32 Y/O, Dying of Old Age

Pharma TRT
1

I’m a 32 y/o male undergoing testosterone replacement therapy. I’m currently taking 100mg testosterone enanthate / week through IM injections. My followup lab work last month showed that my total and free testosterone were in pretty good shape, but my estradiol was WAY out of alignment. In fact, when I asked my doc about my estradiol levels, which she thought was normal at first (I was @ 124), I commented that it must be a different unit of measure than what I had read about because it wasn’t anywhere close to what I had expected.

She went out for a few minutes to do some quick research and then realized what she thought was normal was actually the ovulating woman range - or some other high-hormone stage of the female menstrual cycle. The actual normal range for men (according to the lab report) was <54 pg/ml. Given the ideal range talked about in these forums is 20-30 pg/ml, that puts me about 4-6 times above what I should be.

At this point, my doctor admitted this is beyond her expertise and I should probably see either a urologist or endocrinologist. While I applaud her recognizing this, I’m afraid the specialists may not be any more knowledgeable than she is and I know they won’t be as understanding, patient and flexible as she has been.

So I’ve asked about her continuing to treat me using the protocols outlined in this forum for the short term until I find a suitable doctor and can afford to possibly get a little worse while a new doctor tries whatever the new therapy might be. I’ve suggested using an aromatase inhibitor (arimedix), with smaller and more frequent injections.

What I’d like to know from all of you:

  1. Is arimedix a recognized approach in the traditional medical community?

  2. While I wait for my doctor to respond to my proposal, what can I do to help lower my Estradiol? (I have cut my dose in half and injected 2x per week, added a zinc supplement, and added 500mg saw palmetto supplement as of yesterday)
    Is 500mg saw palmetto, appropriate?

  3. Would Testosterone cypionate be better for aromatase than enanthate?

  4. What’s up with the enanthate limited availability and “permanent back-order”???

  5. Is an estradiol level of 124 ridiculously high? Would this level mean my body is very prone to creating aromatase and converts an abnormal amount of T to E? Could this be why my T was low to begin with? (Yes, I know proper tests before I started TRT could help answer that questions… but it’s too late now).

  6. If I decided to scrap everything, go cold turkey to reset my body… how long would it take to return to it’s natural state so I could perform that LH tests? Or could a MRI be helpful without having to go back to that point?

To anyone who replies…

Thank you for your help. -

Labs

  • I don’t have my lab work in front of me, so this is what I remember right now. Sorry.

                 2/2010    10/2010    1/2011        Range

=======================================================
Estradiol 124 <56 pg/ml
Total Testosterone 295 602 *160-726 ng/dL
*(test method changed between October and January tests)
Testosterone Free 90 143 50-210 pg/ml

Vitamin D 35 33 >30 ng/ml
Vitamin B12 185 283 >=181 pg/ml

Recent Tests (Jan 2011)

CBC Value Range & Units

HCHC 33.2 31-35 GM/DL
RDW-SD 39.5 37-52.3 fl
Abs immature gran ct: .02 0-0.06 ku/l
HCT 52.1 % 38.5-53%
Immature gran: .3 %

  • MPV 9.7 9.9-12.6 FL
    HGB 17.3 13-17 gm/dl
    MCH 28.1 27-33 PG
  • RBC 6.15 4.3-5.9 M/UL
    RDW-CV 12.8 11-16
    WBC 6.9 4-11KU/L
    PLATELET 222 140-400 KU/L
    MCV 85 83-99 FL

LIPID PANEL Value Range & Units

Triglyceride 178 <149 mg/dl
HDL Cholesterol 35 >41 mg/dl
Cholesterol 215 <199 mg/dl
Chol/HDL Ratio 6.14 2.00-6.09
LDL Cholesterol interpretation 144 <100 mg/dl

