20mg dose or two of Test-Cyp help drive my E2 level up a bit faster so I can stop suffering?

Thanks. I tried to keep my text as brief as possible. It's been a roller-coaster ride.

 

[Vince]

It seems like you should get the sensitive for men, like you had in your earlier labs and hopefully you'll be able to stop your or lower you AI dose.

 

[testguy53]

Thanks, Vince. Yeah I’ve cut out the arimidex for now until the sensitive test comes back. I’m hoping over the next week I start to feel better. Can someone point me to the most current comprehensive list of labs that I should be getting done? Thanks!

 

[CoastWatcher]

First of all, your doctor ran Total Estrogens, a lab test that provides no actionable information for your or your doctor. A waste of money, your money. To see where things stand ask your doctor for the following labs, or visit www.discountedlabs.com and run them on your own. Total and free testosterone, SHBG, estradiol/sensitive, (LC, MS/MS), DHT, DHEA, CBC, CMP, and prolactin. Don't adjust your testosterone dose hoping for a short-term gain, a boost in estradiol. Keep in mind that accutane can play havoc with your libido and erectile function. It doesn't happen for all men but does in many. Finally the "ultrasensitive" e2 test that was run at one point is LC, MS/MS - it's Quest's practice to call it ultrasensitive rather than sensitive.

 

[Vince]

Suggested Lab Tests and Questions Before and After Initiation of Testosterone Replacement
https://www.excelmale.com/forum/sho...-After-Initiation-of-Testosterone-Replacement

 

[testguy53]

Why didn't I post here sooner? You guys rock.