Persistent Low E2 symptoms lasting long after crash- Possible Solution or a little relief.

[KovaUkko]

Hello. Do you think this could also come from serm usage? I took tamoxifen for couple of days and I am now on trt. I have all the symptoms of low e2 even tho it's ok in the bloods. Maybe I have to try estradiol valerate also. How much did it improve your sexual function?

 

[zancek0]

Hello. Do you think this could also come from serm usage? I took tamoxifen for couple of days and I am now on trt. I have all the symptoms of low e2 even tho it's ok in the bloods. Maybe I have to try estradiol valerate also. How much did it improve your sexual function?

Dont try anything just yet. Explain in detail your history. When did you take tamoxifen, how much, when did the symptoms start, when did you start TRT and so on. Mention anything that might be useful.

 

[KovaUkko]

Dont try anything just yet. Explain in detail your history. When did you take tamoxifen, how much, when did the symptoms start, when did you start TRT and so on. Mention anything that might be useful.

This my post I just made:
Hello.

So my doctor gave me tamoxifen for low t and I only took 5 pills (20mg) eod. Didn’t help with the symptoms only gave me severe loss of libido, ed and anhedonia. Then we changed to sustanon 250mg every 10 days. My doctor said symptoms of tamoxifen will go away in “couple of weeks” And I know the half life is pretty long, but now after 6 weeks off tamoxifen and 4 susta injections later my libido, ed, anhedonia have just gone gradually worse over the time. I now can’t even have erection with ed meds. I could still get hard like 2 weeks ago with cialis. It’s fucking hopeless now. No sensitivity down there whatsoever.

I have red everything I could get my hands on off this. I have red stories were people mostly get better in 2-4 weeks off serm and some stories where they get better in months. One guy who still gives me hope said it took about 6-8 months with clomid. But the thing is I just don’t understand how can this keep getting worse and worse. I feel totally castrated now, didn’t feel like this weeks ago. Total rock bottom atm. All my symptoms yell low e2 but that was normal in the blood work I had 2 weeks ago. Trt was also fine. Besides serm:s only block your e2 and not destroy it like AI as far as I know.

I will now today start injecting sustanon eod like it’s supposed to. One guy who has helped me with this also said that I should try hcg and proviron and with eod pinning they should do to the trick. No idea where to get them but if this doesn’t improve I will try to get it somewhere. I will walk to the biggest guy in the gym and ask.

I have my docs appointment in two days. Same guy who gave this shit. He was supposed to be the best there is for men’s health in my country. Didn’t tell me anything about these kind of sides that take this long (permanent?).

I know there might be hope, but every day feeling like putting I bullet to your head isn’t making this anymore easy.

Anybody know anything about this?

Maybe this is Post AI Major Dysfunction (PAMD) even tho it was serm? Would taking estradiol valerate help?

I am so fucking tired and angry.

Sorry for the rant.

 

[KovaUkko]

Dont try anything just yet. Explain in detail your history. When did you take tamoxifen, how much, when did the symptoms start, when did you start TRT and so on. Mention anything that might be useful.

Also I can't really sleep and feel no hunger and sweat a lot less then before. But my dick is my biggest issue.
I know I might be being hasty but fuck me. My patience is already at limits and I have only gone throught this for 6 weeks.

 

[zancek0]

@KovaUkko
Yeah man, I know exactly how this is. I actually fucked up because I was impatient too and started HCG way too soon after crashing with aromasin. Now I know it wasn't a smart decision - it actually impeded my recovery. Ugh, I'd slap my past self a few times.

Have you used/do you use finasteride, ssris, heavy duty antibiotics/antifungals, saw palmetto or anything like that? Also, why did you go on TRT? Did you feel bad?

Anyway - I'd say you definitely dont have PAMD. I understand your frustration but you'll hate yourself if you do anything too hasty right now and get even worse.

This is how I see the situation.
The doctor made a big mistake starting you on sustanon immediately after going off tamoxifen. Well, of course, firstly, he made a mistake on putting you on tamoxifen. How stupid can doctors get, ffs. It's ERa and ERb antagonist, likely even an aromatase inhibitor and has some progestinic activity via its metabolites. Tamoxifen blocked your E2 signalling by binding to both ERa and ERb, hence the symptoms. This is why clomid is a bit safer for hypogonadal patients (still not an optimal approach, though) - it's only antagonistic to ERb, and not ERa for which it works as an agonist, in low E2 environment (which you likely were with low TT). I think adding sustanon potentiated them because it only drastically enhanced androgen activity which strongly blocks E2 signalling. I don't think staying on sustanon will do you any good. It's an awkward protocol and difficult to control in terms of evaluating markers on blood tests.

