Why is my Estradiol levels off the charts?

[kixx]

Initial bloodwork showed test level at 206. I was prescribed .4ml every 3.5 days which I do subq. Anyhow my follow up bloodwork resulted in total test 559, free test 158, and Estradiol was 105. I have felt amazing and muscle growth has been great. I do feel like I am carry excessive water and the estrogen level makes that seem likely. I have an appointment with the trt clinic on 01/04/24 but the estradiol level has me freaked out. I search the internet and have not seen a number that high. Bloodwork was done at Quest. Should I stop injecting until I see the doctor?

 

[FunkOdyssey]

I have felt amazing and muscle growth has been great.

Should I stop injecting until I see the doctor?

I certainly wouldn't! Listen to the patient on this one -- he says he feels amazing.

I would only be concerned if the water retention is raising your BP. Have you checked it? If BP is good I'd let it ride.

 

[Systemlord]

. I was prescribed .4ml every 3.5 days which I do subq.

SQ may be the reason for the high estrogen value, as some aromatize more doing SQ injections.

Anyhow my follow up bloodwork resulted in total test 559, free test 158, and Estradiol was 105.

Men typically run higher estrogen values on TRT versus naturally.

Mine is high also (70-90), I feel amazing!

I do feel like I am carry excessive water and the estrogen level makes that seem likely.

Testosterone increases aldosterone produced in adrenal glands, which enters the kidneys, and tells the kidneys to absorb more sodium and sodium, carries water. This leads to fluid retention.

So estrogen may not even be responsible for your fluid retention.

Estrogen improves muscle mass and strength.

 

[kixx]

SQ may be the reason for the high estrogen value, as some aromatize more doing SQ injections.


Men typically run higher estrogen values on TRT versus naturally.

Mine is high also (70-90), I feel amazing!


Testosterone increases aldosterone produced in adrenal glands, which enters the kidneys, and tells the kidneys to absorb more sodium and sodium, carries water. This leads to fluid retention.

So estrogen may not even be responsible for your fluid retention.

Estrogen improves muscle mass and strength.

I appreciate the response. I guess I freaked out at the 105 number but honestly don't feel bad. I just did not know if it would be dangerous at that level. I'm going to talk to the doctor and might try IM. Thanks

 

[Systemlord]

I guess I freaked out at the 105 number but honestly don't feel bad.

Serum estrogen is deceiving, there's 50 times more estrogen in your tissues, that's where estrogen does it's job. You're measuring the leftovers that isn't doing anything.

 

[Nelson Vergel]

otal test 559, free test 158, and Estradiol was 105

What type of assay was used for your estradiol test?

Accurate Estradiol Testing: Key to Hormone Balance

Explore accurate estradiol testing for hormone balance, highlighting the benefits of sensitive LCMS tests over traditional immunoassays.

www.discountedlabs.com

 

[Systemlord]

What type of assay was used for your estradiol test?

Accurate Estradiol Testing: Key to Hormone Balance

Explore accurate estradiol testing for hormone balance, highlighting the benefits of sensitive LCMS tests over traditional immunoassays.

www.discountedlabs.com

@kixx A moderate elevation in C-reactive protein when using the non-sensitive method for estrogen testing would yield a false high value.

Your doctor prescribing 2 mg AI per week is reckless!

 

[Deleted member 43589]

My E2 is 68 and I feel fine too. Absolutely no symptoms. No water retention either.

 

[kixx]

What type of assay was used for your estradiol test?

Accurate Estradiol Testing: Key to Hormone Balance

Explore accurate estradiol testing for hormone balance, highlighting the benefits of sensitive LCMS tests over traditional immunoassays.

www.discountedlabs.com

Estradiol, Ultrasensitive, LC/MS. I think that answers your question. Thanks for the link, very informative.

 

[kixx]

@kixx A moderate elevation in C-reactive protein when using the non-sensitive method for estrogen testing would yield a false high value.

Your doctor prescribing 2 mg AI per week is reckless!

If that was meant for me, I don’t see the doctor until January 4th. I’m sure he will prescribe an AI but have no idea on dose. The more I read, the more I wish I didn’t have to take an AI.

 

[Deleted member 43589]

Again, it you are showing no symptoms of high E2, be very careful taking the AI. Most doctors prescribe anastrozole @ 1mgX2/WK. Starting out much lower is best because it is easy to crash your E2 at those doses. If you even take this stuff, start out with 1/4mg/wk. Always remember, you are the final say when it comes to medicine.

