Seeking feedback on bloodwork. ED and Low Libido Issues

[SPapa]

So I have been lurking on here for about 3 months. First off, thanks to Nelson and so many others for great information. Nelson's several posts about ED and low libodo caused me to walk in to my doc a couple of weeks ago with a long list of additional tests I wanted to run. Now, my doctor is specifically a "Men's clinic" that was born a few years back when TRT started gaining popularity. There are several branches of this office here in Phoenix. From other's experiences here, I would rate mine at better than average. Probably not great, but ok.

Background: 42 year old male. 5'11", Greek family origin. Currently 235lbs. Old GP doc started me on a TRT cream about 2 years ago with almost zero improvement with fatigue, ED and libido. Back then I was at ~200ng/dL. Did not test again after several weeks on cream. I knew it wasn't doing anything and also had a doc that was just taking a shot in the dark. Two years ago I was 285lbs. Started at the men clinic. Initial dose was 140 once per week. Was prescribed 0.5mg Anastrozole on day of injection and 0.5 at mid week. Testosterone levels were coming in at ~1000ng/dL so they backed down the dosage to 130. Now I am consistently between 600-700. E2 levels were between 11 and 17pg/mL. Doc felt it was ok. In all honesty, I got lazy with the Anastrozole over several months. I simply stopped taking them. I thought there's no way a pill So small could be doing anything. I have a technical degree. I should have known better. When I found this site and started trying to understand more about ED, I began to pay attention to this Estradiol number. So I have gone back and found 4 blood tests, taken every 6 weeks. All had E2 between 33 and 37pg/mL. All of these during the time I was not taking the Anastrozole. In understanding the role of E2 and reading posts by many, I started taking the pill again with the goal to get E2 to about 20. This seems to be a reasonable target, but I do understand it will vary for everyone. As you will see from the attached results, my E2 is now at 12.3. This was after 3 weeks (again 2X per week, 0.5mg per dose) of starting the Anastrozole again.I am trying to establish a base line so I will continue this dose for another 4 weeks and measure again before making any changes. I can't say for certain if ED and libido have improved...maybe a slight bump. So besides this, I learned from you folks there are other things to look for like prolactin, T3, SHBG etc. So Attached is my latest blood work where I asked for these additional tests. The thing missing is Reverse T3. I asked for it but not sure why it was left off. Curious if there are any other ideas based on the blood work, or any other questions you might have as far as lifestyle etc etc. Really appreciate your help. Trying not to make any newbie mistakes. Please be patient with me. Will continue to study and try and understand.

 

[MarkM]

Welcome to the forum and thanks for posting.

You have taken the wrong Estradiol test. The Roche ECLIA test is the test designed for women and is not accurate for men. You need the Estradiol Sensitive LCMS/MS assay. That being said, your result of 12.3 for the non-sensitive Estradiol test is dangerously low and I am in fear that you are about to crash your Estradiol which you do not want to do. It is very hard for most men to recover from a crashed E2 in a short period of time. Normally the results on the Estradiol Sensitive test are considerably lower than the non-sensitive test.

When your Estradiol was in the 37 to 39 range did you have symptoms of high E2 or did you go on anastrozole because you thought the number was high? I have an Estradiol Sensitive of 35.3 and I do not take an AI and I have no symptoms. However, my non-sensitive Estradiol was 91.0. Good thing I was taking an AI for my non-sensitive Estradiol. I would highly recommend getting the Estradiol Sensitive test.

Your TSH looks high and I would recommend a complete Thyroid Panel test performed. An under performing thyroid can give you low T symptoms. You should test for the following: TSH, Free T3, Free T4, Reverse T3, and both thyroid antibodies.

Your Vitamin D3 is very low and I would suggest supplementing it.

 

[SPapa]

Hi MarkM - Really appreciate the response.

Frustrating part - I spent several hours reading the Sensitive E2 vs Standard test. I actually have the nurse practitioner the LabCorp codes I wanted to run. LCMS/MS method was one of them. I got the other. Makes me think she instinctively checked the one she is used to. I am due again for blood draw next week as they are rechecking after therapeutic phlebotomy a couple of days ago. I'll make sure the right technique is used.

