TRT and High Estradiol

[Palermitano]

Hello all, Im searching/hoping for some wisdom here. 56 year old very healthy and very strong male here. Been using Axiron then decided to switch to Bioidebntical Testosterone Pellets. Blood work just came back, ready for this? Total test 1475, Free test 236, Bioavailable test 486.8. Yes, Im feeling like a rock star, especially in the gym. (Dr wants to lower dosage a bit next insertion) My problem is my estradiol is 88, I'd like it between 20-30. In the past with test gels Ive controlled this (somewhat) with some DIM/Chrysin formulas, but now its way too high. I just started taking Zinc, Ill retest in a few weeks and see if it helps. My question is, my multi already has 25mg zinc, now I'm adding another 50mg (plus 2mg copper), isn't that too much zinc? Does zinc even work long term? Im open to suggestions on anything else to help control my E2 because I'm loving these pellets and Im hoping to continue this for life.

It seems the more test I have, the higher my E2 goes. DHT just above upper limit but Im ok with that, Hematocrit is a bit high at 51, but I donate blood regularly so this is not a concern. My diet is clean, alcohol is low, and I'm trying to lose weight, no luck, still high E2.If I lower my testosterone, my E2 will go down, but I like my T levels high. If this (zinc) doesn't work, the Dr wants me on 2.5mg of Letrozol, split in half, half tab on Monday, other half on Friday, anyone have any comments about this drug? Is this safe enough at this dose to take for life? I'd prefer a more natural solution but I'm running out of options. Pellets last about 5 months and Test will slightly decline each month, maybe I can take the Letro the first few months when levels are peaking, then take the last month off, the start again when new pellets are reinserted? I'm just concerned about long term use of Letro.

The only other issue to add to the mix, is my pregnenolone levels are just below the bottom level so Im going to be supplementing soon with 100mg every day, I'm concerned this will also stimulate more estrogen.

And finally, Dr says that he prefers to get my test levels between 900-1100 and says that I would not feel any different at these lower levels, than I do now at 1475, is that true? because Im felling pretty damn good at 1475, except I'm sweating all the time!

Any help/comments/suggestions are greatly appreciated and thank you in advance.

 

[ERO]

Your E2 is not too high, in its actually right in the ideal ratio of between 14-20. 1475/88 = 16.76. If I were you, I would not try to lower it. The acid test is how you feel - and since you feel great - if it isn't broken, don't fix it as they say.

Your doctor is going on what would be the ideal E2 levels for someone with a total T level less than half of yours.

 

[Palermitano]

Thank you ERO but all I've ever read says that E2 optimal range for men is 20-30, regardless of T levels, am I missing something? Can anyone else chime in?

 

[ERO]

Thank you ERO but all I've ever read says that E2 optimal range for men is 20-30, regardless of T levels, am I missing something? Can anyone else chime in?

Yes, much of what you have read is outdated - what is missing is the ratio of T to E. Think of it like this example: If I weigh 200 pounds am I underweight, overweight, obese, or just right? Well, with only my weight there is no way to answer that question without knowing my height and body fat percentage. Same with an E2 level. If you only have an E2 level and you are not taking total T into consideration, you have no way to know if its a good level of not. If you have an E2 of say, 20, how can that be optimal at all levels of total T? What if your total T was 250 - would it be good then? Not so much maybe?

 

[CoastWatcher]

Thank you ERO but all I've ever read says that E2 optimal range for men is 20-30, regardless of T levels, am I missing something? Can anyone else chime in?

The simple truth is that there are no accepted ranges for estradiol in men on TRT. None of the professional societies, endocrine/urological, have weighed in. Nelson has noted that E2 management in men is the last frontier in androgen replacement. ERO has pointed out that more and more clinicians are realizing that suppressing estradiol is a knee-jerk reaction to a genuine problem. Yes, levels when too high can play havoc with how a man feels, but men, particularly healthy, young men, have generally higher E2 along with elevated testosterone. Estradiol is a needed byproduct - it should be allowed to find a spot reflective of the accompanying level of testosterone.

 

[Palermitano]

Thank you but I'm still confused as my Dr wants me on 2.5mg of Letrozol per week (split in 2 doses). Its either that, or keep my E2 at 88.