 

[kixx]

Again, it you are showing no symptoms of high E2, be very careful taking the AI. Most doctors prescribe anastrozole @ 1mgX2/WK. Starting out much lower is best because it is easy to crash your E2 at those doses. If you even take this stuff, start out with 1/4mg/wk. Always remember, you are the final say when it comes to medicine.

I would prefer not taking an AI but was concerned with long term effects of a 105 E2 level. I keep searching to find out the potential long term health effects but can’t find much info.

 

[Deleted member 43589]

If you are concerned with long term side effects, start out with a minimum of 1/4mg after your injection. The problem with this drug is we know very little about it as it was developed for the treatment of breast cancer in women. It is being used off label. One thing I would suggest you do is get a baseline lipid test. Anastrozole administration in humans can decrease total cholesterol and HDL levels but seems to have no effect on LDL or Triglyceride concentrations. If you already have low HDL, this could put it below the normal range.

Male bodybuilders started using this drug to keep E2 levels in check when using high doses of testosterone. However, most only use it for short periods of time.

Here is an interesting study

https://journals.sagepub.com/doi/full/10.1177/1557988314539000

Anti-Estrogens: Aromatase Inhibitors/SERM

Currently, there is a controversy on whether to treat patients on exogenous testosterone with high estrogens. One of our goals was to find out if treatment was given, what the preferred drug might be. In our population, anastrazole (Arimidex) was the most prescribed AI. It does not appear that the preference is based on pricing alone. Of the AIs, the most expensive is Femara (letrozole), followed by Arimidex (anastrozole) and then Novaldex (tamoxifen), which is a SERM. A separate study would be needed to investigate further provider and patient preference.

Do We Need to Treat High E2 After TRT? Anastrozole​

This study was not designed specifically to answer this question. A prospective, randomized controlled study would be needed over several years to understand if indeed high E2 after TRT may be beneficial or harmful. Currently, there are no national guidelines that are evidence based for treatment of high E2 after TRT. However, there was a high treatment rate for our group of patients at 30%. Based on interviews with select practitioners, we found that the reasons for the high rates of prescribing AI and SERM are partly patient pressure, practitioner confusion, and fear of the harmful effects of high E2 in long term. Some studies have indicated an association of high estrogens to higher rates of heart attacks, strokes, and prostate cancer (Basaria et al., 2013; Kristal et al., 2012; Lerchbaum et al., 2011). In one such study, higher estradiol levels in men were significantly associated with prevalent strokes, peripheral vascular disease, and carotid artery stenosis compared to lower estradiol levels. High levels of estradiol were also associated with all-cause and noncardiovascular mortality in a large cohort of older men referred to coronary angiography (Lerchbaum et al., 2011). These studies of association do not infer causality and as such should not be used for the basis for treatment of high estrogen. AI and SERM use may be justified for breast tenderness or gynecomastia. However, gynecomastia is rarely documented in problem list; this is an area of improvement for the practice.
In our study, high estradiol levels did not correlate with higher rates of low libido. On the other hand, low levels of E2 were associated with higher rates of low libido. The explanation could be that low E2 usually results from low testosterone levels, as E2 is aromatized from testosterone. Our study results parallel that of others (Finkelstein et al., 2013) suggesting a positive role of estradiol in human male libido functioning. There are limitations to our present study and we do declare that our results cannot be generalized. This is based on our methodology of assigning low libido as captured in the problem list. Providers may have not uniformly entered the ICD-9 diagnoses, and hence it may be possible that results may be overstated. The other limitation is that although 34,016 patients who presented to the Centers were screened, only 50% were eligible for treatment, based on inclusion and exclusion factors. The analysis was done on patients who presented to the Centers and were screened and not limited to those on treatment. The correlation of libido is definitely an area for further study.
The effects of estradiol on the human brain are unclear. Currently, there are no hormone markers within the brain to determine the association of levels of sex hormones with libido. In this study a presumption was made that serum estradiol reflects brain estradiol levels or activity. It may be possible that if serum estradiol level is low more estradiol is available for the brain, as it is shifted from the rest of the body to the brain. This hypothesis is given to support the results of our study, of not associating low libido to higher estradiol levels. In a previous study, positive emission tomography was used in an attempt to map areas of the brain involved in glucose metabolism after administration of testosterone. The brain stem and parietal lobes were highly metabolic, suggesting that these areas are involved in sexual processing (Tan, 2013). There are current arguments for an optimal T:E2 ratio for sexuality (Shabsigh et al., 2005), rather than the actual amounts, but studies are weakly powered.