Other Value Range & Units

Calcium 9.7 8.5-10.4 mg/dl
alk phos 67 40-110 iu/l
CO2 31 22-32 mmol/l
Chloride * 100 101-111 mmol/l
Total Protein 6.9 6-8 gm/dl
Albumin Lvl 4.3 3.5-4.8 gm/dl
Potassium 4.1 3.5-5.3 mmol/l
Anion Gap 7 3-11 mmol/l
Sodium 138 136-144 mmol/l
Glucose Fasting 93 70-99 mg/dl
Total Bilirubin .8 .3-1.2 mg/dl
Creatinine .88 .64-1.27 mg/dl
ALT 22 10-60 iu/l
BUN 11 8-20 mg/dl
AST 23 10-42 iu/l

TSH 1.56 .3-5.00 uIU/ml

Vit B1 17 9-44 NMOL/L

Other - Misc. Stuff

I’ve also had an assortment of other health issues, which may have some relevance so Iâ??ll mention them below in-case you all see some relationship:
2000 - Started gaining weight (I used to be very scrawny, but strong for size) @ age 20 by 26 I was 180 lbs (from 125).
2007 - “adhd-pi” all my life - started treating with adderall/straterra in 2007 - I lost 30lbs dropping to 150 lbs some improvement in energy and concentration

February 10 - Vitamin D deficient, treated with (50,000ui 1x/week for 6 weeks) - felt much better (more energy, better mood/motivation/memory, clearer thoughts) dropped the adderall/straterra. I started gaining some weight - but expected that since I had my appetite back. After the Vit D supplements were gone (while still taking OTC supplements), all the good effects fell away and I slowly grew more weak and tired.

Oct 10 -Lymes disease discovered, treated with antibiotics for 6 weeks, seems to be gone.
Oct 10 -Sleep Apnea discovered central and obstructive apnea with 7 events/hour average.
Oct 10 - B12 Deficient discovered, started b12 OTC supplements
Oct 10 - Testosterone borderline deficient discovered - started TRT IM injections
Jan 11 - Vitamin D dropped slightly from Oct (35 → 33), despite heavy OTC vit d supplementation
Jan 11 - Cholesterol High (HDL low), B12 up some
Jan 11 - Estradiol 124 pg/ml (range <54)

2

Yes, that estradiol number is way too high. I’ve seen guys feel like hell when it is around 40-50-60, but 124? Splitting up your 100mg of testosterone into (2) 50mg’s will provide for a steadier level of T and less of it will aromatize, but you still need an AI.

You said that in Oct 2010, you were diagnosed with sleep apnea. Sleep apnea causes low testosterone scores. Were you treated for sleep apnea before you began TRT? Maybe all you needed was to lose weight, and correct the sleep apnea to raise your testosterone levels.

A lot of people are deficient in Vitamin D. If you felt better with 50,000 IU’s of Vitamin D3 and felt like crap after the trial, why didn’t you jus’ supplement yourself with 2,000 IU’s daily?

In regards to question #6: An MRI will not tell you much about your natural LH or FSH production. It’s only a tool to rule out pituitary abnormalities.

3

you should also test your Thyroid and Cortisol.

Low cortisol results in higher aromatase of T to E2.

chances are if your estradiol is that high then your cortisol is not sufficient to work with the amount of testosterone you are taking, which would also start to cause problems for your thyroid.

4

Please do not cut and paste from word processing software, too many trash characters. Save to plain text then cut and paste from a plain text editor.

Please post your CBC results.

Your list of lab results does not make any sense. Show levels and ranges, without “?”. Use the edit button in the lower RH corner of your post. You can clean up the garbage characters too.

I think that your liver’s ability to clear estrogens is the problem. ALT and AST levels would be good to see. If liver markers are up, might be good to have your liver checked out by ultrasonic imagery.

Please read: Advice for New Guys - Testosterone Replacement - Forums - T Nation

Arimidex lowers T–>E2 aromatization rates and the effect is quite linear. The drug is used to modulate E2 levels in males with small doses. For females, larger doses [1mg/day] are used to drive E2 levels close to zero for estrogen positive breast cancers. So from a functional medicine point of view, it is a good tool to use. For idiot doctors, they will not have a clue and will think that it is insane.

