Elevated E2 After Weight Loss

Pharma / TRT Testosterone Replacement
1

I wasn’t sure where to post this since I’m not actually on TRT but this seemed like the forum with the most knowledge around my question.

I’m 48, 6’1" and for the last 12 years I’ve been hovering between 240 - 250lbs and 30%+ BF (probably more like 35%). In 2000 I was diagnosed with testicular cancer and had a single orchiectomy. Since then my T levels have hovered around 400 - 450 but no Dr has ever been willing to consider TRT, over the last couple years it has declined into the 300’s with me experiencing the typical symptoms over the last several years.

Late last year I made the decision to do whatever I could on my own and in the last 8 months I’ve dropped to 205lbs and ~25%BF. I’ve focused on eating well and heavy weights. While dropping 45 lbs my big 3 lifts have gone from about 500lbs to 800lbs. I still have a long ways to go but my E2 in my recent blood work surprised me.

Before this I logged my meals off and on for months and 4000+ cal was not uncommon (hence the weight gain).

Waist – Currently at 37 down from 44 in September 16’

Normal body and facial hair growth. Hairy chest and I need to shave daily if I don’t want the scruffy look.

My fat is normally pretty evenly dispersed, DEXA scan from early May does down Android – 39.1% and Gynoid 28.5% so the ratio is a bit off. Next DEXA in 2 weeks so hopefully this ratio will improve.

Testicular cancer as mentioned above, diagnosed D deficiency – results below 20 up until 2011 and have slowly risen as I’ve increased my daily iu from 1000 – 5000 (current).

RX & OTC – Ambian as needed, D (5000iu), ZMA, creatine, Fish Oil and multi vitamins. Topical Retin A and sunscreen when outside for extended periods.

My LDL dropped from 200+ over the last several years to 105 and my triglycerides from 400s to 108.

Now to my question. My results from Jan 2017
Test Total - 349 (ng/dl) - (249.0 - 836.0)
Free - 5.8 (ng/dl) - (9.0 - 30.0)
E2 - 17.7 (pg/mL) - (25.8 - 60.7)
SHBG 35.5 - (16.5 - 55.9) - Edited to correct range.

My results from last week - Quest
Test Total - 574 (ng/dL) - (250 - 1100)
Free - 62.7 - (46.0 - 224.0) - Not sure where I cut the previous one from
E2 - 48 (pg/mL) - (Range <29) First time using Quest ultra sensitive
SHBG (nmol/L) - 43 - (10 – 50)
Hematocrit – 43.7 (41.5 – 53.8)
Total cholesterol – 219 (down from 300+), HDL - 92
White BC – 4.4 (3.8 – 10.8)
Red BC – 4.87 (4.33 – 5.82)
Hemoglobin – 15 (13.7 – 17.7)
MCV – 89.7 (80 – 100)
MCH – 30.8 (27 – 33)
MCHC – 34.3 (32 – 36)
MPV – 10.1 (7.5 – 12.5)
Absolute Neutrophils – 2634 (1500 – 7800)
Absolute Lymphocytes – 1365 (850 – 3900)
Absolute Monocytes – 370 (200 – 950)
Absolute Eosinophils – 101 (15 – 500)
Absolute Basophils – 40 (0-200)
Neutrophils – 57.6%
Lymphocytes – 30.8%
Monocytes – 8.4%
Eosinophils – 2.3%
Basophils - .9%
AST – 18 (10 – 40)
ALT – 19 (9 – 46)
DHEA – Never measured in any bloodwork I have
TSH w/Reflex to FT4 (the only TSH test this round) – 2.12 (.4 – 4.5)
No cortisol done yet but I’ve requested the lab work

Previous TSH – No fT4 ever done
1/2017 TSH – 1.450 (.111 – 4.910)
1/2017 fT3 – 3.2 (2.0 – 4.4)

2/2016 TSH – 2.07 (.4 – 4.5)

1/2015 TSH – 2.08 (.4 – 4.5)

Previous E2 from Quest regular test.
2016 - 34 (Range 19 - 144) Quest regular E2
2014 - 32 - No longer have the specifics on this one

Diet – typically ~2000-2500 cal/day with moderate carb cycling. Typical day is 50% protein 25% fat/carbs, 2 – 3 days per week are 50%/40%/10% (P/F/C). About half of protein is whole meats and the rest is supplements. Vo2max and RMR have my BRM at ~2900 cal. No use of iodized salt at this time. All added salt is sea salt.