The potential for full recovery is 100% in cases like yours, in my opinion. It might take some time, though (months). If I were you, I'd try to get blood tests done for this: tt, free t, e2, prog, shbg, dht (!!), prolactin, cortisol, thyroid panel. But these tests must be done on a steady protocol. If you can get them for free in 2 days through your doc then try to get them. But if you cant it only makes sense to get them done after being on a steady protocol with more frequent injections or while being stabilized off TRT (so about 1.5-2 months off TRT). Dont mess around with hcg and serms yet. And no proviron - it will make you suicidal. After you get the tests done I can offer some advice on how to approach this issue (if you dont get better spontaneously till then).

This is only my opinion.

(Oh, to answer your question: E2 val will help but it wont be a cure, just a bandaid.)

 

[KovaUkko]

@KovaUkko
Yeah man, I know exactly how this is. I actually fucked up because I was impatient too and started HCG way too soon after crashing with aromasin. Now I know it wasn't a smart decision - it actually impeded my recovery. Ugh, I'd slap my past self a few times.

Have you used/do you use finasteride, ssris, heavy duty antibiotics/antifungals, saw palmetto or anything like that? Also, why did you go on TRT? Did you feel bad?

Anyway - I'd say you definitely dont have PAMD. I understand your frustration but you'll hate yourself if you do anything too hasty right now and get even worse.

This is how I see the situation.
The doctor made a big mistake starting you on sustanon immediately after going off tamoxifen. Well, of course, firstly, he made a mistake on putting you on tamoxifen. How stupid can doctors get, ffs. It's ERa and ERb antagonist, likely even an aromatase inhibitor and has some progestinic activity via its metabolites. Tamoxifen blocked your E2 signalling by binding to both ERa and ERb, hence the symptoms. This is why clomid is a bit safer for hypogonadal patients (still not an optimal approach, though) - it's only antagonistic to ERb, and not ERa for which it works as an agonist, in low E2 environment (which you likely were with low TT). I think adding sustanon potentiated them because it only drastically enhanced androgen activity which strongly blocks E2 signalling. I don't think staying on sustanon will do you any good. It's an awkward protocol and difficult to control in terms of evaluating markers on blood tests.

The potential for full recovery is 100% in cases like yours, in my opinion. It might take some time, though (months). If I were you, I'd try to get blood tests done for this: tt, free t, e2, prog, shbg, dht (!!), prolactin, cortisol, thyroid panel. But these tests must be done on a steady protocol. If you can get them for free in 2 days through your doc then try to get them. But if you cant it only makes sense to get them done after being on a steady protocol with more frequent injections or while being stabilized off TRT (so about 1.5-2 months off TRT). Dont mess around with hcg and serms yet. And no proviron - it will make you suicidal. After you get the tests done I can offer some advice on how to approach this issue (if you dont get better spontaneously till then).

This is only my opinion.

(Oh, to answer your question: E2 val will help but it wont be a cure, just a bandaid.)

Hey man thank you for your reply. And no none of those drugs never. I went to trt beacause I had felt like shit for years and my numbers were low. Not as shit as now tho. And so you think I should make my trt protocol more stable like I am doing right now and inject little EOD? So do you know what it takes to feel better, do I just have to wait till my e2 singaling gets normal with steady protocol? I am just wondering how can it only get worse over time but maybe it is the shitty sustanon protocol.

 

[zancek0]

Hey man thank you for your reply. And no none of those drugs never. I went to trt beacause I had felt like shit for years and my numbers were low. Not as shit as now tho. And so you think I should make my trt protocol more stable like I am doing right now and inject little EOD? So do you know what it takes to feel better, do I just have to wait till my e2 singaling gets normal with steady protocol? I am just wondering how can it only get worse over time but maybe it is the shitty sustanon protocol.