5

B WS6: I didn’t treat the sleep apnea first, but I don’t think it had a major impact on my testosterone levels since it was very mild. It was also a fairly recent development since gaining weight in the previous 6 months. I think my testosterone has probably been low all my life, at least since I was 20 and had a hernia repaired.

I have been taking about 2,000 IU’s of vitamin D daily. But despite that, my vitamin levels have not risen significantly. I just started another round of 50,000UI doses this past week and I can already tell a difference from it.

I understand an MRI can’t tell me what my LH/FSH levels are, but I am curious if an MRI would be able to detect any pituitary anomalies that would cause them to be low, thus answer why my testosterone was low to begin with. It’s kind of backwards from the normal sequence of testing, and I’m guessing it wouldn’t be very valuable.

PureChance: My thyroid has been tested a couple of times and always comes back fine. this was a TSH only test, so no T3/T4 tests were done.

You’re statement about cortisol is very interesting though… On a day-to-day basis, I am almost completely stress-free (even when I probably should be stressing over something). It isn’t until I have a major deadline with serious consequences for failing that I begin to experience any feelings of stress. And when that kicks in, I go from being a slow, lumbering, dull idiot to being highly motivated, doing 3 things at once and put-out outstanding work. What are appropriate cortisol levels and are there any lab tests that are preferred or more valuable, which I should ask for?

KSMAN: Sorry about the cut/paste, I didn’t notice the garbage pasted in. I’ll try to get my lab details posted tonight or tomorrow.

Thank you all for your help. I’ve been reading on here for a while and learned quite a bit, but there is obviously so much more that I still don’t understand. This forum is a gold-mine of knowledge that doesn’t exist anywhere else. Even though I have access to tons of science and medical journals, I still can’t find anything that addresses what issues can go awry in TRT.

6

The experts here need to confirm this but… An E2 level like that with only 100mg per week would make me think that your e2 was sky high before you started trt. E2 has a big effect on your feedback loop and could cause the low T by itself. How much alcohol do you drink? Take lots of tylenol, ibuprofin, asprin? My understanding is that all of these things tax your p450 pathway in your liver which is also repsonsible for E2 clearance.

If his liver is the culprit would he be a good candidate for AI mono therapy?

7

I have updated my original post to clean it up and add my actual lab values and ranges.

jrm850: I drink very little alcohol (average of a couple of beers per month… and occasionally some red wine). I also don’t take many pain relievers or other drugs. My diet is pretty good (I could certainly use more fruits/vegetables) and buy almost all organic foods, especially meats and animal products. So it’s a complete mystery to me why my estradiol is so through the roof. I can only assume my body/genetics have a strong tendency to over-produce aromatase or something up stream in the sequence of chemical reactions.

I just got an email from my doctor… she doesn’t feel comfortable prescribing the AI so she will refer me to a specialist. Does anyone have any recommendations for the Baltimore area? What about a urologist versus endocrinologist in general?

8

?urologist versus endocrinologist?

They both typically do not to a good job and a motivated GP is always a good thing.

My recommendation would be to drive down E2 first and be mindful that the backup in E2 clearance is probably rooted in the liver.

Sodium and chloride: What is your salt intake? Iodized salt? Iodine in vitamins?

B-12 is great, but you need a high potency B-complex vitamin product to increase HDL. Fish oil and other EFA’s will be needed too.

Many give up with getting a doc to manage E2 and are forced to self medicate.

9

KSman: Why do you think my liver is part of the issue? Is your assumption based on past experience with similar cases or something you saw in my bloodwork? What can I do to optimize my liver function?

As far as salt, my wife constantly nags me every time I pick up the salt shaker (which is sea-salt, not iodized). But given my lower sodium and chloride levels, I’m guessing I really don’t need to be concerned.