Conclusion​

Not much work has been done to understand better the role of estrogens in men. There has also been a distinction between work done on endogenous estrogens and also exogenous estrogens, be it given as estrogen itself or converted from testosterone. Our work in a large database of 34,016 patients represents one of the first attempts to understand the characteristics of exogenous estrogens, which in this case are aromatized from exogenous testosterone given to treat hypogonadism. From our study, it appears that age may be a determinant of the conversion of testosterone to estrogens, except for later years in life after 65 years. The clinical importance of high estrogen after TRT continues to be debated. In our study, high estrogen after TRT does not necessarily associate with low libido. However, AI and SERM were prescribed frequently (30% of cases). There are challenges in setting up a guideline for the threshold beyond which AI and SERM are to be used, as there are no evidence-based studies at this time to guide the practice. Normality based on standard deviation can be used, but our study reports that age in itself may cause variations in normal values. Although our study did not associate low libido with high E2 levels; there may be foreseeable dangers to exposure to high estrogen over a longer period of time (Lerchbaum et al., 2011). The use of AI and SERM should be individualized and carefully monitored. The common side effects of AIs include constipation, diarrhea, nausea, vomiting, upset stomach, loss of appetite, body aches and pains, breast swelling/tenderness/pain, headache, dry mouth, scratchy throat, increased cough, dizziness, trouble sleeping, tiredness/weakness, flushing and sweating (hot flashes/hot flushes), hair thinning, and weight change and should be communicated to the patent. Changes in diet such as eating several small meals may help lessen the chance of nausea and vomiting. More work such as a longitudinal, controlled study is needed to assess the role of exogenous estrogens from TRT and the need to treat this condition.

I would strongly suggest you read over all the information @Nelson Vergel has previously posted on E2:

Role of Estradiol (Estrogen) in Men and Its Management

Check your estradiol (sensitive) blood levels cheaply: DiscountedLabs.com REGISTERED MEMBERS: DOWNLOAD ATTACHED ESTRADIOL LECTURE HANDOUT AT THE BOTTOM OF THIS POST Click here for a comprehensive article about the 18 things you should know about estradiol in men By Nelson Vergel, BsChE...

www.excelmale.com

 

[Daveleeander]

I would prefer not taking an AI but was concerned with long term effects of a 105 E2 level. I keep searching to find out the potential long term health effects but can’t find much info.

Mine has been high 90’s and low 100’s several times the past 8 years. It normally runs in the 80’s on trt. I’m not sure what high symptoms are as I’ve never had any. I have crashed it twice on 1/4 mg x 2 /week of Anastrozole, and that won’t be happening again. I’m not taking ai ever again.
I also have always relied on the “oil based medicine goes in the muscle, and water based goes in the belly”

 

[kixx]

Mine has been high 90’s and low 100’s several times the past 8 years. It normally runs in the 80’s on trt. I’m not sure what high symptoms are as I’ve never had any. I have crashed it twice on 1/4 mg x 2 /week of Anastrozole, and that won’t be happening again. I’m not taking ai ever again.
I also have always relied on the “oil based medicine goes in the muscle, and water based goes in the belly”

I’m really leaning towards not taking an ai. I might just try to lose some body fat which will hopefully lower my estrogen levels. I feel like the internet is full of contradictory information. I choose subq because I felt that was the best method for administering due to slower release. I even was told it would keep my estrogen lower but now I see that maybe false. I might give im a try. Thanks for your input.

 

[Cataceous]

Estradiol, Ultrasensitive, LC/MS. I think that answers your question. Thanks for the link, very informative.

Perform a retest, ideally with both LC/MS and immunoassay tests. I would never trust a lone, unconfirmed LC/MS estradiol measurement. Although this testing methodology is capable of high accuracy, it is also complicated and fiddly and sensitive to human error. If the high estradiol is confirmed then I would have concerns about maintaining it long-term. My understanding is that you are taking 160 mg of testosterone cypionate per week. This about double what a sensible starting dose should be. Cutting back to 2 x 40 mg per week would make the absolute level of estradiol less unreasonable. You should also retest total testosterone and measure free testosterone with equilibrium dialysis. Throw in SHBG too so you can calculate free testosterone as a backup.

