the E2 roller coaster is driving me nuts.

[Tgrappler]

I started TRT using lipo compounded cream in May of this year.
at that point my E2 was a little high 32 (> 29) using QuestDiagnostics scale.
My endo gave me 1mg anastrozole to take 3 times during the 1st week, and then 1mg once a week. In total, I believe it was 14mg over the course of 4-6 weeks. Throughout that time i felt fine, although i realize that the dosage was high. Nontheless from June to September I was feeling quite good. Would love to feel like that again.

Around the middle of September, I ran out of cream, couldn't get in touch with my doc, got sick and didn't get labs done in time. Long story, shot.. it was a perfect storm of events and my TRT protocol got screwed up. I went back to my pre-TRT levels, almost identical numbers to pre-TRT:

Free Test = 35 Range 46.0-224.0 pg/mL)
SHBG = 76 (Range 10-50 nmol/L)
Bio Test = 76 (Range 110.0-575.0 ng/dL)
Estradiol = 32 (Range < OR = 29 pg/mL)

By that time I was feeling really low mentally, physically and in every way imaginable. After a week or so I was able to restart the cream and was given a new script for Anastrozole. About a week into the treatment, I felt a little better, but then I again took 1mg of AI on Friday and then another 1mg pill on Monday (that was October 1st). Within hours of taking that second pill I felt my world crashing. If I wasn't feeling well before... I discovered a new level of hell. I experienced severe depression and panic attacks, night sweats, horrible mood and every other nasty symptom (to the point where I could hardly walk for a few days). I stopped AI immediately and also within a week or so switched from cream to T-cyp injections (.4cc every 5th day), front-loaded with 1cc on the first injection .. I have not been taking anything else besides T-cyp for my TRT since October 1st. Pretty sure it's a "standard" solution of 200mg/ml in organic grape seed oil.

It took me at least a month to feel a little better and things were improving slowly, but surely. I even went for about 5 days in mid November where I had decent libido and was feeling stronger mentally and physically. However the lingering mental effects of the previous month were still with me. That "normality" only lasted about 1 week, maybe a little less.

All in all I was using cream since late September and then about 6 weeks after starting injections (I started on October 12th) I went to get new labs. Now my E2 is showing as "high".

Latest numbers from LabCorp as of exactly two weeks ago, the scale is different because of the different lab:

Free test = 38 (Range 8.7 - 25.1) High
E2, sensitive = 58 (8 - 35) Higher than before
SHBG = 59 ( 16 - 55) High, but looks lower than before

(other numbers seem to be within range).

I don't have any way to prove that I crashed my E2, except the fact that I took a gigantic dosage of Anastrozole and my mental and physical crash coincided entirely too much with that 2nd pill.

What should I do now? I am terrified of taking AI.
Is it possible that I did lower my E2 to unreasonable levels, but now it has jumped back up? Clearly I'm not converting properly, because my E2 was always on the high end. So with .4cc injections on 5th day I feel like I was able to shortly get within range, but now I am experiencing symptoms of high E2, which are still aren't as bad as what I went through last month. Anxiety, night sweats and poor libido being the main symptoms.

I have DIM, I don't know if it can help regulate E2 in my case. Should I reduce my T-cyp dosage? I could get another script for Anastrozole and maybe take a 0.25 of a pill or less (if I can cut it somehow).

Main question: how can I get my E2 under control without resorting to AI, or should I suck it up and try a lower dosage of AI again. My endo says that I should because it's the most effective way to lower E2, but I'm truly terrified of going through that crap again.

Thank you, I know it's a lot of info, so please let me know if I can clarify anything or provide additional test results.

 

[Vince Carter]

Much of the history isn't anything to work with...what's going on NOW? Dosing and frequency, etc etc

 

[jhperez81]

Your symptoms may be due to high testosterone and not high E2. With SHBG at 59 most of that E2 is probably bound.

 

[lowe2sucks]

i would suggest staying the hell away from AI and maybe returning back to cream if that wasnt giving you e2 problems.. not sure about cream but absolutely sure stay away from AI..

 

[Tgrappler]

Much of the history isn't anything to work with...what's going on NOW? Dosing and frequency, etc etc

what's going on now is that i'm injecting .4cc T-cyp every 5th day. my numbers as of two weeks ago (i don't have anything more recent):

Free test = 38 (Range 8.7 - 25.1) High
E2, sensitive = 58 (8 - 35) Higher than before
SHBG = 59 ( 16 - 55) High, but looks lower than before

i feel better than before i.e. in October when I think I went too low with E2, but now i am experiencing symptoms of high E2 (not too bad, but rather annoying). lack of libido, night sweats, heightened anxiety and stress (mild depression).