The reason for starting up again on the AI was a feeling that maybe an E2 at the higher end was causing me a little sluggishness and ED/Low libido.

I'll get the Thyroid work redone as well as I felt that they did leave some thing off.

As for the D3. Never thought I would have this problem. Living in Phoenix, I spend the weekends in the yard and 3X per week, 1 hour each time, running/hiking/biking in the desert. I have a tan to prove it Now I did read in a few places that darker pigmentation requires more sunlight for proper vitamine D production.

Again, really appreciate you taking the time to respond.

 

[MarkM]

I think your E2 is too low and low E2 can cause sluggish, ED and libido issues. It is much easier to reduce E2 is needed verse trying to increase it if it gets too low. I really think yours is getting way too low at 12.3 on the non-sensitive test. My bet is that when you test using the LC/MS/MS assay it is going to be even lower.

You know how you feel better than anyone else but you might consider reducing your AI does in half to 0.25 mg. Of course, your call.

D3 is really hard to bring up. Sun, if by far the best option but most of us are deficient and just being in the sun itself isn't going to get us out of the deficiency. Once you bring it up you might be able to keep it up being in the sun so much. It's pretty inexpensive to supplement.

 

[MarkM]

Are you still injecting 140 mg testosterone a week? Is that one injection per week? I did not see SHBG (Sex Hormone Binding Globulin) on your blood work. Has that been tested?

I also noticed upon taking another look at your labs that your DHEA-s is really low at 34, just over the low end of the range. You might consider taking a supplement to bring it up, many on TRT do. I supplement with 25 mg. Mine was very low like your's and now it is over 300 and I sleep much better.

 

[SPapa]

Are you still injecting 140 mg testosterone a week? Is that one injection per week? I did not see SHBG (Sex Hormone Binding Globulin) on your blood work. Has that been tested?

I also noticed upon taking another look at your labs that your DHEA-s is really low at 34, just over the low end of the range. You might consider taking a supplement to bring it up, many on TRT do. I supplement with 25 mg. Mine was very low like your's and now it is over 300 and I sleep much better.

Somehow my uploaded files overlapped and some things got cut off. Posting them again, separately. SHBG - 26.3nmol/L ; Scale 16.5 - 55.9

I am at 130mg per week. Once per week.

 

[MarkM]

Papa, with an SHBG of 26.3 you might feel a little better splitting that does up into two injections per week of 65 mg. I inject every 3.5 days for example, I inject Monday AM and Thursday PM. But if you feel like the one injection per week is working for you then that is fine.

 

[HealthMan]

Papa, with an SHBG of 26.3 you might feel a little better splitting that does up into two injections per week of 65 mg. I inject every 3.5 days for example, I inject Monday AM and Thursday PM. But if you feel like the one injection per week is working for you then that is fine.

I second that. Just be careful because your estradiol will probably go even lower by splitting the dosage. So better adjust the anastrozole dosage as well

 

[SPapa]

Papa, with an SHBG of 26.3 you might feel a little better splitting that does up into two injections per week of 65 mg. I inject every 3.5 days for example, I inject Monday AM and Thursday PM. But if you feel like the one injection per week is working for you then that is fine.

I can say pretty confidently that I feel pretty consistent throughout the week at the one injection per week. I'll keep this as a final possibility. I appreciate everyone's responses. The take away - E2 Sensitive test in order to dial in or eliminate the anastrozole, Full thyroid panel, DHEA and Vitamin D supplementation and finally look into splitting up injection to 2X per week.

 

[MarkM]

I can say pretty confidently that I feel pretty consistent throughout the week at the one injection per week. I'll keep this as a final possibility. I appreciate everyone's responses. The take away - E2 Sensitive test in order to dial in or eliminate the anastrozole, Full thyroid panel, DHEA and Vitamin D supplementation and finally look into splitting up injection to 2X per week.

I think you have it down accurately Papa. Best wishes on your journey to getting completely dialed in and feeling your best.