A total testosterone of 559 ng/dL seems low for the dose. It could be inaccurate, or it could be reflecting low SHBG or fast absorption. Further testing can help to sort this out. As it is, your estradiol-to-testosterone ratio is close to 2%, extremely high compared to the top of the normal range, which is around 0.6%.

 

[kixx]

Perform a retest, ideally with both LC/MS and immunoassay tests. I would never trust a lone, unconfirmed LC/MS estradiol measurement. Although this testing methodology is capable of high accuracy, it is also complicated and fiddly and sensitive to human error. If the high estradiol is confirmed then I would have concerns about maintaining it long-term. My understanding is that you are taking 160 mg of testosterone cypionate per week. This about double what a sensible starting dose should be. Cutting back to 2 x 40 mg per week would make the absolute level of estradiol less unreasonable. You should also retest total testosterone and measure free testosterone with equilibrium dialysis. Throw in SHBG too so you can calculate free testosterone as a backup.

A total testosterone of 559 ng/dL seems low for the dose. It could be inaccurate, or it could be reflecting low SHBG or fast absorption. Further testing can help to sort this out. As it is, your estradiol-to-testosterone ratio is close to 2%, extremely high compared to the top of the normal range, which is around 0.6%.

I have considered a lower dose but my total is so low that I don’t really want it lower. I have an appointment with the trt clinic doctor tomorrow so I’ll see what he thinks. I’m probably not going to take an ai but have considered your advice of getting additional bloodwork to compare. I’m seriously considering switching to im since I see that may lower my estradiol. Thanks for the comment.

 

[Cataceous]

I have considered a lower dose but my total is so low that I don’t really want it lower. I have an appointment with the trt clinic doctor tomorrow so I’ll see what he thinks. I’m probably not going to take an ai but have considered your advice of getting additional bloodwork to compare. I’m seriously considering switching to im since I see that may lower my estradiol. Thanks for the comment.

Total testosterone has minimal relevance. Free testosterone is what you need to go by. If your SHBG is low then you can still have quite high free testosterone with the total at 559 ng/dL. That's why you should measure free testosterone and SHBG. Even if you have normal SHBG, you'd have to be quite the outlier to have testosterone suppressed so much by metabolic clearance. Being a fast absorber is somewhat more plausible. In this case your levels would be skyrocketing early in each injection cycle before dropping to the trough you measure. This could be improved with more frequent injections, eg. EOD. I would not bother switching to IM, as that can tend to push towards faster absorption.

Do not be reluctant to ask to lower your dose. It is ridiculously high, especially for just starting out. The average healthy young guy makes testosterone equivalent to what's in 60-70 mg testosterone cypionate per week. Even top-of-range is only equivalent to 90-100 mg. It makes no sense for you to begin treatment way above normal physiology. More doctors need to adopt a low-and-slow approach.

If your doctor does not want additional lab work then he is flying blind. The existing measurements are unusual and need to be confirmed.

 

[Ancart]

Initial bloodwork showed test level at 206. I was prescribed .4ml every 3.5 days which I do subq. Anyhow my follow up bloodwork resulted in total test 559, free test 158, and Estradiol was 105. I have felt amazing and muscle growth has been great. I do feel like I am carry excessive water and the estrogen level makes that seem likely. I have an appointment with the trt clinic on 01/04/24 but the estradiol level has me freaked out. I search the internet and have not seen a number that high. Bloodwork was done at Quest. Should I stop injecting until I see the doctor?

 

[Ancart]

Initial bloodwork showed test level at 206. I was prescribed .4ml every 3.5 days which I do subq. Anyhow my follow up bloodwork resulted in total test 559, free test 158, and Estradiol was 105. I have felt amazing and muscle growth has been great. I do feel like I am carry excessive water and the estrogen level makes that seem likely. I have an appointment with the trt clinic on 01/04/24 but the estradiol level has me freaked out. I search the internet and have not seen a number that high. Bloodwork was done at Quest. Should I stop injecting until I see the doctor?

I don’t worry about Estradiol. If you’re feeling good… That’s the goal. It’ll be interesting to see what the doctor says… I’m sure they’ll wanna put you on some meds. Any rate, I don’t think a blood test can truly test estradiol but that’s another story.