10

Has anyone else run into E2 levels as high as I’ve experienced (124pg/ml)? If so, did you ever determine what caused it, or get it resolved through an AI?

I’ve been intrigued by the ideas posted above about low cortisol or poor liver function being the culprits. But I haven’t seen any other cases discussed in this forum or any articles that talk about these issues and such high levels.

Right now i’m only taking T-enanthate, but no AI or hcg. And my T levels are not overly high, especially compared to some folks that are 1200+ and still have less than half my E2.

11

As stated above: “I think that your liver’s ability to clear estrogens is the problem. ALT and AST levels would be good to see. If liver markers are up, might be good to have your liver checked out by ultrasonic imagery.”

Why do I say that? Simple, your levels depend on rate of creation [source] and rate of clearance [sink]. [Those are engineering terms]. Your low TT/FT would not support high E2 generation, so it makes sense to look for a problem with E2 clearance and that is the liver. A repeat E2 test would make sense, you do not want to be treating a lab error.

Get iodized salt on the table and in the kitchen. You can find iodized sea salt. Salt intake is not an issue with younger or healthier people. I suggest that you should get an iodine supplement from the health food store and use that to build up your iodine stores.

Low vit-B12 at your age suggests that something might be wrong with your gut. Get a good probiotic, should be refrigerated, not in drug stores. Had an occult blood stool test? If the guts do not absorb B-12, oral B-12 can be ineffective. Get 5mg Methylcobalamin - Wikipedia sublinguals: methylcobalamin sublingual - Google Search

Alternatively one can inject B-12, which can be co-injected with hCG if using that.

12

[quote]KSman wrote:
As stated above: “I think that your liver’s ability to clear estrogens is the problem. ALT and AST levels would be good to see. If liver markers are up, might be good to have your liver checked out by ultrasonic imagery.”
[/quote]

I understand the source and sink implications to overall levels, I just didn’t see anything in my bloodwork (not that I know the meaning of all the values) that indicated a liver problem - besides elevated E2. My ALT(22)/AST(23) values seemed reasonable (given the lab range… which I know is pretty meaningless in many cases).

Are you recommending the iodized salt and B12 because it will improve my liver function, or just because it may improve my general health and well-being?

Thanks.

13

Take iodine to not have a deficiency and down stream thyroid hormone problems. B-12 injection will get the job done, bypassing the issue of absorbing through the gut; just another option.

14

I have very low Vitamin D also, and I feel like the doctors are throwing ammo at the symptoms by perscribing the 50,000 IU 3x a week of VitD or whatever your rigmen is… The real issue is that our guts are not absorbing Vitamin D from our normal diets, etc – so more diagnostic work needs to be done on the malabsorption of vitamins in the gut, which can also be a root cause of why you need to be on TRT.

There seem to be all types of possible causes that need to be ruled out, but the villi in our guts is probably damaged from some past bacterial infection, and/or Celiac disease (Which usually goes hand in hand with this, even if you don’t have many or any gut symptoms). I’ve been doing a lot of research on Celiac disease lately, and I would say that you should rule it out with a Celiac panel blood test.

I’m not even waiting for my Celiac Panel test to come back (Because even if it’s negative, there is a whole group of people out there who are “Non-Celiac” Wheat Intollerant) – and I’m already on a Gluten Free diet to test how my symptoms change over the course of a month trying this.

Best of luck to you!

15

Thanks hakrjak… That’s interesting about gut issues without symptoms. I’ve always had a stomach of steel and I don’t have any symptoms that I’m aware of. But if its possible to have issues while symptom free, then I probably should investigate it more.

I hate the idea of going gluten free (my wife has mild celiac disease - but still eats gluten). It’s so hard to eat a gluten free diet without preparing everything yourself.