 

[Tgrappler]

I just got off the phone with my endo. His suggestion was to lower T-cyp injections to .3cc every 5th day (.4 lower to .3).
He also said that it's possible that my symptoms are due to high Free Test and not necessarily E2 only.
He wants me to take a low dosage of AI. I'm scared, honestly scared. But he does not suggest I keep taking it. He said something like take 1 today and 1/2 next Friday... and just go from there, based on how I feel. I'm really thinking if I do take it I should start with 0.25.

Belive me I have serious concerns about taking it, but at the same time my lab work clearly shows that E2 is high and we need to bring it back down. I seem to be good when my E2 is around 25-30, which is about 2x lower than I have right now. Is there any concrete evidence that I can "crash" my E2 from 59 to below 15 or whatever, other than my symptoms? And I do not intend on taking it as i did in the past ... I might take .25 and wait for at least a week to see what happens with my symptoms. Is that unreasonable?

The thing is I did take AI in the past with no negative consequences. Unfortunately I don't have any way of knowing that my E2 was crashed (or low) except based on the symptoms... and now it seems to be rather high. Generally speaking, is it possible to for E2 to bounce around so much from 32 to very low(?) to 58... all within 6 weeks really.

 

[Tgrappler]

i would suggest staying the hell away from AI and maybe returning back to cream if that wasnt giving you e2 problems.. not sure about cream but absolutely sure stay away from AI..

I completely share your point of view regarding AI. However I do believe that if used properly it can be helpful. I took way too much in the past. That's obvious.
But if I take a smaller dosage now, I don't think it is a guarantee that I will crash it again.

I can't rely solely on the symptoms. There's still science involved here. Based on the numbers it makes sense that I need to lower my E2. I don't know what else to do, other than try a tiny dosage. Believe me that I am very concerned about the AI, but again what other options do I have? I can't just "wait" because things are not going in the right direction.

 

[Vince Carter]

what's going on now is that i'm injecting .4cc T-cyp every 5th day. my numbers as of two weeks ago (i don't have anything more recent):

Free test = 38 (Range 8.7 - 25.1) High
E2, sensitive = 58 (8 - 35) Higher than before
SHBG = 59 ( 16 - 55) High, but looks lower than before

i feel better than before i.e. in October when I think I went too low with E2, but now i am experiencing symptoms of high E2 (not too bad, but rather annoying). lack of libido, night sweats, heightened anxiety and stress (mild depression).

I just got off the phone with my endo. His suggestion was to lower T-cyp injections to .3cc every 5th day (.4 lower to .3).
He also said that it's possible that my symptoms are due to high Free Test and not necessarily E2 only.
He wants me to take a low dosage of AI. I'm scared, honestly scared. But he does not suggest I keep taking it. He said something like take 1 today and 1/2 next Friday... and just go from there, based on how I feel. I'm really thinking if I do take it I should start with 0.25.

Belive me I have serious concerns about taking it, but at the same time my lab work clearly shows that E2 is high and we need to bring it back down. I seem to be good when my E2 is around 25-30, which is about 2x lower than I have right now. Is there any concrete evidence that I can "crash" my E2 from 59 to below 15 or whatever, other than my symptoms? And I do not intend on taking it as i did in the past ... I might take .25 and wait for at least a week to see what happens with my symptoms. Is that unreasonable?

The thing is I did take AI in the past with no negative consequences. Unfortunately I don't have any way of knowing that my E2 was crashed (or low) except based on the symptoms... and now it seems to be rather high. Generally speaking, is it possible to for E2 to bounce around so much from 32 to very low(?) to 58... all within 6 weeks really.

I completely share your point of view regarding AI. However I do believe that if used properly it can be helpful. I took way too much in the past. That's obvious.
But if I take a smaller dosage now, I don't think it is a guarantee that I will crash it again.

I can't rely solely on the symptoms. There's still science involved here. Based on the numbers it makes sense that I need to lower my E2. I don't know what else to do, other than try a tiny dosage. Believe me that I am very concerned about the AI, but again what other options do I have? I can't just "wait" because things are not going in the right direction.

How much anxiety do you deal with? Diagnosed or not and not related to anything hormonal, either.