You're young (saw your profile) so low test levels and feeling shitty would be likely due to some nutrient deficiency. Using TRT can be avoided by making some lifestyle changes, better diet, exercise etc., specific mineral/vitamin supplementation (I know, all sounds bullshit but it's true). It's possible you're dealing with some other underlying issues not yet discovered. Ask doc to check vit D levels, iron and ferritin, thyroid panel, b12 and b9 levels etc. But ok, let's focus on where you are atm.

Sustanon is a kind of rollercoaster protocol. It's not stable - you get days of intense androgenic activity on shot days which gradually decrease until next shot day comes. I'd go with enan or cyp every other day or every three days. Maybe you can start with cca 70mg/week. This is a low dose that might not work since it's possible that you're not gonna aromatase sufficiently. So maybe 120mg/week might work better for your case. You're likely gonna experience heavy anxiety on this for first few weeks, though. I think 70mg/week is worth trying first, giving it a go for at least one month if you're intent on staying on TRT.
In crude terms, yeah, I think it's a matter of getting back sufficient E2 signalling. And steady protocol is atm the only way to know where you are at in terms of proper hormonal balance/signaling.
I mean, in my opinion you should go off TRT. But that will suck very much. Especially because you probably want to avoid SERMs now and HCG is kinda unpredictable. Might as well try TRT first. Update us with what your doc will say.

 

[KovaUkko]

You're young (saw your profile) so low test levels and feeling shitty would be likely due to some nutrient deficiency. Using TRT can be avoided by making some lifestyle changes, better diet, exercise etc., specific mineral/vitamin supplementation (I know, all sounds bullshit but it's true). It's possible you're dealing with some other underlying issues not yet discovered. Ask doc to check vit D levels, iron and ferritin, thyroid panel, b12 and b9 levels etc. But ok, let's focus on where you are atm.

Sustanon is a kind of rollercoaster protocol. It's not stable - you get days of intense androgenic activity on shot days which gradually decrease until next shot day comes. I'd go with enan or cyp every other day or every three days. Maybe you can start with cca 70mg/week. This is a low dose that might not work since it's possible that you're not gonna aromatase sufficiently. So maybe 120mg/week might work better for your case. You're likely gonna experience heavy anxiety on this for first few weeks, though. I think 70mg/week is worth trying first, giving it a go for at least one month if you're intent on staying on TRT.
In crude terms, yeah, I think it's a matter of getting back sufficient E2 signalling. And steady protocol is atm the only way to know where you are at in terms of proper hormonal balance/signaling.
I mean, in my opinion you should go off TRT. But that will suck very much. Especially because you probably want to avoid SERMs now and HCG is kinda unpredictable. Might as well try TRT first. Update us with what your doc will say.

Hello man. Yeah can't really go off trt. My life was hell before also. My doc said that it can't be tamoxifen anymore and the reason for this is that trt has just not kicked in yet. I tried to say that I am just going worse and worse over the 6 weeks, but didn't really explain or say anything about that. Feeling kinda stuck. Even tho I know there is hope I am really not sure if I have the strength to keep living like this in constant uncertainty and fear. And everything was checked many times before going on trt and I also tried everything else. There was nothing else wrong.

 

[zancek0]

Hello man. Yeah can't really go off trt. My life was hell before also. My doc said that it can't be tamoxifen anymore and the reason for this is that trt has just not kicked in yet. I tried to say that I am just going worse and worse over the 6 weeks, but didn't really explain or say anything about that. Feeling kinda stuck. Even tho I know there is hope I am really not sure if I have the strength to keep living like this in constant uncertainty and fear. And everything was checked many times before going on trt and I also tried everything else. There was nothing else wrong.

There can be underlying issues for which contributing factors most doctors don't care to look for. Typical tests that doctors do can reveal some hints if a competent doctor can interpret them correctly. The fact that you felt like shit is an evidence enough that something was off. And low test levels are usually just a symptom of that. I am most sure you didn't try everything else. That doesn't matter now. You're in a different shithole now. Which is temporary. I know how terrible it is to live like this. It seems that nothing can justify life. But you'll be looking back to these moments in 4 months and feel proud on yourself for managing to push through it.
This doc is useless. Try a better protocol.