Training – usually 3 – 4 days a week of heavy weights, 30 – 60 min, depending on previous recovery. Focused on heavy powerlifts. Very little cardio outside of weights, 10 – 15K steps per day and maybe a 1 – 2 mile jog or bike ride 1 – 2 times per week.

Morning wood – had completely gone away until I started changing my life about 8 months ago, then got very regular…. now disappearing again over the last 3 – 4 weeks.

I’m happy with my increase in total and free T but the E2 has me a bit concerned. About 2 months ago I was feeling great and now the sluggishness and low sex drive have returned and I’m wondering if it’s my E2. I know cal restricted diets and weight loss can increase SHBG but I’m not finding anything that would account for the rise in E2.

Any thoughts on if this is normal? I’m pretty sure my Dr would be willing to work with me on an AI but I don’t want to go overboard either.

2

Edit your post above, see pencil icon below the post and add lab ranges.

You could try 1/4mg anastrozole twice a week and check E2 after three weeks. If you suddenly crash you are an anastrozole over responder, stop for 6 days and take 1/16th mg twice a week.

How is your diets? Do you avoid simple carbs?

I suspect that SHBG is up because of starvation dieting. With more SHBG, FT is reduces and more [non bioavailable] SHBG+T inflates TT lab results. With low FT, FT–>E2 is reduced and the explanation for higher E2 levels when E2 production is low is low liver clearance of E2. Labs for AST/ALT might show something. Some meds, Rx and OTC can reduce liver E2 clearance by competing for the same enzyme pathways that clear E2.

Are you applying anything to your skin?
List all meds.

Fat gain is from a slower metabolic rate. Low T can do this, but thyroid hormones are a major player. Please see the last paragraph in this post and also explain your history of using iodized salt, or not.

Labs:
TT
FT
E2
LH/FSH
CBC
hematocrit
total cholesterol
AST/ALT
DHEA-S
TSH
fT3
fT4 - please not T3, T4
AM cortisol - one hour after waking up

How much Vit-D3?

Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

3

Thank you!

Major updates to my original post based on your reply and the links.

I’ll work on getting the thyroid testing done shortly.

Let me know if you see anything revealing in the updated info.

4

Took temps yesterday and today.

Yesterday afternoon while watching TV - 98.8
Last night in bed, before sleep - 98.6
Within 2 min of waking up this morning before leaving bed - 97.8

5

Based on that your thyroid function is very good.

6

How is Ambian working for you?
Have you needed to be increasing dose?
Might not be a good choice, too many negatives: Zolpidem - Wikipedia

Jan 2017: SHBG is high or range incorrect? Units change?

Look for my questions that you missed?
Do you apply anything to your skin other than sunscreen?
Sun avoidance and sunscreens lower Vit-D.
https://www.google.com/search?q=sunscreen+effects+on+hormones

7

Ambian - I’ve gone for taking it 15 - 20 nights a month 5 years ago (along with trying lunesta and trazadone) to about 5 - 10 now so the frequency has gone down with the same dosage. I spend about 100 nights a year in hotels traveling for work and I’d prefer to take nothing but I also don’t do well when I’ve been up for 30+ hours. :slight_smile:

No idea where I got that range on the Jan SHBG, looks like I somewhat misread the FT into the SHBG. It should have said

SHBG 35.5 - (16.5 - 55.9)

Other than ‘topical Retin A and sunscreen when outside for extended periods’ I don’t apply anything to my skin beyond random soaps and some lotion here and there. I don’t pay attention to brands so those could be anything that a store would have in the bathroom.

I’m not sure which questions I missed other than simple carbs. I don’t specifically avoid simple carbs but with my generally lower carb diet there isn’t much room for simple carbs. On a normal day, if’ I"m allowed 100 grams of carbs, I don’t really pay a lot of attention to where it comes from. My diet still includes McDonalds pretty much every day for the last 8 months (1 hamburger with 1/4 bun) and the rest of my blood work has improved drastically.

8

What are you planning on doing next?