 

[Tgrappler]

How much anxiety do you deal with? Diagnosed or not and not related to anything hormonal, either.

usually my anxiety is not so bad. i do take anti-anxiety meds (trying to taper), diagnosed with PTSD. I started TRT specifically to help me deal with anxiety/stress and everything that stems from that. as I mentioned i felt significantly better during my first 2-3 months of the protocol.

since October 1st - October 20th my anxiety has been horrible. like nothing i have ever experienced (including during certain withdrawals). it was never as intense or as long lasting.

today the symptoms are manageable, and i am doing a bunch of other things (yoga, lots of walking, TM, therapy of all sorts) to help me deal with anxiety, which is certainly good, but I'm sure E2 is a big part of this picture. for example night sweats are very consistent and i have never experienced that before. i was able to sleep pretty well for the most part, even during the times of high stress and anxiety.

i belive that right now it's mostly about E2 management. I would hate to crash my E2 again, but i'm not sure there's any guarantee of that. So i'm debating on taking AI again at a very low dosage to see how it will affect me. I just don't know what else to do. Somehow E2 needs to be managed.

Has anyone been able to stop/start AI as needed? without necessarily crashing things in the process?

 

[Sean Mosher]

You said your doc asked you to lower the dose from 80mg every 5 days to 60 mg, every 5 days, correct?
Based on your labs (as your doctor noted) you had room to drop your dose.
Personally, I'd avoid the AI and re-test in 4-6 weeks on your new protocol.
That sensitive E2 of 58 should drop and hopefully your symptoms will resolve.
But obviously you've got to do what your doctor says or discuss changes and you 2 go from there.

 

[Tgrappler]

You said your doc asked you to lower the dose from 80mg every 5 days to 60 mg, every 5 days, correct?
Based on your labs (as your doctor noted) you had room to drop your dose.
Personally, I'd avoid the AI and re-test in 4-6 weeks on your new protocol.
That sensitive E2 of 58 should drop and hopefully your symptoms will resolve.
But obviously you've got to do what your doctor says or discuss changes and you 2 go from there.

that is correct regarding 80 -> 60 switch. he said it's mostly to bring the Free T down a little. my E2 was high even before i started TRT, that's why I think I need something else to mange it, because clearly i'm not converting well. So even with lower dosage of T-cyp it's unlikely to go down by much if at all.
This is so confusing. I guess the only way I can find out for sure is to try and see how I react. Apparently it's highly different for different people.

For example, my good friend who has been with the same endo (as me) for years was taking 1mg AI and said he had no negative effects and it brought his E2 to the right level.
Even I had no negative effects taking 1mg AI EOD about 6 months ago. Not so, when I took it last month.

 

[Tman]

I had a very similar E2 crash as yours. When people on here state they crashed their E2 and they new it because their joints were clicking, I just think...you have no idea what crashed E2 is. I am talking debilitating, can't leave your house crashed E2. My E2 did rebound in a couple of weeks, and then the E2 symptoms took over again. I was so scared of crashing my E2 again that I let it go. I was miserable on T for several weeks--tried lowering the dose several times, tried daily, etc. It was time to stop taking T or try the AI again. I can still remember where I was pre-T, so I am not ready to give up. So, I dumped half of the powder out and took the pill with extreme concern. I felt a lot better within 2 hours though jealousy kicked in. So, I felt like I was close. Since then, I will empty 3/4 of the powder from the capsule and take it every other day with my T. I am in a better place. That's a very brief synopsis of my story.

As a side note, for me, I've determined through blood work that one .125 anistrizole lowers my E2 about 30 points.

 

[Gman86]

I had a very similar E2 crash as yours. When people on here state they crashed their E2 and they new it because their joints were clicking, I just think...you have no idea what crashed E2 is. I am talking debilitating, can't leave your house crashed E2. My E2 did rebound in a couple of weeks, and then the E2 symptoms took over again. I was so scared of crashing my E2 again that I let it go. I was miserable on T for several weeks--tried lowering the dose several times, tried daily, etc. It was time to stop taking T or try the AI again. I can still remember where I was pre-T, so I am not ready to give up. So, I dumped half of the powder out and took the pill with extreme concern. I felt a lot better within 2 hours though jealousy kicked in. So, I felt like I was close. Since then, I will empty 3/4 of the powder from the capsule and take it every other day with my T. I am in a better place. That's a very brief synopsis of my story.

As a side note, for me, I've determined through blood work that one .125 anistrizole lowers my E2 about 30 points.

Just goes to show how different we all are, and also how strong ai’s can be! Almost unbelievable that E2 can drop 30 points from 1/8 of a pill. But I believe it. I honest to god think that most guys that “don’t feel good” on an ai just don’t realize how strong they can be.