 

[KovaUkko]

There can be underlying issues for which contributing factors most doctors don't care to look for. Typical tests that doctors do can reveal some hints if a competent doctor can interpret them correctly. The fact that you felt like shit is an evidence enough that something was off. And low test levels are usually just a symptom of that. I am most sure you didn't try everything else. That doesn't matter now. You're in a different shithole now. Which is temporary. I know how terrible it is to live like this. It seems that nothing can justify life. But you'll be looking back to these moments in 4 months and feel proud on yourself for managing to push through it.
This doc is useless. Try a better protocol.

Thank you for all the answers man. I am still just clueless because it really just doesn't make sense to me. Like these should not work like this. Everywhere it says serms don't do any permanent damage and my hormones were ok 2 weeks ago. It's like PSSD but without any real "reason" really. Like I should have something, some libido atleast. Is it really that my body just can't singal e2 anymore or what. Even if my trt protocol is shitty I would assume I have atleast SOMETHING.

 

[zancek0]

Thank you for all the answers man. I am still just clueless because it really just doesn't make sense to me. Like these should not work like this. Everywhere it says serms don't do any permanent damage and my hormones were ok 2 weeks ago. It's like PSSD but without any real "reason" really. Like I should have something, some libido atleast. Is it really that my body just can't singal e2 anymore or what. Even if my trt protocol is shitty I would assume I have atleast SOMETHING.

PSSD is a way to describe a set of symptoms induced specifically by SSRIs. Many conditions have similar symptoms. Even some long covid cases have symptoms like that. You were predisposed by something so that you reacted this way to few pills of tamox. Don't worry too much, it's reversible.
TRT makes many people feel worse. Really. Worse than before starting. The idea that everyone should feel good on TRT is ridiculous. Using hormones induces a whole range of compensations in the body. Your electrolyte balance might get very disrupted and you're gonna end up feeling lethargic and depressed. Iron metabolism gets disrupted, as another example. Anyways, what I'm trying got say is - don't get too discouraged about TRT not working and actually making your life even worse. A good protocol might make it much better but this is not a guarantee. I think that using exogenous hormones is something that comes last after other stuff has been tried without success. You'll get better on a steadier protocol but I believe your gonna get much better on protocols that don't involve using hormones. I'll send you a link in DM.

 

[RN2PA0611]

Hey - I suffered for years, with low E2 symptoms and normal to high levels of E2....

I m doing Estradiol Valerate injections. I had tried the cream, and found it to be mostly insufficient, or the dose was too low in the cream. From what I have read is that the Oral Estradiol Valerate gets into your liver and can cause issues and not that much actually gets into your system.

Today I am doing a lot better. I have adjusted my protocol last week, I was doing injections of Testosterone-CYP 90mg/week (30mgs M,W,F), to Testosterone-CYP 70mg every 3 days. This seems to be working a lot better, I may adjust the amount a little lower or keep it the same and do injections of test every 4 days. This is more of an art than one would think. I also adjusted my Estradiol Valerate injections from 2mg per day to 3mg per day. 2mg wasn't dong it, but that was also with injections every MWF so I want to give it a few weeks to see if I can lower the Estradiol Valerate back down to 2mg per day.

I will add that I also got back into the gym by adding Estradiol Valerate injections, it has made all the difference in the world. Before during a workout I would start to feel like complete garbage, and I wasn't sweating or over sweating, and my workouts sucked, it was pointless. No strength no drive, no nothing. For the past week it has been great. Some symptoms come back after a workout but usually go away after a few hours after some heavy lifting. I will say that over time I can feel some of the symptoms coming back, its like my body is almost getting rid of the estrogen.

I want to do some blood tests hours before my shot of Estradiol Valerate and then hours later to see what if anything has changed. My hypothesis is that the addition of Estradiol Valerate maybe increasing my SHBG thus giving the increase levels something to bind with, and that over time it lowers for some reason. Again just a hypothesis, as I have had pretty high E2 levels on the sensitive test yet the symptoms never went away What was notable durning these times is that my SGBG was around 4 or 5 L (range is 10 - 50). I have read that the introduction of external Estrogen can raise your SHBG levels over time