 

[CoastWatcher]

Thank you but I'm still confused as my Dr wants me on 2.5mg of Letrozol per week (split in 2 doses). Its either that, or keep my E2 at 88.

I am a believer in the "start low and go slow" theory of androgen replacement (Gene Devine uses that phrase regulalrly). In other words, it shouldn't be necessary to push testosterone levels well into supraphysiological range to enjoy the benefits of TRT. - and it is always easier to adjust upward when working to balance levels. Most men, posting an estradiol of 88 would feel miserable, I had slight issues when mine was at 55, but most men don't have a testosterone level of 1475. He wants to lower both levels.

i would urge you to consider it. I know I felt healthier and more centered when I adjusted my weekly injections and brought my testosterone below 1035 and my E2 to 36. Each of us is different. Each of us has to work with our doctor to find what works and what doesn't. It is an individual challenge.

 

[ERO]

Additionally - at any level you find yourself to be at - it is always a good idea to consider whether or not you have any high E2 symptoms before rushing to lower it.

 

[Palermitano]

Thats where Im uncertain of what to do because I feel great. I may just try the Letro in half the dose DR suggested, retest E2, and see how I feel, I can always stop. Im curious about my other question as well. Dr claims Ill feel just as good and no different at test levels between 900-1100 as I do now at 1475, any truth to that?

 

[ERO]

Yes, it is unlikely that anyone could feel a difference between a total T of 900-1100 and 1475. Not to beat a dead horse, but since you feel great and according to the newer theory about E2 being in a certain range vs Total T, and you are in the sweet spot already, why not hold off on the Letro, or at least try half the dose and see as you said. The better TRT doctors go off of how you feel as much or more than the "on paper" numbers. In my case it most often happens the other way - on paper, I look like I should feel awesome but I don't feel much of anything as an improvement over when I had low T.

The thing is, many of us have taken months or even years to really get dialed into to feel as good as you do now, so we always hate to see someone that feels great make a change to his protocol "just because" and then loose the feeling. If your E2 goes too low, expect to loose your libido and if it gets really low, start to experience all over joint pain.

Also, Letro is typically used to treat Gyno, not as a general AI for TRT - that is not to say its "bad" or anything - just a bit unusual.

 

[Palermitano]

Thank you ERO, that was my plan, instead go 2.5mg split in 2, I want to get a pill cutter and cut it in quarters, and take half as much as Dr says, retest in a few weeks, see how I feel then go from there. Im just concerned about everything I read concerning E2 levels being elevated, stroke, etc. Im also concerned about long term Letro because I'm not getting off TRT anytime soon. The other thing is that my E2 at 88 was not the "sensitive" test, which Im taking in a few days. Not sure if that makes a difference.

The other factor to consider is that I took my blood test after 30 days of pellet insertion, that is my Test "peak", each month there after my Test levels will start to decline, as will my E2, but Ill still be on the same dose of Letro?

 

[CoastWatcher]

Thank you ERO, that was my plan, instead go 2.5mg split in 2, I want to get a pill cutter and cut it in quarters, and take half as much as Dr says, retest in a few weeks, see how I feel then go from there. Im just concerned about everything I read concerning E2 levels being elevated, stroke, etc. Im also concerned about long term Letro because I'm not getting off TRT anytime soon. The other thing is that my E2 at 88 was not the "sensitive" test, which Im taking in a few days. Not sure if that makes a difference.

The other factor to consider is that I took my blood test after 30 days of pellet insertion, that is my Test "peak", each month there after my Test levels will start to decline, as will my E2, but Ill still be on the same dose of Letro?

Do NOTHING until you have the results of the sensitive test. The standard test is of no value in measuring estradiol in men. It "over reports", sometimes to a significant degree, sometimes to a lesser extent.

 

[Palermitano]

Thank you CoastWatcher, Ill post my "sensitive" results as soon as I can. In the meantime Im taking Zinc plus Copper 50/3 to see if that can lower my E2. My multi already has 25mg zinc so that means Im taking 75mg zinc per day, is that a concern?

 

[CoastWatcher]

When are your having the Sensitive/E2 test run? When will you know the results?