They also forget about half lives of certain medications, like anastrozole for example. It has a half life of around 2 days. And it takes about 5 half lives to reach a steady state of a medication. So you will reach steady state in about 10 days with anastrozole. So basically, in around 10 days you will have double the amount of anastrozole in your system as when you first started taking it. Guy’s think that it’s a good thing when they take one dose and feel better. Which shouldn’t be the case. If you feel good after one dose, it’s going to be hard for you to feel good in 10 days when there’s double the amount in your system. What you really want is to not feel much after one or two doses, and feel really good from day 10-14 on. I think people forgetting about how half lives work, and not realizing how strong ai’s can be, are the two big reasons why some guys don’t have success with ai’s. That’s just my opinion though.

Best way to have success with ai’s is to start extremely low, go extremely slow, and have patience. Which sucks because I’m an extremely inpatient person, so it’s been very difficult for me to implement this myself. So I don’t blame anyone for being inpatient with their ai protocols. We all want to feel better like yesterday. So it’s easier said than done to be patient when you don’t feel well everyday, and you still have obligations like a job or a family. It can be torture, and can make anyone break protocol and take some extra ai to try and feel better. Patience for me has been the most difficult part of TRT by far.

 

[Tgrappler]

I had a very similar E2 crash as yours. When people on here state they crashed their E2 and they new it because their joints were clicking, I just think...you have no idea what crashed E2 is. I am talking debilitating, can't leave your house crashed E2. My E2 did rebound in a couple of weeks, and then the E2 symptoms took over again. I was so scared of crashing my E2 again that I let it go. I was miserable on T for several weeks--tried lowering the dose several times, tried daily, etc. It was time to stop taking T or try the AI again. I can still remember where I was pre-T, so I am not ready to give up. So, I dumped half of the powder out and took the pill with extreme concern. I felt a lot better within 2 hours though jealousy kicked in. So, I felt like I was close. Since then, I will empty 3/4 of the powder from the capsule and take it every other day with my T. I am in a better place. That's a very brief synopsis of my story.

As a side note, for me, I've determined through blood work that one .125 anistrizole lowers my E2 about 30 points.

Thanks so much for your reply. In a way it helps a little to know that I am not alone in this horrible experience. My Endo doesn't want to accept that I can feel so miserable from TRT and taking AI. I am his most "difficult patient" and he's never seen this kinda messed up conversion before.
I took .25 of an anstrazole pill on Saturday. Mine come in a pill form do it's nearly impossible to cut them to smaller dose. I don't know if it had much effect, because I feel just as crappy as I did before.
I have decent days and hours, but that just means I I'm 50% functional.
Every morning I wake up with overwhelming anxiety and this sense like something is terribly wrong. I don't remember the last time I was able to sleep peacefully and wake up feeling good about ... well, anything.

I'm 39, I was very active, able to train BJJ and boxing, I just feel like I had strength and desire to do things and I certainly didn't have any problems with sex drive. I can't even watch porn now. Not that it was something I did all the time, but goes to show that I have almost zero libido. Also I'm noticing that my balls shrunk to the point where they are barely visible.
Thankfully I have a very supportive wife and she is hanging in there with me ... and tries to encourage me the best she can. But it's certainly taking a toll on our relationship. Used to travel, go out, do all the things that "normal" people do. Now going to a neighborhood sushi place feels like I'm about to climb Everest.
Lately I feel like I'm 90, barely able to make it through a yoga class (although to be fair those can be tough).

I can definitely relate to that feeling, where you cannot leave your house. For a while I was terrified of stepping outside. I had to force myself to go for walks because that's all I could do without feeling like I'm going to faint. Still "scared" of going to get a haircut ... Absolutely ridiculous.

Anyways hands down this has been the worst three months of my life. Why did I start TRT? Mostly because my numbers were pretty low and I felt fatigued and lazy, a little too anxious and could use a little boost of confidence and strength. For the first three months I was using a topical cream and felt quite good. Really was in zone and felt like I was getting stronger mentally and physically. Ever since I took that AI my life has become so much worse, I have no idea how I'm supposed to get out of this hell.

I am not ready to give up because I know there has to be a way forward and I really hope that somehow I will improve and feel like myself again.

Sorry, this got unnecessarily long. Perhaps for anyone else who is having a hard time with TRT it may help to know that unfortunately it can be extremely difficult to get it right. But I'm a fighter and I'm going to keep fighting. My life and my future is literally on the line here.

I hope that you are doing well and it's good to hear that you got to a "better place", I can only wish I will be able to say the same at some point.

 

[Tgrappler]

Just goes to show how different we all are, and also how strong ai’s can be! Almost unbelievable that E2 can drop 30 points from 1/8 of a pill. But I believe it. I honest to god think that most guys that “don’t feel good” on an ai just don’t realize how strong they can be.