Mty symptoms are / were

Dehydration (Still present, but not thirsty weird)
Constipation (Big improvement)
Skin changes; pale gray-looking skin / Extremely dry skin. (Big improvement)
Brain fog / Activities took twice as long to complete.
Bloating / Gas (Big improvement)
Nausea (Comes and goes, maybe related to dehydration)
Metallic Taste in Mouth (Gone)
GI Issues (Big improvement)
Body odor changes (Still Present)
Changes in taste and smell (Big improvement)
Loss of Drive / Pleasure (Big improvement)
Indecisive / Unable to make decisions / Trouble concentrating (Big improvement)
Weak / No strength (Big improvement)
Testicular size changes (Tight to my body when symptoms are really bad) (Big improvement)
Lack of trust for others; jealousy, that bears no relation to reality (Gone)
Weight gain / Water retention / Bloated face (Big improvement)
Body temperature changes, early evening would get very hot and red faced. (Gone)
AM Sensitivity to cold temps. (Usually I run rather warm) (Barley Present)
Eye fatigue (eyes seem more tired, dark circles) Floaters (Big improvement)
Loss of vascularity (Big improvement)
Loss of muscle definition (Big improvement)
Decreased sexual libido /Sexual dysfunction / loss of erections. (Minor Improvement)
Tingling in hands (Big improvement)
Over sweating during activities / Not sweating (Big improvement)
Insomnia (Still Fing present)
Shaking / Trembling (Gone)
Its like a Constant Tension within my body (Gone)
Slow Healing (Still on going)
Fatigue along the lines of sleepiness (Gone)
Hypersomnia (sleeping too much and too often) (Gone)

As you can se there has been a big improvement, and that I have been able to add more testosterone, thus eliminating most symptoms that low t causes. All this is still in its infancy stages as I want to be able to take a therapeutic testosterone dose and not have any low e@ symptoms.

The two symptoms that have not seen any changes are my appetite and the impact drinking alcohol has on me. I failed to mention these before as they just don't seem that important compared to the others, and at best are a minor inconvenience when looking at the bigger picture.

My appetite is still barley existent and alcohol does not have a the same affect if you will it once had before the crash. It actually takes a shit load more for me to feel any cognitive impact from alcohol, I can drink for hours and barley feel it, even though my BAC goes up, the impact is not there. Hangovers are a lot worse, again I think its just aggravating the dehydration of low E2.

Sorry for the extremely long reply just wanted to be as transparent as possible as this has crippled my life for years, personally and professionally. The amount of issues this has cost me would make most people gargle with drano.

This is amazing info. I have about 80% of the symptoms you describe. I was abusing AI's for almost 2 years in addition to donating blood regularly. Looking back, I felt and looked good with my E2 in the 30s. Now I'm lucky to be in the 20s and feel and look like shit.
By chance, did your strength significantly decrease even when adding more testosterone? And did all of your muscles feel pumped up?

 

[RAS]

This is amazing info. I have about 80% of the symptoms you describe. I was abusing AI's for almost 2 years in addition to donating blood regularly. Looking back, I felt and looked good with my E2 in the 30s. Now I'm lucky to be in the 20s and feel and look like shit.
By chance, did your strength significantly decrease even when adding more testosterone? And did all of your muscles feel pumped up?

Yes I lost a lot of strength, but I also tossed the muscle pump, I could barley get a pump in the gym. Now as of recently I found that I had elevated Homocysteine levels, and high MCH which indicates a b12 deficiency. Its also to be noted that low E2 causes elevated Homocysteine levels, and estrogen lowers Homocysteine levels, which explains why I felt better taking estrogen. So I would suggest getting your Homocysteine levels checked

 

[RN2PA0611]

Yes I lost a lot of strength, but I also tossed the muscle pump, I could barley get a pump in the gym. Now as of recently I found that I had elevated Homocysteine levels, and high MCH which indicates a b12 deficiency. Its also to be noted that low E2 causes elevated Homocysteine levels, and estrogen lowers Homocysteine levels, which explains why I felt better taking estrogen. So I would suggest getting your Homocysteine levels checked

Thanks for the reply. Had b12 checked recently and it was mid range. I'll request the homocysteine levels. I think I described the muscle pump incorrectly. What I should have said was my entire body gets super tight and stiff if I pin over about 0.2mL test.

 

[alternative_past]

Yes I lost a lot of strength, but I also tossed the muscle pump, I could barley get a pump in the gym. Now as of recently I found that I had elevated Homocysteine levels, and high MCH which indicates a b12 deficiency. Its also to be noted that low E2 causes elevated Homocysteine levels, and estrogen lowers Homocysteine levels, which explains why I felt better taking estrogen. So I would suggest getting your Homocysteine levels checked

How is your pump now?