Out of curiosity, how long do you do the 50,000 units 3x per week? I’m 50,000 1x per week for 8 weeks. And last year it was the same, but only 6 weeks. I can tell a difference after each dose as my vision seems more vivid. It’s like someone turned up the color saturation on my vision and everything is more colorful and slightly sharper. Obviously you’re either much more deficient, or treating the issue much more aggressively. What range do your Vitamin D levels end being?

16

The Wikipedia (Yes, I’m aware it isn’t the most authoritative source) article on anastrozole mentions “… the reduction (of estradiol) may be different for men with grossly elevated estradiol”.

Does anyone know where this info is sourced from? Or know in what way it might be different in an elevated E2 scenario?

I’m guessing my E2 level of 124 qualifies as ‘grossly elevated’, leaving me unsure what an appropriate dose might be. I’m assuming it means I might need a larger dose to receive the same 50% reduction… but I don’t like assuming things about my health. And I can formulate some hypothesis that I might need less AI for a given reduction compared to others.

17

So I started my anastrozole last week (6 days ago), but I haven’t noticed any appreciable change. I still don’t have any libido, morning wood, energy, motivation, etc.

I attempted to ‘front load’ my dosage by taking .5 mg the day before my T injection, and 1mg the day of the injection. Since I wasn’t feeling anything at this point, I continued to take smaller doses daily (.3mg) each day since to see if I wasn’t suppressing the aromatase enzyme enough. (If you look at my bloodwork, you’ll see I have a lot of E2 to lose)

While I know this will be a slow process and take weeks/months to fully complete the changes that are (hopefully) taking place, I did expect some near-term improvements just by changing the ratio of T/E2 flowing through my veins. Am I expecting too much by thinking there would be a noticeable difference within a few days?

Also, any suggestions on dosage/timing for bringing E2 from 124 ng/dl to to ideal 20-30 range? If I don’t see improvement soon, I’ve thought about doing a high daily dose until I feel I’m in the target range and then backing off to hopefully stay there. But without knowing the lag between a dose and it’s impact - it would be hard to time it well.

18

first I would ask for a follow up estradiol test to confirm the results and to see where you stand today. your initial reading should be sufficient reason why.

while you are at it, you can request additional tests like TSH, free T4, free T3, reverse T3, 8am Cortisol, ferritin, Sensitive Estradiol (something like a 10-56? range), Progesterone, Pregnenolone, and DHEA-S.

TSH > 1 indicates a possible problem and warrants further testing.

be careful because saw palmetto can cause false high estrogen readings, but I think you started that AFTER your blood test, right? I had a total estrogen of 800+ when taking it before I knew what I was doing. After experimenting for years and years on various herbs I don’t recommend any simply because everyone reacts differently to them and there is just no way to control or forsee their impact. Best to get of everything except for basic vitamin/mineral supplements. Get to a great baseline on all of your other systems and then if absolutely necessary slowly introduce one thing back at a time and see what it does.

if your cortisol and thyroid are completely off, then your body will keep trying to dump testosterone by aromatasing it to estradiol.

19

Jeffr48,

Hi, I was wondering where your labs were done? My labs from labcorp flagged my HCT as high at 48.3%......your lab seems to indicate normal up to 53% which would be good for me. Thanks
20

I meant to mention that I had the 23andme.com genetic test performed. I ran those the raw results through geneticgenie.org and discovered I had a few mutations that could influence my estrogen clearance and explain my vitamin deficiencies.

Specifically, I had homozygous mutations on COMT V158M and COMT H62H. This gene codes for the COMT enzyme and the mutations will apparently slow clearance of catecolamines and estrogen from the body by a factor of 4 (meaning 1/4 normal clearance rate).

Interestingly I also have a mutation on my Vitamin D Recepter (VDR) genes and MTR/MTRR genes, so perhaps that is part of my issue with being continually low on Vitamin D and B12.

This stuff is very confusing with little useful information available, but I thought it was interesting and I hadn’t seen anyone mention 23andme on these forums - so I thought I would share. The test is only $100 now, so it might be something worth considering that could give more insight into what is going on with our bodies.