They also forget about half lives of certain medications, like anastrozole for example. It has a half life of around 2 days. And it takes about 5 half lives to reach a steady state of a medication. So you will reach steady state in about 10 days with anastrozole. So basically, in around 10 days you will have double the amount of anastrozole in your system as when you first started taking it. Guy’s think that it’s a good thing when they take one dose and feel better. Which shouldn’t be the case. If you feel good after one dose, it’s going to be hard for you to feel good in 10 days when there’s double the amount in your system. What you really want is to not feel much after one or two doses, and feel really good from day 10-14 on. I think people forgetting about how half lives work, and not realizing how strong ai’s can be, are the two big reasons why some guys don’t have success with ai’s. That’s just my opinion though.

Best way to have success with ai’s is to start extremely low, go extremely slow, and have patience. Which sucks because I’m an extremely inpatient person, so it’s been very difficult for me to implement this myself. So I don’t blame anyone for being inpatient with their ai protocols. We all want to feel better like yesterday. So it’s easier said than done to be patient when you don’t feel well everyday, and you still have obligations like a job or a family. It can be torture, and can make anyone break protocol and take some extra ai to try and feel better. Patience for me has been the most difficult part of TRT by far.

Indeed. I feel you about the patience aspect... When I am told to "wait six weeks and see how you feel", I can't comprehend that. It's not like a little headache or something insignificant. When each day is a mini torture mentally and physically, it's very very difficult to accept that I need to get through another month of this hell only to find out that things are still messed up

There are plenty of days when I regret getting on TRT, but I can't stop now. At least not abruptly. Kinda accidentally happened with me when I ran out of cream in September, and that was just as rough. Actually since then I haven't been able to get back to normal life. Ugh.

p.s just one note about half-life, is that it doesn't double up, but slowly gets out of your system. But you are right it takes about 10 days to fully "experience" a single dose.

 

[Gman86]

Indeed. I feel you about the patience aspect... When I am told to "wait six weeks and see how you feel", I can't comprehend that. It's not like a little headache or something insignificant. When each day is a mini torture mentally and physically, it's very very difficult to accept that I need to get through another month of this hell only to find out that things are still messed up

There are plenty of days when I regret getting on TRT, but I can't stop now. At least not abruptly. Kinda accidentally happened with me when I ran out of cream in September, and that was just as rough. Actually since then I haven't been able to get back to normal life. Ugh.

p.s just one note about half-life, is that it doesn't double up, but slowly gets out of your system. But you are right it takes about 10 days to fully "experience" a single dose.

Man, your last two posts really hit home for me. People don’t understand how hard it is to wait 6 weeks to change your protocol and get labs done when every hour feels like torture. I understand what you’re going through. I took clomid for a little while and it was the worst time in my life by far! I literally can’t even explain how bad I felt. Only time in my entire life I’ve ever thought about suicide. Was never depressed before, and haven’t been depressed after. But those 3-4 months......just glad I made it through. It does get better though, that I can promise you. You have a great attitude, and having a wife that supports you is huge! Definitely don’t give up, you’ll feel better eventually. I’m not 100% yet, but a million times better than when I was on clomid. I’m not sure when you’ll be 100% either, but I know you’ll definitely get to a point where you feel better than you do. Hopefully it’s sooner than later. But whatever you do, just keep fighting through it. It will be worth it.

 

[Gman86]

You could be right with the half life thing. But from my understanding, this is how it works. Say you take 1mg of anastrozole EOD. First dose on Monday you have 1mg in your system. Then the second dose on Wednesday you have 1mg in you, plus 50% of monday’s dose. So on wednesday you have 1.5mg in your system. Then you take 1mg on Friday. Now you have 1mg from today, 0.5mg from Wednesday’s dose, and 0.25mg from Monday’s dose. So on Friday you have 1.75mg in your system, even though Friday all you did was take a 1mg tab. It keeps going like that, but if you do the math, it kind of evens out after 5-6 have lives. After 5 half lives you will have 1.93mg in your system on the day you take that 1mg tab, and after 6 half lives it only goes up to having 1.96mg in your system on the day you take a 1mg tab. So that’s why they say after about 5 half lives you’ve basically reached a steady state.

Like I said, I could be wrong, but doesn’t this mean that on day one when you take your first 1mg tab that you only have 1mg in your system, but after 10 days when you take that 1mg tab you will have 1mg, plus around 0.93mg from all the other doses before it still being in your system? Which would mean you would now have around 1.93mg of anastrozole on the days you take your dose, which is basically double the amount. I think I’m doing the math correctly, but again I could be wrong.